Last week, the U.S. House of Representatives introduced the Medicare Advantage Improvement Act (MAIA) of 2026 (H.R. 8375), a bipartisan bill that addresses critical issues within Medicare Advantage (MA).
The bill focuses on issues such as prior authorizations, prompt pay, payment clawbacks, and transparency. This is a big step towards ensuring the MA program delivers on its promise to provide seniors access to timely, medically necessary care.
What’s Included and Impact on Providers
At its core, the MAIA is about restoring predictability, transparency, and fairness in MA. Key takeaways include:
- Faster and More Transparent Prior Authorizations (PA): The bill would require standard prior authorization decisions to be made within 72 hours of submission and expedited PA decisions to be made within 24 hours. It would also shorten timeframes to 14 days for general appeal reconsideration and 24 hours for expedited appeals. It requires real-time decisions for routine, low-risk, and high approval services. Public reporting of PA data would also be required to bring transparency to plans.
- Accountability for MA Plans: The bill establishes a compliance scoring system tied to financial penalties and a new heavily weighted Star Ratings domain. Plans that delay care, deny services inappropriately, or fail to meet program requirements face payment reductions and public reporting of compliance scores.
- Ending Retroactive Denials: The MAIA would ensure that claims must be paid promptly if a PA is granted. This would also prevent MA plans from denying payment claims after PA is granted and disallowing downcoding to reduce payment unless in the case of fraud or error.
- Clinicians Making Decisions: The bill would require MA plans to follow Medicare fee-for-service standards for medical necessity and prevent them from using more restrictive criteria. It also requires that medical necessity decisions be made by clinicians with appropriate expertise.
- Maintaining Reliable Payments: These provisions would speed up and standardize payment for providers by applying prompt payment requirements for both in and out-of-network claims and relieve administrative burden by requiring automated payments for authorized and routine services, ensuring that approved claims are treated as clean claims.
We expect the Senate to release a companion bill soon. This is a significant step forward, but it’s not the finish line.
Come to Congressional Briefing
One of the most impactful ways to shape this legislation is by sharing your story directly with policymakers,
which is why we urge you to join us for Congressional Briefing in Washington DC, June 8–9. This is your opportunity to meet directly with lawmakers and share how Medicare Advantage policies affect your residents and everyday work.
AHCA/NCAL will continue to advocate to ensure MA works as intended for providers, residents, and the future of long term care. Together, we can reaffirm the promise of MA.