POLISCOPE
Back to feed
HR8375FEDERALfiled
High Impact

Medicare Advantage Improvement Act of 2026

April 20, 2026

Track this bill to get notified when it advances a stage. One tap to stop, anytime.

The Frame

What this does

If passed, this bill would legally mandate that insurance plans provide faster decisions on medical coverage requests for millions of seniors and disabled enrollees starting in 2028.

Who is mentioned in the record

Potentially affected actors named in the source documents. Mention is not a position.

Medicare Advantage Enrollees

Patients enrolled in these plans will have legally mandated timeframes for insurance coverage decisions regarding their medical care.

Medicare Advantage Organizations

Insurance companies offering these plans must update their internal authorization processes and increase their public data reporting.

Healthcare Providers

Doctors and hospitals will receive faster notifications regarding coverage determinations for their patients.

What changed

Last recorded activity April 20, 2026.

What's next

Introduced.

Summary

This bill proposes new federal rules for plans to speed up the approval process for medical services and treatments. It sets strict 72-hour deadlines for standard authorization requests and 24-hour deadlines for expedited requests, while requiring more transparent reporting of how plans handle these approvals.

Key Facts

  • Requires Medicare Advantage plans to respond to standard authorization requests within 72 hours starting January 1, 2028.
  • Requires Medicare Advantage plans to respond to expedited authorization requests within 24 hours starting January 1, 2028.
  • Allows plans to extend the 72-hour deadline by up to 7 days if the patient requests it, if medical evidence is needed from an out-of-network provider, or due to extraordinary circumstances.
  • Mandates that Medicare Advantage plans report prior authorization data at the plan and parent-organization level, not just the contract level, starting in 2028.
  • Requires prior authorization data to be published in a downloadable format for research and oversight purposes.
  • Requires plans to implement a mechanism for real-time authorization decisions for specific identified services starting January 1, 2028.
  • Grants the Secretary of Health and Human Services authority to adjust these deadlines through rulemaking starting January 1, 2030.
  • Defines 'specified authorization' to include prior authorizations, preservice determinations, concurrent determinations, and hospital/post-acute care transfers.

Why It Matters

If passed, this bill would legally mandate that insurance plans provide faster decisions on medical coverage requests for millions of seniors and disabled enrollees starting in 2028.

Frequently Asked Questions

When would these new rules take effect?
Most of the new requirements, including the response deadlines and data reporting mandates, are scheduled to begin on January 1, 2028.
Can my insurance plan take longer than 72 hours to approve a request?
Yes, but only under specific conditions, such as if you request an extension, if they need records from an out-of-network doctor, or if there are extraordinary circumstances beyond their control.
Does this apply to all Medicare plans?
The bill specifically targets (Part C) plans.

News Coverage

No news coverage found yet. Articles are indexed twice daily.

Lobbying Activity

AARP

$4,110,000

2026

HEALTH ISSUESMEDICARE/MEDICAIDLAW ENFORCEMENT/CRIME/CRIMINAL JUSTICEPHARMACY

P.L. 119-21, One Big Beautiful Bill Act H.R. 8867, Planning for Long-term Aging Needs (PLAN) Act H.R. 5861, Legacy Act of 2025 H.R. 9393, the Lower Costs, More Transparency Act. H.R. 9396, the Prior Authorization Accountability Act. S. 4916, the Aging with Artificial Intelligence Act. H.R. 8100, Safe Staffing Saves Lives Act. S. 3886, Nurses Belong in Nursing Homes Act. H.R. 6766/S. 3492, the Essential Caregivers Act of 2025. H.R. 7966/S. 4118, Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act. S. 2120, the Older Americans Act Reauthorization Act of 2025 H.R. 5575, the Firefighters Assisting Seniors to Emergency Response (FASTER) Act of 2025. H.R. 3954/S. 4641, Improving Access to Medicare Coverage Act. H.R.5554/S.2831, Stand Strong for Medicare Act. S. 3439/H.R. 6735, Connecting Caregivers to Medicare Act and efforts related to the bill S. 1227/H.R. 2491, Alleviating Barriers for Caregivers Act S. 668/H.R. 3183, Supporting Access to Falls Education and Prevention and Strengthening Training Efforts and Promoting Safety Initiatives (SAFE STEPS) for Veterans Act of 2025 CMS-1851-P, Hospice Proposed rule. CMS-1843-P, Skilled Nursing Facility Proposed rule. CMS-1844-P, Home Health Proposed rule. No bill number. Health care transparency. No bill number. Discussed use of artificial intelligence and health data technology. No bill number. Discussed health-related policies and activities around the fall respiratory virus season. No bill number. Discussed health insurance affordability proposals. No bill number. Discussed Nursing Home staffing standards, safety, and quality. No bill number. Discussed Nursing home transparency and ownership requirements. No bill number. Discussed home health, hospice, and long-term care. No bill number. Discussed falls prevention. No bill number. Discussed social isolation. No bill number. Discussed HUD Assisted Living Requirements No bill number. Discussed family caregiving. No bill number. Discussed AARP paper on Medicare Caregiver Training Services. No bill number. Discussed Medicaid community engagement interim final rule, including the family caregiver exemption. No bill number. Discussed the paid direct care workforce in long-term care. No bill number. Discussed the unaffordability of long-term care. No bill number. Discussed Money Follows the Person Rebalancing Demonstration Program and Medicaid HCBS spousal impoverishment protections. No bill number. Discussed Medicaid fraud and family caregivers, Medicaid self-direction programs. No bill number. Discussed sandwich generation family caregiver hearing and submitted a statement for the record discussing family caregivers and sandwich generation caregivers, programs that support them, AARP caregiving resources, and federal policies to support sandwich generation caregivers and caregivers more broadly. No bill number. Discussed long-term care. No bill number. CMS-2453-NC; Medicaid Program; 2028 Medicaid Home and Community-Based Services Quality Measure Set Submitted comments No bill number. Discussed expanding access to home care. No bill number. Discussed the increasing cost of home care No bill number. Discussed HSA use for telehealth chronic care management services/subscriptions. No bill number. Discussed artificial intelligence and technology

Sponsors

Discoveries

Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.

policy shift90% confidence

Shift toward real-time automation

The bill explicitly mandates the implementation of real-time authorization mechanisms using certified EHR technology, signaling a legislative push to digitize and automate insurance approvals.

Connected Entities

personMs. SchrierCo-sponsor of the bill.Map →
organizationDepartment of Health and Human ServicesThe federal agency responsible for overseeing Medicare and enforcing these new rMap →
personMr. JoyceRepresentative from Pennsylvania who introduced the bill.Map →

Analysis Score

0–100
  • Significance85
    How much this matters to a regular citizen
  • Controversy40
    Intensity of disagreement among stakeholders
  • Entertainment10
    Compellingness for a non-policy-wonk reader
  • Buzz30
    Current news / social attention level

Publisher tools

Share or embed this record

POLISCOPE publisher tools

Share or embed this record