Dems introduce bill to eliminate prior auths for MA plans

WASHINGTON — Reps. Pramila Jayapal, D-Wash., and Ro Khanna, D. Calif., have introduced the Stop Deadly Denials Act to no longer allow Medicare Advantage plans to require prior authorization for necessary medical items and services.

The legislation would ensure patients are able to receive fair affordable coverage without added administrative burdens from prior authorization that frequently block care.

“Medicare DisAdvantage makes it harder for patients to get the care they need – often leading to delays and denials of care that can be deadly,” said Jaypal. “We’re now seeing the Trump Administration bring this tactic to Traditional Medicare as well, denying Americans care they need, and that they would have received before the implementation of the WISeR model.”

The Stop Deadly Denial Act:

• Eliminates prior authorization for all Medicare Advantage Part A and Part B services unless required in traditional Medicare.
• Blocks WISeR and any substantially similar prior authorization model in Traditional Medicare.
• Prohibits CMMI from testing any prior authorization model that imposes prior authorization for Part A/B services, uses AI or algorithm-driven denials without physician review, or outsources prior authorization determinations outside Medicare Administrative Contractors (MACs).
• Requires CMS to use full notice-and-comment rulemaking for all future models starting in 2027.

“It’s time we stop allowing Medicare Advantage to profit off the Medicare name while denying critical coverage,” said Khanna. “Affordable quality healthcare is a human right. I’m proud to introduce this legislation with Rep. Jayapal and stop Medicare Advantage from using prior authorization to delay and deny medically necessary care.”

Cosponsors for the bill are Reps. Steve Cohen, D-Tenn., Debby Dingell, D-Mich., Jonathan Jackson, D-Ill., Eleanor Holmes Norton, D-DC., and Mark Pocan, D-Wis.

Read the full text of the legislation here.