Source: CMSA Today
BY JENNY QUIGLEY-STICKNEY, MSN, RN, MHA, MA, CCM, ACM-RN, CMAC, CPHM, FCM
As of March 2024, the United States did not yet have a comprehensive federal legislation or policy specifically targeting AI technology. There are discussions and initiatives at the federal, state and local levels of government aimed at addressing various aspects of AI regulation, including ethics, privacy, security and potential economic impacts. Most initiatives focus on the development of a task force to examine the current AI structure and look at how to begin implementation at both the state and national level of monitoring and regulation. According to Legal Week 2025, “Legislation of AI will mean adopting a strategic and communicative approach if it can be trusted to provide accurate outcomes.” The case manager’s role in AI is just emerging in our daily roles as case managers as they integrate AI into the assessment process and to aid with leveling patients within the utilization review EHR products. As our professional roles intertwine with AI advancing into the day-to-day working world of case management, it will be our obligation to act as gatekeepers to make sure the use of AI is utilized ethically, regulated, monitored and meets the standards of practice in which we work as certified case managers. Before ushering in task forces to begin writing regulations and legislation, it is important to examine how we want our relationship with AI to evolve. Are we to use products for researching data, or as cooperative partnerships in case management integrating AI portals into writing, assessment and care planning? How do we see AI infiltrating into integrated case management models, case management technology, patient-centered case management, population healthcare management, care transitions and care coordination and value-based care models? How do we establish a system for monitoring that ensures trust for the professional case manager using the product, and develop a task force for case managers to appropriately utilize AI? The case managers must come to the table prepared to know the standards of practice for our profession and know which ones relate to developing professional guidelines for AI usage.
All AI products must meet the first standard of practice for ethics that allows the professional case manager to utilize technology to aid in daily practice. The case management code of ethics is defined by the five fundamental ethical principles. All AI products and documents should demonstrate autonomy (respect for individuals’ rights to make their own decisions) beneficence (to do good), fidelity (to keep promises), justice (to treat others fairly) and non-maleficence (do no harm to patients). The case manager must recognize obligations to the patient and engage in a respectful relationship with other co-workers, employers and professionals. The case manager must adhere to all laws, rules, insurance benefits and regulations when they may conflict with ethical principles addressing conflicts, seeking appropriate consultation and feedback. The case manager must view patients as unique individuals, without regard to disability, familial preferences, gender identity, sexual orientation, race, ethnicity, national origin, migration, religion, socio-economic status or geographic location (SOP 2022). The second most essential standard of practice is health information systems and use of technology (HIT). The HIT standard of practice is designed to improve communication, patient care, reduce costs and improve efficiency and patient outcomes. HIT is demonstrated in the workplace by adherence to standards of practice and regulations at the local, state and federal levels and within the employers’ requirements for case management performance, aid patients and families to have access to all available healthcare technology required to participate within their daily care through access and educational usage for EHR portals, telehealth and monitoring devices for managing chronic care conditions. Patients and families must not only know how the technological health information is used but be educated through teaching guiding and monitoring of outcomes, broadening HIT to the application of AI. Patients and families must be able to monitor the use of AI in their healthcare record and have access to correct any errors in real-time management of their healthcare episode. In careful review of the current standard of practice, it may become necessary to broaden the definition of Standard HIT in the next revision of the SOP to reflect changes in healthcare regulations and laws as they emerge at the local, state and federal level influencing healthcare practice for AI usage.
Key points regarding the emerging state of 2024 legislation gathered from current online research of U.S. legislation that are related to AI in the U.S. and internationally are comprised within the following five standards:
- Federal Agencies’ Guidance: Federal agencies such as the Federal Trade Commission (FTC), the National Institute of Standards and Technology (NIST) and the White House Office of Science and Technology Policy (OSTP) have been active in issuing guidelines, reports and recommendations related to AI ethics, safety and governance.
- State Initiatives: Some states have begun introducing their own AI-related legislation, particularly concerning data privacy and security. For example, California has implemented the California Consumer Privacy Act and the California Privacy Rights Act, which have implications for AI systems that process personal data.
- Congressional Activity: There have been proposals for federal legislation related to AI, although no comprehensive bills have been passed as of January 2023. Congressional discussions have focused on various aspects, including AI ethics, accountability, bias mitigation and workforce impacts.
- Industry Self-Regulation: In addition to government initiatives, industry organizations and companies have been developing their own guidelines and principles for AI ethics and responsible AI development. These efforts aim to promote transparency, fairness and accountability in AI systems.
