Representatives Greg Murphy (R-NC) and Herb Conaway Jr. (D-NJ) on July 16, 2026, introduced the Protecting Patients from Automated Denials Act (HR 9734), legislation aimed at increasing oversight of artificial intelligence (AI) in Medicare Advantage (MA) plan coverage determinations and prior authorization denials beginning with the 2027 plan year.

The bill would require any AI-assisted denial to be reviewed and approved by a qualified physician operating under the supervision of the plan’s medical director. Physicians would also be required to attest that they exercised independent medical judgment and that the denial was not generated or dictated by AI. In addition, the legislation would grant the HHS Secretary authority to audit and inspect the use of AI in prior authorization decisions, including reviewing denial data, internal policies, algorithms, employee practices, and denial overturn rates.

Several provisions would codify existing Medicare Advantage requirements, including that coverage decisions must be based on an individual patient’s medical history, physician recommendations, and clinical circumstances rather than broader population-based criteria. The bill would further reinforce prohibitions on using AI or algorithms as the sole basis for denying care and require review by a qualified health care professional.

The legislation would also strengthen provider protections by requiring physicians to attest that coverage determinations reflect their independent clinical judgment and by ensuring providers can communicate directly with the physician reviewer to discuss denials. Providers have reported that some MA plans have refused to identify the reviewing health care professional, disclose relevant qualifications, or permit direct communication regarding denial decisions. LeadingAge supports the codification of existing regulatory provisions and the additional protections the bill offers.

The bill has been referred to the House Ways and Means and Energy and Commerce Committees for further consideration.