This legislation amends Medicare Advantage insurance plans to establish new rules for prior authorization, which is when insurers require approval before covering certain medical services. Starting in 2026, Medicare Advantage plans must provide transparency by disclosing which services require prior authorization and publishing data on approval rates, appeal outcomes, and decision timelines. Beginning in 2027, plans must implement electronic systems for submitting and responding to authorization requests, adopt clear approval criteria accessible to doctors and patients, and establish safeguards to protect enrollees' access to care. The bill also requires the Centers for Medicare & Medicaid Services to set response timeframes for authorization decisions and directs government agencies to study the effectiveness of these requirements and report to Congress, with the Medicare Payment Advisory Commission providing recommendations within three years of implementation.
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