HR 6361
Ban AI Denials in Medicare Act
TL;DR
Rep. Greg Landsman (D-OH) introduced this bill to prohibit Medicare Advantage plans and Medicare providers from using AI or algorithms as the sole basis to deny, reduce, or terminate coverage for beneficiaries. A human clinician would need to make the final call on coverage denials, not an automated system.
How This Might Impact Your Business
Medicare Advantage insurers (UnitedHealth, Humana, CVS/Aetna, Elevance, etc.) would lose the ability to use AI tools like nH Predict as the deciding factor in coverage denials, requiring human clinical review instead.
Health tech vendors selling prior authorization and utilization management AI to Medicare plans would need to redesign products as decision-support tools rather than decision-makers.
Documentation requirements would likely expand, with insurers needing to prove a qualified human reviewed each denial, not just rubber-stamped an algorithm's output.
Hospitals and post-acute care providers (skilled nursing, rehab facilities) could see fewer AI-driven denials of admissions and length-of-stay decisions, improving revenue cycles.
Class-action litigation risk already exists against Medicare Advantage plans using AI denial tools; this bill would strengthen plaintiffs' positions even before passage.
Traditional Medicare (fee-for-service) providers using AI for claims processing would also fall under the restrictions.
No specific penalty structure or effective date is spelled out yet since the bill is early in committee; expect CMS to write implementing rules if passed.
What Should You Do
If you sell AI to Medicare Advantage plans, map which of your product features make autonomous denial decisions versus support human reviewers, and prepare a repositioning strategy.
Health plan executives should audit current AI-driven prior authorization workflows and quantify how many denials lack meaningful human review; this is already a regulatory and litigation target.
Hospital CFOs should track this bill and related CMS guidance (CMS already issued a February 2024 memo restricting algorithmic denials in Medicare Advantage) to model revenue impact from reduced denials.
Legal and compliance teams should review vendor contracts for indemnification language covering AI-driven adverse coverage decisions.
Monitor Ways and Means and Energy and Commerce committee activity; this bill likely will not pass standalone but provisions could be folded into year-end health packages.
Who It Affects
Sponsors
Status Timeline
committee
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.
December 2, 2025