If You Build It, They Will Come: Implementing the CMS Patient Access API and Payer-to-Payer Exchange Requirements
- December 01, 2021
- Eric Setterlund , BlueCross BlueShield of Tennessee
- Melissa (Mel) Soliz , Coppersmith Brockelman PLC
ABSTRACT: Adoption of electronic health information exchange has grown steadily over the last two decades across the entire health care industry. Since the passage of the 21st Century Cures Act in 2016, the federal government has made interoperability and consumer-directed data exchange the cornerstone of its health information technology policies and regulations. At the same time, however, the health care technology infrastructure, as well as the existing framework of state and federal privacy and security laws, have not kept up with the dream interoperability promises to fulfill. This article examines two key interoperability policies of the 2020 Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access Final Rule—the Patient Access Application Programming Interface (API) requirements and Payer-to-Payer (P2P) Exchange—and some of the challenges facing CMS-regulated payers in implementing these policies. In particular, we explore the difficulties in meeting technical requirements, identifying and making accessible the covered data, and sharing that data in compliance with complex state and federal privacy and security laws.
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