{"check":null,"uid":"7f3620efc6b6c5c5","title":"Doctors Not AI Act of 2026","title_generated":false,"country":"США","organ":"Конгресс США","kind":"law","kind_name":"Законодательство","lang":"en","date":"2026-09-01","summary":"Законопроект запрещает групповым и индивидуальным планам медицинского страхования поручать искусственному интеллекту (AI system) отказы в оплате медицинской помощи, требующие клинической оценки.\nТакие решения — первичные и по апелляции — вправе принимать только лицензированный врач профильной специальности, который самостоятельно оценивает состояние пациента и не считает вывод ИИ заведомо верным. Если система применялась, пациенту в уведомлении сообщают об этом, описывают её роль и указывают принявшего решение врача; документация о работе системы включается в дело и выдаётся по запросу. Использование ИИ при рассмотрении жалоб приравнивается к ограничению лечения для целей паритета услуг психического здоровья.\nПравила вступают в силу для страховых периодов, начинающихся не раньше чем через 12 месяцев после принятия закона.","snippet":"","topics":["Искусственный интеллект"],"status":"ok","error":"","text_len":15422,"versions":1,"url":"https://www.congress.gov/bill/119th-congress/house-bill/10210","first_seen":"2026-09-03","last_checked":"2026-09-17 01:57","relevance":"hit","score":47,"query":"","source_key":"congress_us","verdict":{"relevance":"hit","score":47,"topics":["Искусственный интеллект"],"need_body":3,"authorities":[],"evidence":[{"topic":"Искусственный интеллект","term":"ai act","weak":false,"pos":12,"ctx":"doctors not ai act of 2026 законопроект запрещает групповым и индивидуальным планам медицинского страхования","zone":"название","weight":3},{"topic":"Искусственный интеллект","term":"искусственн","weak":false,"pos":118,"ctx":"аконопроект запрещает групповым и индивидуальным планам медицинского страхования поручать искусственному интеллекту (ai system) отказы в оплате медицинской помощи, требующие клинической оценки.","zone":"название","weight":3},{"topic":"Искусственный интеллект","term":"artificial intelligence","weak":false,"pos":346,"ctx":"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","zone":"текст","weight":1},{"topic":"Искусственный интеллект","term":"artificial intelligence","weak":false,"pos":1299,"ctx":"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","zone":"текст","weight":1},{"topic":"Искусственный интеллект","term":"ai act","weak":false,"pos":1636,"ctx":"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 artif","zone":"текст","weight":1},{"topic":"Искусственный интеллект","term":"artificial intelligence","weak":false,"pos":1727,"ctx":"i 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","zone":"текст","weight":1},{"topic":"Искусственный интеллект","term":"artificial intelligence","weak":false,"pos":1890,"ctx":"e 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","zone":"текст","weight":1},{"topic":"Искусственный интеллект","term":"machine learning","weak":false,"pos":2010,"ctx":"' 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 prediction","zone":"текст","weight":1}],"dropped":[]},"last_changed":"2026-09-04","meta":{"congress":"119","billType":"HR","number":"10210","policyArea":"Health","subjects":[],"latestAction":"2026-09-01 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."},"source_url":"https://www.congress.gov/bill/119th-congress/house-bill/10210","text":"FULL TEXT\n[Congressional Bills 119th Congress]\n[From the U.S. Government Publishing Office]\n[H.R. 10210 Introduced in House (IH)]\n\n<DOC>\n\n119th CONGRESS\n2d Session\nH. R. 10210\n\nTo amend title XXVII of the Public Health Service Act, the Employee\nRetirement Income Security Act of 1974, and the Internal Revenue Code\nof 1986 to regulate the use of artificial intelligence in the review of\nclaims by group health plans and health insurance issuers offering\ngroup or individual health insurance coverage.\n\n_______________________________________________________________________\n\nIN THE HOUSE OF REPRESENTATIVES\n\nSeptember 1, 2026\n\nMr. Landsman (for himself, Mr. Carter of Georgia, Ms. Schrier, and Mr.