Insights for Healthcare Leaders & Change-Makers
Today marks an important milestone in the movement toward a more transparent, interoperable healthcare system.

Starting today, July 1, 2021, health plans offering Medicare Advantage, Medicaid, Children’s Health Insurance Program (CHIP), and most Qualified Health Plans through the Federally-facilitated Exchange are required to make enrollee electronic health information available through application programming interfaces.

Also, this 1st day of July marks expected developments in the evolution of the No Surprise Act:

The first interim final rule (Part 1) on implementation of the No Surprises Act has a statutory deadline of July 1st, 2021. Most likely, Part 1 which is focused on payer-provider reimbursement, interaction with state laws, and how payment rates will be calculated when health plans and healthcare providers disagree on payment amounts, is expected to be published within the next few weeks.

The second interim final rule (Part 2) is expected to provide more details on arbitration processes and is expected to be published soon thereafter, likely in August.

As with many new government regulations, over time this regulation is likely to be adopted for enrollees in commercial and employer-sponsored plans.
Opportunity to Stay Abreast of Mandates
To assist those charged with addressing mandates such as the No Surprises Act, Interoperability & Information Blocking Rules, Transparency in Coverage Rules, and Proposed Modifications to the HIPAA Privacy Rule, HCEG is hosting a series of Focus Area Roundtables and sharing related information of possible interest.

Our Focus Area Roundtables are intended to give every attendee an opportunity to:

• Determine whether, and to what extent, various mandates, rules, and policies will impact the operations of their organization.
• Stay up to date regarding approaches to addressing regulations and their associated details
• Learn about challenges, issues, and opportunities facing similar organizations
Upcoming Focus Area Roundtables
Leaders of health plans, health systems, and healthcare provider organizations are invited to participate in the following roundtables:
Facilitated by Surescripts
Facilitated by Zelis
Facilitated by Softheon
Resources for Price Transparency and Interoperability Mandates
The following are some resources to review as an aid to better understand and address various data transparency and interoperability regulations and mandates.
No Surprises Act
Transparency in Coverage Rule (Health Plans)
Interoperability & Information Blocking Rules
Proposed Modifications to HIPAA’s Privacy Rule
Recaps of Recent Focus Area Roundtables