119 HR 10210 IH: Doctors Not AI Act of 2026 U.S. House of Representatives 2026-09-01 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
I119th CONGRESS2d SessionH. R. 10210IN THE HOUSE OF REPRESENTATIVESSeptember 1, 2026Mr. Landsman (for himself, Mr. Carter of Georgia, Ms. Schrier, and Mr. Barrett) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, 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 concernedA BILLTo amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to regulate the use of artificial intelligence in the review of claims by group health plans and health insurance issuers offering group or individual health insurance coverage.
1.
Short title
This Act may be cited as the Doctors Not AI Act of 2026.
2.
Amendments to the Public Health Service Act
(a)
Definition of artificial intelligence system
Section 2791 of the Public Health Service Act (42 U.S.C. 30099–91) is amended by adding at the end the following: (g)The term artificial intelligence system means an engineered or machine-based system, including any algorithm, predictive model, machine learning system, or automated decision-making software, that processes data to generate predictions, classifications, recommendations, or decisions and that is used to materially influence, automate, or issue determinations regarding coverage of health care items or services.. (b)
Clinical judgment and artificial intelligence
The Public Health Service Act is amended by inserting after section 2719A (42 U.S.C. 300gg–19a) the following new section:
2719B.
Clinical judgment and artificial intelligence
(a)
In general
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall ensure that any adverse benefit determination, whether initially or upon appeal, involving clinical judgment— (1)is not issued by an artificial intelligence system and is not dictated or determined by the output of such system; (2)is made only by a licensed health care professional who is acting within the scope of the professional’s license and who has training and experience in the provision of the health care item or service that is the subject of the determination; (3)reflects the independent clinical judgment of such professional, who shall conduct an independent evaluation of the enrollee’s individual medical circumstances and shall not treat any output of an artificial intelligence system as presumptively valid or defer to such output in lieu of independent clinical judgment applying generally accepted standards of care; (4)includes, in the notice required under section 2719, if an artificial intelligence system was used in connection with the determination— (A)a statement that such system was used; (B)a description of its role in the review process; and (C)the name, professional license, and credentials of the licensed health care professional who made the determination; and (5)is supported by documentation maintained as part of the administrative record describing— (A)the artificial intelligence system used; (B)the role of such system in the review process; (C)any outputs, scores, recommendations, or determinations generated by such system; and (D)documentation demonstrating compliance with subparagraph (C); andsuch materials shall be considered part of the administrative record and made available to the enrollee upon request. (b)
Definitions
For purposes of this section: (1)
Adverse benefit determination
The term adverse benefit determination includes an initial determination and a determination on internal appeal. (2)
Adverse benefit determination involving clinical judgment
The term adverse benefit determination involving clinical judgment means an adverse benefit determination that is based, in whole or in part, on medical necessity, appropriateness, experimental and investigational or similar exclusions or limits, level of care, health care setting, effectiveness, clinical guidelines, utilization review criteria, other standards requiring evaluation of the enrollee's medical condition or treatment needs, or generally accepted standards of care for such treatment needs.
. (c)
Parity treatment of artificial intelligence systems
Section 2726 of the Public Health Service Act (42 U.S.C. 300gg–26) is amended— (1)in subsection (a)(8)(A), by adding at the end the following new clause: (vi)Whether an artificial intelligence system is used in, or materially influences, the design, development, application, or administration of such limitation and, if so, sufficient information regarding the function, operation, and effects of such system to enable the Secretary to evaluate such function, operation, and effects under such limitation with respect to mental health or substance use disorder benefits as compared to medical and surgical benefits, both as written and in operation.; and (2)by adding at the end the following: (f)
Artificial intelligence and utilization review
The use of an artificial intelligence system in connection with utilization review shall constitute a treatment limitation for purposes of this section..
3.
