Bipartisan bill targets Medicare Advantage

Senators Roger Marshall of Kansas and Sheldon Whitehouse of Rhode Island introduced the Medicare Advantage Improvement Act on April 27, adding a Senate companion to a House bill filed the previous week. (marshall.senate.gov) (medcitynews.com) The House measure was introduced on April 23 by Representatives Jimmy Panetta and John Joyce, with Representatives Kim Schrier, Greg Murphy, Mariannette Miller-Meeks, Ami Bera, and Beth Van Duyne listed as cosponsors. (panetta.house.gov) (fiercehealthcare.com) The bill would require standard prior-authorization decisions within 72 hours, expedited decisions within 24 hours, and real-time approvals for routine low-risk services tied to electronic health records. (marshall.senate.gov) (medcitynews.com) It would also bar Medicare Advantage plans from retroactively denying coverage after a service was authorized except in cases of fraud or error, and it would prohibit automated denial algorithms. (marshall.senate.gov) Another provision would stop plans from using stricter medical-necessity standards than original Medicare and would require public reporting of prior-authorization data. (marshall.senate.gov) (medcitynews.com) The measure also targets post-acute care by tightening network adequacy rules for rehabilitation hospitals and long-term care hospitals, a pressure point for providers that treat patients after serious illness or injury. (marshall.senate.gov) (fiercehealthcare.com) The timing reflects the size of the program. KFF said Medicare Advantage enrollment reached 35 million people as of February 1, 2026, up 1.1 million from February 2025. (kff.org) KFF also found that Medicare Advantage insurers received nearly 53 million prior-authorization requests in 2024 and denied 4.1 million, or 7.7%, of them. (kff.org) Federal watchdogs have been pressing the issue too. The Government Accountability Office said in May 2025 that Centers for Medicare and Medicaid Services oversight of prior authorization should specifically target behavioral health services. (gao.gov) Provider groups are backing the bill. The American Health Care Association and National Center for Assisted Living said the proposal addresses insurer practices that make coverage and care navigation harder for Medicare Advantage patients. (fiercehealthcare.com) (medcitynews.com) The bill now heads into the usual congressional process, where its prospects will depend on whether bipartisan frustration with prior authorization turns into committee action. (medcitynews.com)