,i #aaith ,,congress #b;d ,session ,h4 ,r4 #hcgg ,,in ,,the ,,house ,,of ,,representatives ,april #bj1 #bjbf,mr4 ,khanna 7for himself1 ,ms4 ,jayapal1 ,mr4 ,cohen1 ,mrs4 ,dingell1 ,mr4 ,jackson of ,illinois1 ,ms4 ,norton1 and ,mr4 ,pocan7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to prohibit the use of prior authorization under ,medicare ,advantage plans1 to amend title ,,xi of the ,social ,security ,act to limit the implementation of payment models testing prior authorization under traditional ,medicare1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,stop ,deadly ,denials ,act of #bjbf4 #b4 ,prohibiting prior authorization requirements in ,medicare ,advantage 7a7 ,in general ,section #aheb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7 is amended by adding at the end the following new subsection3 7o7 ,limitation on prior authorization 7#a7 ,in general ,subject to paragraph 7#b71 for plan years beginning on or after ,january #a1 #bjbg1 a ,medicare ,advantage plan may not impose any prior authorization requirement with respect to any specified item or service4 7#b7 ,exception ,paragraph 7#a7 shall not apply with respect to a specified item or service for a plan year in the case that1 during such year1 such item or service is subject to prior authorization pursuant to subsection 7t77#b77;,f7 or 7aa7 of section #ahcc1 subsection 7a77#ae71 7l77#af71 7q77#f71 or 7u77#d7 of section #ahcd1 or any other provision of part ,a or part ,b of this title4 7#c7 ,specified item or service defined ,for purposes of this subsection1 the term specified item or service means1 with respect to a ,medicare ,advantage plan1 any item or service for which benefits are available under such plan that is not-- 7,a7 a covered part ,d drug2 or 7,b7 a supplemental health care benefit 7as described in subsection 7a77#c774 4 7b7 ,permitting intermediate sanctions in the case of noncompliance ,section #aheg7;g77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;g77#a77 is amended-- 7#a7 in subparagraph 7,j71 by striking or at the end2 7#b7 in subparagraph 7,k71 by striking subparagraphs 7,a7 through 7,j7 and inserting subparagraphs 7,a7 through 7,k72 7#c7 by redesignating subparagraph 7,k7 as subparagraph 7,l72 and 7#d7 by inserting after subparagraph 7,j7 the following new subparagraph3 7,k7 imposes a prior authorization requirement with respect to an item or service in violation of section #aheb7o72 or 4 7c7 ,conforming change ,section #aheb7;c77#a77;,g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;c77#a77;,g77 is amended-- 7#a7 in the subparagraph heading1 by striking ,prior authorization and inserting ,review2 and 7#b7 by inserting for plan years ending before ,january #a1 #bjbg1 after ,rules regarding prior authorization4 #c4 ,limiting implementation of ,center for ,medicare and ,medicaid ,innovation models testing prior authorization under traditional ,medicare 7a7 ,prohibiting implementation of ,w,i,se,r model ,the ,secretary of ,health and ,human ,services may not implement the innovative payment and service delivery model described in the notice titled ,medicare ,program2 ,implementation of ,prior ,authorization for ,select ,services for the ,wasteful and ,inappropriate ,services ,reduction 7,w,i,se,r7 ,model 7#ij ,fed4 ,reg4 #bhgdi 7,july #a1 #bjbe771 or any substantially similar model4 7b7 ,limiting implementation of future ,,cmi models testing prior authorization under traditional ,medicare ,section #aaae;,a7b77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77 is amended-- 7#a7 in subparagraph 7,a71 by striking ,the ,secretary shall select and inserting ,subject to the limitation under subparagraph 7,d71 the ,secretary shall select2 and 7#b7 by adding at the end the following new subparagraph3 7,d7 ,limitation on models to be tested ,beginning on the date of the enactment of this subparagraph1 the ,secretary may not select a model to be tested under subparagraph 7,a7 if such model-- 7i7 would provide for the implementation of prior authorization with respect to items or services for which payment may be made under part ,a or part ,b of title ,,xviii2 and 7ii7 would provide for-- 7,i7 issuing any denial of coverage or payment that-- 7aa7 is based on a decision made through the use of artificial intelligence1 machine learning1 algorithmic-derived decision logic1 or any other similar technological process1 without review and approval of such denial2 and 7bb7 has not been individually reviewed and approved by a physician on the basis of the physician's independent medical judgment1 taking into account relevant documentation provided by the individual receiving such items or services or the provider furnishing such items or services2 or 7,,ii7 the processing of requests for prior authorization by any entity other than a medicare administrative contractor with a contract under section #ahgd;,a4 4 7c7 ,requiring notice and comment for all future ,,cmi models ,section #aaae;,a7b77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,a771 as amended by subsection 7b71 is further amended by adding at the end the following new sentence3 ,beginning ,january #a1 #bjbg1 a model may only be selected under this subparagraph after notice and opportunity for public comment44