> ## Documentation Index
> Fetch the complete documentation index at: https://docs.pidgeon.health/llms.txt
> Use this file to discover all available pages before exploring further.

# CMS-0057-F

> What the CMS Interoperability and Prior Authorization final rule requires, the FHIR baseline it names, and what Conform checks today.

CMS-0057-F, the CMS Interoperability and Prior Authorization final rule (2024), requires impacted payers to operate a set of FHIR APIs. Impacted payers are Medicare Advantage organizations, state Medicaid and CHIP agencies, and QHP issuers on the federally-facilitated exchanges. The API compliance dates are generally January 1, 2027.

## What the rule requires

The rule requires four payer FHIR APIs:

* **Patient Access API**
* **Provider Access API**
* **Payer-to-Payer API**
* **Prior Authorization API**

The required standards baseline is FHIR R4.0.1, US Core 3.1.1, SMART App Launch 1.0, and Bulk Data 1.0 (45 CFR 170.215, as adopted).

## Required vs recommended

Not everything in the Da Vinci ecosystem is mandated, and keeping that straight decides what you test against.

| Standard             | Status under CMS-0057-F                       |
| -------------------- | --------------------------------------------- |
| FHIR R4.0.1          | **Required** baseline                         |
| US Core 3.1.1        | **Required** baseline                         |
| SMART App Launch 1.0 | **Required** baseline                         |
| Bulk Data 1.0        | **Required** baseline                         |
| Da Vinci PAS 2.1     | **Recommended** (CMS standards/IG FAQ)        |
| Da Vinci CRD 2.1     | **Recommended**                               |
| Da Vinci DTR 2.0     | **Recommended**                               |
| US Core 6.1          | Ecosystem target, a permitted updated version |

## What Conform covers today

Conform ships the Implementation Guides that matter for this rule:

| IG               | Package                | Role                              |
| ---------------- | ---------------------- | --------------------------------- |
| US Core 3.1.1    | `fhir-us-core-3.1.1`   | CMS-0057-F required baseline      |
| US Core 6.0      | `fhir-us-core-6.0`     | Ecosystem target (USCDI v3)       |
| Da Vinci PAS 2.1 | `fhir-davinci-pas-2.1` | Prior authorization               |
| Da Vinci CRD 2.1 | `fhir-davinci-crd-2.1` | Coverage requirements discovery   |
| Da Vinci DTR 2.0 | `fhir-davinci-dtr-2.0` | Documentation templates and rules |

Install an IG package with `pidgeon data install <package>`, then point Conform at your endpoint. The US Core 3.1.1 readiness pack grades a walk against the required baseline and writes an evidence envelope. See [Evidence and CI](/conform/evidence-and-ci).

## What Conform does not do

Conform tests conformance to these Implementation Guides. It does not:

* certify CMS-0057-F compliance, or assert that an endpoint is "compliant";
* exercise SMART App Launch or OIDC end-user authorization flows (it authenticates with a static bearer token or SMART Backend Services);
* run the complete Bulk Data kick-off, poll, and download lifecycle.

The evidence it produces states what was tested and what was not. Treat it as conformance evidence you present, not a verdict on the regulation as a whole.

## Next

* [Running conformance](/conform/running-conformance)
* [Evidence and CI](/conform/evidence-and-ci)