Source: United States House of Representatives – Congresswoman Kim Schrier, M.D. (WA-08)
WASHINGTON, D.C. – Today, Congresswoman Kim Schrier, M.D. (WA-08), introduced the bipartisan Medicare Advantage Improvement Act (MAIA), legislation aimed at strengthening the Medicare Advantage program to protect healthcare for seniors. Congresswoman Schrier is joined in introducing this legislation by Reps John Joyce, M.D. (PA-13), Ami Bera, M.D. (CA-06), Greg Murphy, M.D. (NC-03), Jimmy Panetta (CA-19), Beth Van Duyne (TX-24), and Mariannette Miller-Meeks, M.D. (IA-01).
“Health insurance companies have abused Medicare Advantage plans for too long, and they continue to skyrocket costs, deny coverage, and force taxpayers to pay the price. We need increased oversight into the Medicare Advantage program so that all seniors get the care they were promised,” said Congresswoman Schrier. “I am extremely proud to have worked on these much-needed Medicare Advantage reforms, which will hold insurance companies accountable and get patients timely, quality care.”
This bill will implement sweeping Medicare Advantage reforms aimed at:
- Protecting patients from unnecessary delays and denials.
- Standardizing coverage criteria between MA and traditional Medicare.
- Penalizing plans that fail to meet oversight and compliance benchmarks.
- Reducing administrative burdens through real-time and automated systems.
- Strengthening patient access to post-acute care providers.
“Medicare is a promise to America’s seniors that they will have dependable access to quality healthcare in their later years. However, that promise has been undermined by unnecessary barriers to care—particularly through excessive use of prior authorization and inappropriate coverage denials in Medicare Advantage,” said Rep. John Joyce, M.D. (PA-13). “As a physician, I have seen firsthand how these delays harm patients and take valuable time away from the doctor-patient relationship. The Medicare Advantage Improvement Act will restore accountability, reduce unnecessary barriers, and ensure that seniors receive timely, high-quality care.”
“Medicare Advantage should work for seniors, not enable health insurers to deny life-saving care. The Medicare Advantage Improvement Act is a commonsense step to rein in excessive prior authorization abuse, ensure timely access to care, and restore accountability in a system that too often delays or denies needed treatment. I’m proud to help lead this effort to strengthen Medicare Advantage and uphold the promise we’ve made to America’s seniors,” said Congressman Greg Murphy, M.D. (NC-03).
“For too long, cases of abuse have crept into Medicare Advantage, pulling it away from its core mission of serving America’s seniors,” said Congresswoman Mariannette Miller-Meeks, M.D. (IA-01). “As a physician, I’ve seen how these practices delay care, create unnecessary barriers, and increases the cost of healthcare. This bill restores accountability, cracks down on bad actors, and ensures Iowa seniors can access the care they need, without delay, without denial, and without interference from bureaucratic red tape.”
“Medicare Advantage can play an important role in helping seniors access quality, affordable care, but that only works if plans are holding up their end of the bargain,” said Congressman Ami Bera, M.D. (CA-06). “Right now, too many seniors are running into barriers that delay treatment and create confusion for patients and providers alike. This legislation is about bringing more accountability and oversight to Medicare Advantage so plans better serve the people they are supposed to serve. I’m proud to join this bipartisan effort to strengthen the program and protect our seniors.”
“Medicare Advantage plans too often leave seniors fighting their health insurance companies to obtain lifesaving care in a timely manner,” said Congressman Jimmy Panetta (CA-19). “Our bipartisan bill would make critical reforms to avoid lengthy prior authorization delays and opaque denials of coverage, while improving transparency, expediting payments for previously authorized services, and holding irresponsible actors accountable. I’ll always work with my colleagues across the aisle to make sure Congress does its part to get working families in the 19th Congressional District the affordable, accessible healthcare they need when they need it.”
