H.R. 10210 — Doctors Not AI Act of 2026

This section defines an artificial intelligence system and prohibits group health plans and issuers of group or individual health insurance coverage from using such systems to issue or determine any adverse benefit determination involving clinical judgment. It requires these determinations to be made solely by a licensed health care professional exercising independent judgment based on the enrollee’s circumstances and generally accepted standards of care, with notice and documentation requirements when an artificial intelligence system was used in the review. It also treats the use of an artificial intelligence system in utilization review as a treatment limitation subject to mental health parity rules.

This section defines an artificial intelligence system under the Employee Retirement Income Security Act of 1974 as an engineered or machine-based system, including any algorithm or automated decision-making software, that processes data to generate predictions or decisions and materially influences coverage of health care items or services. It prohibits employee benefit plans from issuing adverse benefit determinations involving clinical judgment through an artificial intelligence system and requires such determinations to be made solely by a licensed health care professional exercising independent clinical judgment, with disclosure of any artificial intelligence role and supporting documentation in the administrative record. It also requires plans to disclose whether an artificial intelligence system is used in mental health or substance use disorder benefit limitations and treats artificial intelligence use in utilization review as a treatment limitation subject to mental health parity requirements.

This section defines an artificial intelligence system as any engineered or machine-based system, including algorithms and automated decision-making software, that processes data to generate predictions or decisions and materially influences coverage determinations for health care items or services. It requires group health plans to ensure that adverse benefit determinations involving clinical judgment are made solely by licensed health care professionals exercising independent judgment, prohibits AI from issuing or dictating such determinations, and mandates specific disclosures, documentation, and recordkeeping. It also treats AI use in utilization review as a treatment limitation under mental health parity rules and requires plans to disclose AI involvement in designing or administering such limitations.