WASHINGTON, D.C. – The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), the nation’s largest organization representing long term and post-acute care providers, praised lawmakers for the introduction of the Medicare Advantage Improvement Act of 2026 (H.R. 8375). The bill was introduced in the U.S. House of Representatives by a bipartisan group of members, many of whom are physicians.
“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 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.”
The bipartisan Medicare Advantage Improvement Act of 2026 is led by Representatives John Joyce (PA-13), Kim Schrier (WA-08), Gregory Murphy (NC-03), Jimmy Panetta (CA-19), Mariannette Miller Meeks (IA-01), Ami Bera (CA-06), and Beth Van Duyne (TX-24). Upon introduction, the bill was referred to the House Committees on Ways and Means and Energy and Commerce. It is the most sweeping attempt to enhance Medicare Advantage (MA) to date, including provisions to:
- Protect patients from inappropriate delays and denials;
- Standardize coverage criteria between MA and traditional Medicare;
- Increase transparency surrounding prior authorizations and compliance;
- Penalize plans that fail to meet oversight and compliance benchmarks;
- Reduce administrative burdens through real-time and automated systems;
- Prevent retroactive “clawback” of payments for pre-approved, reapproved, and delivered care and services; and
- Strengthen patient access to post-acute care providers.
More seniors are enrolling in Medicare Advantage plans than traditional Medicare because it offers many perks appealing to seniors; however, large, insurer-led MA plans are too often denying or delaying beneficiaries’ access to necessary skilled nursing and post-acute care. From 2019 to 2022, the top MA insurers denied prior authorization requests for post-acute care more frequently than for other services. This has contributed to a doubling of seniors leaving MA for traditional Medicare in their final year of life—shifting costs onto taxpayers.
“This bill addresses many of the obstacles driven by insurer-led Medicare Advantage plans that were making it unnecessarily difficult for seniors and their families to navigate care options and receive coverage for medically necessary care,” said Nisha Hammel, Vice President of Reimbursement Policy and Population Health at AHCA/NCAL. “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.”
AHCA/NCAL has been a consistent advocate on addressing MA challenges in post-acute care. AHCA/NCAL and its Post-Acute Care Coalition partners submitted recommendations to the Centers for Medicare and Medicaid Services on improving MA prior authorization processes last fall. In addition, in a report based on a survey of skilled nursing care providers, AHCA found that denials or delays of medically necessary post-acute care by MA plans occur daily and/or weekly for two-thirds of providers.
The Better Way, AHCA’s forward-looking policy agenda to deliver bold solutions for quality long term and post-acute care, identifies MA as one of its key priorities. Through “Reaffirming the Promise of Medicare Advantage,” the organization offers several recommendations for alignment among providers, residents, policymakers and the public.
Learn more about the Medicare Advantage Improvement Act of 2026 HERE.