CMS Rule

We see the requirement related to information with a date of service on or after January 1, 2016 must be available. Is this intended to be a rolling 5 year historical lookback (similar to the Payer to Payer Data Exchange)?

The rule states that, upon approval and at the direction of an enrollee, a payer must make all data they maintain with a date of service on or after January 1, 2016 forward available through the Patient Access API, to a current enrollee, or their personal representative. This is not a “5 year historical lookback” for the Patient Access API or for the Payer-to-Payer Data exchange. To illustrate for the Patient Access API, if a current patient asks for their data to be shared with a third-party app in August 2021 and they have been with the plan since 2014, the plan must make all specified data with a date of service on or after January 1, 2016 forward available. If another current patient requests their data via the API in 2024 and the patient has been with the plan since 2012, the payer must make all data from January 1, 2016 through 2024 available.

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