CMS — Medicare Advantage FAQ on coverage criteria, utilization management, and use of algorithms/AI (CMS-4201-F)
8/12Calibrated Authority
“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 HPMS memo, 'Frequently Asked Questions related to Coverage Criteria and Utilization Management Requirements in CMS Final Rule (CMS-4201-F)', February 6, 2024, Q2 · source ↗
D1
Traceability & inspectability
2
D2
Human authorship & accountability
2
D3
Disclosure & labeling
0
D4
Synthetic-identity / fabrication prohibition
0
D5
Human validation in loop
2
D6
Evidential-trust emphasis
2
Posture BalancedBoundary fit · partiallyTrust-logic Evidential
Reitz, C.H. (2026). The Calibrated Authority Index — CMS — Medicare Advantage FAQ on coverage criteria, utilization management, and use of algorithms/AI (CMS-4201-F). https://calibrated-authority.chrishuberreitz.com/institutions/cms-medicare-advantage-ai-faq Quote: “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.” Source: https://www.cms.gov/files/document/hpms-memo-faq-coverage-criteria-and-utilization-management-cms-4201-f-02-6-2024-pdf.pdf