CMS Interoperability And Patient Access Delay in Enforcement

CMS just announced the Interoperability And Patient Access Rule will be delayed in enforcement until July 1, 2021 (instead of January 1, 2021)

Health plans have 6 more months to execute and launch in response to this update than they would have had otherwise. Nevertheless, when our team is speaking to health plans, the general consensus is they will be live on the original January date even if enforcement is delayed. This helps plans ensure they are no penalties or unforseen setbacks when enforcement begins in July 2021.

1upHealth provides a fully managed solution to cover all new mandates. Our customers, including plans with millions of members, are already in production with 1up’s HHS award-winning API platform. Today, 100s of apps use 1up FHIR® APIs to manage user directed connectivity across 1000s of health systems that we helped attest to similar patient access mandates. Plans can use the same infrastructure to meet all patient access and interoperability requirements.

Explore additional topics about the CMS mandates for health plans

Here’s more detail from the official notice

The Interoperability and Patient Access final rule includes policies that impact a variety of stakeholders. Recognizing that hospitals, including psychiatric hospitals, and critical access hospitals, are on the front lines of the COVID-19 public health emergency, CMS is extending the implementation timeline for the admission, discharge, and transfer (ADT) notification Conditions of Participation (CoPs) by an additional six months. In the version of the rule displayed on March 9, 2020 on the CMS website, it stated these CoPs would be effective 6 months after the publication of the final rule in the Federal Register. We have changed this in the final rule now displayed on the Federal Register to state that the new CoPs at 42 CFR Parts 482 and 485 will now be effective 12 months after the final rule is published in the Federal Register.

CMS also finalized the Patient Access API and Provider Directory API policies for Medicare Advantage (MA), Medicaid, and the Children’s Health Insurance Program (CHIP) effective January 1, 2021. CMS will exercise enforcement discretion for a period of six months in connection with these two API provisions. Therefore, as a result of COVID-19, and to provide additional flexibility to payers, CMS will not enforce the new requirements under 42 CFR Parts 422, 431, 438, and 457 until July 1, 2021.

Finally, CMS finalized the Patient Access API for Qualified Health Plan (QHP) issuers on the individual market Federally-Facilitated Exchanges (FFEs) beginning with plan years beginning on or after January 1, 2021. CMS will not enforce the new requirements under 45 CFR Part 156 until July 1, 2021.

Other policies contained in the final rule will be implemented and enforced on schedule.