HR 9734
To amend title XVIII of the Social Security Act to establish requirements for the use of artificial intelligence in prior authorization denials by Medicare Advantage organizations.
TL;DR
Rep. Herbert Conaway (D-NJ) introduced this bill to restrict how Medicare Advantage plans use AI to deny prior authorization requests. It would require human clinician review of AI-flagged denials and set new transparency and oversight rules for insurers using algorithms to approve or reject care.
How This Might Impact Your Business
Medicare Advantage organizations (private insurers like UnitedHealth, Humana, Aetna, and Elevance) would face new rules on using AI or algorithmic tools to deny coverage for medical services.
Prior authorization denials generated by AI would require review and sign-off by a qualified human clinician before becoming final, ending fully automated denials.
Health tech vendors selling utilization management AI (such as naviHealth, MCG Health, and Cohere Health) would need to modify products to support mandatory human-in-the-loop workflows.
Insurers would likely face new disclosure obligations, meaning documentation of AI decision criteria, training data, and error rates could be subject to CMS oversight.
Providers and hospitals stand to benefit from fewer automated denials, potentially reducing appeals workload and improving cash flow on delayed claims.
No specific penalty amounts or implementation dates are set in the introduced text; enforcement would run through existing CMS Medicare Advantage compliance mechanisms.
The bill is early-stage, sitting in the House Ways and Means and Energy and Commerce Committees with no hearing scheduled.
What Should You Do
If you run a Medicare Advantage plan, inventory every AI or algorithmic tool used in prior authorization and document where human clinician review currently exists.
Health tech vendors serving payers should brief product teams on likely human-in-the-loop requirements and prepare a compliance roadmap for customers.
Hospital and provider CFOs should track this bill as a potential tailwind for reducing denial rates and reassess AI-driven denial appeals staffing.
Ask government affairs or outside counsel to monitor committee activity in Ways and Means and Energy and Commerce and flag any markup or hearing dates.
Review contracts with third-party utilization management vendors for indemnification and compliance clauses tied to future federal AI rules.
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.
July 16, 2026