HR 10210
To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to regulate the use of artificial intelligence in the review of claims by group health plans and health insurance issuers offering group or individual health insurance coverage.
TL;DR
Rep. Greg Landsman (D-OH) introduced this bill to regulate how health insurers use AI to review and deny claims. It would require human oversight of AI-driven claim decisions and set standards for algorithms used by group health plans, insurers, and ERISA-covered plans.
How This Might Impact Your Business
Health insurers and group health plans using AI or algorithms to review, approve, or deny claims would face new federal oversight requirements.
Fully-insured and self-insured employer health plans (ERISA plans) fall within scope, meaning most mid-size and large employers offering health benefits are indirectly affected.
Expect requirements for human review of AI-generated claim denials, meaning insurers cannot rely solely on automated adjudication for coverage decisions.
AI vendors selling utilization management or claims review tools to payers (like companies building prior authorization automation) would need to meet new transparency and validation standards.
Non-compliance likely triggers penalties under three enforcement regimes: HHS (Public Health Service Act), DOL (ERISA), and IRS (tax code), creating overlapping liability exposure.
Currently in committee with referrals to Energy and Commerce, Ways and Means, and Education and Workforce, so specific compliance deadlines are not yet set.
Employers offering health benefits may see downstream contract changes from insurers passing through new compliance costs.
What Should You Do
Inventory where AI or algorithmic tools are used in your claims review, prior authorization, or utilization management workflows, and document the level of human oversight in each.
If you are a self-insured employer, ask your TPA or health plan administrator to disclose what AI tools they use to adjudicate your employees' claims.
Health insurance and health tech leaders should brief their compliance and product teams on likely requirements: human-in-the-loop review, algorithm transparency, and audit trails.
Monitor committee activity in House Energy and Commerce and Ways and Means; flag for legal review if the bill advances to markup.
Review vendor contracts with AI claims-review providers for indemnification and compliance cooperation clauses.
Who It Affects
Sponsors
Status Timeline
committee
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, 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.
September 1, 2026