Advancing Interoperability and Improving Prior Authorization Processes (CMS-10843)
Revision of a currently approved collection
No
Regular
04/20/2026
Requested
Previously Approved
36 Months From Approved
04/30/2027
341
365
181,867
6,896,438
0
0
This proposed rule would place new requirements on Medicare Advantage organizations, Medicaid managed care plans, CHIP managed care entities, state Medicaid and CHIP fee-for-service (FFS) programs, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs) to improve the electronic exchange of healthcare data, and streamline processes related to prior authorization, while continuing CMSâ drive toward interoperability, and reducing burden in the health care market. This proposed rule would also add new requirements for eligible hospitals and critical access hospitals participating in the Medicare Promoting Interoperability Program and for Merit-based Incentive Payment System eligible clinicians participating in the Promoting Interoperability performance category of the Quality Payment Program. These policies taken together play a key role in reducing overall payer and provider burden and improving patient access to health information.
EO: EO 13813 Name/Subject of EO: Promoting Healthcare Choice and Competition
US Code: 42 USC 1395w-4(q)(2) Name of Law: Social Security Act
US Code: 42 USC 1395w-22(h) Name of Law: Social Security Act
US Code: 42 USC 1395w-22(g)(1) Name of Law: Social Security Act
US Code: 42 USC 1396(a)(6) Name of Law: Social Security Act
CMS removed previously approved burden associated with tasks considered to be usual and customary business practices. Also, to more accurately calculate the burden associated with the proposed and finalized requirements to implement FHIR APIs, CMS has removed API implementation burden erroneously included in the previous versions of this package. These revisions would align the approach for calculating information collection burden across existing interoperability-focused PRA packages and streamline the content of the package for increased accuracy and fidelity to the requirements of the PRA. This change eliminates estimated burden of this package by $684 million. For additional information on this change, see section IV.D.1. in the 2026 CMS Interoperability Standards and Prior Authorization for Drugs proposed rule. This iteration of the package also eliminates duplicative burden covered in other PRA packages.
$12,310,000
No
No
No
Yes
No
No
No
William Parham 4107864669
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
CMS-10843.Supporting Statement Part A (proposed rule).docx
Implementation and Maintenance of the Provider Access API, Payer-to-Payer API, and PARDD API and Related Collections