Bipartisan Senators Urge CMS for AI Health Services Payment Pathway

The bipartisan group of Senators, who urged the Centers for Medicare & Medicaid Services (CMS) to create a formal payment pathway for algorithm-based health care services (ABHS) in the upcoming Hospital Outpatient Prospective Payment Systems (HOPPS) rulemaking cycle, have received praise from AdvaMed, the Medtech Association. ABHS, FDA-cleared medical devices that utilize artificial intelligence (AI) and machine learning (ML), are essential tools in assisting with patient diagnosis and treatment. Scott Whitaker, AdvaMed’s president and CEO, highlighted the significance of a well-defined Medicare reimbursement pathway to facilitate the implementation of AI-enabled clinical technology and its acceptance by healthcare providers, ultimately enhancing patient care.

The letter, led by Senators Martin Heinrich (D-NM) and Mike Rounds (R-SD), along with Senators Marsha Blackburn (R-TN) and Todd Young (R-IN), emphasized the importance of CMS in creating a structured payment process for ABHS. The Senators requested that CMS formalize its current Software-as-a-Service (SaaS) payment policy, as outlined in the 2023 Medicare HOPPS Final Rule, in order to establish a sense of stability and predictability. They noted that ABHS enhances care delivery by providing critical clinical information.A uniform payment policy is essential to covering more of the hundreds of FDA-approved ABHS devices and overcome the current regulatory uncertainties and payment inconsistencies.

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