H.R. 8377 — Stop Deadly Denials Act of 2026

This section prohibits Medicare Advantage plans from imposing prior authorization requirements on specified items or services (i.e., any covered benefits other than Part D drugs or supplemental benefits) for plan years beginning on or after January 1, 2027, except for items or services subject to prior authorization under specified traditional Medicare provisions in Parts A or B. It authorizes intermediate sanctions against plans violating this prohibition and limits existing prior authorization rules to plan years ending before January 1, 2027. (Thus, Medicare Advantage plans, which provide all Part A and B benefits plus often supplemental coverage to approximately half of Medicare beneficiaries, must align prior authorization with traditional Medicare for core benefits.)

This section (1) prohibits the Secretary of Health and Human Services from implementing the Wasteful and Inappropriate Services Reduction (WISeR) prior authorization model announced in the Federal Register on July 1, 2025 (90 Fed. Reg. 28749), or any substantially similar model; (2) limits the Center for Medicare and Medicaid Innovation (CMMI)—which tests innovative payment and service delivery models to reduce Medicare, Medicaid, and CHIP costs while preserving or enhancing quality of care—by prohibiting, beginning upon enactment, the selection of any model under Medicare Parts A or B that implements prior authorization and either issues coverage or payment denials based on artificial intelligence, machine learning, algorithmic decision logic, or similar technology without review and approval or processes prior authorization requests through any entity other than a Medicare administrative contractor; and (3) requires, beginning January 1, 2027, notice and opportunity for public comment prior to selecting any CMMI model.