ETO AGORA HR 6361 Ban AI Denials in Medicare Act 2025

HR 6361 Ban AI Denials in Medicare Act 2025

Proposed 2025-12-02 | Official source

Summary

Prohibits the Secretary of Health and Human Services from implementing the WISeR model or similar models and bars future Medicare payment models from using prior authorization, including through artificial intelligence, for services covered under Medicare Parts A and B.

  • This summary is awaiting validation (peer review by a second AGORA editor).
  • This document has not been enacted or otherwise finalized and is subject to change. This summary is based on a copy of the document collected 2026-02-22 - refer to the official source for the most current version.

Key facts

🏛️ This document has been proposed by the United States Congress, but is not yet enacted. For authoritative text and metadata, visit the official source.

🎯 This document primarily applies to the government, rather than the private sector.

📜 This document's name is HR 6361 Ban AI Denials in Medicare Act 2025 . AGORA also tracks this document under the name HR 6361 Ban AI Denials in Medicare Act 2025.

Themes AI risks, applications, governance strategies, and other themes addressed in AGORA documents.
  • Thematic tags for this document are awaiting validation (peer review by a second AGORA editor).
  • This document has not been enacted or otherwise finalized and is subject to change. This summary is based on a copy of the document collected 2026-02-22 - refer to the official source for the most current version.

AI application areas (1)

Full text

  • This is an unofficial copy. The document has been archived and reformatted in plaintext for AGORA. Footnotes, tables, and similar material may be omitted. For the official text, visit the original source.
  • Thematic tags for this document are awaiting validation (peer review by a second AGORA editor).
  • This text may be out of date. According to the latest data in AGORA, this document has been proposed, but is not yet enacted or otherwise finalized. This text was collected 2026-02-22 and may have been revised in the meantime. Visit the official source for authoritative text.
A BILL To prohibit the Secretary of Health and Human Services from testing the WISeR model, and to amend title XI of the Social Security Act to prohibit the implementation of payment models testing prior authorization under traditional Medicare. 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 ``Ban AI Denials in Medicare Act''.

Prohibits HHS from testing the WISeR model and from implementing Medicare payment models that use prior authorization, including through artificial intelligence.

Prohibits HHS from testing the WISeR model and from implementing Medicare payment models that use prior authorization, including through artificial intelligence.
SEC. 2. PROHIBITING 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.

Prohibits the Secretary of Health and Human Services from implementing the WISeR Medicare prior-authorization model or any substantially similar model.

Prohibits the Secretary of Health and Human Services from implementing the WISeR Medicare prior-authorization model or any substantially similar model.
(b) Prohibiting Implementation of Future CMI Models Testing Prior Authorization (including Through the Use of AI) 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 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.''.

Prohibits HHS from selecting future Medicare models that implement prior authorization, including through artificial intelligence, for items or services covered under Medicare Parts A and B.

Prohibits HHS from selecting future Medicare models that implement prior authorization, including through artificial intelligence, for items or services covered under Medicare Parts A and B.