To amend title XVIII of the Social Security Act to establish requirements for the use of artificial intelligence in prior authorization denials by Medicare Advantage organizations.
About This Bill
Committee
Latest Action · July 16, 2026
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
This bill requires Medicare Advantage plans to add human physician oversight when using artificial intelligence to deny prior authorization requests for medical items and services. Starting January 1, 2027, before an AI-based denial can be issued, a qualified physician reviewer must independently review and approve it, provide a signed attestation confirming their independent medical judgment, and allow the healthcare provider to discuss the denial directly with that physician. Medicare Advantage plans must disclose to patients and providers that AI was involved in the denial and provide the reviewer's identification number. Plans must also maintain detailed records of all AI-assisted denials for ten years and submit quarterly reports to the Centers for Medicare and Medicaid Services documenting their use of AI in prior authorization decisions. The bill gives federal regulators broad authority to audit and inspect how plans use AI in these decisions and requires the Secretary to issue implementing regulations within one year of the law's enactment.
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