Amendments to the Employee Retirement Income Security Act of 1974
(a)
Definition of artificial intelligence system
Section 3 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1002) is amended by adding at the end the following: (48)The term artificial intelligence system means an engineered or machine-based system, including any algorithm, predictive model, machine learning system, or automated decision-making software, that processes data to generate predictions, classifications, recommendations, or decisions and that is used to materially influence, automate, or issue determinations regarding coverage of health care items or services.. (b)
Claims procedure requirements
Section 503 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1133) is amended— (1)in paragraph (2), by striking the period at the end and inserting ; and; and (2)by adding at the end the following: (3)ensure that any adverse benefit determination, whether initially or upon appeal, involving clinical judgment— (A)is not issued by an artificial intelligence system and is not dictated or determined by the output of such system; (B)is made only by a licensed health care professional who is acting within the scope of the professional’s license and who has training and experience in the provision of the health care item or service that is the subject of the determination; (C)reflects the independent clinical judgment of such professional, who shall conduct an independent evaluation of the participant’s or beneficiary’s individual medical circumstances and shall not treat any output of an artificial intelligence system as presumptively valid or defer to such output in lieu of independent clinical judgment applying generally accepted standards of care; (D)includes, in the notice required under paragraph (1), if an artificial intelligence system was used in connection with the determination— (i)a statement that such system was used; (ii)a description of its role in the review process; and (iii)the name, professional license, and credentials of the licensed health care professional who made the determination; and (E)is supported by documentation maintained as part of the administrative record describing— (i)the artificial intelligence system used; (ii)the role of such system in the review process; (iii)any outputs, scores, recommendations, or determinations generated by such system; and (iv)documentation demonstrating compliance with subparagraph (C); andsuch materials shall be considered part of the administrative record and made available to the participant or beneficiary upon request. For purposes of this paragraph, the term adverse benefit determination includes an initial determination and a determination on internal appeal, and the term adverse benefit determination involving clinical judgment means an adverse benefit determination that is based, in whole or in part, on medical necessity, appropriateness, experimental and investigational or similar exclusions or limits, level of care, health care setting, effectiveness, clinical guidelines, utilization review criteria, other standards requiring evaluation of the participant's or beneficiary's medical condition or treatment needs, or generally accepted standards of care for such treatment needs.. (c)
Parity treatment of artificial intelligence systems
Section 712 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185a) is amended-— (1)in subsection (a)(8)(A), by adding at the end the following new clause: (vi)Whether an artificial intelligence system is used in, or materially influences, the design, development, application, or administration of such limitation and, if so, sufficient information regarding the function, operation, and effects of such system to enable the Secretary to evaluate such function, operation, and effects under such limitation with respect to mental health or substance use disorder benefits as compared to medical and surgical benefits, both as written and in operation.; and (2)by adding at the end the following: (h)
Artificial intelligence and utilization review
The use of an artificial intelligence system in connection with utilization review shall constitute a treatment limitation for purposes of this section..
4.
Amendments to the Internal Revenue Code of 1986
(a)
Definition of artificial intelligence system
Section 9832 of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph: (11)
Artificial intelligence system
The term artificial intelligence system means an engineered or machine-based system, including any algorithm, predictive model, machine learning system, or automated decision-making software, that processes data to generate predictions, classifications, recommendations, or decisions and that is used to materially influence, automate, or issue determinations regarding coverage of health care items or services.. (b)
Clinical judgment and artificial intelligence
Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by inserting after section 9815 the following new section:
9815A.
Clinical judgment and artificial intelligence
(a)
In general
A group health plan shall ensure that any adverse benefit determination, whether initially or upon appeal, involving clinical judgment— (1)is not issued by an artificial intelligence system and is not dictated or determined by the output of such system; (2)is made only by a licensed health care professional who is acting within the scope of the professional’s license and who has training and experience in the provision of the health care item or service that is the subject of the determination; (3)reflects the independent clinical judgment of such professional, who shall conduct an independent evaluation of the participant’s or beneficiary’s individual medical circumstances and shall not treat any output of an artificial intelligence system as presumptively valid or defer to such output in lieu of independent clinical judgment applying generally accepted standards of care; (4)includes, in the notice required under this chapter, if an artificial intelligence system was used in connection with the determination— (A)a statement that such system was used; (B)a description of its role in the review process; and (C)the name, professional license, and credentials of the licensed health care professional who made the determination; (5)is supported by documentation maintained as part of the administrative record describing— (A)the artificial intelligence system used; (B)the role of such system in the review process; (C)any outputs, scores, recommendations, or determinations generated by such system; and (D)documentation demonstrating compliance with subparagraph (C);and such materials shall be considered part of the administrative record and made available to the participant or beneficiary upon request. (b)
Definitions
For purposes of this section— (1)
Adverse benefit determination
The term adverse benefit determination includes an initial determination and a determination on internal appeal. (2)
Adverse benefit determination involving clinical judgment
The term adverse benefit determination involving clinical judgment means an adverse benefit determination that is based, in whole or in part, on medical necessity, appropriateness, experimental and investigational or similar exclusions or limits, level of care, health care setting, effectiveness, clinical guidelines, utilization review criteria, other standards requiring evaluation of the participant’s or beneficiary’s medical condition or treatment needs, or generally accepted standards of care for such treatment needs.
. (c)
Parity treatment
Section 9812 of the Internal Revenue Code of 1986 is amended— (1)in subsection (a)(8)(A), by adding at the end the following new clause: (vi)Whether an artificial intelligence system is used in, or materially influences, the design, development, application, or administration of such limitation and, if so, sufficient information regarding the function, operation, and effects of such system to enable the Secretary to evaluate such function, operation, and effects under such limitation with respect to mental health or substance use disorder benefits as compared to medical and surgical benefits, both as written and in operation.; and (2)by adding at the end the following: (f)
Artificial intelligence and utilization review
The use of an artificial intelligence system in connection with utilization review shall constitute a treatment limitation for purposes of this section.. (d)
Clerical amendment
The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by inserting after the item related to section 9815 the following new item: Sec. 9815A. Clinical judgment and artificial intelligence..
5.
Effective date
The amendments made by this Act shall apply to plan years beginning on or after January 1 of the first calendar year beginning not less than 12 months after the date of the enactment of this Act.