- International Considerations: The U.S. has also been involved in discussions and collaborations with international partners regarding AI regulation and governance. This includes participation in forums such as the Organization for Economic Cooperation and Development and engagement with other countries on AI policy frameworks.
The most important legislation emerging in 2024 will be the Create AI Act, a bipartisan act written in 2023. Supporters of the bill hope to gain Congress’ support to give students and researchers access to AI resources, data and tools (Lynch, 2023). President Biden issued an executive order that ensures that America will lead the way in managing the risks of AI. The executive order will manage the risks and provide safety for the general public for AI privacy of personal information. This order directs Deputy Chief of Staff Bruce Reed to convene the White House AI council that will provide oversite and development of AI across industries including healthcare. The healthcare AI task force is to be established at the Department of Health and Human Services and tasked with developing policies to provide regulatory clarity and catalysis and oversite of AI innovation in healthcare. The task force will develop methods for evaluating AI-enabled tools and frameworks for AI’s use to advance drug development, bolster public health and improve healthcare delivery. Already, the task force is busy coordinating the work to publish guiding principles for addressing racial biases in healthcare algorithms for EHR and evidence based care-planning.
AI emergence into the U.S. economy has been on a rapid pace in 2023-2024 for its place within the U.S. economy and for technological development in the healthcare community. The evolving societal impact of AI particularly on the landscapes in healthcare has been on a fast-paced trajectory. Despite this evolution, as of March 2024 the United States does not have a comprehensive legislative program for oversite specifically targeting AI technology in healthcare. However, there have been discussions and initiatives at the federal, state and local levels of healthcare aimed at addressing various aspects of AI regulation, including ethics, privacy, security and potential economic impacts. Integration of AI in healthcare is still evolving, and its impact on the field of case management will begin with AI in utilization management review applications and uses of AI in the electronic health record to aid with evidence-based care assessments for case management care planning. Case management standards of practice for ethics and health information systems will play an integral role to provide guidance for case managers as they begin to integrate AI into their daily work practice. The standards need to be used for the development of task force groups working to evolve AI technology and establish standards for AI growth within the case management community. Since AI is only just evolving in healthcare in the U.S., it will be ultimately subject to change. It will be essential to stay updated on legislative developments and regulatory initiatives at the federal, state and local levels to understand the current state of AI regulation in the U.S. Keeping abreast of changes in AI will filter through national organizations. CMSA is committed to following this change process with AI for professional case managers and keeping the CMSA SOP standards current with this emerging trend for safe regulation and monitoring within our field of the case management practice.
Jenny Quigley-Stickney, MSN, RN, MHA, MA, CCM, ACM-RN, CMAC, CPHM, FCM, is a professional case manager with Cape Cod Healthcare. Jenny has been active with CMSA/CMSNE for over 20 years, serving as the president of CMSNE an chair for both CMSA and CMSNE Public Policy Committees. She is currently serving on the Board of Directors for CMSA National. She is active in the New England states promoting the advancement of the Nurse Licensure Compact, and telehealth legislation for healthcare provision. She has a passion for legislative works and believes that legislation helps advance the field of professional case management.
She has been employed at all levels of the transitions of care, working with traumatic brain injury, stroke and spinal cord for over 25 years. During that time, she provided professional case management for inpatient rehab, hospital-based home care, and outpatient rehab care. She recently has shifted her work back to her first love, acute care, focusing on vascular and trauma care.
REFERENCES
Boston Magazine, The Boston AI revolution. Healthcare ethical challenges. April 2024. page 91.
Case Management Society of America. CMSA 2022 Standards of Practice, CMSA.org.
Eckersley,R.& Kolski, D. (2019). Artificial intelligence in healthcare: Anticipating challenges to ethics, privacy, and bias. Journal of Law and Bioscience, 6(3) 1-15.
Joseph, Brian. State Legislators look to regulate use of AI in healthcare. State Net Insights, Lexis Nexis. August 18, 2023.
Lee, C. S., Nagy, P., & Weaver, S. J. (2020). Artificial intelligence for health system leaders during a crisis and beyond. NEJM Catalyst Innovations in Care Delivery, 1(5). Future of Healthcare Journal.
LeZach, Warren. Legal week: 2024-Current US Ai regulation means adopting a strategic and communicative approach. Manager for Enterprise Content for Technology & Innovation /Thomson Reuters Institute. February 11, 2024.
Lynch, Shana. La, regulation and Policy, Machine Learning, What to expect in AI 2024 Seven Stanford HAI faculty and fellows predict the biggest stories for next year in artificial intelligence. December 8, 2023.
The White House Briefing room from statement and releases. Key AI actions following President Biden’s landmark executive order January 29, 2024.
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