Doctors Not AI Act of 2026

FULL TEXT

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 10210 Introduced in House (IH)]

119th CONGRESS 2d Session H. R. 10210

To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to regulate the use of artificial intelligence in the review of claims by group health plans and health insurance issuers offering group or individual health insurance coverage.

IN THE HOUSE OF REPRESENTATIVES

September 1, 2026

Mr. Landsman (for himself, Mr. Carter of Georgia, Ms. Schrier, and Mr. Barrett) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to regulate the use of artificial intelligence in the review of claims by group health plans and health insurance issuers offering group or individual health insurance coverage.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Doctors Not AI Act of 2026''.

SEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

(a) Definition of Artificial Intelligence System.--Section 2791 of the Public Health Service Act (42 U.S.C. 30099-91) is amended by adding at the end the following:

``(g) The term `artificial intelligence system' means an engineered or machine-based system, including any algorithm, predictive model, machine learning system, or automated decision-making software, that processes data to generate predictions, classifications, recommendations, or decisions and that is used to materially influence, automate, or issue determinations regarding coverage of health care items or services.''.

(b) Clinical Judgment and Artificial Intelligence.--The Public

Health Service Act is amended by inserting after section 2719A (42

U.S.C. 300gg-19a) the following new section:

``SEC. 2719B. CLINICAL JUDGMENT AND ARTIFICIAL INTELLIGENCE.

``(a) In General.--A group health plan and a health insurance issuer offering group or individual health insurance coverage shall ensure that any adverse benefit determination, whether initially or upon appeal, involving clinical judgment-- ``(1) is not issued by an artificial intelligence system and is not dictated or determined by the output of such system;

``(2) is made only by a licensed health care professional who is acting within the scope of the professional's license and who has training and experience in the provision of the health care item or service that is the subject of the determination;

``(3) reflects the independent clinical judgment of such professional, who shall conduct an independent evaluation of the enrollee's individual medical circumstances and shall not treat any output of an artificial intelligence system as presumptively valid or defer to such output in lieu of independent clinical judgment applying generally accepted standards of care;

``(4) includes, in the notice required under section 2719, if an artificial intelligence system was used in connection with the determination-- ``(A) a statement that such system was used;

``(B) a description of its role in the review process; and ``(C) the name, professional license, and credentials of the licensed health care professional who made the determination; and ``(5) is supported by documentation maintained as part of the administrative record describing-- ``(A) the artificial intelligence system used;

``(B) the role of such system in the review process;

``(C) any outputs, scores, recommendations, or determinations generated by such system; and ``(D) documentation demonstrating compliance with subparagraph (C); and such materials shall be considered part of the administrative record and made available to the enrollee upon request.

``(b) Definitions.--For purposes of this section:

``(1) Adverse benefit determination.--The term `adverse benefit determination' includes an initial determination and a determination on internal appeal.

``(2) Adverse benefit determination involving clinical judgment.--The term `adverse benefit determination involving clinical judgment' means an adverse benefit determination that is based, in whole or in part, on medical necessity, appropriateness, experimental and investigational or similar exclusions or limits, level of care, health care setting, effectiveness, clinical guidelines, utilization review criteria, other standards requiring evaluation of the enrollee's medical condition or treatment needs, or generally accepted standards of care for such treatment needs.''.

(c) Parity Treatment of Artificial Intelligence Systems.--Section

2726 of the Public Health Service Act (42 U.S.C. 300gg-26) is amended--

(1) in subsection (a)(8)(A), by adding at the end the following new clause:

``(vi) Whether an artificial intelligence system is used in, or materially influences, the design, development, application, or administration of such limitation and, if so, sufficient information regarding the function, operation, and effects of such system to enable the Secretary to evaluate such function, operation, and effects under such limitation with respect to mental health or substance use disorder benefits as compared to medical and surgical benefits, both as written and in operation.''; and

(2) by adding at the end the following:

``(f) Artificial Intelligence and Utilization Review.--The use of an artificial intelligence system in connection with utilization review shall constitute a treatment limitation for purposes of this section.''.

SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.

(a) Definition of Artificial Intelligence System.--Section 3 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1002) is amended by adding at the end the following:

``(48) The term `artificial intelligence system' means an engineered or machine-based system, including any algorithm, predictive model, machine learning system, or automated decision-making software, that processes data to generate predictions, classifications, recommendations, or decisions and that is used to materially influence, automate, or issue determinations regarding coverage of health care items or services.''.

(b) Claims Procedure Requirements.--Section 503 of the Employee

Retirement Income Security Act of 1974 (29 U.S.C. 1133) is amended--

(1) in paragraph (2), by striking the period at the end and inserting ``; and''; and

(2) by adding at the end the following:

``(3) ensure that any adverse benefit determination, whether initially or upon appeal, involving clinical judgment-- ``(A) is not issued by an artificial intelligence system and is not dictated or determined by the output of such system;

``(B) is made only by a licensed health care professional who is acting within the scope of the professional's license and who has training and experience in the provision of the health care item or service that is the subject of the determination;

``(C) reflects the independent clinical judgment of such professional, who shall conduct an independent evaluation of the participant's or beneficiary's individual medical circumstances and shall not treat any output of an artificial intelligence system as presumptively valid or defer to such output in lieu of independent clinical judgment applying generally accepted standards of care;

``(D) includes, in the notice required under paragraph (1), if an artificial intelligence system was used in connection with the determination-- ``(i) a statement that such system was used;

``(ii) a description of its role in the review process; and ``(iii) the name, professional license, and credentials of the licensed health care professional who made the determination; and ``(E) is supported by documentation maintained as part of the administrative record describing-- ``(i) the artificial intelligence system used;

``(ii) the role of such system in the review process;

``(iii) any outputs, scores, recommendations, or determinations generated by such system; and ``(iv) documentation demonstrating compliance with subparagraph (C); and such materials shall be considered part of the administrative record and made available to the participant or beneficiary upon request.

