Congressional bill targets prior-authorisation

House Democrats moved to ban most prior authorization in Medicare Advantage, turning a long-running insurance practice into a fresh Capitol Hill fight. (khanna.house.gov) The bill, called the Stop Deadly Denials Act of 2026, was introduced in the House on April 22 by Representatives Ro Khanna of California and Pramila Jayapal of Washington. Its text says Medicare Advantage plans could not impose prior authorization on covered items and services for plan years starting January 1, 2027, with exceptions where traditional Medicare already requires it. (khanna.house.gov) Prior authorization is the insurer’s requirement that a doctor or hospital get approval before delivering certain care. KFF reported that 99% of Medicare Advantage enrollees are in plans that require prior authorization for some services, while traditional Medicare uses it for a narrower set of services. (kff.org) The scale of the practice has grown with Medicare Advantage enrollment. KFF said insurers received nearly 53 million prior-authorization requests in 2024 and denied 4.1 million of them, or 7.7%. (kff.org) Federal watchdogs have been documenting the problem for years. A 2022 Office of Inspector General report found some Medicare Advantage organizations delayed or denied care that met Medicare coverage rules, including requests involving MRIs and post-acute rehabilitation stays. (oig.hhs.gov) Congress and regulators have been trying a narrower fix: make prior authorization faster and more visible, not eliminate it. The Centers for Medicare & Medicaid Services finalized an interoperability rule on January 17, 2024, requiring Medicare Advantage organizations and other payers to improve electronic prior-authorization workflows and public reporting, with key application-programming-interface requirements due primarily by January 1, 2027. (cms.gov) CMS also tightened some Medicare Advantage guardrails in a separate final rule issued April 4, 2025. That rule said plans generally must honor an approved inpatient admission except in cases of obvious error or fraud, and it applied Medicare Advantage appeals rules to adverse decisions made during a patient’s care, not just before or after it. (cms.gov) Insurers and Medicare Advantage advocates have argued for streamlining rather than scrapping prior authorization. AHIP said in June 2025 that health plans were making commitments to simplify and reduce prior authorization while keeping what it called a safeguard for safe, evidence-based, and affordable care, and Better Medicare Alliance said the process “should be easier” while still helping control costs. (ahip.org) (bettermedicarealliance.org) The new bill goes further than those regulatory and industry steps by targeting the requirement itself inside Medicare Advantage. If it advances, the debate will shift from how fast plans answer prior-authorization requests to whether they should be allowed to ask at all for most Medicare-covered care. (khanna.house.gov)