Medicare Advantage legislation in Congress: 8 bills to know 

Federal lawmakers have introduced a handful of bills aimed at speeding up prior authorization and cracking down on upcoding in Medicare Advantage. 

Not all of the introduced bills have been heard in committee. 

Here are eight proposals introduced in 2025 to know:

1. U.S. Sens. Catherine Cortez Masto, D-Nev., and Marsha Blackburn, R-Tenn., introduced the Medicare Advantage Prompt Pay Act to ensure more efficient MA payments, according to a Sept. 19 news release. Under the legislation, insurers would have to pay electronic claims within 14 days if the provider is in network. Insurance companies would have 30 days for all other claims. The bill would also require insurers to pay at least 95% of a claim while abiding by this timeline. These parameters are similar to those presented in the House’s Prompt and Fair Pay Act.

2. Reps. Lloyd Doggett, D-Texas, and Greg Murphy, MD, R-N.C., introduced the Prompt and Fair Pay Act, which would require MA plans to reimburse services covered by traditional Medicare at the same rate as the Medicare fee schedule. The legislation also establishes requirements for MA plans to reimburse providers within 14 days for claims submitted electronically.
   
   The legislation is backed by America’s Essential Hospitals and other hospital associations.
   
   
3. Reps. Aaron Bean, R-Fla., and Kevin Hern, R-Okla., introduced the Apples to Apples Comparison Act, which would require CMS and Medicare Payment Advisory Commission to report more cost comparison measures for MA and fee-for-service beneficiaries.
   
   
4. Rep. David Schweikert, R-Ariz., introduced H.R.3467, which would overhaul several aspects of MA. The bill would require MA plans to pay capitation payments for most plans, and would allow CMS to enroll Medicare beneficiaries in the least expensive MA plan available to them automatically. Enrollees could opt-out of this option.
   
   The bill would also require MA plans to administer the Medicare hospice benefit. Currently, when MA beneficiaries enter hospice care, traditional Medicare manages these benefits. The National Alliance for Home Care called the proposal “short-sighted.”
   
   “The proposed carve-in seeks to solve a problem that does not exist, upending hospice as we know it, and subjecting dying patients to new administrative hurdles, reduced choice and the risk of diminished care,” the alliance wrote in a June 24 letter to Mr. Schweikert.
   
   
5. A bipartisan group of lawmakers introduced legislation that would allow the Department of Veterans Affairs to bill MA plans for care provided to members. The lawmakers said the provision is designed to close a loophole that allows MA plans to receive payments for veterans enrolled who are receiving care entirely through VA facilities.
   
   
6. Sens. Bill Cassidy, R-La., and Jeff Merkley, D-Ore., reintroduced the No UPCODE Act in March. The legislation would require CMS to use two years of data in its risk adjustment methodology and prohibit CMS from using diagnoses collected from chart reviews or health risk assessments in risk adjustments.
   
   
7. Rep. Victoria Spartz, R-Ind., introduced the Stopping Medicare Abuses to Restore Trust in Health Care Act in May. The act would also require CMS to use two years of data in its risk adjustment methodology alongside other provisions.
   
   
8. Lawmakers reintroduced the Improving Seniors’ Timely Access to Care Act, a bipartisan bill that aims to streamline the prior authorization process for Medicare Advantage enrollees. The bill has received backing from insurers and the American Medical Association.