Bill > HR6197

This bill amends Medicare payment rules to ensure appropriate reimbursement for algorithm-based healthcare services, which are defined as services delivered through FDA-cleared devices using artificial intelligence, machine learning, or similar software to help physicians diagnose or treat medical conditions. Specifically, the bill requires the Secretary of Health and Human Services to assign these services to a "new technology ambulatory payment classification" based on the full cost submitted by the manufacturer, including technology, staff, and overhead expenses. The bill mandates that such services cannot be removed from this special payment classification for at least two years and only then if adequate claims data exists to reassign them. The legislation also codifies existing payment policies for software-as-a-service in hospital outpatient settings and expands eligibility criteria for these payment classifications to include services that are performed concurrently with or are adjunctive to other medical procedures. The changes are set to take effect on January 1, 2026, with some provisions becoming effective earlier in 2023, aiming to provide more accurate and comprehensive reimbursement for emerging healthcare technologies.

Business and Industry

https://www.congress.gov/bill/119th-congress/house-bill/6197/all-info