Medicare Advantage Improvement Act of 2026

Faster Care Decisions: Medicare Advantage organizations would be required to respond to certain authorization requests within 72 hours, and expedited requests must be responded to within 24 hours after receipt of the request or necessary information (Section 2(a)(1)(C)(i) and Section 2(a)(2)(B)(ii)).

Real-Time Approvals: For certain identified services, organizations must have a mechanism to provide real-time determinations, including tools capable of providing immediate automated approvals (Section 2(b)(1)(D)(i) and Section 2(b)(1)(D)(ii)(I)).

Protection Against Unnecessary Denials: If a provider determines a modification or extension of an approved service is clinically necessary, the organization cannot require a new authorization (Section 2(c)).

Faster Appeals Processes: The bill shortens timeframes for reconsiderations, requiring organizations to submit case files to independent entities within 14 days of a request (Section 2(d)(1)(A)).

Consistent Medical Necessity Standards: Medicare Advantage organizations cannot apply medical necessity criteria that are more restrictive than the standards used in original fee-for-service Medicare (Section 5(b)(1)(A)).

Improved Access to Specialized Care: The bill adds requirements for organizations to provide adequate access to long-term care hospitals and inpatient rehabilitation facilities (Section 7).

Potential for Delay via Extensions: Medicare Advantage organizations may extend the deadline for authorization determinations by up to 7 calendar days under certain circumstances, such as needing additional medical evidence (Section 2(a)(1)(C)(ii)).

Variable Deadlines: The Secretary of Health and Human Services has the authority to specify different deadlines for authorization requests through rulemaking (Section 2(a)(1)(C)(iv)).