CMS: Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligible Hospitals and Critical Access Hospitals in the Medicare Promoting Interoperability Program

Federal Register

Feb 8, 2024

Notice of final rule from the Centers for Medicare & Medicaid Services (CMS) aiming to improve the electronic exchange of healthcare data and streamline processes related to prior authorization through new requirements for Medicare Advantage (MA) organizations, state Medicaid fee-for-service (FFS) programs, state Children's Health Insurance Program (CHIP) FFS programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan issuers on the Federally-facilitated Exchanges. This final rule will also add new measures for eligible hospitals and Critical Access Hospitals (CAHs) to report under the Medicare Promoting Interoperability Program and for Merit-based Incentive Payment System (MIPS) eligible clinicians to report under the MIPS Promoting Interoperability performance category. These regulations are effective April 8, 2024.

Critical Access Hospitals · Health information technology · Health insurance · Healthcare business and finance · Healthcare quality · Legislation and regulations · Medicaid · Medicare · Physicians · Reimbursement and payment models