CMS Proposes Rule on Application Programming Interface Reporting

What: On April 14, 2025, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule to require impacted payers to report their application programming interfaces (API) endpoints and related information for the Patient Access, Provider Directory, Provider Access, Payer-to-Payer, and Prior Authorization APIs to CMS.

Why: CMS determined that the proposed rule impacts small entities, including health care providers, physicians, and clinics who transmit information in an electronic form, hospitals, all health plans, health care clearinghouses, and support service vendors. CMS invites comments on the economic impact of the proposed rule. For example, CMS seeks comments on the potential impact of this proposal on clearinghouses (NAICS code 522320) and all other support service vendors (NAICS code 561990).

Action: Review the proposed rule and submit comments before the June 15, 2026, deadline.

PROPOSED RULE:

Medicare and Medicaid Programs: Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, etc.

CONTACT: Will Purcell

EMAIL: will.purcell@sba.gov

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Is your small business or entity being impacted by a proposed rule? If yes, write a comment letter to the proposing agency.