This resolution urges the Centers for Medicare & Medicaid Services to immediately halt its AI-driven pilot program for determining Medicare coverage to protect seniors' access to critical healthcare.
Greg Landsman
Representative
OH-1
This resolution expresses the sense of the House of Representatives that the Centers for Medicare & Medicaid Services (CMS) must immediately halt its pilot program utilizing artificial intelligence to determine Medicare coverage. Congress is urging CMS to stop using AI in coverage decisions to ensure seniors' access to critical healthcare is not jeopardized. Furthermore, the resolution requires CMS to review any coverage decisions made under the suspended pilot program.
Congress Moves to Stop CMS Pilot Program Using AI to Decide Senior Medicare Coverage
This House Resolution is essentially Congress telling the Centers for Medicare & Medicaid Services (CMS) to hit the emergency brake on a new pilot program launched on June 27, 2025. This program was set to hire private, for-profit companies to use artificial intelligence (AI) to determine what medical services Medicare would cover for seniors. The resolution demands that CMS immediately halt this experimental AI program, arguing that algorithms shouldn’t be making final, life-altering decisions about patient care.
The Algorithm vs. The Doctor’s Note
For anyone with a parent or grandparent on Medicare, this is a big deal. The core of the resolution is a firm statement that CMS should not use AI tools to make final coverage determinations. Think of it this way: instead of a human reviewer, who can look at a patient’s complex medical history and the doctor’s rationale, an algorithm could be making a simple yes/no decision. The House is signaling that they want human oversight and judgment, not just speed and potential cost savings, when it comes to critical healthcare access.
Mandatory Review: Checking the AI’s Homework
The resolution doesn’t just stop the future use of the AI program; it forces CMS to clean up any mess the pilot might have already made. CMS must notify all contractors, providers, and the public that the program is over. Crucially, the bill mandates that CMS must immediately review any coverage decisions already made by the AI or the private companies under the pilot program. This is a critical protection for patients who may have been wrongly denied coverage for necessary procedures because of an unproven, experimental review process. If you were denied a service between June 27, 2025, and the date this program is halted, your case should be looked at again by a human.
Who Benefits from the Pause Button?
This resolution is a clear win for Medicare beneficiaries. It removes the uncertainty and potential risk associated with having a machine decide whether a high-cost treatment—like a necessary surgery or a specialized therapy—is covered. For healthcare providers, it means a return to dealing with human reviewers, who are often easier to appeal to than a black-box algorithm. The only groups negatively impacted are the for-profit companies that stood to gain contracts from running this AI review system. Ultimately, this move reflects a priority shift: protecting seniors’ access to care over pursuing a potentially streamlined, but risky, automated process.