Sponsors (2)
The bill strengthens patient protections, transparency, and federal oversight of AI-influenced Medicare prior-authorizations, trading off higher plan/admin costs, potential delays in decisions, IP disclosure risks for vendors, and added privacy exposure from expanded auditing and recordkeeping.
Medicare beneficiaries (especially people with chronic conditions) face fewer wrongful automated denials because any AI-associated prior-authorization denial must be clinically reviewed and approved by a qualified physician.
Hospitals and clinicians gain greater transparency and recourse: plans must provide signed attestations, disclose when AI was used and the reviewing clinician's NPI, and allow clinicians to speak with the reviewer to contest decisions.
Federal oversight and recordkeeping improve monitoring and auditability — the Secretary receives reports on AI use and plans must retain records for at least 10 years, enabling detection of biased or erroneous denials and supporting appeals and audits.
Medicare Advantage enrollees and taxpayers may face higher costs or reduced plan benefits because MA plans will incur added administrative expenses for physician review, attestations, long-term record retention, and quarterly reporting.
Medicare beneficiaries and provider organizations could experience slower prior-authorization decisions because reviewers must be licensed in the furnishing State and board-certified in a matching specialty, shrinking the reviewer pool.
Mandatory disclosure of algorithms and internal documentation may expose proprietary information and competitive business details of plans and AI vendors, harming small vendors and raising commercial concerns.
Based on analysis of 2 sections of legislative text.
Limits Medicare Advantage denials based on AI by requiring qualified physician review, attestations, disclosures, 10-year records, and regular HHS reporting.
Official title: 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.
Introduced July 16, 2026 by Herbert C. Conaway · Last progress July 16, 2026
Prohibits Medicare Advantage plans from denying prior authorization requests solely on the basis of artificial intelligence (AI) outputs unless a qualified physician reviewer clinically reviews and approves the denial and signs an attestation. Requires plans that use prior authorization to disclose AI use, provide the reviewer’s NPI, allow the provider to speak with the reviewer, retain records for 10 years, and regularly report AI-related denials to the Department of Health and Human Services (HHS). The Secretary must issue an implementing final rule within one year of enactment. Applies to Medicare Advantage plan years beginning January 1, 2027, establishes definitions for AI and qualified physician reviewer, gives HHS audit and inspection authority over AI use in denials, and requires 90‑day reporting cycles (first report due March 31, 2027).