Ban AI Denials in Medicare Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6361 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 6361

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.


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                    IN THE HOUSE OF REPRESENTATIVES

                            December 2, 2025

   Mr. Landsman (for himself and Mrs. Watson Coleman) introduced the 
following bill; which was 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

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                                 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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ban AI Denials in Medicare Act''.

SEC. 2. PROHIBITING IMPLEMENTATION OF CENTER FOR MEDICARE AND MEDICAID 
              INNOVATION MODELS TESTING PRIOR AUTHORIZATION UNDER 
              TRADITIONAL MEDICARE.

    (a) 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.
    (b) 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--
            (1) in subparagraph (A), by striking ``The Secretary shall 
        select'' and inserting ``Subject to the limitation under 
        subparagraph (D), the Secretary shall select''; and
            (2) 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.''.
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