Protecting Patients from Automated Denials Act

This bill changes Medicare Advantage rules starting with plan years on or after January 1, 2027. A Medicare Advantage plan could not deny a prior authorization request based on artificial intelligence output unless a licensed physician in a matching specialty reviews and approves the denial and signs a statement that they used independent medical judgment. The plan would have to give the requesting provider a copy of that statement and a chance to talk with the reviewing physician, tell the patient and provider that artificial intelligence was used, and keep records for at least 10 years. Plans would report these denials to the federal government every 90 days, and the Secretary of Health and Human Services could audit the plans' use of artificial intelligence.

Full text and official record on Congress.gov

Sponsors

• Herbert C. Conaway, Jr. Democrat sponsor
• 2 cosponsors