Medicare Advantage: Limits on AI Medical Denials
A house committee must act next: committee consideration.
While it addresses a popular issue, it was introduced late in the session and faces opposition from insurance lobbies.
Scores run from -100 (strongly harmful) to +100 (strongly beneficial) for each group, combining impact, certainty, scope, and duration ratings of 1-5. How impact scoring works
About half of all Medicare beneficiaries are enrolled in Medicare Advantage plans, and this bill would require a licensed, specialty-matched physician to personally review and sign off on any prior authorization denial that involves AI, rather than letting a plan rely on an algorithm's output alone. Plans would also have to disclose AI use and give the treating provider a chance to talk directly with the reviewing doctor before a final denial.
“an MA plan that imposes a prior authorization requirement with respect to an item or service for which benefits are available under such plan may not deny a request for prior authorization with respect to such item or service based on the output of artificial intelligence, unless the following requirements are met”
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in House
The bill was officially filed and given a number. It now enters the legislative queue.
Rep. Greg Murphy and Rep. Herb Conaway Jr. introduced the Protecting Patients from Automated Denials Act, requiring Medicare Advantage plans to provide physician attestations and allow direct communication with reviewing doctors for any AI-assisted denials.
The Protecting Patients from Automated Denials Act, introduced this week, aims to curb AI-driven denials in Medicare Advantage by requiring human-in-the-loop reviews and peer-to-peer consultations before any treatment is rejected.
Bipartisan legislation introduced by Reps. Murphy and Conaway would establish safeguards on the use of AI in Medicare Advantage, including a 10-year record retention requirement for AI-related denial records and mandatory physician oversight.
No votes or related bills recorded for this bill yet.
Document Type
Congressional Bill
Official Title
Protecting Patients from Automated Denials Act
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