Medicare Advantage Improvement Act of 2026

Sponsor: John Joyce (Republican-PA)April 20, 2026

AI-generated ?

Report an error

Introduced

In Committee

Passed One Chamber

Passed Both Chambers

Signed into Law

Sponsor introductory remarks on measure. (CR H3095)

Requires Medicare Advantage plans to speed up care approvals and follow stricter rules.

This bill would make Medicare Advantage plans respond quicker to requests for medical care and pay healthcare providers more quickly. It would also increase government monitoring of these plans and make their coverage rules clearer. This aims to help people enrolled in Medicare Advantage get the care they need without needless waits, starting January 1, 2028.

What Would Change

Today, Medicare Advantage plans have longer timeframes for prior authorization decisions and more flexibility in their medical necessity criteria and payment practices. They can also require new authorizations for minor changes to approved care. After this bill, Medicare Advantage plans would have much shorter deadlines for approving care, would need to provide real-time approvals for some services, and would be prohibited from requiring new authorizations for minor, clinically necessary adjustments. They would also face stricter rules on denying payment for approved services and greater government oversight.

Key Provisions

Requires Medicare Advantage plans to respond to most care requests within 72 hours, and urgent requests within 24 hours, starting January 1, 2028.
Requires Medicare Advantage plans to complete internal reconsiderations of care denials within 14 days, down from 60 days, starting January 1, 2028.
Requires Medicare Advantage plans to provide "real-time" (immediate automated) approvals for certain routine and low-risk services, starting January 1, 2028.
Bans Medicare Advantage plans from requiring new authorizations for small, clinically necessary changes or extensions to an already approved service, starting January 1, 2028.
Requires Medicare Advantage plans to pay 100% of claims for services they already authorized, treating them as "clean claims" that cannot be denied later for lack of medical necessity, starting January 1, 2028.

View on Congress.gov

HR 8375 · 119th Congress · April 20, 2026 · AI Summary by gemini-2.5-flash · 9/10

Creates a new government scoring system for Medicare Advantage plans to assess their following of rules, with plans scoring poorly facing payment reductions, starting January 1, 2028.

Requires Medicare Advantage plans to use the same medical necessity standards as original Medicare (the traditional program where doctors and hospitals are paid for each service) when deciding on coverage, starting January 1, 2028.

Requires Medicare Advantage plans to publish their coverage standards for services not covered by national or local rules, starting January 1, 2028.

Requires Medicare Advantage plans to ensure adequate access to long-term care hospitals and inpatient rehabilitation facilities, starting January 1, 2028.

Lobbying Activity

1 filings mentioned this bill

Top Lobbying Clients

SCULLY ROSKEY AND MISSMAR ON BEHALF OF ENCOMPASS HEALTH

$20K

1 filing

Top Lobbying Firms

1.FEDERAL HEALTH POLICY STRATEGIES1 filing

Amounts reflect total quarterly lobbying spend reported to the Senate, not bill-specific spending. Source: Senate LDA filings.

Take Action on This Bill

Write a Letter

Send a letter to your representatives via ResistBot

Text 50409 Open ResistBot