On December 21, 2022, HHS proposed a new rule to adopt standards for health care attachments transactions and a standard for electronic signatures to be used with those transactions. HHS has identified that these standards would support electronic transmissions of certain types of information that cannot be adequately conveyed in specified fields or data elements of current prior authorization requests or health care claims transactions. This effort comes after widespread usage of electronic health records (EHRs) because the transmission of health care attachments is primarily a manual process with no adopted HIPAA standards, implementation guides, or operating rules supporting electronic signatures or transmission of this type of information. The proposed rule would implement requirements in the HIPAA Administrative Simplification subtitle and the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010. The Council for Affordable Quality Healthcare (CAQH) 2019 report indicates that a fully electronic system for prior authorization with health care attachments could save as much as $454 million in annual savings to the health care industry. The report further estimates savings of $374 million annually with the full adoption of health care attachments for claims. The public comment deadline is March 21, 2023.