Ban AI Denials in Medicare Act
Summary
The "Ban AI Denials in Medicare Act" (H.R. 6361) aims to prevent the Secretary of Health and Human Services from implementing or testing the WISeR model, or any similar model, which uses prior authorization under traditional Medicare. The bill also amends the Social Security Act to prohibit the implementation of payment models testing prior authorization, including those using artificial intelligence (AI), for items or services under Medicare Parts A and B. This legislation seeks to ensure that healthcare decisions are not solely determined by AI algorithms.
Expected Effects
If enacted, this bill would prevent the use of AI and similar models for prior authorization in traditional Medicare. This would likely maintain the current system where human review is required for prior authorization decisions. It could also impact the adoption of AI in healthcare administration.
Potential Benefits
- Prevents potential errors or biases in AI-driven healthcare decisions.
- Ensures human oversight in medical necessity determinations.
- May reduce the risk of inappropriate denials of care.
- Protects the doctor-patient relationship by preventing automated interference.
- Could foster greater trust in the Medicare system by ensuring human accountability.
Potential Disadvantages
- May slow down the prior authorization process compared to automated systems.
- Could increase administrative costs due to the need for human review.
- May limit the potential for AI to improve efficiency and reduce healthcare spending.
- Could miss opportunities to identify and prevent wasteful or inappropriate services through AI analysis.
- May not address existing issues with the prior authorization process, such as delays and administrative burdens.
Constitutional Alignment
The bill appears to align with the general welfare clause of the Constitution, as it aims to ensure access to healthcare for seniors and individuals with disabilities. By preventing AI denials, it could be argued that the bill is promoting the general welfare by ensuring that healthcare decisions are made with human oversight. Article 1, Section 8 gives Congress the power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).