CMS-0057-F Final Rule · CHIP managed care

CMS-0057-F deadlines & requirements for CHIP managed care

There are 12 tracked CMS-0057-F obligations for CHIP managed care, with compliance dates from April 8, 2024 through January 1, 2028 — each traced to the Federal Register.

days
hours
minutes
until the January 1, 2027 Patient Access & Prior Authorization API compliance date for most impacted payers.
The calendar

Every CHIP managed care compliance date

Only the CMS-0057-F obligations that apply to CHIP managed care, grouped by date. Managed-care obligations key to the rating period on or after the date. Every row traced to the Federal Register.

April 8, 2024
2 obligations · already in force
Patient Access API — expanded data content (all USCDI data classes and elements per 45 CFR 170.213)
April 8, 2024 (effective date of the final rule; already in force)
CHIP managed care 89 FR 8758
Rule effective 2024-04-08
All impacted payers 89 FR 8758
October 1, 2025
1 obligation · already in force
Rule effective 2025-10-01
All impacted payers 90 FR 36536
January 1, 2026
4 obligations · already in force
Annual public reporting of prior authorization metrics on payer website
Beginning in 2026; first public posting due March 31, 2026, covering calendar year 2025 data; recurring annually each March 31 for the prior calendar year
CHIP managed care 89 FR 8758
Prior authorization decision timeframes (72 hours expedited / 7 calendar days standard)
Rating periods that start on or after January 1, 2026
CHIP managed care 89 FR 8758
Specific reason for prior authorization denial (any communication channel)
Rating periods beginning on or after January 1, 2026
CHIP managed care 89 FR 8758
HL7 FHIR US Core IG 3.1.1 expires 2026-01-01
All impacted payers 89 FR 8758
March 31, 2026
4 obligations · already in force
Annual public reporting of prior authorization metrics on payer website
First report due 2026-03-31 (PAYER_WEBSITE)
All impacted payers 89 FR 8758
Annual public reporting of prior authorization metrics on payer website
Beginning in 2026; first public posting due March 31, 2026, covering calendar year 2025 data; recurring annually each March 31 for the prior calendar year
CHIP managed care 89 FR 8758
Patient Access API usage metrics — annual report to CMS
First report due 2026-03-31 (CMS)
All impacted payers 89 FR 8758
Patient Access API usage metrics — annual report to CMS
Beginning in 2026: due March 31 each year for the previous calendar year (first report due March 31, 2026, covering CY2025)
CHIP managed care 89 FR 8758
May 26, 2026
1 obligation · already in force
Rule effective 2026-05-26
All impacted payers 91 FR 14350
June 15, 2026
1 obligation · already in force
Comment period closes 2026-06-15
All impacted payers Proposed 91 FR 19890
January 1, 2027 Key deadline
4 obligations
Patient Access API — prior authorization information
Rating periods beginning on or after January 1, 2027
CHIP managed care 89 FR 8758
Payer-to-Payer API
Rating periods beginning on or after January 1, 2027
CHIP managed care 89 FR 8758
Prior Authorization API (CRD+DTR+PAS capability)
Rating periods beginning on or after January 1, 2027
CHIP managed care 89 FR 8758
Provider Access API
Rating periods beginning on or after January 1, 2027
CHIP managed care 89 FR 8758
March 31, 2027
2 obligations
Annual public reporting of prior authorization metrics on payer website
Next annual 3/31 recurrence (PAYER_WEBSITE)
All impacted payers 89 FR 8758
Patient Access API usage metrics — annual report to CMS
Next annual 3/31 recurrence (CMS)
All impacted payers 89 FR 8758
October 1, 2027
2 obligations
Incorporate drugs covered under a medical benefit into the Prior Authorization API
October 1, 2027 (proposed)
CHIP managed care Proposed 91 FR 19890
Prior authorization decision timeframes for drugs
October 1, 2027 (proposed)
CHIP managed care Proposed 91 FR 19890
January 1, 2028
1 obligation
HL7 FHIR Da Vinci Prior Authorization Support (PAS) IG 2.0.1 expires 2028-01-01
All impacted payers 89 FR 8758
Other payer types

CMS-0057-F for other payer types

The same deadline detail, scoped to a different organization type.

Beyond the rulebook

Knowing the rules is the easy part. Who’s actually complying?

The deadlines above are public. What isn’t: which payers have already posted their prior-authorization metrics, and what they reported. Dataplex tracks that layer — human-reviewed and traced to each payer’s own published source.

475+payer organizations tracked
500+posted PA metrics, source-traced
  • See which of your competitors have posted — and their approval, denial, and appeal rates.
  • Every metric human-reviewed and linked to the payer’s own published page.
  • Benchmark your organization against the field, or embed the matrix in your own product.
Free download

The one-page milestone cheat sheet

Every key CMS-0057-F compliance date on a single printable page — what’s due, who it hits, traced to the Federal Register. We’ll email you the PDF and a note from our team.

No spam. One follow-up from a human, then only if you ask.
Dataplex maintains this tracker from the published Federal Register text of CMS-0057-F and adjacent rulemaking. It is a reference summary, not legal advice — verify against the citations shown. For payer benchmarking, the full provenance-traced matrix, or embedding it in your product, talk to our team. Teams who want to self-serve the queryable dataset can find it on the Snowflake Marketplace.