Protecting Approved Care Act
Sponsored By: Representative Landsman, Greg [D-OH-1]
Introduced
Summary
limit retroactive denials and payment reductions by Medicare Advantage plans. This bill would add a new rule to the Social Security Act that stops Medicare Advantage organizations from reversing approvals or cutting payment after an item or service has been authorized or provided, with narrow exceptions for fraud or specified "good cause."
Show full summary
- Medicare Advantage enrollees and families: Would prevent plans from denying coverage after a prior or concurrent authorization, including authorizations for hospital-to-hospital or hospital-to-post-acute transfers. It takes effect for plan years beginning January 1, 2028.
- Hospitals and providers: Would make payments and authorizations more stable by barring plans from reopening coverage or changing claim codes in ways that reduce payment except for fraud or defined good cause.
- Medicare Advantage plans and insurers: Would limit the use of post-authorization adjustments as a way to reduce liabilities while preserving existing anti-fraud and good-cause rules referenced in federal regulations.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Protect Medicare Advantage approvals
If enacted, Medicare Advantage (MA) plans would not be allowed to retroactively deny coverage or reduce payment after they approve a service while you are receiving it. The protection would also apply when you receive a service that did not require prior approval. It would start for plan years beginning on or after January 1, 2028. Exceptions would allow reopenings or payment changes only for good cause or reliable evidence of fraud. The rule would cover prior, preservice, and concurrent authorizations, including hospital-to-hospital and hospital-to-post-acute transfers.
Sponsors & CoSponsors
Sponsor
Landsman, Greg [D-OH-1]
OH • D
Cosponsors
Rep. Onder, Robert F. [R-MO-3]
MO • R
Sponsored 9/15/2026
Rep. Miller-Meeks, Mariannette [R-IA-1]
IA • R
Sponsored 9/24/2026
Rep. Wilson, Joe [R-SC-2]
SC • R
Sponsored 10/1/2026
Rep. Goodlander, Maggie [D-NH-2]
NH • D
Sponsored 10/5/2026
Roll Call Votes
No roll call votes available for this bill.
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