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S4384119th CongressWALLET

Medicare Advantage Improvement Act of 2026

Sponsored By: Senator Marshall, Roger [R-KS]

Introduced

Summary

Faster, real-time prior authorizations and stronger plan oversight. This bill would require Medicare Advantage organizations to issue standardized, expedited decisions for certain authorization requests and build automated real-time approvals for routine, low-risk services beginning January 1, 2028.

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  • Patients and providers: Determinations for specified authorizations would be required within 72 hours in most cases, and providers would get immediate automated approvals for services on a Secretary-defined list.
  • Providers and post-acute care facilities: The bill would extend prompt-payment rules to in-network services and require automated processing and payment for authorized claims. Networks must also ensure access to long-term care hospitals and inpatient rehabilitation facilities starting in 2028.
  • Plans and regulators: CMS would score plans on a 0–100 compliance scale, publish results, add a higher-weighted compliance domain to star ratings, and impose payment reductions or other penalties for low compliance.

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 4 benefits, 0 costs, 0 mixed.

New compliance scores and star ratings

If enacted, CMS would score each Medicare Advantage organization on a 0–100 compliance scale and place plans into four tiers. Scores would cover timely authorizations, coverage protections, prompt payment, improper retroactive denials, marketing, and other Part C rules. CMS would add a Compliance and Coverage Protection domain to MA five‑star ratings and give that domain more weight than any other domain. Plan‑level scores would be published after plans get a chance to review them. These changes would take effect for plan years starting Jan 1, 2028.

Better access to post‑acute hospitals

If enacted, Medicare Advantage plans would have to meet network adequacy standards that ensure in‑network access to long‑term acute care hospitals and inpatient rehabilitation facilities. This requirement would apply for plan years starting Jan 1, 2028. The Secretary would set the specific network rules that define adequate access.

Faster prior authorizations for Medicare

If enacted, Medicare Advantage plans would have to decide on most prior authorization and preservice requests within 72 hours. For urgent requests, plans would have to decide within 24 hours. Plans could extend the 72-hour deadline up to 7 calendar days only in narrow cases (you ask, records are needed from an outside provider, or an extraordinary reason in your interest). These rules would apply to requests made on or after Jan 1, 2028, and the Secretary could change deadlines for requests made on or after Jan 1, 2030.

Faster, protected payments for MA claims

If enacted, Medicare Advantage plans would have to follow fee‑for‑service prompt payment rules and could not later reclassify a clean claim as not clean except under rules set by the Secretary. For plan years starting Jan 1, 2028, plans would also have to automatically process and pay certain routine, authorized claims without manual review unless there is evidence of fraud. These changes would speed provider payments and reduce retroactive payment reversals.

Sponsors & CoSponsors

Sponsor

Marshall, Roger [R-KS]

KS • R

Cosponsors

  • Sen. Whitehouse, Sheldon [D-RI]

    RI • D

    Sponsored 4/27/2026

  • Sen. Coons, Christopher A. [D-DE]

    DE • D

    Sponsored 6/15/2026

  • Sen. Lankford, James [R-OK]

    OK • R

    Sponsored 6/15/2026

Roll Call Votes

No roll call votes available for this bill.

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