Bill · H.R. 6109· House(119-HR-6109)

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.

Age: 62 years

Wisconsin

Introduced: 11/18/2025
Last activity: 11/18/2025 — 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.
Sponsored by: Mark Pocan
Cosponsors: - 18 - 0

Health

Introduced
In Committee

What this bill would do

This bill proposes an amendment to title XVIII of the Social Security Act regarding Medicare Advantage plans. It aims to establish specific requirements for the rates of reversed prior authorization coverage determinations. If a plan exceeds a certain allowable rate of these reversals, the Secretary is required to terminate the contract for that plan. A plan exceeds the allowable rate if more than 25 percent of initial denials are later reversed through reconsideration or appeal. It also addresses situations where there is a significant drop in reversed determinations due to a failure to appropriately reconsider coverage.

Yes· 3 of 8

Would people over 65 be better off under this?+5
The bill protects seniors enrolled in Medicare Advantage plans by penalizing plans that frequently deny coverage that should be granted.
Would retired people be better off under this?+5
The bill improves the reliability of coverage for retirees using Medicare Advantage plans by curbing excessive denials.
Does this make health care easier to get in general?+4
The bill aims to prevent excessive and unjustified coverage denials for medical services through stricter oversight of Medicare Advantage plans.