> For the complete documentation index, see [llms.txt](https://docs.dataplex-consulting.com/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.dataplex-consulting.com/data-catalog/cms-prior-auth-compliance-dataset/deadline-calendar.md). # Deadline Calendar The verified compliance anchors across the CMS prior-authorization rulemaking wave, organized by date. Every anchor below is drawn from the curated `OBLIGATION_APPLICABILITY` facts and is reproducible from the `COMPLIANCE_DEADLINES` view; this page is a narrative rendering of the same data, not a separate source. **Final and proposed dates are marked; proposed dates come from CMS-0062-P and are not binding.** {% hint style="warning" %} Informational reference compiled from public Federal Register, eCFR, and CMS sources. Not legal advice; consult counsel for compliance decisions. Dates key off entity-specific semantics; see [How the anchors read per entity](#how-the-anchors-read-per-entity) before treating any anchor as a literal due date. {% endhint %} ## Milestone timeline | Anchor | What is due | Rule | Certainty | Status | | ---------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ | ----------------------------------------------- | | **Apr 8, 2024** | Patient Access API: expanded data content (all USCDI classes) for impacted payers | CMS-0057-F | Final | In effect | | **Jan 1, 2026** | PA decision timeframes: 72h expedited / 7 calendar days standard (all impacted payers **except** QHP issuers on the FFEs, who are exempt) | CMS-0057-F | Final | In effect | | **Jan 1, 2026** | Denial-reason specificity, any communication channel (all impacted payers) | CMS-0057-F | Final | In effect | | **Jan 1, 2026** | Public reporting of PA metrics begins (all impacted payers) | CMS-0057-F | Final | In effect | | **Mar 31, 2026** | **First public PA-metrics posting due** on payer websites (for CY2025), recurring annually thereafter | CMS-0057-F | Final | In effect · recurs annually (next Mar 31, 2027) | | **Mar 31, 2026** | **First Patient Access API usage metrics reported to CMS** (for CY2025), recurring annually | CMS-0057-F | Final | In effect · recurs annually (next Mar 31, 2027) | | **Jan 1, 2027** | Patient Access API: add prior-authorization information | CMS-0057-F | Final | Upcoming | | **Jan 1, 2027** | Provider Access API (extension path available for Medicaid/CHIP FFS) | CMS-0057-F | Final | Upcoming | | **Jan 1, 2027** | Payer-to-Payer API (extension path available for Medicaid/CHIP FFS) | CMS-0057-F | Final | Upcoming | | **Jan 1, 2027** | Prior Authorization API: CRD + DTR + PAS capability (extension path available for Medicaid/CHIP FFS) | CMS-0057-F | Final | Upcoming | | **CY2027** | MIPS Electronic Prior Authorization measure performance period (clinicians and eligible hospitals/CAHs) | CMS-0057-F | Final | Upcoming | | **Oct 1, 2027** | Drug prior-authorization into the Prior Authorization API; drug PA decision timeframes; drug denial-reason specificity; NCPDP pharmacy PA standards; public drug-PA metrics | CMS-0062-P | **Proposed** | Proposed | | **Jan 1, 2028** | Interoperability + PA API requirements extended to small-group QHP issuers on the FF-SHOPs | CMS-0062-P | **Proposed** | Proposed | | **Jan 1, 2028** | STU-2-era FHIR implementation-guide stack proposed to expire | CMS-0062-P | **Proposed** | Proposed | | **May 26, 2028** | Claims-attachments standards: X12N 275/277 and the C-CDA attachments IGs (claims attachments only; **not** prior-authorization scope) | CMS-0053-F | Final | Upcoming | *Status computed as of July 7, 2026 from the anchor dates above; proposed dates are never marked in effect.* Two obligations from CMS-0062-P (adopting FHIR as the HIPAA standard replacing X12N 278, and the FHIR PA-attachments standard) attach to HIPAA covered entities with a compliance clock defined **relative to a future final rule's effective date** ("24 months from the effective date of a final rule"). Because no dated anchor exists yet, they carry `compliance_date_type = RELATIVE_TO_FINALIZATION` with a NULL anchor and are quarantined from the gold view; **the date is tracked, never fabricated**, and will resolve when CMS-0062-P is finalized. ## How the anchors read per entity The same anchor date means different things for different entity types. This is why the product never publishes a bare `compliance_date`: the anchor is paired with a `compliance_date_type` that tells you how to resolve it. | Entity type | Default date semantics | How to read a Jan 1 anchor | | ------------------------------------------- | --------------------------- | -------------------------------------------------------- | | Medicare Advantage organizations | `LITERAL` | The literal calendar date | | State Medicaid / CHIP fee-for-service | `LITERAL` | The literal calendar date | | Medicaid / CHIP managed care | `RATING_PERIOD_ON_OR_AFTER` | The first rating period beginning on or after the anchor | | QHP issuers on the FFEs (and FF-SHOPs) | `PLAN_YEAR_ON_OR_AFTER` | The first plan year beginning on or after the anchor | | MIPS clinicians / eligible hospitals & CAHs | `PERFORMANCE_PERIOD` | The applicable EHR reporting / performance period | Resolving a managed-care plan's actual due date requires its rating-period start, and a QHP's requires its plan-year start; neither is in the rule text, so the product supplies the anchor and the semantics and leaves the final resolution to the entity. Query `OBLIGATION_APPLICABILITY` (or `COMPLIANCE_GOLD`) with your `entity_type_id` to get the anchor and its semantics for every obligation. ## Extensions and exemptions These are first-class rows, not footnotes: * **QHP issuers on the FFEs are exempt** from the PA decision-timeframe obligation: an explicit `EXEMPT` applicability row, not a missing one. * **Medicaid and CHIP fee-for-service programs have an extension path** on the Provider Access, Payer-to-Payer, and Prior Authorization APIs: `EXTENSION_AVAILABLE` applicability, with the basis in `extension_exemption_notes`. * **CMS-0053-F rows are adjacency only**: every one carries `is_pa_scope = FALSE`. They appear in the calendar because the May 26, 2028 claims-attachments date is a real CMS deadline payers track, but they are not prior-authorization obligations, and CMS explicitly declined to finalize X12N 278 for prior-authorization attachments (the gap CMS-0062-P proposes to fill with FHIR). ## Reproduce this calendar ```sql SELECT deadline_type, entity_type_id, obligation_id, compliance_date_anchor, compliance_date_type, compliance_date_display, date_certainty FROM DWV.COMPLIANCE_DEADLINES ORDER BY compliance_date_anchor, date_certainty DESC, entity_type_id; ``` *** *Informational reference compiled from public Federal Register, eCFR, and CMS sources. Not legal advice; consult counsel for compliance decisions.* --- # Agent Instructions This documentation is published with GitBook. GitBook is the documentation platform designed so that both humans and AI agents can read, navigate, and reason over technical content effectively. 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