The drumbeat for reforms to the way in which Medicare Advantage (MA) plans operate is growing louder in Congress after Rep. Mariannette Miller-Meeks (R-Iowa) joined fellow physician members of Congress in introducing bipartisan legislation “aimed at restoring accountability, strengthening patient protections, and ensuring seniors receive timely, reliable care.”

The long-term care sector applauded the legislation and called for its quick approval.

“The Medicare Advantage Improvement Act of 2026 represents a significant step towards ensuring Medicare Advantage delivers on its promise to America’s seniors,” said Clif Porter, president and CEO of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). “We commend these lawmakers for developing a better way to enable seniors to have timely access to care and hold plans accountable. We urge continued bipartisan support and swift passage through Congress.”

In recent months, MA plans have been the focus of negative attention for everything from stringent prior authorization practices to inefficiencies that have delayed care for seniors, notably in the nursing home setting.

“For too long, cases of abuse have crept into Medicare Advantage, pulling it away from its core mission of serving America’s seniors,” said Miller-Meeks. “As a physician, I’ve seen how these practices delay care, create unnecessary barriers, and increase the cost of healthcare. This bill restores accountability, cracks down on bad actors, and ensures Iowa seniors can access the care they need, without delay, without denial, and without interference from bureaucratic red tape.”

‘Whining’ by Plans

Martin Allen, the former head of reimbursement policy at AHCA/NCAL, said the wait for such legislation has been too long.

“The reform of Medicare Advantage prior authorization and coverage determinations is long overdue,” he said. “Through my time at AHCA/NCAL, CMS [Centers for Medicare and Medicaid Services] put forth multiple MA rules to improve beneficiary access and mirror traditional Medicare A, however plans continued to skirt compliance with their own interpretations of what constitutes contractual requirements.”

Allen said without strong congressional action and enforcement nothing will change.

“MA plans will whine and moan and continue to make outsize profits at the expense of seniors,” he added.

Nisha Hammel, vice president of reimbursement policy and population health at AHCA/NCAL, said the bill addresses many of the obstacles driven by insurer-led MA plans that were making it unnecessarily difficult for seniors and their families to navigate care options and receive coverage for medically necessary care.

“Coverage decisions for Medicare Advantage beneficiaries must be driven by each patient’s needs and clinical necessity, with appropriate oversight that ensures compliance and patient protections,” she said.

What the Bill Would Do

If made law, the MA reform legislation would kick in on Jan. 1, 2028, and:

• Strengthen oversight and accountability for Medicare Advantage plans that fail to meet compliance standards

• Expand access to post-acute providers

• Increase transparency and streamline prior authorization processes to reduce delays in care, requiring approval within 72 hours for most cases

• Align coverage criteria with traditional Medicare to ensure consistency for patients and providers

• Reduce administrative burdens through real-time, automated systems that improve efficiency

• Expand access to post-acute care providers, ensuring seniors can receive the care they need without unnecessary barriers

Bill co-sponsors are Reps. John Joyce (R-Pa.), Greg Murphy (R-N.C.), Jimmy Panetta (D-Calif.), Ami Bera (D-Calif), Beth Van Duyne (R-Texas), and Kim Schrier (D-Wash.).

Read the bill here.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.