This bill directs the Medicare program to reduce unnecessary delays in approving medical treatments and prescription drugs for seniors enrolled in Medicare Advantage plans. The legislation requires the Department of Health and Human Services to audit which high-cost medical services and drugs have enough scientific evidence to support standardized approval processes, then issue new rules by October 1, 2026 that make prior authorization requirements consistent across all Medicare Advantage plans instead of varying by individual insurance plan. The bill also creates an exemption allowing high-performing medical groups called accountable care organizations to skip prior authorization for their patients if they meet cost-saving benchmarks, though individual insurance plans can opt out of this exemption. The audit must be completed by January 1, 2026, and the reforms primarily affect Medicare Advantage enrollees, healthcare providers, and insurance companies offering these plans. This legislation aims to speed up patient access to care while ensuring that standardized approval requirements are based on solid medical evidence rather than administrative burden.
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