Communications

(June 2, 2026) - The Centers for Medicare & Medicaid Services has released the 2026 CMS Interoperability Standards and Prior Authorization for Drugs proposed rule (CMS-0062-P.)The proposed rule builds on the 2020 CMS Interoperability and Patient Access final rule (CMS-9115-F) and the 2024 CMS Interoperability and Prior Authorization final rule (CMS-0057-F). Those rules require Medicare Advantage organizations, state Medicaid and Children’s Health Insurance Program (fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan issuers on the federally-facilitated Exchanges to implement Patient Access, Provider Directory, Provider Access, Payer-to-Payer and Prior Authorization Application Programming Interfaces. While the prior authorization requirements in the 2024 final rule focused on non-drug items and services, the 2026 CMS Interoperability Standards and Prior Authorization for Drugs proposed rule extends many of those requirements to cover prior authorizations for drugs. Specifically, CMS now proposes to require impacted payers to support electronic prior authorization, make decisions on requests within shorter timeframes that align with CMS programs and increase transparency in prior authorization for drugs. In addition, CMS is proposing to require impacted payers to update health information technology standards and to report interoperability API endpoints and API usage metrics to CMS. For more information, see CMS’s Fact Sheet. The proposed rule will be available for public comment until June 15, 2026. Please let the Kansas Hospital Association team know if you have comments to be included in KHA’s comments.