Lawmakers introduce bipartisan bill to speed up prior authorization in Medicare Advantage

Members of Congress recently introduced bipartisan legislation aimed at speeding up prior authorization in the Medicare Advantage program. 

Leaders in the House led by Rep. John Joyce, MD, R-Pa., on April 20 proposed Medicare Advantage Improvement Act, renewing efforts to rein in this payer utilization-management tactic. Co-sponsored by five others, the bill would require health plans to complete standard authorizations within 72 hours. 

The MA Improvement Act additionally would require insurers to publish prior authorization data, including how long it takes to make determinations. Previous studies have shown that radiology and radiation oncology face a heavy burden from prior authorization in Medicare Advantage, potentially leading to delayed care and worse outcomes.  

“Medicare is a promise to America’s seniors that they will have dependable access to quality healthcare in their later years,” Joyce said in a statement April 23. “However, that promise has been undermined by unnecessary barriers to care—particularly through excessive use of prior authorization and inappropriate coverage denials in Medicare Advantage.” 

In addition, the act would only allow prior authorization extensions (of up to 7 days) in limited, “beneficiary protective” situations. It also would require plans to adopt real-time, automated approval systems integrated into electronic health records, according to a summary of the bill. Plus, the legislation would prohibit new authorizations for clinically necessary modifications or extensions during treatment, among other changes. It is co-sponsored by other trained physicians in Congress including Reps. Kim Schrier, MD, D-Wash., Greg Murphy, MD, R-N.C., Mariannette Miller-Meeks, MD, R-Iowa, and Ami Bera, MD-D-Calif. 

Several healthcare stakeholders have voiced their support for the effort, including the Medical Group Management Association. MGMA noted that prior authorization, denials and downcoding in Medicare Advantage are 3 of the top 5 administrative burdens medical groups face in 2026, according to its own survey data. MGMA represents over 15,000 medical group practices across radiology and other specialties. 

“These excessive utilization tactics delay care, undermine appropriate physician payment, and force practices to divert resources from patient care into unnecessary administrative tasks,” Anders M. Gilberg, senior VP of government affairs for the association, wrote to lawmakers on April 23. “Without policy intervention, participating in MA will become untenable for many practices and MA beneficiaries may face more barriers to accessing care.”

Others supporting the bill include the Ascension hospital system, the American Medical Rehabilitation Providers Association, PAM Health and Community Health Systems. MGMA also noted that the legislation would establish “important guardrails” on retrospective clawbacks, strengthening prompt-payment requirements while limiting post-authorization denials. 

“By coupling these initiatives with a new compliance program, medical groups can trust that MA plans will be held accountable,” Gilberg added. “Together, these provisions will reduce administrative burden for medical groups participating in MA and allow them to focus on what’s most important: providing care to seniors.”