The Healthcare Information and Management Systems Society (HIMSS) supports the Centers for Medicare and Medicaid Services (CMS) in its efforts to improve patient care through better data access and streamlined data management. HIMSS is a global society that endorses the following proposed CMS authorization rule:
- Provide patients with greater access to and control over their data.
- Extend necessary access to complete health records to patients, providers, and payers.
- Reduce the burden of information management across the healthcare ecosystem.
In written comments submitted to the Notice of Proposed Rule Making (NPRM), HIMSS expressed its support for the proposed rule (0938-AU87 CMS 0057), which aims to advance interoperability and improve 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 that 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. This goal promotes greater patient empowerment and improved outcomes. The 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 that seamless, secure, ubiquitous, and nationwide data access and interoperable health information exchange should ensure that 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 the 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 (APIs) to make 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.