ONC “Rider” Proposes New Standards for Prior Authorization, Burden Reduction

On April 10, the Centers for Medicare and Medicaid Services (CMS) published the Interoperability and Prior Authorization for Drugs Proposed Rule, to streamline the exchange of clinical and administrative data.  Specifically, a series of ONC proposals are included as a rider in the CMS proposed rule and would adopt a suite of new standards related to electronic prior authorization, payer-to-payer data exchange, and other burden reduction specifications developed by the HL7 FHIR® Da Vinci Project.  ONC proposes to adopt the newest versions of several HL7 FHIR® implementation specifications, including:

• HL7 FHIR® Da Vinci—Coverage Requirements Discovery (CRD) Implementation Guide, Version 2.2.1—STU 2.2
• HL7 FHIR® Da Vinci—Documentation Templates and Rules (DTR) Implementation Guide, Version 2.2.0—STU 2.2
• HL7 FHIR® Da Vinci—Prior Authorization Support (PAS) FHIR Implementation Guide, Version 2.2.1—STU 2.2
• HL7 FHIR® CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) Implementation Guide, Version 2.2.0—STU 2.1
• HL7 FHIR® Da Vinci Payer Data Exchange (PDex) US Drug Formulary Implementation Guide, Version 2.1.0—STU 2.1
• HL7 FHIR® Da Vinci Payer Data Exchange (PDex) Plan Net Implementation Guide, Version 1.2.0—STU 1.2
• HL7 FHIR® Da Vinci—Clinical Data Exchange (CDex) Implementation Guide, Version 2.1.0—STU 2.1

In parallel with these proposals, ONC and CMS have announced a collaborative testing roadmap for these versions of Da Vinci specifications, leveraging the Inferno Test Tool.  Test kits for CRD version 2.2.1 are under development now, and we intend to make these test kits available for both payer-side and provider/EHR-side testing by early summer.

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Advancing Nationwide Electronic Prior Authorization Through a Collaborative Testing Roadmap

ONC and CMS are advancing a collaborative approach to electronic prior authorization (ePA) testing in 2026, with the goal of supporting broad implementation, improving readiness across the ecosystem, and helping reduce burden for providers, payers, and patients.  At the center of this work is a testing strategy focused on preparing stakeholders for nationwide ePA deployment.  ONC and CMS have identified two primary areas of focus for ePA collaborative testing:

• Pre-production testing and engagement.  This effort will leverage the Da Vinci Project’s educational resources, implementer community, and connectathons to support immediate testing and participation.
• Conformance testing.  This work includes updating the Inferno testing tool for Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS) implementation guides (IGs) to version 2.2.0 to better support developer and implementer needs.

Early activities in 2026 are designed to help participants begin engaging with the broader implementation community.  Planned activities include:

• Available Now!  Provider-side and payer-side testing of Da Vinci IGs v2.0.1 using the Inferno Testing Tool.

During the early summer 2026, the roadmap calls for expanded testing support and updated tooling:

• CRD IG v2.2.0 Inferno Testing Tool update to support provider-side and payer-side testing.
• 2026 CMS & HL7 Connectathon – (June/July TBD, virtual).  A dedicated track to test Da Vinci IGs all Davinci IGs.
• Join prep calls (info forthcoming) to identify use cases and learn how to participate.
• Testing may include any version of the IGs, including 2.1.0, 2.2.1, and partial builds.

ONC Health IT Certification Program Resources

• Enforcement Discretion Notices
• Real World Testing Resource Guide
• Attestations Resource Guide
• SVAP Approved Standards for 2025 Fact Sheet
• Insights Measure Specifications Version 4 Clarifications Fact Sheet
• ONC Certification Criteria for Health IT by Regulatory Update Deadline page
• API Developer Obligations and Responsibilities Fact Sheet