Doctors Not AI Act of 2026

This bill aims to regulate the use of artificial intelligence systems by group health plans and health insurance issuers in the review of healthcare claims. It defines an AI system as an engineered or machine-based system that processes data to generate predictions, classifications, recommendations, or decisions materially influencing coverage determinations. A central provision prohibits AI systems from issuing or dictating adverse benefit determinations involving clinical judgment. These determinations, whether initial or on appeal, must be made solely by a licensed health care professional acting within their scope and with relevant experience. Professionals are required to exercise independent clinical judgment , evaluating individual medical circumstances and not deferring to AI outputs as presumptively valid. If an AI system was used, the notice of determination must disclose its use, describe its role, and provide the professional's name and credentials. The bill also mandates detailed documentation of the AI system used, its role, and any outputs, making these records part of the administrative record available to the enrollee. Furthermore, the use of an AI system in utilization review will be considered a treatment limitation for mental health and substance use disorder parity laws, requiring evaluation of its effects compared to medical and surgical benefits. These amendments apply broadly to health plans and issuers under the Public Health Service Act, ERISA, and the Internal Revenue Code, with an effective date for plan years beginning at least 12 months after enactment.