What applies to a physician in Washington

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 that enrolls biometric identifiers in a database for a commercial purpose

Binds any person enrolling biometrics for a commercial purpose; only data used for HIPAA treatment, payment or operations is excluded, a data-level exclusion, so practices and hospitals stay covered.

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: Regulated entities and small businesses that collect, process, share or sell Washington consumers' health data, and their processors; the geofencing ban applies to any person

Binds regulated entities of any size handling consumer health data and bars anyone from geofencing care sites; PHI-only exemption, so practices and hospitals are covered for health data outside PHI.

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: Any person or nonhuman entity that uses a nursing title in Washington

Bars any nonhuman entity, including an AI tool a practice or hospital deploys, from using nursing titles; the deploying entity answers for the tool, not the individual physician.

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: Health carriers and their contracted health care benefit managers, and public and school employee health plans (PEBB and SEBB), that use AI in prior authorization

Binds carriers and PEBB and SEBB plans only: AI may not be the sole means to deny, delay or modify care, and only a licensed physician or professional may deny on medical necessity.

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.