What applies to a physician in Ohio

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: Licensed therapy professionals: psychologists, professional clinical counselors, independent social workers, independent marriage and family therapists, art and music therapists, independent chemical dependency counselors, certified mental health assistants, certified behavior analysts and any other professional authorized to provide therapy or psychotherapy services

Would bind licensed therapy professionals, a list ending with any other professional authorized to provide therapy and enforced by boards including the state medical board; it places no duty on entities.

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: 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: 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: 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 artificial intelligence models or applications in Ohio

Would bar any person from developing or deploying an AI model or application that encourages self-harm, which reaches deploying practices and hospitals; physician is left off as the narrower reading of deployer.

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: 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: 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: Ohio Medicaid managed care entities: Ohio Managed Care, MyCare Ohio and OhioRISE plans and the single pharmacy benefit manager

Binds Ohio Medicaid managed care entities only: AI may not deny, limit or terminate a service without a human final decisionmaker, and automating prior authorization needs approval.

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: 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.

Applies to: Health plan issuers and the physicians who conduct medical necessity or utilization review for them

Would bind health plan issuers only: no care decision based solely on AI, and record review by the plan's physician reviewers, whose duties count as plan duties.