Medicare Advantage insurers must show their work on denials—and fast.

What it does

This bill requires Medicare Advantage plans to establish electronic systems for prior authorization requests (the approval process insurers use before covering certain medical items and services), meet transparency standards by publishing data on approval/denial rates and decision times, and adopt enrollee protections. Plans must respond to urgent requests within 24 hours and routine requests within timeframes set by the Secretary, with the goal of reducing delays in seniors' access to care.

Why we flagged it

The bill's core mechanism is a procedural and transparency mandate on Medicare Advantage plans—requiring electronic prior authorization systems, public reporting of approval/denial data, and faster response times. It is fundamentally a patient-access and regulatory-transparency measure, not a payment or coverage expansion.

What the text implies

• Real-time decision automation (AI/machine learning) for 'routinely approved' items may reduce human review and create disparate access outcomes for rural and low-income beneficiaries, despite the bill's stated intent to reduce disparities—CMS is directed to analyze this but no corrective mechanism is mandated.
• Plans may use the 'optional' reporting provision (paragraph 3(B)(ii)) to disclose denial rates based on 'clinical criteria not met,' potentially shifting blame to patients rather than plan policies and obscuring systematic under-coverage.
• Transparency requirements apply only to plans that impose prior authorization; plans that eliminate prior authorization entirely face no reporting obligation, creating an incentive to shift denial mechanisms upstream (e.g., narrower networks, higher cost-sharing) rather than reform authorization processes.
• The bill does not establish a private right of action or penalty for non-compliance; enforcement relies on CMS oversight and GAO/HHS reporting, which may be slow and lack teeth if political will to enforce is absent.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Seniors gain faster access to medically necessary care through electronic systems, faster response times, and public transparency about which services are routinely denied. Providers gain clarity on approval criteria. The bill imposes operational costs on insurers but does not restrict seniors' rights or shift costs to beneficiaries.

Who stands to gain

• Healthcare providers and suppliers (reduced administrative burden from electronic systems and faster
• Health IT vendors (electronic prior authorization platform development and deployment)

Named in the bill

Medicare Advantage plans, Centers for Medicare & Medicaid Services (CMS), Office of National Coordinator for Health Information Technology (ONC), Medicare Payment Advisory Commission (MedPAC), Government Accountability Office (GAO), Department of Health and Human Services (HHS), Providers and suppliers, Medicare beneficiaries (seniors)

Where it stands

306 cosponsors: 170 Democrats, 136 Republicans.

• May 20, 2025 — Introduced · Congress.gov: “Introduced in House”
• May 20, 2025 — Referred to House Committee on Energy and Commerce and House Committee on Ways and Means · Congress.gov: “Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a…”
• Jun 25, 2026 — Markup held in committee · Congress.gov: “Subcommittee Consideration and Mark-up Session Held”
• Jul 15, 2026 — Reported out of committee · Congress.gov: “Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 42 - 0”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

77 lobbying clients named this bill on 113 disclosure filings across 3 quarters, Dec 2025 to Jun 2026. Those filings disclosed $33,643,975 in lobbying spend. A filing names 12 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 99% of bills with at least one filing.

Mike Kelly, the sponsor, reported $955,974 in PAC receipts in the 2026 cycle. $12,500 of that came from 3 PACs tied to these lobbying clients.

• American Medical Association — $5,643,000 on 2 filings
• American Hospital Association — $4,470,000 on 1 filing
• Alzheimer's Association — $1,800,000 on 1 filing
• Mckesson Corporation & Affiliates U.S. Oncology and Rx Savings Solutions — $1,710,000 on 2 filings
• Johnson & Johnson Services Inc — $1,440,000 on 1 filing

Lobbying Disclosure Act filings through Jul 21, 2026. A filing shows who paid to lobby on a bill it names, not what changed.