Health Reform WK-EDGE CMS encourages states to build interoperability into new provider directories
Tuesday, July 31, 2018

CMS encourages states to build interoperability into new provider directories

By Dietrich Knauth

CMS issued a letter to state Medicaid directors providing sub-regulatory guidance a new requirement to publish directories of fee-for-service providers, encouraging states to use federal funds to integrate the new directories into other systems or efforts. The letter addresses compliance with Section 5006 of the 21st Century Cures Act, which requires the publication of a fee-for-service provider directory, with information including a provider’s name, specialty, telephone number, website, languages spoken, and whether the provider is open to new patients. The fee-for-service directories should be published by January 1, 2017, and updated annually, according to the Cures Act (CMS Letter, SMD 18-007, July 17, 2018).

Directories. The directories should not be treated as stand-alone projects, but should support broader efforts to improve access to care, reduce provider burden, improve interoperability, and promote the objectives of the recently-announced MyHealthEData Initiative, which aims to provide patients with greater flexibility to access and share their health data. States should consider creating a "dynamic" provider directory that is more than just a list of providers, and explore how such provider directories could help reduce provider burden and improve interoperability, Hill said.

That will likely require integration with other Medicaid systems, including Case Management Systems, Medicaid Management Information Systems, and Eligibility and Enrollment systems.

CMS specifically supports states’ use of enhanced Federal Financial Participation to integrate provider directories in a way that supports MyHealthEData Initiative goals announced in March 2018. States should also remember that federal funds are available for provider support, and such funds can help train and assist Medicaid providers in their on-boarding to quality reporting systems and provider directories, Hill wrote.

CMS also asked State Medicaid Providers to report whether they complied with the Section 5006 of the 21st Century Cures Act. If they were not in compliance, CMS asked states to report a date that they expected to comply, whether the state’s managed care coverage exempts it from the requirements, or whether the state would need to enact legislation to comply.

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