# 119-hr-6109: To amend title XVIII of the Social Security Act to establish certain requirements with respect to rates of reversed prior authorization coverage determinations under Medicare Advantage plans.

119-hr-6109, To amend title XVIII of the Social Security Act to establish certain requirements with respect to rates of reversed prior authorization coverage determinations under Medicare Advantage plans., is a 119th Congress bill sponsored by Rep. Pocan, Mark [D-WI-2] (D-WI); status introduced; PRIA reads it as touching household money (as of 2026-04-21).

- Canonical: https://policyrisk.com/legislation/119-hr-6109
- As of: 2026-04-21
- Plain-text twin of the page above; the HTML and this file carry the same facts.

## Facts
- Bill: 119-hr-6109
- Congress: 119
- Title: To amend title XVIII of the Social Security Act to establish certain requirements with respect to rates of reversed prior authorization coverage determinations under Medicare Advantage plans.
- Status: introduced
- Introduced: 2025-11-18
- Sponsor: Rep. Pocan, Mark [D-WI-2] (D-WI)
- Cosponsors: 18
- Policy area: Health
- Touches household money: yes
- Last recorded action: 2026-04-21

## Summary

**Tightens penalties on Medicare Advantage plans that have high rates of prior-authorization denials later overturned.** This bill would create a new rule letting the Secretary terminate a Medicare Advantage contract when a plan exceeds an allowable rate of reversed prior-authorization coverage determinations. - Medicare Advantage plans. Plans that impose prior authorization would risk contract termination if more than 25% of their prior-authorization coverage determinations initially deny coverage and are later reversed on reconsideration or appeal. This standard would apply to plan years beginning one year after enactment. - Review-and-reconsideration monitoring. The bill also triggers termination if the Secretary finds a significant drop in the number of determinations reconsidered and reversed compared with the prior year, when that drop occurred because the plan failed to appropriately reconsider decisions. - Enforcement mechanics. It adds the new reversal-rate requirement to section 1857(e) and adjusts certain contract-termination language so the Secretary can act under the new standard.

## Cosponsors (18)

- Rep. Carson, André [D-IN-7] (D-IN), 2025-11-18T00:00:00.000Z
- Rep. Cohen, Steve [D-TN-9] (D-TN), 2025-11-18T00:00:00.000Z
- Rep. DeLauro, Rosa L. [D-CT-3] (D-CT), 2025-11-18T00:00:00.000Z
- Rep. Doggett, Lloyd [D-TX-37] (D-TX), 2025-11-18T00:00:00.000Z
- Rep. Jayapal, Pramila [D-WA-7] (D-WA), 2025-11-18T00:00:00.000Z
- Rep. Khanna, Ro [D-CA-17] (D-CA), 2025-11-18T00:00:00.000Z
- Del. Norton, Eleanor Holmes [D-DC-At Large] (D-DC), 2025-11-18T00:00:00.000Z
- Rep. Ocasio-Cortez, Alexandria [D-NY-14] (D-NY), 2025-11-18T00:00:00.000Z
- Rep. Schakowsky, Janice D. [D-IL-9] (D-IL), 2025-11-18T00:00:00.000Z
- Rep. Takano, Mark [D-CA-39] (D-CA), 2025-11-18T00:00:00.000Z
- Rep. Thanedar, Shri [D-MI-13] (D-MI), 2025-11-18T00:00:00.000Z
- Rep. Tlaib, Rashida [D-MI-12] (D-MI), 2025-11-18T00:00:00.000Z
- Rep. Johnson, Julie [D-TX-32] (D-TX), 2025-11-18T00:00:00.000Z
- Rep. McBride, Sarah [D-DE-At Large] (D-DE), 2025-11-18T00:00:00.000Z
- Rep. Omar, Ilhan [D-MN-5] (D-MN), 2025-11-18T00:00:00.000Z
- Rep. Dingell, Debbie [D-MI-6] (D-MI), 2025-11-20T00:00:00.000Z
- Rep. Casar, Greg [D-TX-35] (D-TX), 2025-12-01T00:00:00.000Z
- Rep. Pingree, Chellie [D-ME-1] (D-ME), 2025-12-16T00:00:00.000Z

## Provisions PRIA read

- New limits on Medicare Advantage denials: benefit, medium. This bill would set a limit on bad prior-authorization denials in Medicare Advantage. Starting with plan years that begin one year after enactment, the Secretary of Health and Human Services would end a plan if more than 25% of its prior-authorization determinations start as denials and are later o…

## Related bills

- 119-hr-7973: Momnibus Act
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- 119-hr-2045: Medicare Dental, Vision, and Hearing Benefit Act of 2025
- 119-hr-51: Washington, D.C. Admission Act
- 119-hr-20: Richard L. Trumka Protecting the Right to Organize Act of 2025
- 119-hr-5390: FAMILY Act

## Sources
- [119-hr-6109 on Congress.gov](https://www.congress.gov/bill/119th-congress/house-bill/6109)

## Related
- [119-hr-7973: Momnibus Act](https://policyrisk.com/legislation/119-hr-7973)
- [119-hres-1058: Recognizing that it is the duty of the Federal Government to develop and implem…](https://policyrisk.com/legislation/119-hres-1058)
- [119-hr-2045: Medicare Dental, Vision, and Hearing Benefit Act of 2025](https://policyrisk.com/legislation/119-hr-2045)
- [119-hr-51: Washington, D.C. Admission Act](https://policyrisk.com/legislation/119-hr-51)
- [119-hr-20: Richard L. Trumka Protecting the Right to Organize Act of 2025](https://policyrisk.com/legislation/119-hr-20)
- [119-hr-5390: FAMILY Act](https://policyrisk.com/legislation/119-hr-5390)
- [All bills in Congress](https://policyrisk.com/legislation)

Source: PRIA, https://policyrisk.com/legislation/119-hr-6109 (as of 2026-04-21).