Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligible Hospitals and Critical Access Hospitals in the Medicare Promoting Interoperability Program
89 Fed. Reg. 8758 (Feb. 8, 2024)1 Analyses of this federal-register by attorneys
Regulation of AI in Healthcare Utilization Management and Prior Authorization Increases
Holland & Knight LLPNovember 1, 2024lf has been subject to increased regulatory and media scrutiny over the past couple of years, collaboration can also foster the development of best practices for the ethical and effective use of AI in UM/PA. This is a new regulatory and technological landscape, and regulators are still catching up. In the meantime, stakeholders should be committed to setting strong industry standards to build greater trust and reliability in their platforms.ConclusionThe regulatory environment surrounding the use of AI in healthcare, particularly in UM/PA, is rapidly evolving. Insurers must remain vigilant and adaptable, ensuring that their AI applications and processes for conducting UM/PA are compliant with the latest regulations. Holland & Knight's Healthcare & Life Sciences Team will continue to monitor for any new federal and state initiatives governing the use of AI in UM/PA – and more generally within the healthcare sector.Notes E.O., Sec. 8(b)(i)(A). 88 Fed. Reg. 22120, 22195 (April 12, 2023). 89 Fed. Reg. 8758 et seq.