BILLS
This is a list of bills relating to Medicare Advantage 2021-2024 that have a substantial number of co-sponsors.
June 13, 2024 “A bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans” (S.4532) – Sen. Marshall et al., referred to Finance
Co-sponsors: (Dem) 25, (Rep) 26, (Ind) 1
Summary unavailable as of Aug. 5, 2024
https://www.congress.gov/bill/118th-congress/senate-bill/4532
June 12, 2024 “To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans” (H.R.8702) – Rep Kelly et al., referred to 2 committees
Summary unavailable as of Aug. 5, 2024
Co-sponsors: (Dem) 107, (Rep) 70
https://www.congress.gov/bill/118th-congress/house-bill/8702
May 23, 2024 “To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification” (H.R.8561) – Rep. Tenney et al., referred to 3 committees
Co-sponsors – ALL FROM NEW YORK: (Dem) Tonko, Morelle; (Rep) Stefanik, Williams, Langworthy, Molinaro, Lawler)
Summary unavailable as of Aug. 5, 2024
https://www.congress.gov/bill/118th-congress/house-bill/8561
Sept. 29, 2023 "Medicare Advantage Consumer Protection and Transparency Act" (H.R.5854) – Rep. Porter et al., referred to 2 committees
Co-sponsors: (Dem) DeGette, Doggett, Schakowsky, Castor, Takano, Jayapal, DeLauro, Grijalva, Mullin, Cohen, Nadler, Cherfilus-McCormick, Pocan
Summary: This bill generally requires Medicare Advantage organizations to report additional information to the Centers for Medicare & Medicaid Services, including supplemental plan benefits, encounter data, and the number of coverage denials and prior authorization requests. Failure to comply with the bill's requirements may result in payment reductions.
https://www.congress.gov/bill/118th-congress/house-bill/5854
Feb. 1, 2023 “Save Medicare Act” (H.R.732) – Rep. Pocan et al., referred to 2 committees
25 co-sponsors, all Democrats
Summary: This bill renames Medicare Advantage (MA) as the Alternative Private Health Plan program. It also establishes civil penalties for entities that continue to advertise MA plans with Medicare in the title.
Text: Sec.2 (a) There is hereby established the “Alternative Private Health Plan” program. The Alternative Private Health Plan program shall consist of the program under part C of title XVIII of the Social Security Act.
https://www.congress.gov/bill/118th-congress/house-bill/732
Sept. 28, 2022 “Medicare Advantage Consumer Protection and Transparency Act” (H.R.9019) – Rep. Porter et al., referred to 2 committees
Co-sponsors: (Dem) DeGette, Doggett, Schakowsky, Pocan, Grijalva, akano, Castor, DeLauro, Jayapal
Summary: This bill generally requires Medicare Advantage organizations to report additional information to the Centers for Medicare & Medicaid Services, including supplemental plan benefits, encounter data, and the number of coverage denials and prior authorization requests. Failure to comply with the bill's requirements may result in payment reductions.
https://www.congress.gov/bill/117th-congress/house-bill/9019
June 9, 2022 “To amend title XVIII of the Social Security Act to exempt qualifying physicians from prior authorization requirements under Medicare Advantage plans, and for other purposes (Gold Card Act of 2022” (H.R.7995) – Rep. Burgess et al., referred to 2 committees
Co-sponsors: (Dem) Gonzalez, Thompson, Panetta, Wild, Cuellar, Doggett, Axne, Keating, Schneider, Norton, Cohen, Bishop; (Rep) Jackson, Miller-Meeks, Bucshon, Van Drew, Fitzpatrick, Meuser, Joyce, Gohmert, Babin, Tiffany, Fallon
This bill exempts physicians from prior authorization requirements under Medicare Advantage plans with respect to specific items and services if at least 90% of the physician's requests for such items and services were approved during the previous plan year.
https://www.congress.gov/bill/117th-congress/house-bill/7995
Oct. 20, 2021 “Improving Seniors’ Timely Access to Care Act of 2021” (S.3018) – Sen. Marshall et al., referred to Finance
Co-sponsors: (Dem) 29, (Rep) 23
Summary: This bill establishes several requirements and standards relating to prior authorization processes under Medicare Advantage (MA) plans. Specifically, MA plans must (1) establish an electronic prior authorization program that meets specified standards, including the ability to provide real-time decisions in response to requests for items and services that are routinely approved; (2) annually publish specified prior authorization information, including the percentage of requests approved and the average response time; and (3) meet other standards, as set by the Centers for Medicare & Medicaid Services, relating to the quality and timeliness of prior authorization determinations.
https://www.congress.gov/bill/117th-congress/senate-bill/3018
May 13, 2021 “Improving Seniors’ Timely Access to Care Act of 2022” (H.R.3713) – Rep DelBene et al., passed the House by voice vote, received in the Senate Sept. 15, 2022
Co-sponsors: (Dem) 191, (Rep) 135
Summary: This bill establishes several requirements and standards relating to prior authorization processes under Medicare Advantage (MA) plans. Specifically, MA plans must (1) establish an electronic prior authorization program that meets specified standards, including the ability to provide real-time decisions in response to requests for items and services that are routinely approved; (2) annually publish specified prior authorization information, including the percentage of requests approved and the average response time; and (3) meet other standards, as set by the Centers for Medicare & Medicaid Services, relating to the quality and timeliness of prior authorization determinations.
https://www.congress.gov/bill/117th-congress/house-bill/3173
March 23, 2021 “Medicare Drug Price Negotiation Act” (S.908) – Sen. Sanders et al., referred to Finance, same as H.R.2139
Co-sponsors: (Dem) Blumenthal, Booker, Gillibrand, Leahy, Padilla, Reed, Smith, Warren
Summary:This bill makes a series of changes relating to the prices of prescription drugs under the Medicare prescription drug benefit and Medicare Advantage (MA) prescription drug plans (PDPs). Under current law, the Centers for Medicare & Medicaid Services (CMS) may neither negotiate the prices of covered drugs nor establish a formulary. The bill repeals these restrictions and instead specifically requires the CMS to (1) negotiate the prices of covered drugs; and (2) either establish a formulary for covered drugs, or require changes to PDP formularies that take into account CMS negotiations. If the CMS is unable to negotiate an appropriate price for a drug in accordance with certain criteria, the price must be the lowest of three specified options (e.g., the median price in other countries). The CMS must identify drugs that are subject to negotiation, with priority given to certain categories of drugs based on usage and cost. Additionally, drug manufacturers must issue rebates to the CMS for drugs dispensed to eligible low-income individuals. Subject to civil monetary penalties, a Medicare or MA PDP sponsor must report, both to drug manufacturers and to the CMS, specified information related to the determination and payment of such rebates.
https://www.congress.gov/bill/117th-congress/senate-bill/908
March 23, 2021 “Medicare Drug Price Negotiation Act” (H.R.2139) – Rep. Doggett et al., referred to 2 committees
Co-sponsors, all Democrats
Summary: same as S.908
https://www.congress.gov/bill/117th-congress/house-bill/2139
Sept 27, 2021, “Inflation Reduction Act” (H.R.5376) – with 295 amendments, became Pub. Law No: 117-169 with 295 amendments after 43 roll call votes
https://www.congress.gov/bill/117th-congress/house-bill/5376
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