The Medicare Advantage Improvement Act of 2026: What Providers Need to Know — and Do Now

By Elena Pak, Credentialing Department, WCH

A bipartisan group of lawmakers has introduced the Medicare Advantage Improvement Act of 2026 in both the House and Senate, targeting prior authorization delays, retroactive denials, and inadequate network access that have frustrated providers and patients alike for years. The bill has support from physicians on both sides of the aisle and has drawn early applause from major industry associations. Whether or not it passes in its current form, its provisions signal where regulatory pressure on Medicare Advantage plans is heading — and providers who understand that direction will be better positioned to respond.

Here is what the bill proposes, why it matters, and what your practice should be doing right now, regardless of how the legislative process unfolds.

What the Bill Actually Requires

The Medicare Advantage Improvement Act targets five specific areas of plan conduct.

First, it sets binding timelines for prior authorization decisions: standard approvals within 72 hours, expedited decisions within 24 hours, and real-time approvals for routine low-risk services. For providers who have grown accustomed to waiting days or weeks for authorizations on straightforward procedures, these deadlines would represent a fundamental shift in how plans are required to operate.

Second, the bill bans retroactive denials of coverage once a service has been authorized — with a narrow exception for fraud or billing error. This provision addresses one of the most damaging patterns in MA plan behavior: approving a service upfront, then reversing that approval after the care has been delivered and the claim submitted. Retroactive denials leave providers holding costs they had every reasonable expectation of recovering, and they erode the value of prior authorization as a planning tool entirely.

Third, plans would be required to publicly report prior authorization data — approval rates, denial rates, appeal outcomes, and turnaround times. This transparency requirement is significant. Right now, providers often lack the aggregate data needed to document and challenge a plan’s systematic denial patterns. Public reporting changes that calculus and creates external accountability that individual appeal processes cannot.

Fourth, and perhaps most importantly for clinical practice, the bill prohibits MA plans from applying medical necessity standards that are stricter than original Medicare. This is a provision that addresses the root cause of many denials — plans have developed their own internal coverage criteria that diverge from Medicare’s published standards, allowing them to deny services that traditional Medicare would cover without question. Standardizing medical necessity criteria removes that avenue and anchors coverage decisions in established policy.

Fifth, the bill strengthens network adequacy requirements specifically for rehabilitation hospitals and long-term care facilities. Patients requiring post-acute care have faced some of the most severe access barriers under MA plans, often being directed to facilities that are inadequate for their clinical needs or simply unavailable within a reasonable distance.

Why this Bill Exists — and What It Tells You About the Landscape

Medicare Advantage enrollment now exceeds 50% of all Medicare beneficiaries. That scale has made the program’s structural problems impossible to ignore politically. Prior authorization denial rates in MA plans have drawn attention from the HHS Office of Inspector General, the Government Accountability Office, and now a bipartisan congressional coalition that includes multiple physician-legislators.

The bill’s lead sponsors in the House — Reps. Miller-Meeks, Joyce, and Murphy — are all physicians. That is not incidental. The frustrations driving this legislation are clinical as well as administrative. When a physician orders a service and must then spend staff hours navigating a prior authorization process that ends in a denial inconsistent with any published standard, the problem is not just financial. It disrupts care, delays treatment, and introduces clinical risk.

For providers, the policy momentum here matters independent of this bill’s passage. CMS has been moving in this direction through rulemaking for several years, and congressional pressure accelerates that movement. Practices that have treated MA plan friction as an unavoidable cost of doing business may need to recalibrate that assumption.

What Providers Should Be Doing Now

Waiting for the bill to pass before adjusting practice operations is the wrong approach. The compliance and revenue management steps worth taking now are valuable regardless of the legislative outcome.

Document every denial systematically. The bill’s transparency provisions reflect a broader trend toward data-driven oversight of MA plans. Practices that have not been tracking denial rates by plan, by service category, and by payer will find themselves at a disadvantage when appealing denials, negotiating contracts, or participating in any future audit process. Build that tracking infrastructure now if you do not have it.

Know the timelines you are entitled to today. CMS finalized prior authorization rules for MA plans in 2024, requiring 72-hour turnarounds for expedited requests and seven calendar days for standard requests. These requirements are already in effect. If plans are not meeting them, that is documentable and appealable. The proposed legislation would tighten these timelines further — but providers who do not know their current rights are leaving leverage unused.

Challenge denials that contradict original Medicare coverage. The bill’s medical necessity standardization provision codifies something providers can already argue in appeals today: that an MA plan’s internal criteria cannot be used to deny coverage for services original Medicare covers without restriction. This argument succeeds in appeals more often than providers realize, particularly when the denial is documented, the Medicare Local Coverage Determination is cited, and the appeal is submitted with clinical notes attached.

Audit your MA contracts against network adequacy standards. If your practice serves post-acute populations — or refers patients to rehabilitation or long-term care facilities — review whether those facilities are adequately represented in the MA networks you contract with. Network gaps create care coordination problems that ultimately fall on the referring provider, and strengthened adequacy requirements will raise the bar for what plans must demonstrate.

Prepare your billing staff for a changing environment. If the retroactive denial prohibition becomes law, the workflows your billing team uses to manage authorization documentation will need updating. Services authorized in writing should be flagged, and that documentation retained in a format accessible for any future dispute. Even before the bill passes, this is sound practice.

The Medicare Advantage Improvement Act of 2026 is a serious piece of legislation with genuine bipartisan physician support and industry backing. It may pass, it may be amended, or it may stall — but the problems it targets are real, well-documented, and increasingly untenable both clinically and politically.

For providers, the right response is not to wait and see. The practices that will benefit most from any reform in this space are the ones that have already built the documentation habits, the denial-tracking systems, and the appeals infrastructure to operate effectively in a high-scrutiny environment. The bill is a signal. The preparation is yours to do.

Have questions about how your MA plan contracts and billing practices hold up under current rules? The team at WCH Service Bureau works with providers navigating payer compliance every day. Contact us to learn more.