119-HR-8375 Journalist Public Summary
119 · HR 8375 Medicare Advantage Improvement Act of 2026
A bipartisan House bill would speed up and simplify Medicare Advantage prior authorization, curb post-claim clawbacks, align coverage rules with traditional Medicare, and penalize plans that don’t comply—changes aimed at quicker care decisions and fewer billing disputes starting in 2028.
Headline Summary
A bipartisan plan to make Medicare Advantage decisions faster and fairer—tightening prior-authorization timelines, requiring real‑time approvals for routine care, limiting post-claim denials, and tying plan payments and star ratings to compliance.
What It Does
In plain terms, the Medicare Advantage Improvement Act of 2026 tries to get patients timely care and cut red tape. Starting January 1, 2028, it shortens decision deadlines for prior authorization, requires instant approvals for certain routine services through electronic health records, and bars plans from reversing approved care after the fact except for fraud or clear error. It also aligns Medicare Advantage coverage criteria with traditional Medicare (including the “two‑midnight” inpatient rule), adds public reporting on plan practices, and creates penalties and star‑rating consequences for plans that don’t follow the rules.
- Faster prior authorization: standard decisions within 72 hours; expedited within 24 hours, with limited extensions.
- Real‑time approvals for a government‑set list of routine/low‑risk services via certified EHR tools, plus public reporting on outcomes.
- No new prior auth needed for clinically necessary tweaks while an approved service is being provided.
- Stronger appeals timelines and independent review deadlines.
- Limits on post‑service “clawbacks” and code downgrades after an approval; prompt payment required for authorized claims.
- Coverage rules can’t be stricter than traditional Medicare; codifies the two‑midnight benchmark and presumption for inpatient admissions.
- New compliance scorecard with public disclosure; payment reductions for repeated noncompliance and added weight in MA Star Ratings.
- Requires adequate networks for certain post‑acute providers (long‑term care hospitals and inpatient rehab facilities).
Who’s For It
- Sponsors: Reps. John Joyce (R‑PA), Kim Schrier (D‑WA), Greg Murphy (R‑NC), Jimmy Panetta (D‑CA), Mariannette Miller‑Meeks (R‑IA), Ami Bera (D‑CA), and Beth Van Duyne (R‑TX) — signaling bipartisan backing.
- Patient and caregiver advocates who want fewer delays from prior authorization and clearer appeal paths.
- Hospitals, physicians, and post‑acute providers who favor prompt payment, consistent coverage standards with traditional Medicare, and fewer mid‑care authorization hurdles.
Who’s Against It
- Some Medicare Advantage insurers and industry groups may argue the bill’s penalties, prompt‑payment mandates, and limits on post‑claim review could raise costs and reduce tools to prevent waste or fraud.
- Budget hawks may worry that faster approvals and restricted denials could increase Medicare spending or premiums if not offset elsewhere.
- Technology and administrative concerns: smaller providers and plans could face up‑front costs to integrate real‑time EHR authorization tools.
What’s Next
Status as of April 29, 2026: Introduced in the House on April 20, 2026; referred to the Committees on Ways and Means and Energy & Commerce; sponsor remarks entered April 27, 2026. Next steps typically include committee hearings/markups, a House vote, then consideration in the Senate, and, if passed, the President’s signature. Most provisions would take effect January 1, 2028.
Key Numbers and Dates
- Bill number
- H.R. 8375 (119th Congress)
- Short title
- Medicare Advantage Improvement Act of 2026
- Introduced
- April 20, 2026 (House)
- Recent action
- Sponsor remarks entered April 27, 2026
- Primary committees
- Ways and Means; Energy & Commerce
- General effective date
- January 1, 2028 (various sections)
Discussion