Whitehouse, Marshall Introduce Legislation to Fix Delays in Care for Seniors

Whitehouse, Marshall Introduce Legislation to Fix Delays in Care for Seniors

Washington, D.C. - U.S. Senators Sheldon Whitehouse (D-RI) and Roger Marshall, M.D. (R-KS) have introduced the Medicare Advantage Improvement Act, bipartisan legislation designed to reform Medicare Advantage (MA) and ensure seniors receive the reliable, patient-centered care the program promises.

Medicare Advantage now serves more than half of all Medicare beneficiaries - and that number is growing. But as enrollment has surged, so have reports of delayed approval, surprise denials, confusing appeals processes, and disruptions to care that seniors depend on. Prior authorization is a requirement imposed by insurers that forces patients and providers to seek advance approval for care, often delaying treatment and adding administrative hurdles even when the services are medically necessary. This bill directly addresses those failures while preserving benefits.

"Americans are rightfully fed up with health care bureaucracy, and prior authorization is one of the worst offenders: delaying treatment, driving up costs, and putting paperwork ahead of patients. We need to cut this red tape so providers can deliver timely, high-quality care," said Whitehouse.

"As a physician and someone who ran a hospital, I've seen firsthand what happens when bureaucratic barriers get between a patient and the care they need - and it is not acceptable," said Marshall. "This bill makes expectations clearer, timelines shorter, and protections stronger. It fixes what's broken without changing what's working. Our seniors deserve better, and this bill delivers."

Whitehouse has been a leading voice for prior authorization reform in the Senate. Earlier this year, Whitehouse reintroduced his Prior Authorization Relief Act to cut the administrative burdens associated with prior authorizations in value-based payment models and provide faster, easier, and cheaper care to patients.

The Medicare Advantage Improvement Act would:

• Require standard prior authorization approvals within 72 hours, expedited decisions within 24 hours, and real-time approvals for routine low-risk services integrated with electronic health records - and once care is approved, plans cannot require new authorizations mid-treatment.
• Ensure that once a service is authorized, coverage cannot be retroactively denied (except for fraud or error), automated denial algorithms are prohibited, and prompt-pay protections ensure providers are reliably compensated for approved care.
• Require MA plans to publicly report detailed prior authorization data, giving patients, providers, and policymakers the information they need to hold plans accountable.
• Prevent MA plans from applying stricter medical necessity standards than original Medicare and codify clear inpatient admission standards to protect seniors from unexpected costs and coverage disputes.
• Strengthen network adequacy requirements for rehabilitation hospitals and long-term care hospitals, improving access to post-acute care for seniors recovering from serious illness or injury.

The full text of the bill is available here. Companion legislation has been introduced in the House of Representatives.

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