HB8377, titled the Stop Deadly Denials Act of 2026, would sharply restrict the use of prior authorization in Medicare. For Medicare Advantage plans, the bill would prohibit prior authorization for any “specified item or service” beginning with plan years on or after January 1, 2027, except where that item or service is already subject to prior authorization under existing Medicare Part A or Part B rules. It also updates Medicare Advantage enforcement provisions so that plans can face intermediate sanctions for violating the new ban, and it makes a conforming change to existing prior-authorization review language for plan years ending before 2027.
The bill also targets federal testing of prior authorization in traditional Medicare. It would bar the Secretary of Health and Human Services from implementing the WISeR model described in a 2025 Federal Register notice, or any substantially similar model, and would limit future Center for Medicare and Medicaid Innovation models that would test prior authorization for Part A or Part B services. Under the bill, such models could not rely on AI, machine learning, algorithmic decision logic, or similar tools to issue denials without physician review and approval, and requests for prior authorization would have to be processed by a Medicare administrative contractor rather than another entity. Beginning January 1, 2027, future CMMI models would also require notice and an opportunity for public comment.
In practical terms, the bill would amend Title XVIII of the Social Security Act and Section 1115A governing CMMI demonstrations, changing how Medicare Advantage plans and Medicare innovation models may manage utilization review. It would reduce plan and model flexibility to delay or deny care through prior authorization, while increasing oversight, physician involvement, and public transparency. The affected parties would include Medicare Advantage organizations, CMS, CMMI, Medicare administrative contractors, physicians, and Medicare beneficiaries.
The general sentiment reflected by the bill’s sponsors is strongly opposed to prior authorization, especially when it is used to delay or deny medically necessary care. The bill’s title and structure suggest a patient-protection framing, emphasizing harm from “deadly denials” and concern about automated or opaque denial systems. No committee debate or votes were provided, so there is no recorded bipartisan or opposing sentiment in the supplied materials.
The main points of contention likely center on whether eliminating or sharply limiting prior authorization would improve access to care or instead reduce tools used to control costs and prevent unnecessary services. Another likely dispute is the bill’s restriction on AI- and algorithm-based denial systems and its requirement for physician review, which could be viewed by supporters as necessary safeguards but by opponents as an operational burden. The prohibition on future CMMI models testing prior authorization, along with the notice-and-comment requirement, may also be controversial because it constrains CMS innovation and demonstration authority.
HB8377 would amend the Social Security Act to prohibit Medicare Advantage plans from imposing prior authorization on covered items and services, subject to a narrow exception for services already subject to prior authorization under existing Medicare provisions. It would also authorize sanctions against plans that violate the new prohibition. In addition, it would block implementation of the WISeR model and restrict CMMI from testing future traditional Medicare models that use prior authorization, especially those relying on AI or automated decision-making without physician review, while requiring public notice and comment for future models beginning in 2027.
The bill appears to be driven by a strong pro-patient, anti-denial sentiment, with sponsors framing prior authorization as a harmful barrier to care. The available materials do not include committee testimony or votes, so there is no recorded opposition or negotiated compromise in the provided record. Based on the text alone, the bill’s tone is adversarial toward insurer utilization management and supportive of beneficiary access and physician judgment.
Likely points of contention include the elimination of prior authorization in Medicare Advantage, which insurers may argue is necessary for cost control and program integrity, versus supporters’ view that it causes delays and denials of needed care. The bill’s limits on AI, machine learning, and algorithmic denial tools are another flashpoint, because they would require individualized physician review and could significantly constrain automated claims management. CMS and CMMI’s authority to test new payment and service delivery models would also be narrowed, which may concern policymakers who favor demonstration flexibility and innovation.