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Congress·In Committee·27 days ago

Senate Bill Would Standardize Medicare Advantage Prior Authorization Rules Across All Plans

Also known as: Prior Authorization Relief Act

Legislative Progress

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Impact Analysis

Scores: 1 = low, 5 = highSentiment: -5 to +5 (net benefit)

Key Points

  • This bill aims to fix the "prior authorization" process, which is when an insurance company must approve a medical service or drug before they agree to pay for it. Currently, every Medicare Advantage plan has different rules, which can lead to delays in care and extra paperwork for doctors.
  • The government would conduct a major audit by 2027 to find the most expensive treatments and drugs that currently require too many steps to get approved. By May 2028, the government would create one standard set of rules that all Medicare Advantage plans must follow for these specific items.
  • Doctors and hospitals that take on financial risk for their patients' health would be exempt from these approval rules entirely. This is because these doctors already have a financial reason to avoid unnecessary treatments, so the extra layer of insurance paperwork is less necessary.
  • The goal is to make it faster and easier for seniors to get the care they need without waiting weeks for insurance companies to sign off on common treatments. It also helps doctors spend less time on forms and more time with patients.
Healthcare

Milestones

2 milestones2 actions
Feb 3, 2026Senate

Read twice and referred to the Committee on Finance.

Feb 3, 2026

Introduced in Senate

Related News

2 articles
InsuranceNewsNet·26 days ago

WHITEHOUSE REINTRODUCES BILL TO REFORM PRIOR AUTHORIZATION AND DELIVER CARE TO PATIENTS FASTER

Senator Whitehouse's Prior Authorization Relief Act would require CMS to perform an audit of Medicare Advantage insurance plans and standardize requirements. The bill also exempts providers in two-sided risk value-based payment models from prior authorization for their beneficiaries.

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Tash.org·12 days ago

Washington Update | February 2026

The Prior Authorization Relief Act (S. 3762), introduced by Senator Sheldon Whitehouse, would require the Centers for Medicare and Medicaid Services (CMS) to streamline and standardize prior authorization for services in Medicare Advantage.

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Source Information

Document Type

Congressional Bill

Official Title

Prior Authorization Relief Act

Bill NumberS 3762
Congress119th Congress
ChamberSenate
Latest ActionRead twice and referred to the Committee on Finance.

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