The Centers for Medicare and Medicaid Services (CMS) on April 4th issued its Contract Year (CY) 2026 Medicare Advantage (MA) and Part D rule. The final rule does not include provisions that would have increased guardrails on the use of artificial intelligence and prevent automatic denials of basic benefits without individual assessments, as contained in the proposed rule issued at the end of the Biden Administration last November. Providers, lawmakers and advocates had urged CMS to adopt reforms to address MA programs’ use of prior authorization through application of artificial intelligence and algorithms to inappropriately limit or deny access to care, including post-acute care. The new CMS administration stated in the final rule that while it does not intend to finalize the ‘Ensuring Access to MA Services - Guardrails for Artificial Intelligence (AI)’, the agency acknowledges the broad interest in regulation of AI and will continue to consider the extent to which it may be appropriate to engage in future rulemaking in this area.
For more information on the CY 2026 MA and Part D rule, view the fact sheet.