CMS begins enforcing interoperability and patient access rule

The rule was adopted more than a year ago, but the COVID-19 pandemic pushed off enforcement.

The Centers for Medicare and Medicaid Services (CMS) began enforcing the interoperability and patient access final rule on July 1 after a year’s delay.

According to the agency’s website, CMS has begun enforcement requirement some insurers to support patient access and provider directory application programming interfaces (APIs) with the aim of improving the electronic exchange of health care data. The policy went into effect Jan. 1 but, due to the COVID-19 pandemic, the agency exercised discretion in enforcing it until the beginning of this month.

Specifically, the rule requires Medicare Advantage, Medicaid, CHIP, and federal exchange health plans to share claims data electronically with patients. The information is required to be made available to patients in a safe, secure, understandable, user-friendly electronic format through the Patient Access API, as previously reported.

The CMS rule also established a new Condition of Participation which requires all Medicare and Medicaid hospitals to send electronic notifications to other healthcare providers when a patient is admitted, transferred, or discharged.

In April, Office of the National Coordinator for Health Information Technology (ONC) began enforcement of an information blocking rule which established penalties for those who interfere with the access, exchange, or use of electronic health information.

The rules were a centerpiece of former President Donald J. Trump’s MyHealthData initiative, which sought to give patients more access to their health data so they can make informed decisions about their care.