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The payers impacted by the Final Rule include Medicare Advantage (“MA”) organizations, state Medicaid and Children’s HealthInsurance Program (“CHIP”) agencies, Medicaid and CHIP managed care plans, and plans on the Affordable Care Act exchanges (collectively, “Impacted Payers”).
The regulations impact CMS-regulated payers and provide incentives for providers and hospitals that participate in the Medicare Promoting Interoperability Program and the Merit-based Incentive PaymentSystem (MIPS). Most of the Proposed Rule’s provisions will be effective on January 1, 2026.
The Final Rule also imposes additional reporting requirements under the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals and for eligible clinicians reporting under the Promoting Interoperability performance category of the Merit-Based Incentive PaymentSystem.
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