\nBarrett) introduced the following bill; which was referred to the\nCommittee on Energy and Commerce, and in addition to the Committees on\nWays and Means, and Education and Workforce, for a period to be\nsubsequently determined by the Speaker, in each case for consideration\nof such provisions as fall within the jurisdiction of the committee\nconcerned\n\n_______________________________________________________________________\n\nA BILL\n\nTo amend title XXVII of the Public Health Service Act, the Employee\nRetirement Income Security Act of 1974, and the Internal Revenue Code\nof 1986 to regulate the use of artificial intelligence in the review of\nclaims by group health plans and health insurance issuers offering\ngroup or individual health insurance coverage.\n\nBe it enacted by the Senate and House of Representatives of the\nUnited States of America in Congress assembled,\n\nSECTION 1. SHORT TITLE.\n\nThis Act may be cited as the ``Doctors Not AI Act of 2026''.\n\nSEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.\n\n(a) Definition of Artificial Intelligence System.--Section 2791 of\nthe Public Health Service Act (42 U.S.C. 30099-91) is amended by adding\nat the end the following:\n``(g) The term `artificial intelligence system' means an engineered\nor machine-based system, including any algorithm, predictive model,\nmachine learning system, or automated decision-making software, that\nprocesses data to generate predictions, classifications,\nrecommendations, or decisions and that is used to materially influence,\nautomate, or issue determinations regarding coverage of health care\nitems or services.''.\n(b) Clinical Judgment and Artificial Intelligence.--The Public\nHealth Service Act is amended by inserting after section 2719A (42\nU.S.C. 300gg-19a) the following new section:\n\n``SEC. 2719B. CLINICAL JUDGMENT AND ARTIFICIAL INTELLIGENCE.\n\n``(a) In General.--A group health plan and a health insurance\nissuer offering group or individual health insurance coverage shall\nensure that any adverse benefit determination, whether initially or\nupon appeal, involving clinical judgment--\n``(1) is not issued by an artificial intelligence system\nand is not dictated or determined by the output of such system;\n``(2) is made only by a licensed health care professional\nwho is acting within the scope of the professional's license\nand who has training and experience in the provision of the\nhealth care item or service that is the subject of the\ndetermination;\n``(3) reflects the independent clinical judgment of such\nprofessional, who shall conduct an independent evaluation of\nthe enrollee's individual medical circumstances and shall not\ntreat any output of an artificial intelligence system as\npresumptively valid or defer to such output in lieu of\nindependent clinical judgment applying generally accepted\nstandards of care;\n``(4) includes, in the notice required under section 2719,\nif an artificial intelligence system was used in connection\nwith the determination--\n``(A) a statement that such system was used;\n``(B) a description of its role in the review\nprocess; and\n``(C) the name, professional license, and\ncredentials of the licensed health care professional\nwho made the determination; and\n``(5) is supported by documentation maintained as part of\nthe administrative record describing--\n``(A) the artificial intelligence system used;\n``(B) the role of such system in the review\nprocess;\n``(C) any outputs, scores, recommendations, or\ndeterminations generated by such system; and\n``(D) documentation demonstrating compliance with\nsubparagraph (C); and\nsuch materials shall be considered part of the administrative\nrecord and made available to the enrollee upon request.\n``(b) Definitions.--For purposes of this section:\n``(1) Adverse benefit determination.--The term `adverse\nbenefit determination' includes an initial determination and a\ndetermination on internal appeal.\n``(2) Adverse benefit determination involving clinical\njudgment.--The term `adverse benefit determination involving\nclinical judgment' means an adverse benefit determination that\nis based, in whole or in part, on medical necessity,\nappropriateness, experimental and investigational or similar\nexclusions or limits, level of care, health care setting,\neffectiveness, clinical guidelines, utilization review\ncriteria, other standards requiring evaluation of the\nenrollee's medical condition or treatment needs, or generally\naccepted standards of care for such treatment needs.''.\n(c) Parity Treatment of Artificial Intelligence Systems.