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One Month to Compliance: Patient Access API

One Month to Compliance: Patient Access API

Published: 6/1/2021 – 


One Month to Compliance: Patient Access API 

In one month, the Center for Medicare & Medicaid Services (CMS) will begin a compliance period for their Patient Access API. The Patient Access API and corresponding requirements are one portion of the larger CMS Final Interoperability Rule of 2020 which is often dubbed the Patient Access Rule. The reason for this title, and for the impending compliance period, is because it places an affirmation responsibility on certain federal payers to make individual and general information available to their enrollee population so individuals may take control of their own health information in an educated manner.  

On the individual side, certain payers must make available via API 

  • Current and past medical conditions and care received, which includes claims and cost data  
  • Encounters with capitated providers (provider receiving federal assistance) 
  • Provider remittances, which is a summary of all reimbursements made on a claim submitted 
  • Enroll cost- sharing information  
  • Clinical data  
  • Laboratory notes  

On the general information side, certain payers must make available: 

  • Plan provider networks  
  • Plan’s formulary  
  • Coverage policies  
  • Patient education tools  

Under the Patient Access API compliance period, payers will be required to make all individual information available via an API so mobile applications, of an enrollee’s choosing can access and relay this information to the enrollee.  

MiHIN has developed a product, titled InterOp Station (IO Station), to assist providers with meeting the federal mandate. IO Station serves a variety of functions but most notably it assists payers in converting all the disparate pieces of information into one format (FHIR), making the information available through an open API, facilitates the process for mobile applications to register for access by meeting privacy and security requirements, and builds a modular framework that can support future compliance periods to come. 

For more information on MiHIN’s IO Station or on the CMS Interoperability Rule, Patient Access, please contact help@mihin.org 

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