Sponsors (7)
The bill prioritizes faster, simpler access to care for Medicare beneficiaries and reduced provider paperwork by limiting prior authorization in Medicare Advantage, at the expense of reduced utilization controls, potential higher Medicare spending, some administrative confusion, and constraints on CMS's ability to pilot new authorization models.
Medicare beneficiaries will face fewer prior-authorization hurdles for most Medicare Advantage plan–covered items and services starting in 2027, likely speeding access to tests, procedures, and treatment.
Hospitals, clinics, and clinicians will have reduced administrative burden and fewer delays from prior authorization requirements in MA plans, lowering clinician paperwork and speeding care delivery.
The bill preserves traditional Medicare (Part A/B) protections, prevents non‑MAC contractors from denying coverage or processing prior authorization, and requires public notice and comment before new prior‑authorization models (including protections against abrupt pilots like WISeR), increasing oversight and transparency for beneficiaries and providers.
Limiting prior authorization in MA plans may raise Medicare program expenditures and/or premiums, increasing costs for taxpayers and potentially beneficiaries.
Insurers and plan sponsors will lose a key tool to manage inappropriate or low‑value care, which could increase utilization, program waste, and opportunities for fraud absent replacement controls.
The bill constrains CMS's ability to pilot or test prior‑authorization approaches that might reduce wasteful spending and could slow innovation in payment and utilization management by adding a public‑comment requirement before model selection.
Based on analysis of 3 sections of legislative text.
Bans most prior-authorization requirements by Medicare Advantage plans and restricts Innovation Center models from imposing Part A/B prior authorization, effective for plan years and models beginning Jan 1, 2027.
Official title: To amend title XVIII of the Social Security Act to prohibit the use of prior authorization under Medicare Advantage plans, to amend title XI of the Social Security Act to limit the implementation of payment models testing prior authorization under traditional Medicare, and for other purposes.
Introduced April 20, 2026 by Ro Khanna · Last progress April 20, 2026
Prohibits Medicare Advantage plans from requiring prior authorization for most specified items and services beginning with plan years starting January 1, 2027, and makes violating that prohibition a basis for CMS enforcement. Blocks the Department of Health and Human Services from implementing the WISeR prior-authorization model or any substantially similar model, restricts Innovation Center model selection so no model may impose prior authorization for Part A or Part B services or delegate denial authority outside Medicare Administrative Contractors, and requires public notice and comment for certain Innovation Center model selections beginning January 1, 2027.