Header: HHS Issues Important New RFI on AI Reimbursement - Connections to Digital Pathology.
It's been a big several weeks for news related to digital pathology and healthcare AI more generally. I'll quick link to several very recent blogs, then jump into today's big news, an AI RFI from HHS that includes Reimbursement explicitly.
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- Is Digital Pathology Outrunning the AMA CPT Process? December 13, 2025.
- CMS Current Approaches to AI Reimbursement (MedPAC 2024) December 16, 2025.
- HHS RFI - AI REIMBURSEMENT. This blog today.
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- For an entry point, see Linked In posting on December 19 from Steven Posnack, HHS.
- He is the Principal Deputy Assistant Secretary for Technology Policy at the HHS Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT. Posnack holds a Master's in health policy from Hopkins and has been in government IT health policy since 2018.
- See Steven Posnack's standalone article on December 19 at healthItBuzz here.
- See the HHS Press Release on December 19 here.
- And see the RFI itself here - 7 pages in pre-publication format.
- 60 day comment period - around February 15.
- See Fed Reg Dec 23.
Excited to see a whole section under the title, REIMBURSEMENT.
Reimbursement
HHS’s payment policies and programs have massive effects on how health care is delivered in the United States, often times with unintended consequences. Hypothetically, if a payer is taking financial risk for the long-term health and health costs of an individual, that payer will have an inherent incentive to promote access to the highest-value interventions for patients.
Under government designed and dictated fee-for-service regimes, however, coverage and reimbursement decisions are slow. Rarely does covering new innovations reduce net spending; and waste, fraud, and abuse is difficult to prevent, often times leading to massive spending bubbles on concentrated items or services that are not commensurate with the value of such products.
Given the inherent flaws in legacy payment systems, we seek to ensure that the potential promises of AI innovations are not diminished through inertia and instead such payment systems are modernized to meet the needs of a changing healthcare system. We seek feedback on payment policy changes that ensure payers have the incentive and ability to promote access to high-value AI clinical interventions, foster competition among clinical care AI tool builders, and accelerate access to and affordability of AI tools for clinical care.
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AI CORNER
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Chat GPT 5 brings us an update on all the stuff above.
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Below is a detailed TLDR–style synthesis —policy-literate, reimbursement-focused, and already steeped in AI, CPT, and CMS dynamics. We focus squarely on the new HHS RFI itself, with Posnack’s post and the press release as framing, and we pull in the 21-page HHS AI Strategy, MedPAC 2024, Gottlieb (JAMA Health Forum), and finally our Dec 13 digital pathology/CPT essay as context.
TLDR —
HHS’s AI RFI Is Really a Reimbursement RFI
(and CMS Knows It)
On December 19, 2025, HHS released a Request for Information (RFI) on accelerating AI in clinical care, jointly issued by the Office of the Deputy Secretary and ASTP/ONC, and formally published in the Federal Register shortly thereafter . While the RFI is framed around three levers—regulation, reimbursement, and R&D—the document’s most consequential signals sit unmistakably in the reimbursement section, where HHS openly acknowledges that legacy fee-for-service payment systems are structurally misaligned with AI-driven clinical value.
This is not a vague “tell us your ideas” exercise. It is a targeted solicitation for experience-based input from those building, buying, deploying, and being blocked by AI tools in real clinical workflows, with CMS explicitly in the room.
Why this RFI matters now
The RFI follows, and operationalizes, the HHS Artificial Intelligence Strategy released earlier in December—a 21-page “OneHHS” blueprint focused mainly on internal federal AI use (FDA, CMS, NIH, CDC, etc.) rather than payment reform . The RFI is the outward-facing counterpart: how HHS should reshape the healthcare system itself to accommodate AI.
Steven Posnack’s Health IT Buzz post makes this explicit: the question is what it would look like if the entire department leaned in together—using reimbursement policy as much as regulation—to accelerate AI in clinical care . The accompanying HHS press release goes further, tying AI adoption directly to cost deflation, burden reduction, and system-level efficiency, not just innovation for its own sake .
The Reimbursement Section: HHS Says the Quiet Part Out Loud
The reimbursement language in the RFI is unusually candid for a federal document. HHS acknowledges that:
Fee-for-service payment is slow, inertial, and innovation-resistant
New coverage decisions rarely reduce net spending, even when they improve outcomes
Waste, fraud, and abuse are difficult to control once spending concentrates
AI risks being throttled by payment inertia, not science or regulation
The RFI explicitly asks for input on payment policy changes that would:
Give payers incentives to adopt high-value AI clinical interventions
Foster competition among AI tool builders (not entrench incumbents)
Accelerate access and affordability of AI in routine care
This language aligns directly with the MedPAC 2024 chapter on “Paying for Software Technologies in Medicare,” which documents CMS’s growing discomfort with trying to force AI-based software into legacy benefit categories, CPT structures, and budget-neutral fee schedules . MedPAC is blunt: Medicare lacks adequate pricing tools for software and AI, and current approaches risk either overuse or underpayment, often both.
How this connects to our Dec 13 digital pathology/CPT warning
The December 13 essay—Will FDA and Other Digital Pathology Advances Outrun AMA CPT Rules in 2026?—argued that scientific reality is already outrunning CPT’s mental model of what a “test” is, particularly in computational pathology and AI-driven diagnostics . The HHS RFI implicitly validates that critique at a system level.
Where that essay focused on AMA CPT bottlenecks (PLA dead-ends, cloud execution disqualifications, biomarker formalism), the RFI zooms out: even if CPT modernization occurs, CMS payment architecture itself may still suppress AI adoption.
In other words, CPT reform is necessary—but not sufficient.
Gottlieb + MedPAC:
The productivity paradox HHS is now confronting
Scott Gottlieb’s December 2025 JAMA Health Forum article provides the economic through-line . AI can finally address Baumol’s cost disease in medicine by substituting for discrete physician cognitive labor—not merely augmenting it. But CMS payment rules perversely penalize that substitution:
AI reduces physician work → RVUs fall
New AI services trigger budget neutrality cuts
AI vendors can’t bill CMS directly
Providers must absorb AI costs from stagnant reimbursement
The HHS RFI reads as if CMS has internalized this critique. It does not promise solutions—but it unmistakably signals that status quo reimbursement is incompatible with AI-enabled productivity gains.
Bottom line
This RFI is not about whether AI works. HHS takes that as given.
It is about whether Medicare payment policy will continue to define value in terms of human labor inputs, or whether it will evolve to recognize computational extraction of clinical value, even when that value displaces traditional work units.
For those in digital pathology, imaging AI, CDS, and software-defined diagnostics, the message is clear: HHS is asking—explicitly—how to fix reimbursement before AI adoption stalls at scale.
Our Dec 13 warning that digital pathology is outrunning CPT has now been echoed, at a higher altitude, by HHS itself.
