Lawmakers Introduce Bipartisan Bill to Reform Medicare Advantage: Faster Prior Authorizations, Greater Transparency, and Stronger Access for Home Health Providers

A bipartisan group of U.S. Lawmakers has introduced legislation aimed at reforming Medicare Advantage plans, citing concerns over prior authorization delays and coverage denials that affect seniors’ access to timely care. The bill, formally titled the Medicare Advantage Improvement Act of 2026, was introduced in the House of Representatives on Wednesday, April 23, 2026, by seven members of Congress representing both major parties.

The legislation seeks to align Medicare Advantage coverage standards more closely with traditional Medicare by prohibiting plans from using stricter criteria for approving services. It also includes specific timelines for prior authorization responses: standard requests must be addressed within 72 hours, even as expedited requests—such as those for urgent or inpatient care—must be resolved within 24 hours. The bill allows for limited extensions under defined circumstances but prohibits plans from requiring prior authorization when a service has already been approved or when a clinician makes a clinically necessary adjustment to a treatment plan.

Among its provisions, the bill mandates that Medicare Advantage plans implement real-time approval systems and publicly report key performance data. It also prohibits plans from denying payment for services that have already been authorized. To enforce compliance, the legislation establishes a modern scoring system to evaluate plan performance, with payment reductions proposed for those that consistently fail to meet benchmarks.

The lawmakers sponsoring the bill are Representatives John Joyce (R-PA), Greg Murphy (R-NC), Jimmy Panetta (D-CA), Ami Bera (D-CA), Beth Van Duyne (R-TX), Kim Schrier (D-WA) and Mariannette Miller-Meeks (R-IA). In a joint statement, Rep. Joyce emphasized that the legislation aims to restore accountability in the Medicare Advantage program and ensure that seniors receive the care they are promised without unnecessary delays or denials.

The introduction of the bill follows sustained criticism from healthcare providers, particularly in the home health and post-acute care sectors, who have argued that aggressive utilization management practices in some Medicare Advantage plans create administrative burdens and delay patient access to necessary services. Supporters of the reform argue that aligning Medicare Advantage with traditional Medicare standards will improve transparency and reduce variability in coverage decisions across plans.

As of the bill’s introduction, it has been referred to the relevant House committees for consideration. No companion legislation has yet been introduced in the Senate. The next step in the legislative process will involve committee review, potential hearings, and possible markup before any floor vote can be scheduled.

For updates on the bill’s progress, including full text, amendments, and committee actions, the public can consult the official congressional database at Congress.gov.

If you have insights or experiences related to Medicare Advantage coverage, prior authorization challenges, or access to care, we encourage you to share your thoughts in the comments below. Help spread awareness by sharing this article with others who may be affected by these policy developments.