Medicaid provider directories will soon have to be upgraded to provide members with important information for them to select a provider and access care. New CMS rules require that by July 1, 2025, provider directories must include providers’ names, addresses, languages spoken, whether they are accepting new patients, practice accessibility features, website addresses, and telehealth availability. Updates will be required at least every three months.
By January 1, 2027, directories must use a specific type of technology to make detailed information about providers easily accessible. Provider directories will be required to support a FHIR API to ensure public access to detailed information about a payer’s network of contracted providers. A FHIR API, which stands for Fast Healthcare Interoperability Resources Application Programming Interface, is a standard for exchanging healthcare information electronically, making it easier for different systems to communicate and share data. This rule will apply to Medicaid and CHIP programs, as well as some health plans on the federal marketplace. Directories will also need to indicate which networks providers are a part of and whether they are in-network or out-of-network.
By 2028, states must have a system in place to rate the quality of Medicaid and CHIP plans, helping beneficiaries compare and choose the best options.
Some states will require major updates to their current directories to meet the new CMS rules.
Learn more about these rules and discover how IPRO can assist you with implementation to ensure compliance.
