CMS Includes MAOs In Data Exchange And Prior Authorization Requirements

The Centers for Medicare and Medicaid Services ("CMS") issued a proposed rule, "Advancing Interoperability and Improving Prior Authorization Processes" (the "Proposed Rule"), that is intended to improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services. The Proposed Rule would withdraw CMS's December 18, 2020 Interoperability and Prior Authorization proposed rule, build on the policies finalized in the agency's May 1, 2020 Interoperability and Patient Access final rule, and incorporate feedback CMS received from commenters on the December 2020 proposed rule.

The Proposed Rule, among other proposals, provides for new rules and standards for a payer-to-payer data exchange. Notably, CMS proposes that its electronic prior authorization requirements would also apply to Medicare Advantage organizations ("MAOs") – a significant change from the previous iteration of the rule, which only