For purposes of this paragraph, the term `adverse benefit determination' includes an initial determination and a determination on internal appeal, and the term `adverse benefit determination involving clinical judgment' means an adverse benefit determination that is based, in whole or in part, on medical necessity, appropriateness, experimental and investigational or similar exclusions or limits, level of care, health care setting, effectiveness, clinical guidelines, utilization review criteria, other standards requiring evaluation of the participant's or beneficiary's medical condition or treatment needs, or generally accepted standards of care for such treatment needs.''.

(c) Parity Treatment of Artificial Intelligence Systems.--Section

712 of the Employee Retirement Income Security Act of 1974 (29 U.S.C.

1185a) is amended---

(1) in subsection (a)(8)(A), by adding at the end the following new clause:

``(vi) Whether an artificial intelligence system is used in, or materially influences, the design, development, application, or administration of such limitation and, if so, sufficient information regarding the function, operation, and effects of such system to enable the Secretary to evaluate such function, operation, and effects under such limitation with respect to mental health or substance use disorder benefits as compared to medical and surgical benefits, both as written and in operation.''; and

(2) by adding at the end the following:

``(h) Artificial Intelligence and Utilization Review.--The use of an artificial intelligence system in connection with utilization review shall constitute a treatment limitation for purposes of this section.''.

SEC. 4. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

(a) Definition of Artificial Intelligence System.--Section 9832 of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:

``(11) Artificial intelligence system.--The term

`artificial intelligence system' means an engineered or machine-based system, including any algorithm, predictive model, machine learning system, or automated decision-making software, that processes data to generate predictions, classifications, recommendations, or decisions and that is used to materially influence, automate, or issue determinations regarding coverage of health care items or services.''.

(b) Clinical Judgment and Artificial Intelligence.--Subchapter B of

chapter 100 of the Internal Revenue Code of 1986 is amended by inserting after section 9815 the following new section:

``SEC. 9815A. CLINICAL JUDGMENT AND ARTIFICIAL INTELLIGENCE.

``(a) In General.--A group health plan shall ensure that any adverse benefit determination, whether initially or upon appeal, involving clinical judgment-- ``(1) is not issued by an artificial intelligence system and is not dictated or determined by the output of such system;

``(2) is made only by a licensed health care professional who is acting within the scope of the professional's license and who has training and experience in the provision of the health care item or service that is the subject of the determination;

``(3) reflects the independent clinical judgment of such professional, who shall conduct an independent evaluation of the participant's or beneficiary's individual medical circumstances and shall not treat any output of an artificial intelligence system as presumptively valid or defer to such output in lieu of independent clinical judgment applying generally accepted standards of care;

``(4) includes, in the notice required under this chapter, if an artificial intelligence system was used in connection with the determination-- ``(A) a statement that such system was used;

``(B) a description of its role in the review process; and ``(C) the name, professional license, and credentials of the licensed health care professional who made the determination;

``(5) is supported by documentation maintained as part of the administrative record describing-- ``(A) the artificial intelligence system used;

``(B) the role of such system in the review process;

``(C) any outputs, scores, recommendations, or determinations generated by such system; and ``(D) documentation demonstrating compliance with subparagraph (C);

and such materials shall be considered part of the administrative record and made available to the participant or beneficiary upon request.

``(b) Definitions.--For purposes of this section-- ``(1) Adverse benefit determination.--The term `adverse benefit determination' includes an initial determination and a determination on internal appeal.

``(2) Adverse benefit determination involving clinical judgment.--The term `adverse benefit determination involving clinical judgment' means an adverse benefit determination that is based, in whole or in part, on medical necessity, appropriateness, experimental and investigational or similar exclusions or limits, level of care, health care setting, effectiveness, clinical guidelines, utilization review criteria, other standards requiring evaluation of the participant's or beneficiary's medical condition or treatment needs, or generally accepted standards of care for such treatment needs.''.

(c) Parity Treatment.--Section 9812 of the Internal Revenue Code of 1986 is amended--

(1) in subsection (a)(8)(A), by adding at the end the following new clause:

``(vi) Whether an artificial intelligence system is used in, or materially influences, the design, development, application, or administration of such limitation and, if so, sufficient information regarding the function, operation, and effects of such system to enable the Secretary to evaluate such function, operation, and effects under such limitation with respect to mental health or substance use disorder benefits as compared to medical and surgical benefits, both as written and in operation.''; and

(2) by adding at the end the following:

``(f) Artificial Intelligence and Utilization Review.--The use of an artificial intelligence system in connection with utilization review shall constitute a treatment limitation for purposes of this section.''.

(d) Clerical Amendment.--The table of sections for subchapter B of

chapter 100 of the Internal Revenue Code of 1986 is amended by inserting after the item related to section 9815 the following new item:

``Sec. 9815A. Clinical judgment and artificial intelligence.''.

SEC. 5. EFFECTIVE DATE.

The amendments made by this Act shall apply to plan years beginning on or after January 1 of the first calendar year beginning not less than 12 months after the date of the enactment of this Act. <all>