The U.S. Department of Health & Human Services has finalized a series of new rules related to the use of technology for electronic prescribing and prior authorization.
In the rules, the Assistant Secretary for Technology Policy and the Office of the National Coordinator for Health IT have added requirements for real-time prescription benefit checks at the point of care and formally adopted FHIR certification for prior auth.
The rules also include the same prescription information criteria that the Centers for Medicare & Medicaid Services requires of Medicare Part D plan sponsors.
WHY IT MATTERS
The new requirements are meant to ensure efficiencies that are expected to reduce clinicians' administrative burdens, improve prescription drug cost transparency and speed patients' access to care, ASTP/ONC officials said in a blog post this past week.
The Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization (HTI-4) requires providers to be able to process prior authorizations in real time during patient care encounters through health IT and supports standardized, electronic prior authorization exchange through HL7's FHIR standard.
The third major update to the health IT certification rule affecting electronic health records and other systems coordinates with the CMS Hospital Inpatient Prospective Payment System final rule.
Under the CMS rule, providers participating in the Medicare Promoting Interoperability program must report on an electronic prior authorization measure beginning in 2027.
"This policy complements requirements in the Medicare Part D program and is based on common standards for real-time prescription benefit exchange developed by the National Council for Prescription Drug Programs," said ASTP/ONC's Tom Keane and Steven Posnack in the blog post.
To support the secure exchange of prescription information and align Medicare Part D plan sponsor requirements, the HTI-4 final rule adopts two standards for API functionality for electronic prior authorization.
Developers certifying a Health IT Module to the criterion may use either the NCPDP SCRIPT standard version 2017071 or 2023011 during a transition period ending Dec. 31, 2027. Beginning in 2028, certification requires the latter version.
THE LARGER TREND
HTI-4 finalizes additional proposals in ASTP/ONC’s original HTI-2 draft rule, which was released this past year to reduce prior authorization workflow burdens and support more timely and transparent clinical decision-making for certified health IT.
The HTI-2 draft proposed changes to HHS' health IT certification program that expanded regulatory scope beyond electronic health records to include technologies used by payers and public health agencies.
The American Hospital Association and others soon expressed concerns about aggressive data sharing standards and timelines.
But then in December, ASTP finalized just part of HTI-2, to the disappointment of health IT developers. In the final HTI-2 rule, the agency made updates to the Trusted Exchange Framework and Common Agreement and some administrative corrections, but left questions about certifying artificial intelligence enhancements unanswered.
HTI-3 (also released in December) focused on criteria that aimed to improve patient care access.
ON THE RECORD
"ASTP/ONC released a final rule enabling the use of certified EHRs to submit prior authorizations, select drugs consistent with a patient’s insurance coverage, and exchange electronic prescription information with pharmacies and insurance plans," Keane and Posnack said in the agency's blog.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
