What does Preamble of Stop Deadly Denials Act of 2026 do?

This bill aims to amend titles XVIII and XI of the Social Security Act. It proposes to prohibit the use of prior authorization under Medicare Advantage plans. The bill also seeks to limit the implementation of payment models testing prior authorization under traditional Medicare.

What does SHORT TITLE. of Stop Deadly Denials Act of 2026 do?

This bill is formally titled the Stop Deadly Denials Act of 2026

What does PROHIBITING PRIOR AUTHORIZATION REQUIREMENTS IN MEDICARE of Stop Deadly Denials Act of 2026 do?

This section amends Section 1852 of the Social Security Act to limit prior authorization requirements in Medicare Advantage plans. Starting January 1, 2027, Medicare Advantage plans generally may not impose prior authorization requirements for specified items or services. An exception to this limitation exists if a specified item or service is already subject to prior authorization under other provisions of parts A or B of title XVIII of the Social Security Act. A 'specified item or service' excludes covered part D drugs and supplemental health care benefits. The section also amends Section 1857(g)(1) to permit intermediate sanctions for imposing prior authorization requirements in violation of Section 1852(o). Finally, Section 1852(c)(1)(G) is amended to change the heading of a subparagraph from 'Prior authorization' to 'Review' and add a temporal limitation.

What does LIMITING IMPLEMENTATION OF CENTER FOR MEDICARE AND MEDICAID of Stop Deadly Denials Act of 2026 do?

This section prohibits the Secretary of Health and Human Services from implementing the WISeR model or any substantially similar model that tests prior authorization under traditional Medicare. It amends Section 1115A(b)(2) of the Social Security Act to limit the selection of future CMI models tested under traditional Medicare. The amendment introduces a limitation preventing the Secretary from selecting models that implement prior authorization for items or services under Medicare Parts A or B if denials are based on AI/ML without physician review or processed by entities other than Medicare Administrative Contractors. The section requires notice and opportunity for public comment before a model can be selected under Section 1115A(b)(2)(A) beginning January 1, 2027.

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Stop Deadly Denials Act of 2026

Last updated: 4/20/2026 · Introduced: 4/20/2026

Author: Ro Khanna (D-CA)

TL;DR (AI)

The bill prohibits Medicare Advantage plans from imposing prior authorization requirements for specified items or services starting January 1, 2027, with exceptions for items already subject to prior authorization under other provisions.
The Secretary of Health and Human Services is prohibited from implementing models that test prior authorization under traditional Medicare, including the WISeR model or similar models.
The bill limits the selection of future models tested under traditional Medicare, preventing the implementation of prior authorization for items or services based on AI/ML without physician review or processed by entities other than Medicare Administrative Contractors.

119th Congressin committeeOfficial page

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Other Sections

Includes provisions on preamble, short title., and 2 more.

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