Stop Deadly Denials Act of 2026

Bill Number

H.R. 8377

Origin Chamber

House

Congress

119th Congress, Session 2

Policy Area

Health

Status

Introduced

Latest Action

2026-04-20: 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.

Last Updated

2026-04-28T15:07:01Z

AI-Generated Summary

H.R. 8377: Stop Deadly Denials Act of 2026

Purpose

This bill aims to eliminate or severely restrict prior authorization—a process where insurers require advance approval before covering certain medical services—in Medicare programs. It seeks to prevent delays or denials of care, particularly in Medicare Advantage (private plans that replace traditional Medicare) and experimental models under traditional Medicare.

Key Provisions

• Prohibition in Medicare Advantage (Section 2):
• Starting January 1, 2027, Medicare Advantage plans cannot require prior authorization for most covered items or services (called "specified items or services," excluding prescription drugs under Part D and extra benefits like dental or vision).
• Exceptions apply if the service already requires prior authorization under traditional Medicare rules.
• Noncompliance triggers intermediate sanctions (penalties short of terminating the plan's contract).
• Existing prior authorization rules in Medicare Advantage end after 2026.

• Limits on Innovation Models in Traditional Medicare (Section 3):
• Bans implementation of the "WISeR Model" (a proposed prior authorization test announced in 2025) or similar models.
• Prohibits future models by the Center for Medicare and Medicaid Innovation (CMMI) that test prior authorization under Medicare Parts A or B if they:
• Use artificial intelligence (AI), machine learning, or algorithms to deny coverage without physician review based on independent medical judgment.
• Process requests through entities other than Medicare Administrative Contractors (MACs, government-contracted processors).
• From January 1, 2027, all new CMMI models require public notice and comment periods before selection.

Significant Changes to Existing Law

• Amends Social Security Act Titles XI and XVIII: Adds new subsection to ban prior authorization in Medicare Advantage; expands sanctions for violations; restricts CMMI model testing; mandates public input for models.
• Shifts from allowing plans flexibility in using prior authorization to outright prohibition (with narrow exceptions).
• Introduces safeguards against automated denials and non-government processors in experimental models.

Potential Impacts

• On Citizens (Medicare Beneficiaries): Faster access to care in Medicare Advantage (affecting over half of Medicare enrollees), reducing delays that could harm health outcomes.
• On Government Agencies: Centers for Medicare & Medicaid Services (CMS) and HHS Secretary lose flexibility to test cost-saving prior authorization models; increased rulemaking burdens due to notice-and-comment requirements.
• On Healthcare Providers: Reduced paperwork and approvals, potentially speeding up treatments.
• On Insurers: Medicare Advantage plans may face higher costs without prior authorization to control spending, possibly leading to premium increases or benefit cuts.
• No direct impact on international relations.

Main Stakeholders Affected

• Medicare Beneficiaries: Especially those in Medicare Advantage plans.
• Healthcare Providers: Doctors and facilities serving Medicare patients.
• Medicare Advantage Insurers: Private companies offering these plans.
• CMS and HHS: Oversee Medicare; face new limits on innovation.
• Medicare Administrative Contractors (MACs): Gain exclusive role in processing certain requests.

Notable Legal, Constitutional, or Political Implications

• Legal: Strengthens enforcement through sanctions; prioritizes physician judgment over AI in denials; aligns with broader scrutiny of insurer practices but limits CMS experimentation authority.
• Constitutional: No clear challenges; operates within Congress's power to regulate federal programs like Medicare.
• Political: Focuses on patient protections against "deadly denials," potentially sparking debates over healthcare costs vs. access; referred to House committees on Ways and Means and Energy and Commerce for review.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Khanna, Ro [D-CA-17]

Cosponsors (6)

Rep. Jayapal, Pramila [D-WA-7], Rep. Cohen, Steve [D-TN-9], Rep. Dingell, Debbie [D-MI-6], Rep. Jackson, Jonathan L. [D-IL-1], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Pocan, Mark [D-WI-2]

Recent Actions

• 2026-04-20: 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.
• 2026-04-20: 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.
• 2026-04-20: Introduced in House
• 2026-04-20: Introduced in House

Bill Versions

• Stop Deadly Denials Act of 2026 — issued 2026-04-20 — PDF (6 pages)