Protecting Patients from Automated Denials Act

The Protecting Patients from Automated Denials Act requires Medicare Advantage plans to ensure that any denial of medical coverage based on artificial intelligence is reviewed and approved by a qualified physician before it is issued. This rule, which applies to plan years starting on or after January 1, 2027, mandates that the reviewing doctor must exercise independent medical judgment and provide a signed statement confirming the denial was not generated by AI. Additionally, the plan must inform the patient and provider that AI was used, share the doctor's contact information, and keep detailed records of the process for at least 10 years. The legislation also establishes a system for the government to audit these plans and requires them to submit regular reports on how often AI is used to deny care.