*   *   *   *   *

(d) Health information systems.

(1) The State must ensure, through its contracts, that each MCO, PIHP, and PAHP complies with the health information systems requirements as provided in §438.242(a), (b)(1) through (4), (c), (d), and (e) of this chapter.

(2) Each MCO, PIHP, and PAHP must implement an Application Programming Interface (API) as specified in §457.730 as if such requirements applied directly to the MCO, PIHP, or PAHP, and include—

(i) All encounter data, including encounter data from any network providers the MCO, PIHP, or PAHP is compensating on the basis of capitation payments and adjudicated claims and encounter data from any subcontractors.

(ii) [Reserved]

(3) Implement, by January 1, 2021, and maintain a publicly accessible standards-based API described in §457.760, which must include all information specified in §438.10(h)(1) and (2) of this chapter.

*   *   *   *   *

Need assistance?