[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8377 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 8377
To amend title XVIII of the Social Security Act to prohibit the use of
prior authorization under Medicare Advantage plans, to amend title XI
of the Social Security Act to limit the implementation of payment
models testing prior authorization under traditional Medicare, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 20, 2026
Mr. Khanna (for himself, Ms. Jayapal, Mr. Cohen, Mrs. Dingell, Mr.
Jackson of Illinois, Ms. Norton, and Mr. Pocan) 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
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to prohibit the use of
prior authorization under Medicare Advantage plans, to amend title XI
of the Social Security Act to limit the implementation of payment
models testing prior authorization under traditional Medicare, and for
other purposes.
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 ``Stop Deadly Denials Act of 2026''.
SEC. 2. PROHIBITING PRIOR AUTHORIZATION REQUIREMENTS IN MEDICARE
ADVANTAGE.
(a) In General.--Section 1852 of the Social Security Act (42 U.S.C.
1395w-22) is amended by adding at the end the following new subsection:
``(o) Limitation on Prior Authorization.--
``(1) In general.--Subject to paragraph (2), for plan years
beginning on or after January 1, 2027, a Medicare Advantage
plan may not impose any prior authorization requirement with
respect to any specified item or service.
``(2) Exception.--Paragraph (1) shall not apply with
respect to a specified item or service for a plan year in the
case that, during such year, such item or service is subject to
prior authorization pursuant to subsection (t)(2)(F) or (aa) of
section 1833, subsection (a)(15), (l)(16), (q)(6), or (u)(4) of
section 1834, or any other provision of part A or part B of
this title.
``(3) Specified item or service defined.--For purposes of
this subsection, the term `specified item or service' means,
with respect to a Medicare Advantage plan, any item or service
for which benefits are available under such plan that is not--
``(A) a covered part D drug; or
``(B) a supplemental health care benefit (as
described in subsection (a)(3)).''.
(b) Permitting Intermediate Sanctions in the Case of
Noncompliance.--Section 1857(g)(1) of the Social Security Act (42
U.S.C. 1395w-27(g)(1)) is amended--
(1) in subparagraph (J), by striking ``or'' at the end;
(2) in subparagraph (K), by striking ``subparagraphs (A)
through (J)'' and inserting ``subparagraphs (A) through (K)'';
(3) by redesignating subparagraph (K) as subparagraph (L);
and
(4) by inserting after subparagraph (J) the following new
subparagraph:
``(K) imposes a prior authorization requirement
with respect to an item or service in violation of
section 1852(o); or''.
(c) Conforming Change.--Section 1852(c)(1)(G) of the Social
Security Act (42 U.S.C. 1395w-22(c)(1)(G)) is amended--
(1) in the subparagraph heading, by striking ``Prior
authorization'' and inserting ``Review''; and
(2) by inserting ``for plan years ending before January 1,
2027,'' after ``Rules regarding prior authorization''.
SEC. 3. LIMITING 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) Limiting Implementation of Future CMI Models Testing Prior
Authorization 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--
``(i) would provide for the implementation
of prior authorization with respect to items or
services for which payment may be made under
part A or part B of title XVIII; and
``(ii) would provide for--
``(I) issuing any denial of
coverage or payment that--
``(aa) is based on a
decision made through the use
of artificial intelligence,
machine learning, algorithmic-
derived decision logic, or any
other similar technological
process, without review and
approval of such denial; and
``(bb) has not been
individually reviewed and
approved by a physician on the
basis of the physician's
independent medical judgment,
taking into account relevant
documentation provided by the
individual receiving such items
or services or the provider
furnishing such items or
services; or
``(II) the processing of requests
for prior authorization by any entity
other than a medicare administrative
contractor with a contract under
section 1874A.''.
(c) Requiring Notice and Comment for All Future CMI Models.--
Section 1115A(b)(2)(A) of the Social Security Act (42 U.S.C.
1315a(b)(2)(A)), as amended by subsection (b), is further amended by
adding at the end the following new sentence: ``Beginning January 1,
2027, a model may only be selected under this subparagraph after notice
and opportunity for public comment.''.
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