1c. Is Your Project an Investigative Project (aka PSS-Lite)?
1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?
2a. Primary/Sponsor WG
2b. Co-Sponsor WG
Community Based Care and Privacy
2c. Co-Sponsor Level of Involvement
Request formal content review prior to ballot
2d. Project Facilitator
Amol Vyas, Ryan Howells
2g. Publishing Facilitator
Amol Vyas/Paul Knapp
2h. Vocabulary Facilitator
Amol Vyas/Paul Knapp
2k. Conformance Facilitator
Cambia Health, BCBSA, United Health Care, Kaiser Permanente, BCBS of NC, Humana, Security Health Plan
3a. Project Scope
Develop a FHIR R4 based implementation guide for an API similar to the CMS Medicare Blue Button 2.0 API, FHIR R3 based, that will allow consumer-directed exchange of commercial Health Plan/Payer adjudicated claims data to meet the requirements of the CMS Interoperability and Patient Access proposed rule.
This FHIR Implementation guide will use the US core profiles. If this FHIR Implementation Guide is unable to use a US Core Profile we will request approval from US Realm Steering Committee and provide the US Realm approved rationale for deviation in the Implementation Guide
3b. Project Need
MA, CHIP, Medicaid Managed Care & QHP Plans will have to adopt a standards-based API in the CMS Interoperability and Patient Access proposed rule so beneficiaries can connect an app of their choice to their claims. The rule has a current proposed implementation date of 1/1/2020. Health plans are required to use standards-based API options, including CMS Medicare Blue Button 2.0 and this implementation guide will provide a FHIR R4 means to meet those requirements. This implementation guide will help those plans meet the proposed regulatory requirements.
3c. Security Risk
3d. External Drivers
March 2019 Interoperability and Patient Access Proposed Rule by CMS
3e. Objectives/Deliverables and Target Dates
7/2019 - Draft implementation guide published (complete)
9/2019 - Connectathon
10/2019 - Development and Connectathon outcomes documented and presented to FM Work Group
11/2019 - Ballot material approved by FM Work Group
1/2020 - Ballot