Overview

• The multi‑year demonstration is scheduled to begin in January for beneficiaries in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
• Private contractors will use artificial intelligence to screen requests, with any denials issued by licensed clinicians, and emergency services and hospital stays excluded.
• Roughly a dozen procedures are in scope, including certain spine surgeries, select steroid injections, electrical nerve stimulators, skin and tissue substitutes, incontinence devices, and impotence treatments.
• Selected vendors are slated to receive a share of savings from rejected claims, and officials say companies could face penalties for inappropriate decisions.
• Democratic lawmakers, the American Medical Association, physicians, and patients warn of red tape and delayed care, while CMS projects several billions in savings from reduced waste.