HIMSS Recommends Better Interoperability and Access on Proposed CMS Prior Authorization Rule

HIMSS supports the ongoing work to improve patient care with better data access and streamlined data management by the Centers for Medicare & Medicaid Services (CMS).  

The global society endorses the following on the proposed CMS authorization rule: provide patients greater access to and control over their data, extend patients, providers and payers necessary access to complete health records, and reduce the burden of information management across the healthcare ecosystem. 

HIMSS provided written comments to the Notice of Proposed Rule Making (NPRM) regarding 0938-AU87 CMS 0057 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. 

HIMSS believes patients should be at the center of their own care, a goal affirmed in this regulation and in the CMS Interoperability and Patient Access Final Regulation. Such a goal promotes greater patient empowerment and improved outcomes. These changes to the prior authorization process, if executed effectively, would improve the patient experience and access to care.  

As a matter of principle, HIMSS believes seamless, secure, ubiquitous and nationwide data access and interoperable health information exchange should ensure the right people have the right access to the right health information in a usable format at the right time to provide the optimal level of care.  

Removing barriers to exchange of health information by harmonizing privacy and security laws and industry-led guidelines is paramount to transforming the health ecosystem. It would modernize care delivery, drive health innovation at the institutional and personal level and better enable health research.  

HIMSS supports the proposed rule’s standards-based approach and the use of Application Programming Interfaces. It makes information about prior authorization decisions available to patients, providers and payers through the Patient Access, Provider Access APIs. HIMSS appreciates the opportunity to leverage its members’ expertise to share feedback on improving interoperability and appropriate access to prior authorization data for patients, providers and payers. 

Read HIMSS’s full recommendations in its letter to CMS.