Reflections on MESC 2024: CMS Interoperability and Prior Authorization Final Rule

North Highland had the pleasure of attending the 2024 MESC conference in Louisville and participating in the CMS Workshop discussing the Future of Prior Authorization as well as demonstrating the MITA Work Group’s Proof-of-Concept (POC) Demo Utilizing FHIR APIs. We discussed highlights from the POC, lessons learned and recommended next steps to comply with Interoperability and Prior Authorization (PA) Final Rule 2026 and 2027 requirements.

Final Rule Quickly Approaching

While many in the audience were familiar with the January 1st, 2027, deadline to implement the final rule for the API, the January 1, 2026, deadline was less known.

Beginning January 1, 2026, all PAs, regardless of submission mode (electronic, fax, portal, etc.), must meet the new more aggressive turn-around-times. Standard PAs drop from a fourteen-day turnaround to a seven-day turnaround while Exceptions drop from thirty days to fourteen days.

Develop Your Strategy

Being ready to effectively engage with the vendor community requires proper planning. This includes investing the time to develop a comprehensive understanding of the final rule, the Implementation guidelines, and the current PA process.

With this knowledge base at hand, it’s possible to envision the future state, develop an aligned strategy and roadmap, and implement the required changes.

Engage the Stakeholder Community

The MITA Governance Board (MGB) is inviting States to join the MGB Interoperability Workshop. The work group, which is run by representatives from MITA, Mitre, North Highland, and NTT Data, focuses on helping States plan and prepare for their implementation of the PA final rule. We meet once a month focusing on:

Translating PA items from their current form into a format required by the PA FHIR API
Enhancing tools and materials designed to guide states on implementing the PA final rule
Facilitating collaborative discussions between states on challenges, questions, and planning around the PA final rule
Sharing and reuse of PA specifications completed by states and vendors
Other topics and guest speakers, as proposed by participants

Our session at MESC, followed by our first virtual MITA MGB Meeting set the foundation for collaboration, joint learning, and shared problem solving amongst a diverse group of State and vendor participants.

January 1, 2026, will be here before you know it, but the MITA Governance Board is here to help.

With North Highland, you'll gain:

Expertise in healthcare regulations, technology integration, and strategic planning, which are all essential in interpreting and implementing the complex requirements of the rule
Our insights into best practices, potential pitfalls, and innovative solutions that align with both your organization's goals and the regulatory mandates, which will streamline the transition process
Full compliance with the PA Final Rule, saving you valuable time and effort