Lexology February 13, 2024
On February 6, the Centers for Medicare and Medicaid (CMS) published an important FAQ for Medicare Advantage Organizations (MA) and Medicare-Medicaid Plans intended to clarify ambiguities identified by the public in the “Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly” which provisions went into effect January 1, 2024.
MA organizations have historically employed certain software tools, including artificial intelligence (AI)-powered decision-making tools, to assist with informing care-related decisions, such as predicting lengths of stay, making diagnoses, or offering recommendations. Traditionally, these systems utilize prior patient experiences and current patient conditions to inform care recommendations. However, official CMS...
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