How Is This Bill Enforced
Verbatim statutory text on the left; plain-language analysis and a per-section checklist on the right. Numbered markers cross-link to the matching checklist row.
This Act may be cited as the ''Ban AI Denials in Medicare Act''.
This section establishes the short title of the Act as the Ban AI Denials in Medicare Act. It creates no compliance obligations.
(a) 1 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) 2 Section 1115A(b)(2) of the Social Security Act (42 U.S.C. 1315a(b)(2)) is amended— (1) inWIin 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.''.
Section 2 contains two prohibitions directed at the Secretary of Health and Human Services. Subsection (a) immediately bars implementation of the specific WISeR model described in the July 1, 2025, Federal Register notice (90 Fed. Reg. 28749), as well as any substantially similar model. Subsection (b) imposes a forward-looking structural prohibition by amending Section 1115A(b)(2) of the Social Security Act to prevent the Secretary from selecting any future CMMI model that would implement prior authorization — including through the use of artificial intelligence — for items or services payable under Medicare Part A or Part B.
Neither subsection creates obligations for private parties. The bill operates entirely as a constraint on federal agency authority, preventing CMS from using prior authorization as a cost-control mechanism in traditional Medicare, whether AI-driven or otherwise.