,i #aaith ,,congress #b;d ,session ,h4 ,r4 #igcd ,,in ,,the ,,house ,,of ,,representatives ,july #af1 #bjbf,mr4 ,conaway 7for himself and ,mr4 ,murphy7 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 establish requirements for the use of artificial intelligence in prior authorization denials by ,medicare ,advantage organizations4 #a4 ,short title ,this ,act may be cited as the ,protecting ,patients from ,automated ,denials ,act4 #b4 ,establishing requirements for use of artificial intelligence in prior authorization denials under ,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 ,requirements for use of artificial intelligence in prior authorization denials 7#a7 ,in general ,with respect to plan years beginning on or after ,january #a1 #bjbg1 an ,,ma plan that imposes a prior authorization requirement with respect to an item or service for which benefits are available under such plan may not deny a request for prior authorization with respect to such item or service based on the output of artificial intelligence1 unless the following requirements are met3 7,a7 ,before such denial is issued1 such denial is reviewed and approved1 under the clinical direction of a medical director of such ,,ma plan1 by a qualified physician reviewer4 7,b7 ,such qualified physician reviewer provides to such ,,ma plan a signed attestation that1 in reviewing and approving such denial-- 7i7 such qualified physician reviewer exercised medical judgment that was independent from such output2 7ii7 such denial was not generated or dictated by artificial intelligence2 and 7iii7 any software used in preparing such denial was used only for administrative purposes4 7,c7 ,such ,,ma plan provides to the provider who submitted such request-- 7i7 a copy of the signed attestation described in subparagraph 7,b72 7ii7 an opportunity to communicate directly with such qualified physician reviewer2 and 7iii7 an opportunity to discuss with such qualified physician reviewer the proposed individualized clinical basis for such denial4 7,d7 ,such ,,ma plan discloses to the individual to whom such denial is issued and to such provider-- 7i7 that artificial intelligence was used as part of such denial2 and 7ii7 the ,national ,provider ,identifier number of such qualified physician reviewer4 7,e7 ,such ,,ma plan makes1 and maintains for not less than #aj years after the date on which such denial is issued1 records with respect to such denial about-- 7i7 the use of artificial intelligence2 7ii7 the review and approval by such qualified physician reviewer under subparagraph 7,a72 and 7iii7 information provided under subparagraph 7,c71 including a copy of the signed attestation described in subparagraph 7,b74 7#b7 ,report to ,secretary ,not later than ,march #ca1 #bjbg1 and every #ij days thereafter1 an ,,ma plan that imposes a prior authorization requirement with respect to an item or service for which benefits are available under such plan shall submit to the ,secretary a report that includes1 with respect to the most recent #ij-;day period for which such data is available1 information with respect to any requests for prior authorization for such an item or service that were denied based on the output of artificial intelligence1 including-- 7,a7 any signed attestations provided under paragraph 7#a77;,b72 and 7,b7 any algorithm1 decision protocol1 or documentation associated with such output4 7#c7 ,oversight authority ,in the case of an ,,ma plan that imposes a prior authorization requirement with respect to an item or service for which benefits are available under such plan1 the ,secretary may audit and inspect any use of artificial intelligence by such plan that is associated with such requirement1 including by-- 7,a7 reviewing data related to denials of requests for prior authorization2 7,b7 examining whether qualified physician reviewers provided signed attestations under paragraph 7#a77;,b72 7,c7 reviewing such signed attestations2 7,d7 comparing outputs of artificial intelligence to denials of requests for prior authorization2 7,e7 assessing the rates of such denials that were overturned or did not satisfy the requirements of paragraph 7#a72 7,f7 reviewing internal policies2 7,g7 interviewing employees2 and 7,h7 reviewing any algorithm1 decision protocol1 or documentation related to such use4 7#d7 ,definitions ,in this subsection3 7,a7 ,artificial intelligence ,the term artificial intelligence has the meaning given such term in section #ejjb of the ,national ,artificial ,intelligence ,initiative ,act of #bjbj 7#ae ,u4,s4,c4 #idja7 and includes technology that-- 7i7 produces synthetic content in response to prompts using patterns learned from data2 7ii7 acts with autonomy and purpose by executing tasks proactively and independently with minimal or no human intervention2 and 7iii7 interfaces with external systems and tools to take meaningful action1 make decisions1 set goals1 and operate beyond initial training data4 7,b7 ,qualified physician reviewer ,the term qualified physician reviewer means1 with respect to an item or service for which a request for prior authorization is submitted to an ,,ma plan1 a physician who-- 7i7 possesses a current and valid non-restricted license to practice medicine in the ,state where such item or service will be furnished2 7ii7 is board-certified or eligible under the rules and guidelines of the ,american ,board of ,medical ,specialties or ,american ,osteopathic ,association in a specialty that correlates with the specialty of the provider who submitted such request2 and 7iii7 has experience practicing in such specialty4 4 7b7 ,promulgation of regulations ,not later than #a year after the date of the enactment of this section1 the ,secretary shall issue a final rule to carry out the amendments made by this section4