119-HR-6110 Journalist Public Summary

Headline Summary

Make Medicare Advantage plans automatically review every coverage denial—without the patient having to ask—and start the review deadline from the day the denial is issued.

What It Does

The bill changes Medicare Advantage appeals rules in the Social Security Act so that when a plan denies coverage, the plan must automatically reconsider that decision for each denial. It also shifts the timeline so the 60‑day reconsideration window starts on the date of the denial, rather than waiting for a patient to request a review. Today, federal law says reconsideration happens only “upon request by the enrollee,” with a 60‑day clock that runs from when the plan receives that request. The bill would replace that request‑based system with automatic reconsideration and an earlier start to the deadline. [1]Legal Information Institute (Cornell Law School) — 42 U.S. Code § 1395w‑22 — Be…

Why It Matters

Most Medicare Advantage denials are never appealed, even though the majority of appealed denials get overturned—meaning many wrong decisions may never be fixed. In 2023, only about 12% of denials were appealed, but roughly 82% of those appeals were partially or fully successful. Automatic reconsideration could surface errors without putting the burden on patients. [2]KFF — KFF issue brief — Medicare Advantage prior authorization determinations a…

Federal oversight has also found that some plan denials wrongly block medically necessary care that would be covered under traditional Medicare, highlighting the stakes for patients and providers. [3]HHS Office of Inspector General — HHS OIG report — Some Medicare Advantage Orga…

Who’s For It

• The bill is sponsored by Rep. Mark Pocan (D‑WI) and several House Democrats; supporters frame it as a patient‑protection step that removes red tape for seniors and people with disabilities.
• Patient and provider advocates who have pushed for prior‑authorization reforms, pointing to data showing low appeal rates and high overturn rates when people do appeal. [2]KFF — KFF issue brief — Medicare Advantage prior authorization determinations a…
• Hospitals and physician groups that have criticized Medicare Advantage delays and denials as barriers to needed care. [4]AHA — American Hospital Association statement on Medicare Advantage delays and…[3]HHS Office of Inspector General — HHS OIG report — Some Medicare Advantage Orga…

Who’s Against It

• Medicare Advantage insurers and their trade group (AHIP) generally say prior authorization and related reviews are safeguards for evidence‑based, affordable care; they favor streamlining and electronic automation over new mandates that could add administrative burden. [5]AHIP — AHIP statement on CMS Interoperability and Prior Authorization final rule[6]AHIP — AHIP press release — Health Plans Take Action to Simplify Prior Authoriz…

What’s Next

Status: Introduced in the House on November 18, 2025, and referred to the Committees on Ways and Means and Energy and Commerce. Next steps could include committee hearings or markups, a House floor vote, Senate consideration, and then the President’s desk if it passes both chambers.