--Section\n2726 of the Public Health Service Act (42 U.S.C. 300gg-26) is amended--\n(1) in subsection (a)(8)(A), by adding at the end the\nfollowing new clause:\n``(vi) Whether an artificial intelligence\nsystem is used in, or materially influences,\nthe design, development, application, or\nadministration of such limitation and, if so,\nsufficient information regarding the function,\noperation, and effects of such system to enable\nthe Secretary to evaluate such function,\noperation, and effects under such limitation\nwith respect to mental health or substance use\ndisorder benefits as compared to medical and\nsurgical benefits, both as written and in\noperation.''; and\n(2) by adding at the end the following:\n``(f) Artificial Intelligence and Utilization Review.--The use of\nan artificial intelligence system in connection with utilization review\nshall constitute a treatment limitation for purposes of this\nsection.''.\n\nSEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF\n1974.\n\n(a) Definition of Artificial Intelligence System.--Section 3 of the\nEmployee Retirement Income Security Act of 1974 (29 U.S.C. 1002) is\namended by adding at the end the following:\n``(48) The term `artificial intelligence system' means an\nengineered or machine-based system, including any algorithm,\npredictive model, machine learning system, or automated\ndecision-making software, that processes data to generate\npredictions, classifications, recommendations, or decisions and\nthat is used to materially influence, automate, or issue\ndeterminations regarding coverage of health care items or\nservices.''.\n(b) Claims Procedure Requirements.--Section 503 of the Employee\nRetirement Income Security Act of 1974 (29 U.S.C. 1133) is amended--\n(1) in paragraph (2), by striking the period at the end and\ninserting ``; and''; and\n(2) by adding at the end the following:\n``(3) ensure that any adverse benefit determination,\nwhether initially or upon appeal, involving clinical judgment--\n``(A) is not issued by an artificial intelligence\nsystem and is not dictated or determined by the output\nof such system;\n``(B) is made only by a licensed health care\nprofessional who is acting within the scope of the\nprofessional's license and who has training and\nexperience in the provision of the health care item or\nservice that is the subject of the determination;\n``(C) reflects the independent clinical judgment of\nsuch professional, who shall conduct an independent\nevaluation of the participant's or beneficiary's\nindividual medical circumstances and shall not treat\nany output of an artificial intelligence system as\npresumptively valid or defer to such output in lieu of\nindependent clinical judgment applying generally\naccepted standards of care;\n``(D) includes, in the notice required under\nparagraph (1), if an artificial intelligence system was\nused in connection with the determination--\n``(i) a statement that such system was\nused;\n``(ii) a description of its role in the\nreview process; and\n``(iii) the name, professional license, and\ncredentials of the licensed health care\nprofessional who made the determination; and\n``(E) is supported by documentation maintained as\npart of the administrative record describing--\n``(i) the artificial intelligence system\nused;\n``(ii) the role of such system in the\nreview process;\n``(iii) any outputs, scores,\nrecommendations, or determinations generated by\nsuch system; and\n``(iv) documentation demonstrating\ncompliance with subparagraph (C); and\nsuch materials shall be considered part of the\nadministrative record and made available to the\nparticipant or beneficiary upon request.\nFor purposes of this paragraph, the term `adverse benefit\ndetermination' includes an initial determination and a\ndetermination on internal appeal, and the term `adverse benefit\ndetermination involving clinical judgment' means an adverse\nbenefit determination that is based, in whole or in part, on\nmedical necessity, appropriateness, experimental and\ninvestigational or similar exclusions or limits, level of care,\nhealth care setting, effectiveness, clinical guidelines,\nutilization review criteria, other standards requiring\nevaluation of the participant's or beneficiary's medical\ncondition or treatment needs, or generally accepted standards\nof care for such treatment needs.''.\n(c) Parity Treatment of Artificial Intelligence Systems.--Section\n712 of the Employee Retirement Income Security Act of 1974 (29 U.S.C.