Advancing Interoperability and Improving Prior Authorization Processes (CMS-10843)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10843.Supporting Statement Part A (proposed rule).docx	Supporting Statement A	Uploaded 2026-04-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
257431	Implementation and Maintenance of the Provider Access API, Payer-to-Payer API, and PARDD API and Related Collections		Modified

ICR Details

OMB Control No: 0938-1437	ICR Reference No: 202604-0938-014
Status: Received in OIRA	Previous ICR Reference No: 202402-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: OHEI
Title: Advancing Interoperability and Improving Prior Authorization Processes (CMS-10843)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/20/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2027
Responses	341	365
Time Burden (Hours)	181,867	6,896,438
Cost Burden (Dollars)	0	0

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Abstract: 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 CMS’ 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.

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Authorizing Statute(s): 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
  

Citations for New Statutory Requirements: 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

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV44	Proposed rulemaking	91 FR 19890	04/14/2026

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Implementation and Maintenance of the Provider Access API, Payer-to-Payer API, and PARDD API and Related Collections

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	341	365	0	-24	0	0
Annual Time Burden (Hours)	181,867	6,896,438	0	-6,714,571	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: 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.

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Annual Cost to Federal Government: $12,310,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/20/2026

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