Pathways' Pick of the Week: Medicare Advantage Guide

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CMS publishes Medicare Advantage coverage guidance. Excerpted from Pathways' Picks February 14: AI on the Hill, IMDRF on Equity, Germany on Digital Health, and More.

CMS published a “frequently asked questions” guidance on February 6 underscoring its new requirements for Medicare Advantage (MA) plans in how they set coverage policies by being more transparent and aligning with Medicare coverage determinations. The guide interprets mandates established in an April 2023 CMS regulation. Device manufacturers touted that rule as a step toward fairer MA coverage for new technologies. One issue the guidance addresses is the extent to which plans can rely on AI or other algorithms to make coverage decisions. “An algorithm or software tool can be used to assist MA plans in making coverage determinations, but it is the responsibility of the MA organization to ensure that the algorithm or artificial intelligence complies with all applicable rules for how coverage determinations by MA organizations are made,” CMS states. 

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