Medicare Advantage Improvement Act of 2026

Faster Care Access: Medicare Advantage organizations must respond to specified authorization requests within 72 hours, and expedited requests must be addressed within 24 hours (Section 2(a)).

Real-Time Approvals: For certain identified services, organizations must provide real-sime determinations and automated approvals through interoperable electronic health record technology (Section 2(b)).

Protection Against Denials for Necessary Changes: If a provider determines a modification or extension to an approved service is clinically necessary, the organization cannot require a new authorization (Section 2(c)).

Faster Appeals Process: The bill reduces the timeframe for organizations to submit case files during the reconsideration process to as little as 14 days (Section 2(d)).

Consistent Medical Necessity Standards: Medicare Advantage organizations cannot apply medical necessity criteria that are more restrictive than the standards used in Original Medicare (Section 5(b)).

Increased Transparency: Organizations are required to make coverage criteria and prior authorization data publicly available, providing better oversight for patients and researchers (Section 2(a) and Section 5(c)).

Guaranteed Payment for Approved Services: Once an item or service is authorized, the organization cannot deny coverage or reduce payment amounts later, except for good cause or fraud (Section 4(b)).

Potential for Deadline Extensions: Medicare Advantage organizations may extend the 72-hour response deadline by up to 7 days under specific circumstances, such as needing more medical evidence (Section 2(a)).

Secretarial Authority to Change Deadlines: The Secretary has the power to change the established response deadlines through rulemaking (Section 2(a)).