This bill establishes new rules for Medicare Advantage plans' use of prior authorization, which is the requirement that doctors get approval before providing certain treatments. Starting in 2026, Medicare Advantage plans must be transparent about which services require prior authorization and report detailed data to the federal government, including approval rates, appeal outcomes, and how long decisions take. Beginning in 2027, plans must adopt electronic systems for submitting and responding to authorization requests that meet federal standards, and they must implement protections for seniors including transparent processes developed with input from patients and doctors. The bill also directs the government to study how to speed up approvals for routinely approved services through real-time decisions and requires multiple reports to Congress evaluating the new requirements and their impact on patient access to care. The legislation affects millions of Medicare seniors and the doctors and hospitals that serve them through Medicare Advantage plans.
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