Stop Deadly Denials Act of 2026

Prohibition of Prior Authorization in Medicare Advantage: Starting January 1, 2027, Medicare Advantage plans would be prohibited from imposing prior authorization requirements for specified items or services, excluding certain drugs or supplemental benefits (Section 2(a)).

Protection Against Automated Denials: The bill prevents the implementation of models that issue coverage or payment denials based on artificial intelligence, machine learning, or algorithmic decision logic without a review and approval by a physician using independent medical judgment (Section 3(b)(2)(ii)(I)).

Ensuring Physician Oversight: Future models would be prohibited from issuing denials that have not been individually reviewed and approved by a physician based on medical judgment and relevant documentation (Section 3(b)(2)(ii)(I)(bb)).

Increased Public Transparency: Starting January 1, 2027, new models can only be selected after there is a notice and opportunity for public comment (Section 3(c)).

Accountability for Noncompliance: The bill allows for intermediate sanctions to be imposed on Medicare Advantage plans that violate the prohibition on prior authorization requirements (Section 2(b)).

Exceptions to Prior Authorization Prohibitions: Certain items or services may still be subject to prior authorization under specific provisions of the Social Security Act (Section 2(a)(2)).

Exclusions from Prohibitions: The prohibition on prior authorization in Medicare Advantage plans does not apply to covered part D drugs or supplemental health care benefits (Section 2(a)(3)).