\n1185a) is amended---\n(1) in subsection (a)(8)(A), by adding at the end the\nfollowing new clause:\n``(vi) Whether an artificial intelligence\nsystem is used in, or materially influences,\nthe design, development, application, or\nadministration of such limitation and, if so,\nsufficient information regarding the function,\noperation, and effects of such system to enable\nthe Secretary to evaluate such function,\noperation, and effects under such limitation\nwith respect to mental health or substance use\ndisorder benefits as compared to medical and\nsurgical benefits, both as written and in\noperation.''; and\n(2) by adding at the end the following:\n``(h) Artificial Intelligence and Utilization Review.--The use of\nan artificial intelligence system in connection with utilization review\nshall constitute a treatment limitation for purposes of this\nsection.''.\n\nSEC. 4. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.\n\n(a) Definition of Artificial Intelligence System.--Section 9832 of\nthe Internal Revenue Code of 1986 is amended by adding at the end the\nfollowing new paragraph:\n``(11) Artificial intelligence system.--The term\n`artificial intelligence system' means an engineered or\nmachine-based system, including any algorithm, predictive\nmodel, machine learning system, or automated decision-making\nsoftware, that processes data to generate predictions,\nclassifications, recommendations, or decisions and that is used\nto materially influence, automate, or issue determinations\nregarding coverage of health care items or services.''.\n(b) Clinical Judgment and Artificial Intelligence.--Subchapter B of\nchapter 100 of the Internal Revenue Code of 1986 is amended by\ninserting after section 9815 the following new section:\n\n``SEC. 9815A. CLINICAL JUDGMENT AND ARTIFICIAL INTELLIGENCE.\n\n``(a) In General.--A group health plan shall ensure that any\nadverse benefit determination, whether initially or upon appeal,\ninvolving clinical judgment--\n``(1) is not issued by an artificial intelligence system\nand is not dictated or determined by the output of such system;\n``(2) is made only by a licensed health care professional\nwho is acting within the scope of the professional's license\nand who has training and experience in the provision of the\nhealth care item or service that is the subject of the\ndetermination;\n``(3) reflects the independent clinical judgment of such\nprofessional, who shall conduct an independent evaluation of\nthe participant's or beneficiary's individual medical\ncircumstances and shall not treat any output of an artificial\nintelligence system as presumptively valid or defer to such\noutput in lieu of independent clinical judgment applying\ngenerally accepted standards of care;\n``(4) includes, in the notice required under this chapter,\nif an artificial intelligence system was used in connection\nwith the determination--\n``(A) a statement that such system was used;\n``(B) a description of its role in the review\nprocess; and\n``(C) the name, professional license, and\ncredentials of the licensed health care professional\nwho made the determination;\n``(5) is supported by documentation maintained as part of\nthe administrative record describing--\n``(A) the artificial intelligence system used;\n``(B) the role of such system in the review\nprocess;\n``(C) any outputs, scores, recommendations, or\ndeterminations generated by such system; and\n``(D) documentation demonstrating compliance with\nsubparagraph (C);\nand such materials shall be considered part of the\nadministrative record and made available to the participant or\nbeneficiary upon request.\n``(b) Definitions.--For purposes of this section--\n``(1) Adverse benefit determination.--The term `adverse\nbenefit determination' includes an initial determination and a\ndetermination on internal appeal.\n``(2) Adverse benefit determination involving clinical\njudgment.--The term `adverse benefit determination involving\nclinical judgment' means an adverse benefit determination that\nis based, in whole or in part, on medical necessity,\nappropriateness, experimental and investigational or similar\nexclusions or limits, level of care, health care setting,\neffectiveness, clinical guidelines, utilization review\ncriteria, other standards requiring evaluation of the\nparticipant's or beneficiary's medical condition or treatment\nneeds, or generally accepted standards of care for such\ntreatment needs.''.\n(c) Parity Treatment.