Stop Deadly Denials Act of 2026

Section 1852 of the Social Security Act (42 U.S.C. 1395w–22) is amended by adding at the end the following new subsection:

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.

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.

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)).

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

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.

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.

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:

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.

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..