The federal instinct when a standard matters is to mandate it: a rule, a deadline, a compliance checkpoint. Fifty states then implement to the letter of the mandate on the mandated timeline, whether or not the standard is ready, whether or not it fits, and with exactly the enthusiasm compliance inspires. The mandate also destroys the most valuable signal a standard can produce: voluntary adoption. When use is compelled, universal adoption tells us nothing about whether the thing works. When use is chosen, adoption is the market test, and a standard that cannot attract states on its usefulness is telling CMS something a compliance rate never will.
The CMS-9115-F Interoperability and Patient Access final rule (85 FR 25510) provides a cautionary example. We made a standard, mandated it through regulation and deadlines, and forced states to invest heavily, pulling staff and attention away from urgent priorities like fraud, waste, and abuse. Can we point to what has become meaningfully more interoperable for a beneficiary, a caseworker, or a state as a result? Texas, reporting the usage metrics CMS itself now requires under a later rule, put a number on it for 2025: zero unique beneficiaries had data transferred through its Patient Access API, and zero had it transferred more than once. An independent review of 352 payers across 30 vendors found the best-performing payer scored 82 out of 100 on API functionality, with authorization success rates ranging from under 50 percent to fully reliable depending on the payer. The compliance rate will reach one hundred percent. The interoperability may never arrive.
The alternative is to first discover whether something is worth doing, and how it is best accomplished, before standardizing and scaling it. Declare the target outcomes for interoperability, then experiment with multiple solutions for achieving them in real pilots. Continue until a solution emerges so compelling that states opt in without being asked, or until we discover that the cost and effort of achieving the outcome does not justify doing it at all. Both discoveries are wins, and only one of them was available under a mandate.
Consider the income and wage verification service described in S9. Today, states buy wage data from private services at enormous recurring cost, supplement it with consortiums and interfaces they each maintain separately, and still struggle to get complete information. A simple, clear, secure, single federal wage and income service for any individual seeking state benefits, one call, exactly the information state programs need, available to every state, would require no mandate at all. Every state would use it because using it would beat the alternative, and the adoption curve would prove it.
So: declare the outcome, experiment until something proves worth scaling, then publish the interface and let usefulness do the enforcement. If no experiment justifies the outcome, stop, and count that as the process working. And where adoption lags on something that scaled, treat that as evidence about the quality of the standard or the capability, not about the states.