To amend title XVIII of the Social Security Act to establish certain requirements with respect to rates of reversed prior authorization coverage determinations under Medicare Advantage plans.
About This Bill
Committee
Latest Action · November 18, 2025
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
This bill would establish new oversight rules for Medicare Advantage plans that use prior authorization—a process where insurers must approve medical services before patients receive them. The legislation would require the Centers for Medicare & Medicaid Services to terminate a Medicare Advantage plan's contract if more than 25 percent of initially denied prior authorizations are later overturned through reconsideration or appeal, or if the plan significantly reduces its reversal rate from the previous year without good reason. The requirements would take effect one year after the bill becomes law and apply to plan years beginning thereafter. This bill would primarily affect Medicare Advantage enrollees (seniors and disabled individuals covered under these private insurance plans) and the insurance companies offering them, as it aims to reduce inappropriate denials of medical services and ensure patients can access care they are entitled to receive.
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