“Seniors in North Texas who rely on Medicare Advantage did not sign up to navigate a maze of bureaucracy, fight inconsistent coverage standards, or wait for care their doctors already approved,” saidCongresswoman Beth Van Duyne (TX-24). “The Medicare Advantage Improvement Act cuts through the red tape, holds insurance companies accountable, and ensures American seniors get the care they deserve.”
CLICK HERE to view the full text of the Medicare Advantage Improvement Act (MAIA).
CLICK HERE to view the section-by-section.
Support from Stakeholders:
“Medicare Advantage was intended to provide more options and improve outcomes for seniors, but in too many cases it is creating new barriers,” said Eduardo Conrado, President and CEO of Ascension. “Our physicians and care teams see it every day. Prior authorizations and inappropriate denials delay care and create confusion when patients need clarity and support most. We are committed to being part of the solution. This legislation is an important step toward strengthening the doctor-patient relationship, improving transparency, and helping Medicare Advantage better serve seniors and the clinicians who care for them.”
“On behalf of our 800+ inpatient rehabilitation hospital members, the American Medical Rehabilitation Providers Association (AMRPA) applauds Dr. Joyce and his colleagues for introducing the Medicare Advantage Improvement Act (MAIA),” said Kate Beller, President of AMRPA. “AMRPA member hospitals help patients maximize their health, functional ability, and independence following serious illness or injury. This legislation will provide timely and essential reforms to ensure that Medicare beneficiaries enrolled in the Medicare Advantage program are able to access the critical services provided by inpatient rehabilitation providers and, in turn, return to their home or community at higher rates than any other post-acute care setting. As AMRPA’s recent member survey shows, far too many seniors currently face unnecessary delays and erroneous denials after getting a referral for medically necessary inpatient rehabilitation care. This bill takes a critical step forward in accelerating determination timeframes, increasing plan transparency and oversight, and reducing administrative burdens for patients, caregivers, and providers. This commonsense legislation will strengthen Medicare Advantage and provide immediate protections to the patients served by the program, particularly those in need of inpatient rehabilitation. We look forward to working with our Congressional champions and allied organizations to get this vital bill signed into law.”
“I want to commend Dr. Joyce and his colleagues for introducing the Medicare Advantage Improvement Act. Dr. Joyce, along with many of his physician colleagues in Congress, understand the daily challenges our patients face. While Medicare Advantage promises many benefits, its current form presents significant obstacles to care, causes confusion and delays, and limits provider choice. It is not the optimal solution for everyone,” said Anthony Misitano, President and CEO of PAM Health. “However, with more than half of all Medicare beneficiaries enrolled in a Medicare Advantage plan, we recognize the program’s importance and strongly support legislation to improve it so it can fulfill its goal of providing seniors with timely, efficient access to high-quality medical care and services. On behalf of our patients nationwide, I thank Dr. Joyce and his colleagues for safeguarding patient care and working to strengthen this critical program.”
“Across the communities we serve, we see too many seniors enrolled in Medicare Advantage struggling to get the care they need — facing delays, unexpected denials, and confusion at moments when they should be focused on their health,” said Kevin Hammons, CEO of Community Health Systems. “When care becomes unpredictable, it creates stress and uncertainty for patients and their families and can stand in the way of timely treatment. We thank Dr. Joyce and his colleagues for their leadership in introducing the Medicare Advantage Improvement Act. By improving prior authorization processes, reducing unnecessary administrative barriers, and increasing transparency, this legislation will help create a more consistent, dependable experience for seniors and strengthen Medicare Advantage for the long term.”
“Medicare Advantage has grown rapidly, and we are proud of our ability to meet the needs of many patients who are covered by the program,” said Mark Tarr, President and Chief Executive Officer of Encompass Health. “However, Medicare Advantage prior authorization and patient access issues persist. With the introduction of the Medicare Advantage Improvement Act, we are excited that policymakers in Congress are now closer to making much-needed changes to strengthen oversight for plans that fail to meet compliance standards, and expand access to Inpatient Rehabilitation Facilities, ensuring patients can receive the care they need without unnecessary barriers.”
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