Ban AI Denials in Medicare Act
- Sponsor
- Rep. Landsman, Greg [D-OH-1]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Dec 2, 2025
Bottom line
The bill aims to prevent the use of prior authorization, particularly when driven by artificial intelligence, within traditional Medicare payment models, citing concerns about beneficiary access and provider burden.
What it actually does
This bill prohibits the Secretary of Health and Human Services (HHS) from implementing the specific "Wasteful and Inappropriate Services Reduction (WISeR) Model" or any substantially similar model. Furthermore, it amends the Social Security Act to prevent HHS from selecting any future Center for Medicare and Medicaid Innovation (CMI) models that would implement prior authorization, including through the use of artificial intelligence, for services covered under traditional Medicare Parts A or B.
Proponents argue
Supporters argue that this bill is crucial for protecting Medicare beneficiaries from potentially inappropriate denials or delays of necessary medical services that could result from automated or overly restrictive prior authorization processes. They also contend it will reduce the significant administrative burden placed on healthcare providers, allowing them to focus more on patient care rather than navigating complex approval systems.
Opponents contend
Opponents might argue that prohibiting prior authorization models, especially those leveraging AI, prevents the Medicare program from adopting innovative tools designed to reduce wasteful spending, combat fraud and abuse, and ensure that services are medically necessary. They may contend that such models are essential for the long-term sustainability of Medicare and that AI can improve efficiency and consistency in utilization management.
The bill is very short and straightforward, making it highly accessible for any reader to understand its core provisions quickly.
Section 2(a)
Prohibition of the WISeR Model
This provision explicitly forbids the Secretary of Health and Human Services from implementing the "Wasteful and Inappropriate Services Reduction (WISeR) Model," which was described in a July 1, 2025, Federal Register notice. It also prohibits the implementation of any model that is substantially similar to WISeR. This means the specific prior authorization model outlined by CMS for certain services cannot be put into practice.
Supporters argue
Supporters argue that prohibiting the WISeR model is necessary to protect beneficiaries from potential care delays or denials and to alleviate the administrative burden on healthcare providers, who often face significant challenges with prior authorization processes.
Critics contend
Opponents might contend that preventing the WISeR model from being tested foregoes an opportunity to identify and reduce wasteful or inappropriate services in Medicare, potentially leading to higher program costs.
Tradeoffs
This provision balances the desire to protect beneficiaries and reduce provider administrative burden against the potential for the Medicare program to achieve cost savings and improve efficiency through new utilization management models.
Section 2(b)
Prohibition of Future CMI Models Testing Prior Authorization (Including AI) in Traditional Medicare
This section amends Section 1115A(b)(2) of the Social Security Act, which governs the Center for Medicare and Medicaid Innovation (CMI). It adds a new subparagraph (D) that prohibits the Secretary of HHS from selecting any new CMI model for testing if that model would include prior authorization, especially through the use of artificial intelligence, for items or services covered under Medicare Parts A or B. This creates a permanent statutory ban on such models in traditional Medicare.