--Section 9812 of the Internal Revenue Code of\n1986 is amended--\n(1) in subsection (a)(8)(A), by adding at the end the\nfollowing new clause:\n``(vi) Whether an artificial intelligence\nsystem is used in, or materially influences,\nthe design, development, application, or\nadministration of such limitation and, if so,\nsufficient information regarding the function,\noperation, and effects of such system to enable\nthe Secretary to evaluate such function,\noperation, and effects under such limitation\nwith respect to mental health or substance use\ndisorder benefits as compared to medical and\nsurgical benefits, both as written and in\noperation.''; and\n(2) by adding at the end the following:\n``(f) Artificial Intelligence and Utilization Review.--The use of\nan artificial intelligence system in connection with utilization review\nshall constitute a treatment limitation for purposes of this\nsection.''.\n(d) Clerical Amendment.--The table of sections for subchapter B of\nchapter 100 of the Internal Revenue Code of 1986 is amended by\ninserting after the item related to section 9815 the following new\nitem:\n\n``Sec. 9815A. Clinical judgment and artificial intelligence.''.\n\nSEC. 5. EFFECTIVE DATE.\n\nThe amendments made by this Act shall apply to plan years beginning\non or after January 1 of the first calendar year beginning not less\nthan 12 months after the date of the enactment of this Act.\n<all>","changes":[],"passport":{"data":{"act":{"jurisdiction":"США","title_official":"Doctors Not AI Act of 2026","title_short":"Doctors Not AI Act","level":"законопроект","date_adopted":"2026-09-01","date_in_force":"план годы начиная с января первого календарного года спустя минимум 12 месяцев после принятия","date_version":"","phased":"","status":"законопроект: на рассмотрении","sunset":"","regulator":"Конгресс США","related":""},"goal":{"problem":"Искусственный интеллект используется страховыми компаниями для отказа в покрытии медицинских расходов без участия врачей","goal":"Обеспечить участие квалифицированных специалистов здравоохранения в принятии решений относительно покрытия медицинских расходов","targets":"","scope":"Групповые и индивидуальные планы медицинского страхования","exclusions":""},"subjects_note":{"protected":"Пациенты"},"subjects":[{"role":"Поставщик","who":"Страховая компания, предлагающая групповое или индивидуальное медицинское страхование","criteria":"Предлагает медицинские страховые услуги","count":"нет данных"}],"norms":[{"address":"Sec. 2719B(a)","addressee":"Поставщик","essence":"Запрет использования искусственного интеллекта для вынесения отрицательных решений по медицинским услугам","type":"запрет","mechanism":"Ограничение модели","cost_channel":"Содержательные","cost_kind":"Регулярные","trigger":"При обращении за покрытием медицинских расходов","sanction":"","refs":"","form":"Цифровая","in_force":"Через год после принятия","ru_analog":"Требует проверки"},{"address":"Sec. 2719B(a)(1)-(3)","addressee":"Поставщик","essence":"Обязанность обеспечения того, чтобы все отрицательные решения принимались врачом соответствующей специализации","type":"обязанность","mechanism":"Информирование, ограничение модели","cost_channel":"Административный","cost_kind":"Постоянно","trigger":"До начала деятельности","sanction":"","refs":"","form":"Бумажная","in_force":"Через год после принятия","ru_analog":"Требует проверки"},{"address":"Sec. 2719B(a)(4)","addressee":"Поставщик","essence":"Обязанность уведомления пациентов о применении искусственного интеллекта при отказе в покрытии","type":"обязанность","mechanism":"Информирование","cost_channel":"Административные","cost_kind":"По событию","trigger":"При отказе в покрытии","sanction":"","refs":"","form":"Цифровая","in_force":"Через год после принятия","ru_analog":"Требует проверки"},{"address":"Sec. 2719B(a)(5)","addressee":"Поставщик","essence":"Обязанность документирования работы искусственного интеллекта и предоставления этих документов пациентам по запросу","type":"обязанность","mechanism":"Информирование","cost_channel":"Административные","cost_kind":"По событию","trigger":"По запросу органа","sanction":"","refs":"","form":"Смешанная","in_force":"Через год после принятия","ru_analog":"Требует проверки"},{"address":"Sec. 2726(f)","addressee":"Поставщик","essence":"Применение искусственного интеллекта при рассмотрении жалоб считается ограничением лечения","type":"ограничение","mechanism":"Распределение риска","cost_channel":"Нет прямых издержек","cost_kind":"Регулярные","trigger":"Постоянно","sanction":"","refs":"","form":"Цифровая","in_force":"Через год после принятия","ru_analog":"Требует проверки"}]},"made_by":"GigaChat-2-Max","made_at":"2026-09-10 11:40:45","edited_at":null,"edited_by":null}}