What applies to a physician in Oklahoma

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: 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: 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: Health benefit plans and utilization review entities

Binds health benefit plans and UR entities only: adverse determinations by a licensed physician or mental health professional, with same-specialty appeals; 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: Health benefit plans and utilization review entities handling prescription drug prior authorization

Binds health benefit plans and UR entities only: drug prior authorization denials by a physician, pharmacist or licensed mental health professional, with deadlines; no AI rule.

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: 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.