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  • Writer's pictureJulie Barnes

September 23, 2021

Maverick's Update

Only What Matters In Information Policy

Last week, for the first time in 17 years, Rolling Stone magazine revisited its Top 500 Best Songs Ever List. We are pleased to announce that they correctly named the #1 song (drum roll please):

Aretha Franklin’s R-E-S-P-E-C-T. The Queen of Soul sneaks in so many fantastic phrases in that unique arrangement, but one is “take care, TCB” -- meaning “Taking Care of Business.” Our favorite federal health agency, CMS, is not taking care of one important piece of business -- find out more in the One Thoughtful Paragraph below.

Maverick is taking care of business by offering you these top news highlights:

  1. CMS delayed the enforcement of a payer-to-payer data exchange requirement, included in its May 2020 Interoperability and Patient Access final rule, until it issues a new rule to make technical specifications more clear.

  2. Micky Tripathi, the National Coordinator for Health IT at HHS, announced that new resources are available to address questions related to the ONC Cures Act (information blocking) final rule that went into effect on April 5, 2021.

  3. The Sequoia Project, the Recognized Coordinating Entity chosen to support the implementation of ONC’s Trusted Exchange Framework and Common Agreement (TEFCA), released Elements of the Common Agreement for stakeholder feedback. Comments are due by October 21, 2021.

One Thoughtful Paragraph

Quietly, and at an unknown date and time, CMS slipped in an update to its FAQs to answer a truly frequent question: Where the heck is the final rule on prior authorization that is part of the interoperability rules? You know, the one that says health plans have to streamline the prior authorization doctors and patients know what documentation they need to show to get a medical service paid for? This get-permission-before-getting-medical-care process is a long-time pain point for patients and their doctors. But without it, health plans (who are supposed to be paying for only medically necessary services) might as well just send doctors a blank check with a post-it note that says “sky’s the limit!” So, if this is an important check and balance to make sure requested medical services are necessary, then where is the prior authorization final rule that is supposed to streamline this process? The CMS Answer: Ron Klain told us to withdraw it because it wasn’t published in the Federal Register yet before the Biden Administration took office. Um, OK. But out of R-E-S-P-E-C-T for patients and doctors and those industry players who are trying to implement dramatic operational changes to improve the system, maybe provide at least a timeline for the prior authorization requirements? Everyone knows it is coming, just like everyone knew that Aretha would finally get her props, but when?

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