HealthLeaders Media February 12, 2024
CMS is cracking down on AI use in Medicare Advantage.
KEY TAKEAWAYS
– CMS is warning Medicare Advantage insurers not to use AI to deny care.
– The agency also provided lengthy guidance on topics such as length-of-stay and coverage determinations.
Medicare Advantage (MA) insurers can use AI and algorithms to assist in making coverage decisions, but CMS is warning the insurers that they must follow the agency’s internal benefits requirements and nondiscrimination rules under the ACA and lawfully deny care.
This recent warning aimed at MA insurers addressed concerns surrounding coverage criteria and utilization management requirements from CMS’ final rule policy that detailed policy and technical changes to MA; the rule was originally issued last April.
“We are concerned...
Today's Sponsors
Today's Sponsor