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The CMS proposed ruling requires impacted payers to build and maintain a FHIR API, starting January 1st, 2026, in effort to improve the cumbersome and costly prior authorization process. This will further endeavor to cement FHIR as the data standard to support future information exchange. Clay Ritchey, CEO at Verato.
Faxing, always to my surprise, continues to be the primary way that data is shared, especially with smaller entities. In the State of California, there is a mandate for improved data sharing for smaller entities by Jan 2026, and they are even providing incentives to get it done. However, this rule is only the first step.
Small physician practices, rehabilitation hospitals, long-term acute care hospitals, acute psychiatric hospitals, small rural acute care hospitals, and nonprofit clinics will have until January 2026. And, while not required, participants may also share data for social services and research activity purposes.
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