This bill, titled the "Protecting Patients from Automated Denials Act," aims to amend the Social Security Act to establish stringent requirements for Medicare Advantage (MA) plans regarding the use of artificial intelligence (AI) in prior authorization denials. Starting January 1, 2027, MA plans will be prohibited from denying prior authorization requests based solely on AI output unless specific conditions are met. The core purpose is to ensure that medical judgment, not just algorithmic decisions, drives patient care approvals. A key provision mandates that any AI-generated denial must undergo review and approval by a qualified physician reviewer , acting under the clinical direction of the MA plan's medical director. This physician must provide a signed attestation confirming that their medical judgment was independent of the AI output and that the denial was not dictated by AI. Furthermore, the bill requires MA plans to offer transparency to both providers and patients, including disclosing the use of AI, providing the reviewer's NPI, and allowing direct communication with the physician reviewer to discuss the clinical basis for the denial. The Secretary of Health and Human Services is also granted significant oversight authority, including the ability to audit AI use and review related data and algorithms.