Ban AI Denials in Medicare Act
Sponsors
Legislative Progress
In CommitteeMr. Landsman (for himself and Mrs. Watson Coleman) introduced the …
Summary
What This Bill Does
The Ban AI Denials in Medicare Act prohibits the Department of Health and Human Services from implementing a new prior authorization program for traditional Medicare. It specifically blocks the "WISeR" (Wasteful and Inappropriate Services Reduction) model and permanently bans the CMS Innovation Center from testing any prior authorization systems - including those using artificial intelligence - for Medicare Part A and Part B services.
Who Benefits and How
Medicare beneficiaries (approximately 67 million seniors and disabled Americans) benefit by being protected from AI-powered claim denials that could delay or block access to medical care. Healthcare providers - including physicians, hospitals, and clinics treating Medicare patients - benefit by avoiding the administrative burden of seeking prior authorization before providing services. Patient advocacy organizations see this as a win for healthcare access.
Who Bears the Burden and How
The CMS Center for Medicare and Medicaid Innovation loses the ability to test prior authorization models in traditional Medicare, limiting their policy experimentation options. AI-based healthcare claims processing companies and health insurance technology providers lose a significant potential market opportunity, as they cannot sell prior authorization technology or services to the traditional Medicare program.
Key Provisions
- Blocks implementation of the specific WISeR prior authorization model announced in July 2025
- Amends Section 1115A of the Social Security Act to permanently prohibit CMMI from selecting any prior authorization models for Medicare Part A or Part B
- Explicitly includes AI-assisted prior authorization in the prohibition
- Applies to both existing and future innovation models
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Prohibits the Secretary of Health and Human Services from implementing prior authorization models under traditional Medicare, including those using artificial intelligence, to prevent AI-driven claim denials.
Policy Domains
Legislative Strategy
"Block a specific CMS Innovation Center model (WISeR) that would implement prior authorization in traditional Medicare, and prevent any future similar models that use AI for claim review"
Likely Beneficiaries
- Medicare beneficiaries
- Healthcare providers (physicians, hospitals, clinics)
- Patient advocacy organizations
Likely Burden Bearers
- CMS Innovation Center
- Health insurance technology companies
- AI-based healthcare claims processing companies
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
Key Definitions
Terms defined in this bill
Wasteful and Inappropriate Services Reduction Model - the innovative payment and service delivery model described in 90 Fed. Reg. 28749 (July 1, 2025) for Medicare prior authorization
Approval required before certain items or services can be provided under Medicare Part A or Part B (implicitly includes AI-assisted prior authorization)
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology