Worries Mount as Interoperability Rules Near Finalization

As two federal proposed rules aimed at improving health care data sharing — interoperability — between payers, providers and patients await finalization, America’s Health Insurance Plans (AHIP), Medicaid Health Plans of America (MHPA) and other groups are advocating for phased-in or delayed implementation so that patient privacy, data standards, administrative and operational concerns can be addressed. Both rules are targeted for 2020 implementation. The 21st Century Cures Act provides for expanding interoperability to increase health care efficiency and transparency.

One proposed rule, from CMS, concerns interoperability and patient access and impacts Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and insurers offering qualified health plans in federally facilitated exchanges. Those payers will be required to give patients access to their own health data via third-party apps, including claims information. The impacted organizations must also participate in a health information network of their choice.

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