WASHINGTON, D.C. (February 11, 2019)—The Centers for Medicare & Medicaid Services (CMS) released CMS-9115-P, the Interoperability and Patient Access Proposed Rule. The new rule outlines proposed policy changes to the MyHealthEData initiative to improve patient access to and advance electronic data exchange and care coordination throughout the health care system. CMS is also releasing two requests for information (RFIs) for feedback from providers in post-acute care settings.

“For far too long, electronic health information has been stuck in silos and inaccessible for healthcare consumers,” said CMS Administrator Seema Verma in a press release. “Our proposals help break down existing barriers to important data exchange needed to empower patients by giving them access to their health data. Touching all aspects of health care, from patients to providers to payers and researchers, our work leverages identified technology and standards to spark new opportunities for industry and researchers while improving healthcare quality for all Americans. We ask that members of the health care system join forces to provide patients with safe, secure access to, and control over, their health care data.”

Big Ideas

The rule proposes to update application programming interfaces (APIs) in order to provide Medicare Advantage patients access to their health information. In addition, as patients move between plan types and from payer to payer, access to health information should be maintained, eliminating redundant procedures and testing.

The rule also proposes the creation of health plan provider directories to help patients find in-network providers and allow health care professionals to locate other providers for access to medical records, referrals, transitions of care and care coordination. Because qualified health plan (QHP) issuers on Federally Funded Exchanges are already required to make directory information available, the rule does not propose these requirements for QHP issuers at this time.

Also, for dual eligible beneficiaries, CMS proposes updating the frequency of data exchange between Medicare and Medicaid from monthly to daily to improve benefit coordination. CMS seeks public comment for consideration in future rulemaking on achieving greater interoperability of federal-state data.

Read CMS’s press release on the rule here and find the full text of the rule here. RFIs can be subimitted after the proposed rule posts to the Federal Register.