Short answer What does managed care change about who decides? Managed care moves the coverage decision from a state office to a company the state pays. The company decides, but the state keeps three powers: it writes the contract, it defines what expertise counts, and it runs the hearing that can overturn the company. Call …
What Managed Care Changes About Who Decides · Hanh D. Brown Read More »
Short answer Do federal Medicaid rules address automated denials? Federal Medicaid managed care rules require that a denial be made by an individual with appropriate expertise. They do not mention automation at all. The rule exists and binds the decision to a person, and the silence is about the software that may have helped reach …
Short answer Do Medicaid managed care rules cover automated denials? Medicaid managed care already has a rule: a denial must be made by an individual with appropriate expertise. It does not mention automation. Regular Medicaid has no equivalent rule on who decides. Federal advisers asked for guidance on one and a rule change on the …
Medicaid Managed Care and Automated Denial · Hanh D. Brown Read More »
Short answer How do algorithms decide how many home care hours you get? Algorithms decide home care hours by turning an assessment into a score, and the score sets the number. States run this through Medicaid waivers, and some now use such a tool. A cut needs written notice naming the reason and the rule. …
Algorithms Decide How Many Home Care Hours You Get · Hanh D. Brown Read More »
Short answer Can prior authorization and utilization review be done by machine? Prior authorization and utilization review can be automated in part, but the refusal itself needs a person. Texas bars a utilization review agent from using an automated decision system to make an adverse determination, wholly or partly. Federal rules name a human but …
Prior Authorization and Utilization Review by Machine · Hanh D. Brown Read More »
Short answer Is AI deciding Medicare coverage? AI is not deciding Medicare coverage on its own. Medicare runs a pilot using artificial intelligence to review some prior authorization requests in six states, covering Original Medicare only. Under Medicare Advantage a licensed clinician must review any denial based on medical necessity. Medicare began an experiment this …
AI Is Deciding Medicare Coverage · Hanh D. Brown Read More »
The first time the model finished one of my sentences, I was writing about a caregiving tool for an aging parent. I paused at the end of a clause. The completion appeared in my draft. I read it. It was correct. I kept writing. Three weeks later, I went back to that section and could …
The model that knew too much and understood nothing · Hanh D. Brown Read More »
The sentence is not about loss. Loss has already been described too well by too many machines trained on too much literature. The sentence is about the cadence my mother sang while she cooked. I do not remember the words. I remember the cadence. IN THIS ESSAY 01The category is embodied continuity, not autobiography, the …
What the machine simply cannot ever manage to say to you · Hanh D. Brown Read More »
The decision before the sentence# Before a writer commits to a sentence, they have to commit to a position. Most don’t. They write the sentence first and hope the position emerges from it. Not for me. IN THIS ESSAY 01The decision that arrives before the sentence does 02What the decision actually is when you write …
On writing like you genuinely mean every single word · Hanh D. Brown Read More »
I have been a real estate investor for eighteen years. My first home was in Plymouth, Michigan, in 2008. Since then I have moved into multi-family. I started building with AI when ChatGPT shipped in November 2022. The first practice is far older than the second, and it is teaching the second most of what …
The other twenty years of a long working life ahead · Hanh D. Brown Read More »
