Ban AI Denials in Medicare Act
Summary
What This Bill Does
The Ban AI Denials in Medicare Act prevents the Center for Medicare and Medicaid Innovation from testing prior authorization in traditional Medicare. It specifically bars the HHS Secretary from implementing the WISeR model described in the July 1, 2025 Federal Register notice, or any substantially similar model. It then amends Social Security Act section 1115A so that, beginning on enactment, the Secretary may not select a CMMI payment or service delivery model if that model would implement prior authorization, including through artificial intelligence, for items or services payable under Medicare Part A or Part B. The bill is not about Medicare Advantage prior authorization; it targets traditional Medicare experiments run through CMMI.
Who Benefits and How
Traditional Medicare beneficiaries benefit because covered Part A and Part B services would not face a new CMMI prior-authorization gate under WISeR or a similar model. Physicians, hospitals, clinics, and other Medicare providers benefit because the bill avoids added documentation, appeal, and delay burdens from a prior-authorization test. Patient advocates benefit because AI-assisted denials in traditional Medicare would be blocked at the model-selection stage.
Who Bears the Burden and How
CMMI and CMS innovation staff bear the main policy constraint because they lose the ability to test the WISeR model or similar prior-authorization models in traditional Medicare. AI prior-authorization vendors and utilization-management contractors lose a potential Medicare testing market. Federal budget officials lose one possible tool for testing waste-reduction or utilization-control savings in Part A and Part B.
Key Provisions
- Bars HHS from implementing the WISeR prior-authorization model published at 90 Federal Register 28749.
- Bars any substantially similar model under traditional Medicare.
- Amends Social Security Act section 1115A to prohibit CMMI tests that implement prior authorization for Part A or Part B items or services.
- Includes prior authorization carried out through artificial intelligence in the prohibition.
- Preserves Medicare beneficiaries access to traditional Medicare items and services without the blocked CMMI prior-authorization model.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Blocks HHS from implementing the WISeR prior-authorization model or any substantially similar CMMI model, and bars future CMMI tests that would add prior authorization, including AI-assisted prior authorization, for traditional Medicare Part A or Part B items and services.
Key Policy Areas
Medicare, Healthcare, Artificial Intelligence
Primary Purpose
Blocks HHS from implementing the WISeR prior-authorization model or any substantially similar CMMI model, and bars future CMMI tests that would add prior authorization, including AI-assisted prior authorization, for traditional Medicare Part A or Part B items and services.
Policy Domains
Substantive provisions
Identified Gains
- Traditional Medicare beneficiaries
- Physicians treating Medicare patients
- Hospitals treating Medicare patients
- Medicare patient advocates
Identified Costs
- CMMI innovation staff
- CMS program integrity staff
- AI prior authorization vendors
- Utilization management contractors
- Federal budget analysts
Sponsors
Legislative Progress
In CommitteeMr. Landsman (for himself and Mrs. Watson Coleman) introduced the …
Referred to the Committee on Ways and Means, and in …
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Hospitals treating Medicare patients, Physicians treating Medicare patients, Utilization management contractors
Positive-direction: Hospitals treating Medicare patients, Physicians treating Medicare patients
Negative-direction: Utilization management contractors
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
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