Lawmakers Introduce Bipartisan Bill to Speed up Prior Authorization in Medicare Advantage

Why It Matters

Faster authorizations could improve access for seniors and reduce costly administrative overhead for providers, while increasing accountability for Medicare Advantage plans.

Key Takeaways

• Bill forces Medicare Advantage plans to decide prior authorizations within 72 hours.
• Insurers must publicly report authorization turnaround times and denial rates.
• Real‑time, EHR‑linked approval systems are required for faster processing.
• Extensions limited to seven days only in beneficiary‑protective scenarios.
• Medical groups back bill, citing reduced administrative burden and better care.

Pulse Analysis

Prior authorization has become a major friction point in the United States health‑care system, especially within Medicare Advantage (MA) plans that cover roughly 30 % of seniors. Providers argue that the process adds weeks of delay, inflates administrative costs, and can jeopardize outcomes for time‑sensitive services such as radiology or oncology. A 2026 MGMA survey identified prior‑authorization hurdles as one of the top five burdens for medical groups, translating into thousands of staff hours and lost revenue. As the federal government seeks to curb wasteful utilization tactics, the focus has shifted to legislative remedies.

The bipartisan Medicare Advantage Improvement Act, introduced by Rep. John Joyce and co‑sponsors on April 20, aims to tighten those bottlenecks. It obliges MA insurers to render standard authorizations within 72 hours and to publish detailed turnaround metrics, creating a public accountability layer. The bill also mandates real‑time, automated approval workflows embedded in electronic health‑record systems, and restricts extensions to a maximum of seven days except in narrowly defined beneficiary‑protective cases. Support from the Medical Group Management Association, Ascension, and other provider groups underscores the perceived urgency of reducing paperwork and improving patient access.

If enacted, the legislation could reshape the MA market by forcing plans to invest in interoperable technology and to streamline decision‑making processes, potentially lowering administrative overhead for both insurers and providers. Faster approvals may improve clinical outcomes and patient satisfaction, while transparent reporting could pressure lagging plans to adopt best practices. Critics warn that rapid automation might increase erroneous approvals, but the bill’s safeguard provisions aim to balance speed with clinical safety. Overall, the act reflects a growing bipartisan consensus that administrative reform is essential to sustain quality care for America’s aging population.