Information Blocking Provisions
• CMS will publicly report eligible providers that may be information blocking based on how they attested to certain Promoting Interoperability Program requirements
• Data must be made available for payer use
Key milestones for healthcare payer organizations
The CMS Interoperability and Patient Access Final Rule affects how CMS-regulated health plans aggregate and share data.
APR 5, 2021
Patient Access & Provider Directory API Capabilities
• Health Plan organizations must implement and maintain a secure, standards-based API (HL7 FHIR Release 4.0.1)
• Members must be able to access their claims and encounter information, including cost, and certain clinical information through third-party applications of their choice no later than one business day after data generation
• Provider directory information must be publicly available
JULY 1, 2021
Payer-to-Payer
Data Exchange
• Payers are required to exchange certain patient clinical data at the patient’s request, allowing the patient to take their information with them as they move from payer-to-payer to help create a cumulative health record
JAN 1, 2022