What applies to a physician in Virginia

Applies to: Mental health service providers as defined in Va. Code § 54.1-2400.1, a list that includes physicians, physician assistants, nurses, psychologists, counselors and social workers, and any person or business entity offering therapy or counseling services to the public in Virginia

Would bind mental health service providers, a 54.1-2400.1 list that includes physicians, and bar any person or business entity from offering therapy unless such a provider conducts it.

Applies to: Hospitals, nursing homes and certified nursing facilities licensed or certified by the Board of Health

Binds hospitals, nursing homes and nursing facilities licensed by the Board of Health; physician offices fall outside that licensure, so practice is not tagged.

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: Suppliers in consumer transactions under the Virginia Consumer Protection Act

Binds suppliers in consumer transactions, practices and hospitals among them, with no HIPAA exemption; physician is not tagged because the entry does not say clinical care is a consumer transaction.

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: Every operator of a chatbot offered to users in Virginia (disclosure duties) and operators of chatbots with 500,000 or more monthly active users worldwide (safety and reporting duties), excluding from the latter chatbots not offered to the general public, such as internal workplace tools, clinician-supervised clinical tools or university research systems, and chatbots used solely for customer service

Would require every chatbot operator, meaning any person or entity offering a website or app with a chatbot, practices and hospitals included, to disclose it is not human; the duty is the operator's, not the clinician's.

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: 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 carriers regulated by the State Corporation Commission's Bureau of Insurance

Would bind health carriers only: enrollees and providers must be told when AI is used to issue an adverse determination, with a clear and timely appeal process.