Section 1 Short title
This Act may be cited as the “Ban AI Denials in Medicare Act”.
Ban AI Denials in Medicare Act
A BILL
To prohibit the Secretary of Health and Human Services from testing the WISeR model, and to amend title XI of the Social Security Act to prohibit the implementation of payment models testing prior authorization under traditional Medicare.
Sec. 2 Prohibiting implementation of Center for Medicare and Medicaid Innovation models testing prior authorization under traditional Medicare
Prohibiting implementation of WISeR model— The Secretary of Health and Human Services may not implement the innovative payment and service delivery model described in the notice titled “Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model” (90 Fed. Reg. 28749 (July 1, 2025)), or any substantially similar model.
Prohibiting implementation of future CMI models testing prior authorization (including through the use of AI) under traditional Medicare— Section 1115A(b)(2) of the Social Security Act (42 U.S.C. 1315a(b)(2)) is amended—
in subparagraph (A), by striking “The Secretary shall select” and inserting “Subject to the limitation under subparagraph (D), the Secretary shall select”; and
by adding at the end the following new subparagraph:
“(D) Limitation on models to be tested—Beginning on the date of the enactment of this subparagraph, the Secretary may not select a model to be tested under subparagraph (A) if such model would provide for the implementation of prior authorization (including through the use of artificial intelligence) with respect to items or services for which payment may be made under part A or part B of title XVIII.”