H.R. 8377

[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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