Prior Authorization Relief Act
Senate Bill Would Standardize Medicare Advantage Prior Authorization Rules Across All Plans
Legislative Progress
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.
Impact Analysis
Personal Impact
Life & Work
Small medical practices and physician-owned clinics spend significant staff time navigating different prior authorization rules for each Medicare Advantage plan. Standardizing these requirements would reduce the administrative burden on these practices, allowing them to spend less money on paperwork staff and more time on patient care. However, this only applies to the subset of items and drugs identified in the audit.
Programs
Disabilities
Milestones
Read twice and referred to the Committee on Finance.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in Senate
The bill was officially filed and given a number. It now enters the legislative queue.
Votes
No votes have been recorded for this legislation yet.
Related News
2 articles
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.
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.
Source Information
Document Type
Congressional Bill
Official Title
Prior Authorization Relief Act
Data Sources
Sponsor
Analysis generated by AI. Always verify with official sources.