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Billing News · Tuesday, April 7, 2026

CMS suspends MA prior authorization AI guardrails and health equity reporting

Georgetown Medicare Policy Initiative, April 2026
CMS

CMS declined to finalize guardrails on artificial intelligence use in MA prior authorization decisions. The agency also suspended the Biden-era requirement for MA plans to publish plan-level health equity analyses of denial rates by population (dually eligible, low-income, disabled). The aggregate-only reporting requirement remains — contract-level, not plan-level, with no service-type breakdown.

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