Regulatory Updates

OMB Reviewing Final Rules for HTI-5 and Transparency in Coverage. The Office of Management and Budget (OMB) is reviewing two final rules. The first regulation is the Office of the National Coordinator for Health Information Technology’s (ONC’s) “Health Data, Technology, and Interoperability: ASTP/ONC Deregulatory Actions to Unleash Prosperity” final rule, known as “HTI-5.” The proposed…

Key Prior Authorization Policies Finalized in FY2027 CMS IPPS Final Rule. The Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) partnered to finalize key Fast Healthcare Interoperability Resources (FHIR®) electronic prior authorization policies impacting the 2024 CMS Promoting Interoperability and Advancing Prior Authorization Final Rule…

CMS Posts New FAQs on CMS-0057-F, Includes Metric Reporting Template. The Centers for Medicare & Medicaid Services (CMS) posted new Frequently Asked Questions (FAQs) on the Prior Authorization application programming interface requirements in the CMS Interoperability and Prior Authorization (CMS-0057-F) final rule. Included in the FAQs is information on the public reporting by impacted payers…

CMS Releases CY2027 Medicare PFS Proposed Rule. The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2027 Medicare Physician Fee Schedule (PFS) proposed rule. In addition to the physician payment proposals, other proposals address value-based care programs and Medicare accountable care organizations (ACOs). Proposed improvements to the Medicare Shared Savings Program…

OMB Releases 2026 Federal Regulatory Unified Agenda. The Office of Management and Budget released the 2026 Unified Agenda of Federal Regulatory and Deregulatory Actions (Unified Agenda). The Unified Agenda identifies the regulatory actions under development by the various Departments. For the Department of Health and Human Services, items in the 2026 Unified Agenda include potential…

WEDI Presents at CMS Listening Session on X12 Version 008060. WEDI presented at a Listening Session conducted by the Centers for Medicare & Medicaid Services (CMS) Office of Health Technology and Products on the topic of adopting the X12 Version 008060 standards under the Health Insurance Portability and Accountability Act. WEDI was invited to present…

WEDI Holds MPA on CMS QHP Directory Pilot. WEDI held a Member Position Advisory (MPA) event on Wednesday August 26 to solicit member feedback on the Centers for Medicare & Medicaid Services (CMS) Qualified Health Plans Directory Pilot currently ongoing in Oklahoma. The MPA was held at the request of CMS to obtain broad industry…

WEDI Submits Comments on CMS-0062-P Proposed Rule. WEDI submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the Interoperability and Drug Prior Authorization (CMS-0062-P) proposed rule. The proposed rule intends to improve the electronic exchange of health care data and streamline processes related to drug prior authorization by increasing the interoperability of…

CMS Announces New Office of Health Technology and Products. The Centers for Medicare & Medicaid Services (CMS) announced the formation of the new Office of Health Technology and Products (OHTP), effective June 9. This new organizational component will provide enterprise leadership and oversight for CMS health care technology modernization, digital products, and transformation of platforms…

WEDI Holds MPA on X12 Version 008060. WEDI held a Member Position Advisory (MPA) event to solicit member perspectives and recommendations on the potential adoption of the X12 Version 008060 HIPAA Administrative Transactions. The MPA was in response to WEDI being invited to present at a July 1 (1-4 pm ET) Listening Session conducted by…