Artificial Intelligence deployment for pre-authorization of medical treatments in a Medicare trial program
The Centers for Medicare and Medicaid Services (CMS) is implementing a new pilot program that will commence next year in seven states, including Arkansas. This program aims to test whether it can reduce waste, fraud, and abuse in traditional Medicare systems.
The pilot program will require prior authorization for certain medical procedures, such as steroid injections, spine surgeries, and skin substitutes. This means that before these treatments can be administered, they will need to be approved by private AI firms that have been contracted by CMS to make decisions about care for specific medical procedures.
Arkansas will be the seventh state to participate in this pilot program, joining Ohio, Oklahoma, Arizona, New Jersey, Texas, and Washington. This program will only apply to traditional Medicare and not Medicaid in any of these states.
There are concerns about potential inappropriate denials due to the use of AI firms in the program. Critics argue that relying on AI to make decisions about what is and isn't covered could lead to denials that are too strict or too lenient, potentially denying necessary care to patients or allowing unnecessary treatments to proceed. These concerns apply to Arkansas as well.
The government estimates that these treatments could cost billions in unnecessary taxpayer dollars each year. By requiring prior authorization for these procedures, the program aims to reduce these costs and ensure that only necessary treatments are covered.
It is important to note that the search results do not provide information about the specific private AI companies commissioned by CMS in the new pilot program. The use of private AI firms to make decisions on what is and isn't covered is controversial, and this controversy extends to Arkansas.
In conclusion, the new Medicare pilot program aims to reduce waste, fraud, and abuse by requiring prior authorization for certain medical procedures. The program will commence next year in seven states, including Arkansas, and will only apply to traditional Medicare, not Medicaid. There are concerns about potential inappropriate denials due to the use of AI firms in the program, and it is important to monitor the impact of the program closely to ensure that patients receive the care they need while avoiding unnecessary costs to taxpayers.
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