The cross-agency view of healthcare interoperability — ONC certification, CMS APIs and TEFCA exchange — triaged into what an interoperability team must act on.
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ONC's TEFCA update details progress toward nationwide health information exchange with new qualified health information network designations and updated common agreement provisions. The Office of the National Coordinator for Health Information Technology (ONC) has released an updated presentation...
The deregulatory HTI-5 rule finalizes administrative simplification, mutual recognition of certification, and performance-based approaches to reduce unnecessary administrative burdens and promote innovation in health IT. The U.S.
Establishes new requirements for healthcare data exchange and prior authorization processes under the Interoperability and Patient Access final rule. The Centers for Medicare & Medicaid Services (CMS) has issued the Interoperability and Prior Authorization Final Rule (CMS-0057-F), establishing...
CMS’s 2026 proposed rule would let payers automatically use newer versions of required FHIR and USCDI standards as ONC approves them, reducing the need for frequent CMS rule changes. CMS released a CMS.gov resource page outlining the API and standards requirements stemming from the 2020...
The rule mandates standardized APIs, reduces prior authorization burdens, and aligns with FHIR to improve data exchange and patient access. The Centers for Medicare & Medicaid Services (CMS) issued a final rule that combines interoperability initiatives with prior authorization reforms to...
Fact sheet outlines ONC's enhanced monitoring, complaint handling, and sanctioning processes for health IT developers under the 2015 Edition certification program. The Office of the National Coordinator for Health IT (ONC) has published an updated fact sheet detailing its Certification Program...
Teal Health raises funding to prepare for increased demand as CMS requires health plans to cover self-collected tests at no cost starting in 2027. Teal Health has raised $22 million in funding to prepare for an expected surge in demand stemming from a new federal coverage mandate.
The finalized model applies international price comparisons to Medicare Part B drugs, potentially reshaping reimbursement for oncology and specialty therapies. The Centers for Medicare & Medicaid Services (CMS) has finalized the Most Favored Nation (MFN) Model, which aims to align Medicare Part B...
A new CMS-led initiative seeks to overhaul how quality is measured across Medicaid and CHIP programs in partnership with a majority of states. The Trump administration announced a new partnership between CMS and 37 states aimed at fundamentally rethinking quality measurement approaches for...
The partnership will test whether combining AI-driven primary care with Oura Ring data can improve outcomes for patients with cardio-kidney-metabolic conditions under a value-based payment model. Counsel Health, an AI-native primary care company, will participate in the CMS Innovation Center's...
Settlement resolves allegations that Florida-based primary care network inflated Medicare Advantage risk scores through improper diagnosis submission. The Villages Health System has agreed to pay $541.5 million to settle allegations that it submitted false diagnosis codes to the government to...
The AMA supports CMS's revised guidance addressing payer compliance with prior authorization transparency requirements under the 2024 Interoperability and Prior Authorization final rule. The American Medical Association (AMA) has publicly endorsed updated guidance from the Centers for Medicare &...
The ONC's refreshed TEFCA fact sheet shows Qualified Health Information Networks now connect over 150 million unique patients and 1.8 million clinicians, underscoring rapid national scaled exchange under the Trusted Exchange Framework. The Office of the National Coordinator for Health IT (ONC)...
The portal consolidates TEFCA's governance details, designated Qualified Health Information Networks, and the latest Common Agreement version for nationwide health information exchange. The Sequoia Project's Recognized Coordinating Entity (RCE) portal for the Trusted Exchange Framework and Common...
A study found four mandatory CMS VBC programs generated substantially higher administrative expenses compared to non-participating hospitals. Researchers analyzing Medicare cost reports determined that four mandatory value-based payment programs administered by CMS were associated with more than...
The investigation examines whether Epic's health IT dominance and data-sharing policies violate antitrust laws, with potential implications for interoperability and EHR market competition. The U.S.
CMS locks in inpatient hospital payment update at 2.3%, below earlier proposal but projecting hundreds of millions in higher hospital payments from rule changes. The Centers for Medicare & Medicaid Services (CMS) has finalized the Inpatient Prospective Payment System (IPPS) rule, establishing a...
The health plans allege CMS' methodology unfairly penalizes MA plans, potentially affecting reimbursement and plan competitiveness in the 2026 star ratings cycle. SCAN Health Plan and Alignment Healthcare have filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) alongside...
By embedding structured clinical terminology directly into CPT codes, AMA aims to accelerate electronic prior authorization and cut administrative burden at the point of care. The American Medical Association has launched a new interoperability initiative focused on mapping structured clinical...
The Trusted Exchange Framework and Common Agreement has crossed a major adoption threshold, signaling that the national interoperability network is moving from pilot to production scale. The Office of the National Coordinator for Health Information Technology (ONC) has announced that TEFCA — the...
