Bipartisan Lawmakers Call for Greater AI Oversight in Medicare Advantage Coverage Decisions

A bipartisan group of 51 lawmakers in the House and Senate is calling for greater oversight of artificial intelligence (AI) in Medicare Advantage (MA) coverage decisions.

In the letter addressed to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services (CMS), the group of lawmakers said they are “concerned about the use of prior authorization by MA plans, specifically the continued use of artificial intelligence (AI) and algorithmic software to guide coverage decisions.”

“Plans continue to use AI tools to erroneously deny care and contradict provider assessment findings,” says the Lettersigned by several lawmakers, including Representative Judy Chu (D-Calif.), Representative Jerry Nadler (DN.Y.), Senator Elizabeth Warren (D-Mass.), and Senator Mike Braun (R-Ind.).

Lawmakers are pushing for CMS to take action, including creating “an approval process to review AI and algorithmic tools and their contributions to ensuring the integrity of their use, and conducting a review of AI algorithms and tools in I currently use.”

“We believe CMS should be more proactive in monitoring plans’ use of AI and algorithm-driven tools,” the letter says. “MA plans cannot be allowed to avoid oversight by claiming that these tools are mere ‘guidance.’ Given that we do not know what data is used for the currently used algorithms and AI tools, it is difficult to know how accurate the information they generate and whether the data complies with regulations.”

“In the absence of an outright ban on the use of such tools, CMS should limit their use until a systematic assessment can be conducted of how these tools are impacting care,” the letter continues.

The Hill reached out to CMS.

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