What applies to a physician in Texas

Applies to: Covered entities, meaning any person who assembles, collects, analyzes, uses, evaluates, stores or transmits protected health information, including physicians, practices and health technology vendors

Binds any person handling PHI, naming providers, clinics and facilities, on top of HIPAA: patient notice and authorization for electronic disclosures outside listed exceptions, and no sale of PHI.

Applies to: Health care practitioners who use AI for diagnostic purposes; covered entities, including practitioners, that maintain electronic health records

Practitioners using AI for diagnosis must disclose it and review AI-created records, and covered entities, practices and hospitals included, must store electronic health records in the U.S.

Applies to: Providers of health care services or treatment that use an AI system (disclosure); anyone developing or deploying AI systems in Texas (prohibited uses); state agencies

Health care providers that use AI with a patient must disclose it, and no person may develop or deploy AI intended to incite self-harm; the duties reach physicians, practices and hospitals.

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: Any person who captures or possesses a biometric identifier of an individual for a commercial purpose

Binds any person capturing biometric identifiers for a commercial purpose, with no health care exemption, so practices and hospitals capturing patient or staff biometrics need notice and consent.

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: 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: Utilization review agents conducting utilization review for health benefit plans under Texas Insurance Code Chapter 4201

Binds utilization review agents only: an automated decision system may not make, wholly or partly, an adverse determination, and denial notices must give the clinical basis.

Applies to: All entities the Texas Department of Insurance regulates, including insurers and utilization review agents, and their agents and representatives

Applies to TDI-regulated entities and their agents and representatives only: it expects a person to review and agree with every consequential AI decision and restates the ban on AI adverse determinations.

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.