MACPAC calls for increased transparency on AI-supported prior authorization
MACPAC calls for increased transparency on AI-supported prior authorization
Publish Date: 2026-05-12 16:19:00
Source Domain: www.aha.org
- The Medicaid and CHIP Payment and Access Commission approved recommendations to enhance oversight and transparency regarding artificial intelligence usage for prior authorization.
- The commission advised the Centers for Medicare & Medicaid Services (CMS) to clarify federal requirements to ensure that medical necessity determinations for adverse decisions, like denials, involve an expert rather than automation alone.
- CMS was recommended to amend fee-for-service regulations to align with these oversight requirements.
- The commission emphasized the need for CMS to provide guidance on managing AI’s usage in managed care oversight.
- States are being urged to mandate that Medicaid health plans disclose their AI usage, including for testing, evaluation, and oversight.
