Interoperability and Patient Access Rule

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The Centers for Medicare and Medicaid Services (CMS) have issued a new rule intended to make it easier for certain patients to not only have better access to their healthcare information, but also the ability for that information to seamlessly move with the patient as they utilize different healthcare providers and health plans. This rule is part of the MyHealthEData initiative that started in 2018 and is intended to help encourage and improve data-sharing across health plan organizations and health care professionals. The ultimate goal is to create an experience that truly puts patients first, making their health care journey safer, easier, and more effective.

Who is Eligible?

  • Members of a Medicare Plan, including the Memorial Hermann Medicare Advantage Plans and Dual Special Needs Plan (D-SNP)
  • Individuals eligible for Medicaid
  • Children’s Health Insurance Plans (CHIP)
  • Qualified Health Insurance Plans (QHP) in the health insurance exchanges established by the Affordable Care Act (ACA)

How it Will Work

CMS-regulated health plans like Memorial Hermann Health Plan will be required to implement and maintain a standards-based Patient Access API (Application Programming Interface). While you are a plan member, you may access this information – which includes claims and clinical data – by downloading an app on your smart phone, computer, or similar device.

Memorial Hermann Health Plan will also be required to make publicly available in-network provider information, again using a standards-based API. The intent of these APIs is to encourage innovation, as third-party developers can compete to create easier and better ways for patients to find providers and healthcare services and have all their information immediately available in one place.

What Happens Next

Memorial Hermann Health Plan is currently on track to develop the necessary APIs as required by CMS. If you have any questions concerning this process, please contact us so we can help. We will also provide more information as we continue to make progress, so check back here on a regular basis for the latest updates.

Additional Information & Resources

You can view an infographic of the interoperability roadmap and timeline here.
You can learn more about the goals and overall interoperability roadmap here.
You can read the CMS final rule document here.

(Please note that by clicking on the links above, you will be leaving Memorial Hermann Advantage HMO website.)

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