# What the CMS Patient Access Rule Means for You

The CMS Interoperability and Patient Access final rule (CMS-9115-F), published May 1, 2020, requires certain health plans to let members share claims and clinical data with apps they choose through a Patient Access API. Its scope includes Medicare Advantage, Medicaid and CHIP programs and managed plans, and Qualified Health Plan issuers on federally facilitated exchanges.

How it works: Covered health plan -> Patient authorization -> Available plan data. CMS-9115-F requires specified plans to provide a Patient Access API.

## What plans must share

- Adjudicated claims and your cost-sharing.
- Encounters with capitated providers.
- Clinical data the plan maintains, including lab results.

## How far back

CMS requires impacted payers to make data they maintain with service dates on or after January 1, 2016 available to current enrollees through the Patient Access API. What you can retrieve depends on the records the plan holds.

## Which plans

- Medicare Advantage organizations.
- Medicaid and CHIP fee-for-service programs.
- Medicaid managed care plans and CHIP managed care entities.
- QHP issuers on the federally facilitated exchanges.

## Questions

**What is CMS-9115-F?** CMS-9115-F is the CMS Interoperability and Patient Access final rule, published May 1, 2020. It requires specified health plans to offer a standards-based Patient Access API.

**Does it cover employer plans?** CMS-9115-F applies to specified Medicare Advantage, Medicaid, CHIP, and federally facilitated exchange plans. It does not impose that Patient Access API requirement on all employer-sponsored plans. Check your specific plan in the Flexpa endpoint directory.

**How do I use my Patient Access API?** Connect your plan through an app such as Flexpa, which signs you in with your plan's account and retrieves your data with your consent.

## More

- [CMS-9115-F (cms.gov)](https://www.cms.gov/files/document/cms-9115-f.pdf)
- [What is patient access? (docs)](https://www.flexpa.com/docs/consent/patient-access)
- [Use your claims history with AI](https://www.flexpa.com/health-insurance-claims-with-ai)
- [Health records for agents (docs)](https://www.flexpa.com/docs/guides/agents)

Last updated 2026-11-11.