,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #igcd  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #af1 #bjbf,mr4  
,conaway 7= himself & ,mr4 ,murphy7     
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,ways & ,means1 & 9    
addition to ! ,committee on ,en]gy &    
,comm]ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to e/abli%       
requirem5ts = ! use ( artificial        
intellig5ce 9 prior au?orization d5ials 
by ,m$ic>e ,advantage organizations4    
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,protect+ ,pati5ts f ,automat$ ,d5ials
 ,act4  #b4 ,e/abli%+ requirem5ts = use 
( artificial intellig5ce 9 prior        
au?orization d5ials "u ,m$ic>e          
,advantage  7a7 ,9 g5]al ,section #aheb 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#bb7 is am5d$ by add+  
at ! end ! foll[+ new subsection3  7o7  

,requirem5ts = use ( artificial         
intellig5ce 9 prior au?orization d5ials 
7#a7 ,9 g5]al ,) respect to plan ye>s   
beg9n+ on or aft] ,janu>y #a1 #bjbg1 an 
,,ma plan t imposes a prior au?orization
 requirem5t ) respect to an item or     
s]vice = :i* b5efits are available "u   
su* plan may n d5y a reque/ = prior     
au?orization ) respect to su* item or   
s]vice bas$ on ! output ( artificial    
intellig5ce1 unless ! foll[+ requirem5ts
 are met3 7,a7 ,be=e su* d5ial is issu$1
 su* d5ial is review$ & approv$1 "u !   
cl9ical direction ( a m$ical director ( 
su* ,,ma plan1 by a qualifi$ physician  
review]4  7,b7 ,su* qualifi$ physician  
review] provides to su* ,,ma plan a     
sign$ atte/ation t1 9 review+ & approv+ 
su* d5ial-- 7i7 su* qualifi$ physician  
review] ex]cis$ m$ical judgm5t t 0      
indep5d5t f su* output2  7ii7 su* d5ial 
0 n g5]at$ or dictat$ by artificial     
intellig5ce2 &  7iii7 any s(tw>e us$ 9  
prep>+ su* d5ial 0 us$ only =           
adm9i/rative purposes4  7,c7 ,su* ,,ma  

plan provides to ! provid] :o submitt$  
su* reque/-- 7i7 a copy ( ! sign$       
atte/ation describ$ 9 subp>agraph 7,b72 
7ii7 an opportunity to communicate      
directly ) su* qualifi$ physician       
review]2 &  7iii7 an opportunity to     
discuss ) su* qualifi$ physician review]
 ! propos$ individualiz$ cl9ical basis =
 su* d5ial4  7,d7 ,su* ,,ma plan        
discloses to ! individual to :om su*    
d5ial is issu$ & to su* provid]-- 7i7 t 
artificial intellig5ce 0 us$ z "p ( su* 
d5ial2 &  7ii7 ! ,national ,provid]     
,id5tifi] numb] ( su* qualifi$ physician
 review]4  7,e7 ,su* ,,ma plan makes1 & 
ma9ta9s = n less ?an #aj ye>s aft] !    
date on :i* su* d5ial is issu$1 records 
) respect to su* d5ial ab\t--  7i7 ! use
 ( artificial intellig5ce2  7ii7 !      
review & approval by su* qualifi$       
physician review] "u subp>agraph 7,a72 &
  7iii7 in=mation provid$ "u subp>agraph
 7,c71 includ+ a copy ( ! sign$         
atte/ation describ$ 9 subp>agraph 7,b74 
7#b7 ,report to ,secret>y ,n lat] ?an   

,m>* #ca1 #bjbg1 & e #ij days !reaft]1  
an ,,ma plan t imposes a prior          
au?orization requirem5t ) respect to an 
item or s]vice = :i* b5efits are        
available "u su* plan %all submit to !  
,secret>y a report t includes1 ) respect
 to ! mo/ rec5t #ij-;day p]iod = :i* su*
 data is available1 in=mation ) respect 
to any reque/s = prior au?orization =   
su* an item or s]vice t 7 d5i$ bas$ on !
 output ( artificial intellig5ce1       
includ+--  7,a7 any sign$ atte/ations   
provid$ "u p>agraph 7#a77;,b72 &  7,b7  
any algori?m1 decision protocol1 or     
docum5tation associat$ ) su* output4    
7#c7 ,ov]sight au?ority ,9 ! case ( an  
,,ma plan t imposes a prior au?orization
 requirem5t ) respect to an item or     
s]vice = :i* b5efits are available "u   
su* plan1 ! ,secret>y may audit &       
inspect any use ( artificial intellig5ce
 by su* plan t is associat$ ) su*       
requirem5t1 includ+ by-- 7,a7 review+   
data relat$ to d5ials ( reque/s = prior 
au?orization2  7,b7 exam9+ :e!r qualifi$

 physician review]s provid$ sign$       
atte/ations "u p>agraph 7#a77;,b72  7,c7
 review+ su* sign$ atte/ations2  7,d7   
comp>+ outputs ( artificial intellig5ce 
to d5ials ( reque/s = prior             
au?orization2  7,e7 assess+ ! rates (   
su* d5ials t 7 ov]turn$ or did n satisfy
 ! requirem5ts ( p>agraph 7#a72  7,f7   
review+ int]nal policies2  7,g7         
int]view+ employees2 &  7,h7 review+ any
 algori?m1 decision protocol1 or        
docum5tation relat$ to su* use4  7#d7   
,def9itions ,9 ?is subsection3  7,a7    
,artificial intellig5ce ,! t]m          
artificial intellig5ce has ! mean+ giv5 
su* t]m 9 section #ejjb ( ! ,national   
,artificial ,intellig5ce ,initiative    
,act ( #bjbj 7#ae ,u4,s4,c4 #idja7 &    
includes te*nology t-- 7i7 produces     
syn!tic cont5t 9 response to prompts us+
 patt]ns le>n$ f data2  7ii7 acts )     
autonomy & purpose by execut+ tasks     
proactively & indep5d5tly ) m9imal or no
 human int]v5tion2 &  7iii7 int]faces ) 
ext]nal sy/ems & tools to take mean+ful 

action1 make decisions1 set goals1 &    
op]ate beyond initial tra9+ data4  7,b7 
,qualifi$ physician review] ,! t]m      
qualifi$ physician review] means1 )     
respect to an item or s]vice = :i* a    
reque/ = prior au?orization is submitt$ 
to an ,,ma plan1 a physician :o-- 7i7   
possesses a curr5t & valid non-re/rict$ 
lic5se to practice m$ic9e 9 ! ,/ate :]e 
su* item or s]vice w be furni%$2  7ii7  
is bo>d-c]tifi$ or eligible "u ! rules &
 guidel9es ( ! ,am]ican ,bo>d ( ,m$ical 
,specialties or ,am]ican ,o/eopa?ic     
,association 9 a specialty t correlates 
) ! specialty ( ! provid] :o submitt$   
su* reque/2 &  7iii7 has exp]i5ce       
practic+ 9 su* specialty4  4  7b7       
,promulgation ( regulations ,n lat] ?an 
#a ye> aft] ! date ( ! enactm5t ( ?is   
section1 ! ,secret>y %all issue a f9al  
rule to c>ry out ! am5dm5ts made by ?is 
section4