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CMS 9115-F Compiled FAQs

This document is intended only to provide clarity to the public and regulated payers regarding existing requirements under the law, specifically, the May 2020 Interoperability and Patient Access final rule (CMS-9115-F)(85 FR 25510). The entities to whom this guidance applies include Medicare Advantage (MA) Organizations and Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans (QHP) on the Federally-facilitated Exchanges (FFEs) (referred to in this document as “impacted payers”) and Health Care Providers.

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Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: June 11, 2021

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.