Guided by federal and state regulations, the Interoperability Project ensures the Department of Health Care Services (DHCS) compliance; with regulations; facilitating patient data access, payer data exchange, and provider directory updates. Interoperability enables seamless sharing of patient data among health systems, promoting care coordination and improving outcomes. DHCS is committed to the development of secure application programming interfaces (APIs) to grant Californians easy access to their health data and aims to empower individuals in managing their health and fostering a connected healthcare ecosystem for a healthier California.

Medi-Cal Fee-for-Service Prior Authorization Metrics Reporting

DHCS is required to annually report aggregated Medi-Cal and Children’s Health Insurance Program (CHIP) fee-for-service (FFS) prior authorization metrics to comply with the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). Publicly reporting these metrics promotes transparency and accountability, helps Medi-Cal and CHIP FFS members understand prior authorization processes, and enables providers and stakeholders to evaluate payer performance and administrative efficiency. The reporting includes access to information for all Medi-Cal and CHIP FFS items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services over the previous calendar year. 

Please contact the DHCS Interoperability team with any questions or comments on the prior authorization metrics reports at interoperability@dhcs.ca.gov.

2025 Prior Authorization Metrics Reports

• Medi-Cal – 2025 Prior Authorization Metrics for Medi-Cal Fee-for-Service Medical and Behavioral Health Items and Services
• Medi-Cal Dental – 2025 Prior Authorization Metrics for Medi-Cal Fee-for-Service Dental Items and Services
• California Children’s Services – 2025 Prior Authorization Metrics for California Children’s Services (CCS) Items and Services

Third-Party Application Developers 

Third-party application developers interested in providing health data through the Patient Access API must register and become certified through DHCS.

Please email interop-api@dhcs.ca.gov to request registration.

Federal Guidance

• Centers for Medicare and Medicaid (CMS): Interoperability
• CMS Interoperability and Patient Access Final Rule (CMS-9115-F)
• CMS Interoperability and Patient Access Final Rule Fact Sheet
• CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)
• CMS Interoperability and Prior Authorization Final Rule Fact Sheet
• CMS Implementation Guides and Standards
• CMS Blue Button 2.0

Guidance for Managed Care Plans

• All Plan Letter 22-026: Interoperability and Patient Access Final Rule This All Plan Letter (APL) notifies all Medi-Cal managed care health plans (MCPs) of the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule requirements as required by federal law.
• All Plan Letter 22-013: Interoperability and Patient Access Final Rule This APL notified all Dental Managed Care (DMC) Plans about the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule requirements.

Guidance for Mental Health Plans

• Behavioral Health Information Notice No: 22-068 This Behavioral Health Information Notice was used to notify all Mental Health Plans (MHPs) and Drug Medi-Cal Organized Delivery System (DMC-ODS) counties about the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule requirements.

Guidance for Managed Care Plans & Behavioral Health Plans/Counties

• Managed Care Plans and Behavioral Health Plans/Counties This site provides additional information for Managed Care Plans and Behavioral Health Plans/Counties regarding California’s Data Exchange Framework, CalAIM Data Sharing Authorization Guidance, Consent Forms and Consent Management, Data Submission Requirements, and other topics.

State Guidance

• Data Exchange Framework – CDII (ca.gov) California’s Data Exchange Framework (DxF) is the first-ever, statewide data-sharing agreement that will accelerate and expand the exchange of information among healthcare entities across the state. Beginning in January 2024, the DxF includes a single data sharing agreement and a common set of policies and procedures to govern and require the exchange of health and human services information in California. The DxF builds upon the federal Trusted Exchange Framework and Common Agreement (TEFCA), which establishes a foundation for nationwide interoperability.
• State Health Information Guidance (SHIG) The SHIG is a collaboration of the Center for Data Insights and Innovation with various organizations to develop specific materials to help clarify federal and state laws that affect disclosure and sharing of health information.
• Data Exchange and Sharing The Department of Health Care Services (DHCS) is advancing health information exchange and data sharing to improve the care and outcomes for Medi-Cal Members as California continues its journey into data-driven, value-based health care. Data sharing is foundational to care coordination and is essential to supporting whole-person care programs such as Enhanced Care Management, Community Supports, Population Health management, and other Medi-Cal initiatives.

Precursor Programs

• State Medicaid Health Information Plan (March 2022) The final State Medicaid Health Information Technology Plan (SMHP) presents the impact of the Medi-Cal Promoting Interoperability Program, formerly known as the Medi-Cal Electronic Health Record Incentive Program. The SMHP includes the findings of a health information technology assessment completed by researchers at the University of California, San Francisco in February 2022.
• Medi-Cal Promoting Interoperability Program The Health Information Management Division (HIMD), formerly the Office of Health Information Technolgy, was established in DHCS to develop goals and metrics for for the program, establish policies and procedures, and to implement systems to disburse, track, and report the incentive payments. The Promoting Interoperability Program officially ended in December 2021.
• California Health Information Exchange Onboarding Program (Cal-HOP) All Cal-HOP project activity concluded effective September 30, 2021. Cal-HOP provided up to $50 million in state and federal funding to Qualified Health Information Organizations (QHIOs) to support Medi-Cal providers’ access and use health information exchange (HIE) technology to improve the quality and effectiveness of care for Medi-Cal beneficiaries.
• California Technical Assistance Program In November 2015, the California Technical Assistance Program (CTAP) was launched with $37.5 million in federal and state funds. This program was designed to provide assistance to professionals in adopting, implementing, upgrading and meaningfully using certified electronic health record technology. CTAP concluded in November 2020.