CHA News

Summary: Finalized Interoperability and Prior Authorization Policies

What’s happening: A members-only summary of finalized interoperability and prior authorization processes is available.  

What else to know: The final rule is scheduled for publication in the Feb. 8 issue of the Federal Register.  

The summary from Health Policy Alternatives, Inc., details the finalized electronic exchange of health information and prior authorization requirements for Medicare Advantage organizations, Medicaid, Children’s Health Insurance Program (CHIP) fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and issuers of qualified health plans offered on federally facilitated exchanges. The final rule also includes one new measure for hospitals under the Promoting Interoperability Program that assesses the utilization of electronic prior authorization processes. 

The policies established in the final rule are generally effective in 2026 and 2027.