HR 8377
Stop Deadly Denials Act of 2026
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Bill overview
The Stop Deadly Denials Act of 2026 aims to reduce administrative burdens and potential delays in healthcare by limiting prior authorization requirements in Medicare Advantage plans. It prohibits Medicare Advantage plans from imposing prior authorization requirements on most services, with limited exceptions. Additionally, the bill restricts the implementation of new payment models that test prior authorization under traditional Medicare and requires public comment for any future models.
Key provisions
- Medicare Advantage plans cannot impose prior authorization requirements for most items or services starting January 1, 2027.
- The law allows for intermediate sanctions if Medicare Advantage plans violate prior authorization rules.
- The implementation of the Wasteful and Inappropriate Services Reduction (WISeR) model is prohibited.
- Future Center for Medicare and Medicaid Innovation (CMI) models testing prior authorization under traditional Medicare are limited.
- New CMI models must not rely on artificial intelligence or algorithmic decision-making without physician review.
- Future CMI models require a public comment period before selection.
- The Act clarifies that ‘Review’ should be used instead of ‘Prior authorization’ in relevant sections.
- The Act clarifies that Medicare Administrative Contractors should handle prior authorization requests.
Who is affected
- Medicare Advantage beneficiaries
- Medicare Advantage plans
Sponsors
Official sponsors from legislative records.
Primary sponsor
Cosponsors
Eleanor Holmes [D-DC-At Large] Norton
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119th CONGRESS — 2d Session
H. R. 8377
IN THE HOUSE OF REPRESENTATIVES
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.
This Act may be cited as the Stop Deadly Denials Act of 2026
.
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 covered part D drug; or
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—
in subparagraph (J), by striking or
at the end;
in subparagraph (K), by striking subparagraphs (A) through (J)
and inserting subparagraphs (A) through (K)
;
by redesignating subparagraph (K) as subparagraph (L); and
by inserting after subparagraph (J) the following new subparagraph:
in the subparagraph heading, by striking Prior authorization
and inserting Review
; and
by inserting for plan years ending before January 1, 2027,
after Rules regarding prior authorization
.
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—
in subparagraph (A), by striking The Secretary shall select
and inserting Subject to the limitation under subparagraph (D), the Secretary shall select
; and
by adding at the end the following new subparagraph:
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
issuing any denial of coverage or payment that—
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
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
Beginning January 1, 2027, a model may only be selected under this subparagraph after notice and opportunity for public comment..