HR 6361 Ban AI Denials in Medicare Act 2025

• Authority: United States Congress
• Parent authority: Federal government
• Jurisdiction: United States
• Collections: U.S. federal laws
• Most recent activity: Proposed
• Most recent activity date: 2025-12-02

Risk subdomain coverage

Minimal coverage — Brief mention but no specific mitigations, recommendations or governance measures relating to the risk subdomain are described.

• Overreliance and unsafe use
• Loss of human agency and autonomy
• Lack of capability or robustness

All other risk subdomains had no coverage in this document.

Risk Coverage Summary

The document primarily addresses risks in Human-Computer Interaction (5.1, 5.2) and AI System Safety (7.3), with focus on overreliance on AI systems for critical healthcare decisions, loss of human agency in medical authorization processes, and concerns about AI system robustness in healthcare contexts. Coverage is concentrated in healthcare-specific AI deployment risks.

Sector coverage

Good coverage — Comprehensive governance measures or mitigations with clear procedures relating to the sector are explicitly described.

• Health Care & Social Assistance
• Public Administration (excl. National Security)

All other sectors had no coverage in this document.

Sectors Summary

This document primarily governs the Health Care and Social Assistance sector, specifically Medicare services under Parts A and B (hospital insurance and medical insurance). It also has significant implications for Public Administration as it regulates the Secretary of Health and Human Services and the Center for Medicare and Medicaid Innovation's authority to implement payment models.

Legislative Status

Hard Law

Legislative Status Summary

This is a Congressional bill that would create binding statutory prohibitions on the Secretary of Health and Human Services, amending the Social Security Act with mandatory language and legal enforceability.

Actors

Proposer

• Entity Types: AI_Governance_Actor
• Entities: United States Congress; Senate and House of Representatives of the United States of America
• Summary: The document is a Congressional bill as indicated by the formal enactment clause and bill format. Congress is the legislative body proposing this governance measure.

Target

• Entity Types: AI_Governance_Actor, AI_Deployer
• Entities: Secretary of Health and Human Services; Center for Medicare and Medicaid Innovation
• Summary: The bill directly targets the Secretary of Health and Human Services, prohibiting implementation of AI-based prior authorization models. The Center for Medicare and Medicaid Innovation (CMI) is referenced as the entity that would test such models.

Enforcer

• Entity Types: AI_Governance_Actor
• Entities: Secretary of Health and Human Services; Federal courts
• Summary: Enforcement would occur through standard statutory mechanisms - the Secretary must comply with the statutory prohibition, and federal courts would enforce through judicial review if challenged. No specific enforcement agency is named but enforcement is implicit in the statutory prohibition structure.

Monitor

• Summary: No explicit monitoring body or oversight mechanism is specified in this bill excerpt. Monitoring would likely occur through standard congressional oversight and administrative review processes, but these are not detailed in the document.

AI Lifecycle Stages

Lifecycle stages covered by the documents, as defined in the OECD Framework for the Classification of AI Systems

• Deploy
• Operate and Monitor

AI Lifecycle Summary

The document focuses exclusively on the deployment and operation stages of AI systems, specifically prohibiting the deployment and operation of AI-based prior authorization models in Medicare. It does not address earlier lifecycle stages such as design, data collection, model development, or validation.

Technical Scope

Terms relating to technical scope that are mentioned or implicitly referenced in the document

• AI Models
• AI Systems
• Task-specific AI

Technical Scope Summary

The document explicitly mentions artificial intelligence in the context of prior authorization systems. It references the WISeR model as a specific payment and service delivery model. There is no mention of frontier AI, general purpose AI, foundation models, generative AI, compute thresholds, or open-source models.