The Senate's vote to preserve WISeR clears a key political hurdle for CMS's first AI-driven prior authorization model in fee-for-service Medicare. Democratic lawmakers in both the Senate and House introduced Congressional Review Act-style resolutions in May seeking to overturn the CMS WISeR...
HHS/ONC's fifth Health Data, Technology, and Interoperability rulemaking targets certification program efficiency and continued information-blocking enforcement improvements. HHS and ONC have proposed the HTI-5 rule, the latest in the Health Data, Technology, and Interoperability rulemaking...
CMS's official FAQ spells out exactly what payers must do under CMS-0057-F — from 72-hour urgent decision windows to the nine public metrics due on websites by March 31, 2026. CMS has published a detailed FAQ on the Prior Authorization API requirements established in the 2024 CMS Interoperability...
New federal oversight measures — including third-party audits of TEFCA participants — signal ONC is shifting from network-building to network-accountability mode. ONC has announced a package of oversight measures designed to strengthen governance of the Trusted Exchange Framework and Common...
With HTI-4 finalized on August 4, 2025, ONC has now closed out four major rulemakings that together reshape certification criteria, information blocking, TEFCA, and prescription workflows. ONC's certification program regulations page now reflects a completed four-rule cycle stretching from early...
Medicare Advantage, Medicaid, CHIP, and Marketplace payers must deploy four new FHIR APIs and compress prior authorization timelines by 2026–2027, reshaping payer-provider-patient data exchange across the industry. CMS has finalized the Interoperability and Prior Authorization rule (CMS-0057-F),...
ONC's certification framework — the gatekeeper for federally recognized health IT — is updating criteria, surveillance rules, and standards versioning processes that every EHR and API developer must track. The ONC Health IT Certification Program is the federal mechanism through which health...
As CMS's LEAD model extends value-based care timelines, health systems that lack real-time post-acute data will find themselves structurally disadvantaged on cost and quality performance. CMS's LEAD (Longitudinal Episode-based Alternative Payment) model reshapes how accountable care organizations...
The 2024 CMS Interoperability and Prior Authorization final rule sets hard compliance deadlines for payers to implement FHIR APIs that streamline prior authorization and cross-payer data exchange — with a key HIPAA carve-out clearing the path. CMS released the 2024 Interoperability and Prior...
New conflict-of-interest protections and updated performance-review requirements will reshape how the nine CMS-recognized accrediting organizations survey more than 9,000 Medicare-participating providers. CMS has issued a final rule updating the regulatory framework governing the organizations...
The scale of non-compliance enforcement is larger than previously disclosed, signaling CMS is actively using its price transparency authority against a broad swath of providers. At least 519 hospitals across the country have received either a warning notice or a Corrective Action Plan (CAP)...
The agency is formalizing its ambitions in health-IT modernization by creating a dedicated organizational unit to lead interoperability initiatives and digital product development. The Centers for Medicare & Medicaid Services (CMS) has established a new health technology office designed to...
Federal officials are working behind the scenes to align state AI testing initiatives with federal oversight as more states launch clinical AI sandboxes. FDA and CMS officials are actively coordinating to avoid a regulatory logjam between federal oversight and state-level AI sandbox programs for...
Updates payment rates and quality measures for dialysis facilities serving ESRD and AKI patients effective calendar year 2027. The Centers for Medicare & Medicaid Services (CMS) issued a final rule updating the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2027.
CMS launches a computer matching program to verify eligibility for ACA subsidy programs and prevent duplicate Medicaid enrollment across states, with public comment open until November 30, 2026. The Centers for Medicare & Medicaid Services (CMS) has issued a notice under the Privacy Act of 1974...
Epic's selective data access controls disadvantage competitors and slow health tech innovation, according to new STAT reporting. A STAT investigation published October 28, 2026 reveals that Epic Systems selectively restricts access to patient data within its electronic health record system,...
ONC reduced HTI-5 certification requirements by nearly 60% while postponing enforcement on information blocking and privacy safeguards, raising concerns about weakened interoperability progress. The Office of the National Coordinator for Health IT (ONC) issued its HTI-5 final rule, cutting 14 of...
The rule reduces regulatory burden for developers and providers while aiming to support innovation through targeted certification reforms. The U.S.
Proposed rule implements WFTC legislation affecting Exchange eligibility verification, inconsistency periods, redeterminations, enrollment methods, and coverage effective dates. The Department of Health and Human Services (HHS) has published a proposed rule implementing new requirements under the...
The Trump administration eliminated specific privacy, security and transparency provisions for electronic health record software developers under HTI-5 rule modifications. The Department of Health and Human Services has relaxed several security, privacy and transparency requirements for vendors...
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