Bipartisan Bill Targets Medicare Advantage Prior Authorization Delays
Lawmakers introduced the Medicare Advantage Improvement Act of 2026 to reform prior authorization practices.
Why it matters: The proposed legislation could reshape compliance and oversight rules for Medicare Advantage plans, directly impacting legal counsel advising health insurers and providers. Enhanced transparency and penalties may require updated due diligence and regulatory strategies.
- H.R. 8375 was introduced by a bipartisan group in the U.S. House of Representatives.
- The bill aims to standardize coverage between Medicare Advantage and traditional Medicare.
- It would increase transparency and penalize plans that miss oversight benchmarks.
- Nearly 53 million prior authorization requests were processed by Medicare Advantage insurers in 2024.
A bipartisan coalition in the U.S. House has introduced the Medicare Advantage Improvement Act of 2026 (H.R. 8375), seeking to significantly reform oversight and transparency within Medicare Advantage (MA) plans.
- The bill’s sponsors—Representatives John Joyce (PA-13), Kim Schrier (WA-08), Gregory Murphy (NC-03), Jimmy Panetta (CA-19), Mariannette Miller-Meeks (IA-01), Ami Bera (CA-06), and Beth Van Duyne (TX-24)—have proposed major changes focusing on prior authorization practices within MA programs.
- Key provisions include standardizing coverage criteria with traditional Medicare, increasing transparency in prior authorization, and imposing penalties for plans failing oversight or compliance checkpoints. The bill also calls for real-time and automated processes to reduce administrative burdens, timely payment measures, and protections against retroactive payment clawbacks.
Industry scrutiny of MA prior authorizations continues to grow: In 2024, nearly 53 million requests were submitted, with around 4.1 million (7.7%) fully or partially denied. A 2022 HHS Inspector General report revealed that 13% of denied requests met Medicare coverage rules and should have been approved.
The American Health Care Association and National Center for Assisted Living endorsed the bill, saying it moves Medicare Advantage closer to delivering on its core commitments to seniors. Clif Porter, CEO of AHCA/NCAL, called it “a significant step towards ensuring Medicare Advantage delivers on its promise to America's seniors.”
While details on proposed penalties remain scarce and legislative timelines are unclear, legal and compliance teams advising healthcare sector clients should monitor the bill’s progression and prepare for potential shifts in regulatory and operational requirements.
By the numbers:
- 53 million — prior authorization requests processed by MA insurers in 2024
- 7.7% — rate of full or partial denials among 2024 requests (approx. 4.1 million)
- 13% — share of denied requests in 2022 that met Medicare coverage rules
Yes, but: Details about the specific penalties and implementation timeline are not yet available.
What's next: Progress of the bill through Congress and details on enforcement mechanisms remain to be announced.