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ARTICLE · 31 MARCH 2024

Navigating The Future: Medicare Advantage Plan Rules On The Use Of Artificial Intelligence

Venable LLP
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The use of technology in healthcare services and payment for healthcare is evolving at an unprecedented pace, reshaping how medical services are delivered, managed, and paid for.

United StatesTechnology
Ari J. Markenson
Ari J. Markenson
Heather West
Heather West
Ryan Sweigard
Ryan Sweigard

The use of technology in healthcare services and payment for healthcare is evolving at an unprecedented pace, reshaping how medical services are delivered, managed, and paid for. The use of artificial intelligence systems (AI), particularly in the area of reimbursement for care, is a technological advancement that has garnered significant attention.

On February 6, 2024, CMS released a FAQ Memo to all MAOs, providing guidance on the April 5, 2023 MAO Final Rule and clarifying how MAOs can use AI and algorithms in making coverage determinations. The MAO Final Rule is applicable to coverage beginning January 1, 2024.

As a threshold matter, CMS explains in the FAQ Memo that it is not prohibiting the use of AI or algorithms in coverage decisions. It explicitly provides that "[a]n algorithm or software tool can be used to assist MA plans in making coverage determinations, but it is the responsibility of the MA organization to ensure that the algorithm or artificial

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