Medicare Advantage plans face payment cuts for slow approvals and improper denials

What it does

This bill tightens Medicare Advantage (MA) plan rules to speed up authorization decisions, improve transparency, and penalize plans that deny coverage improperly. Starting in 2028, MA plans must approve or deny routine requests within 72 hours (24 hours for urgent cases), publish their approval rates publicly, and cannot deny claims after approving them or require new authorizations for clinically necessary changes to approved services. Plans that fail compliance audits face payment cuts of 1–2%.

Why we flagged it

The bill's core function is to enforce faster authorization decisions, prevent retroactive denials, and create financial penalties for non-compliant MA plans. It is regulatory enforcement and consumer protection, not a subsidy or carve-out.

What the text implies

• MA plans may respond by narrowing networks or raising premiums to offset 1–2% payment reductions, shifting costs to beneficiaries indirectly.
• Real-time authorization requirements may force plans to invest in EHR integration and automated approval systems, raising operational costs that could be passed to enrollees.
• Compliance scoring and public disclosure of plan performance may accelerate beneficiary switching away from low-performing plans, destabilizing enrollment for some regional MA insurers.
• Prohibition on retroactive denials and code-change clawbacks removes a major revenue lever for MA plans; financial impact on plan profitability is material and may trigger industry consolidation.

Who it affects

Beneficiaries gain faster access to care, stronger protections against retroactive denials, and more transparent plan performance data. Providers face reduced administrative burden and faster payment. MA plans face compliance costs and payment penalties, but these are enforcement mechanisms designed to protect enrollees, not subsidies to plans.

Who stands to gain

• Medicare beneficiaries (faster care access, stronger protections)
• Healthcare providers (faster payment, reduced prior-auth burden)
• Independent review entities (expanded appeals workload)

Named in the bill

Medicare Advantage organizations (MAOs), Centers for Medicare & Medicaid Services (CMS), Healthcare providers and suppliers, Independent review entities, Pharmaceutical companies (regulatory exposure via MA coverage rules), Dialysis providers (DVA — regulatory exposure), Pharmaceutical manufacturers (BMY, PFE, JNJ — regulatory exposure)

Where it stands

3 cosponsors: 2 Democrats, 1 Republicans.

• Apr 27, 2026 — Introduced · Congress.gov: “Introduced in Senate”
• Apr 27, 2026 — Referred to Senate Committee on Finance · Congress.gov: “Read twice and referred to the Committee on Finance”

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

Money around this bill

17 lobbying clients named this bill on 17 disclosure filings across 1 quarter, Jun 2026 to Jun 2026. Those filings disclosed $9,549,253 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 96% of bills with at least one filing.

Roger Marshall, the sponsor, reported $1,777,391 in PAC receipts in the 2026 cycle.

• American Hospital Association — $4,470,000 on 1 filing
• American Academy of Family Physicians — $1,048,023 on 1 filing
• American Health Care Association — $840,000 on 1 filing
• Federation of American Hospitals — $710,000 on 1 filing
• National Alliance for Care at Home (formerly Natl Assn for Home Care & Hospice) — $610,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.