What applies to a physician in New Jersey

Applies to: Providers and suppliers furnishing selected items and services to Original Medicare patients in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington; the companies selected as model participants

Only in: Arizona, New Jersey, Ohio, Oklahoma, Texas, Washington

Binds providers and suppliers furnishing selected services to Original Medicare patients in six states: they may request AI-assisted prior authorization or face prepayment review.

Applies to: HIPAA covered entities and business associates that use tracking technologies on websites or mobile apps

HHS guidance for HIPAA covered entities: tracking technologies on patient portals and apps may not send PHI to vendors without a business associate agreement or patient authorization.

Applies to: Employers, housing providers, places of public accommodation including health care providers, and others covered by the Law Against Discrimination

Guidance applying the Law Against Discrimination to places of public accommodation, including practices, clinics and hospitals, that use AI tools; duties run to the covered entity.

Applies to: Covered entities under Section 1557 that use patient care decision support tools

OCR guidance on 45 CFR 92.210 for Section 1557 covered entities, such as practices and hospitals; it changes no coverage, payment or licensure decision reaching physicians.

Applies to: Controllers that do business in New Jersey or target its residents and control or process the personal data of at least 100,000 New Jersey consumers, or of at least 25,000 while earning revenue from selling personal data; protected health information collected by a HIPAA covered entity or business associate is exempt

Binds controllers over 100,000 New Jersey consumers; PHI-only exemption, so practices and hospitals over the thresholds are covered for other personal data, though most practices fall below them.

Applies to: Covered entities under Section 1557 of the Affordable Care Act: health programs and activities receiving HHS federal financial assistance, HHS-administered programs and ACA Exchanges

Binds Section 1557 covered entities, such as practices and hospitals receiving HHS funds, on decision support tools; it changes no coverage, payment or licensure decision reaching physicians.

Applies to: Any individual or legal entity, regardless of size, for the ban on selling sensitive data; data brokers and data collectors, for annual registration and the ban on selling or licensing sensitive data

Bars any individual or entity, whatever its size, from selling sensitive data; PHI-only exemption, so practices and hospitals may not sell sensitive data they hold outside PHI.

Applies to: HIPAA covered entities and the vendors that handle PHI for them

HHS guidance for HIPAA covered entities: a vendor's AI chatbot handling PHI on a patient portal is a business associate, so the practice or hospital needs a business associate agreement first.

Applies to: HIPAA covered entities and business associates

Proposed rule binding HIPAA covered entities and business associates: asset inventory, network map, ePHI encryption and multifactor authentication, with ePHI in AI training data protected.

Applies to: Developers and deployers of generative AI in New Jersey

Would bar any developer or deployer of generative AI from representing that it can practice a licensed profession, which reaches practices and hospitals that deploy patient-facing AI.

Applies to: Anyone who makes an AI chatbot publicly available to consumers

Would bind anyone who makes an AI chatbot publicly available to consumers, which reaches a practice's or hospital's patient-facing chatbot.

Applies to: Persons who develop or deploy artificial intelligence systems in New Jersey

Would bar any person who develops or deploys an AI system from presenting it as a licensed mental health professional, which reaches deploying practices and hospitals; physician is left off as the narrower reading.

Applies to: Medicare Advantage organizations

Binds Medicare Advantage plans only: medical necessity decisions rest on the enrollee's own circumstances, and a qualified professional reviews adverse decisions before issue.

Applies to: Medicare Advantage organizations and Medicare-Medicaid Plans

Applies to Medicare Advantage organizations and Medicare-Medicaid Plans only: AI alone may not deny an admission, downgrade to observation or end post-acute care, and decisions rest on the patient's own circumstances.

Applies to: Carriers and other payers issuing health benefits plans in New Jersey, and their utilization management agents

Binds carriers and UM agents only: prior authorization denials under a licensed medical director, same-specialty appeal review and peer-to-peer on request; no AI rule.

Applies to: Physicians and other practitioners billing the Medicare physician fee schedule

Fee schedule codes G0552 to G0554 let clinicians bill for FDA-cleared digital mental health treatment devices; a payment option, not a duty.

Applies to: Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities and qualified health plan issuers on the federally facilitated Exchanges

Binds MA, Medicaid, CHIP and Exchange payers only: prior authorization deadlines, specific denial reasons and a prior authorization API; no AI rule, listed for prior authorization.

Applies to: Medicare Part B-enrolled organizations that join the model, other than suppliers of durable medical equipment, prosthetics, orthotics and supplies and laboratory suppliers; their Original Medicare patients; and clinicians who co-manage those patients

Voluntary CMS model: participating organizations and co-managing clinicians gain new billing options; no duty unless an organization joins.

Applies to: Physicians and other practitioners paid under the Medicare physician fee schedule

Proposed fee schedule pricing for 10 software analysis codes, paid to whoever bills the fee schedule; a payment change, not a duty.

Applies to: The Director of the Division of Consumer Affairs and the professional boards listed in N.J.S.A. 45:1-15, including the State Board of Medical Examiners, and their licensees

Would direct licensing boards, including the State Board of Medical Examiners, to adopt rules on licensees' generative AI use; the bill binds no physician itself, so physician goes in affects.

Applies to: Medicare Advantage organizations; CMS and ONC for a report to Congress

Would bind Medicare Advantage plans only: electronic prior authorization and annual reports on requests approved or denied with AI or other decision technology.