Washington, D.C. — A group of physician-lawmakers from both parties introduced legislation this week aimed at reining in Medicare Advantage plans that routinely delay or deny care for nursing home residents — the kind of care that operators say should never require a fight in the first place.
The Medicare Advantage Improvement Act of 2026, introduced Wednesday, takes direct aim at prior authorization barriers, coverage denials, and payment clawbacks that have long frustrated skilled nursing facilities trying to get their patients covered.
What the bill would do
The legislation includes a range of protections: preventing delays and denials of medically necessary care, increasing transparency in prior authorization decisions, penalizing plans that don’t comply, and reducing administrative red tape through automation. It would also block retroactive clawbacks — a practice where insurers recoup payments after care has already been delivered — and expand access to post-acute services like skilled nursing.
“For too long, cases of abuse have crept into Medicare Advantage, pulling it away from its core mission of serving America’s seniors,” said Rep. Mariannette Miller-Meeks (R-Iowa), a physician and co-lead on the bill. “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.”
The bill is co-led by a bipartisan group of physician-members: Reps. John Joyce (R-Pa.), Greg Murphy (R-N.C.), Jimmy Panetta (D-Calif.), Ami Bera (D-Calif.), Beth Van Duyne (R-Texas), and Kim Schrier (D-Wash.).
Industry reaction
The American Health Care Association and National Center for Assisted Living came out strongly in favor, urging Congress to move quickly.
“This represents a significant step towards ensuring Medicare Advantage delivers on its promise to America’s seniors,” said Clif Porter, president and CEO of AHCA/NCAL. “We commend these lawmakers for developing a better way to enable seniors to have timely access to care and hold plans accountable.”
AHCA/NCAL’s vice president of reimbursement policy, Nisha Hammel, called out the insurer practices the bill is designed to fix. “Coverage decisions for Medicare Advantage beneficiaries must be driven by each patient’s needs and clinical necessity, with appropriate oversight that ensures compliance and patient protections,” Hammel said.
The push comes as nursing home operators continue to report that Medicare Advantage plans are sending them sicker patients while cutting covered stays shorter than ever — a dynamic that’s squeezing both care quality and facility finances.
Why it matters for nursing homes
MA enrollment has grown to cover more than half of all Medicare beneficiaries, which means a growing share of post-acute admissions now flow through private plans rather than traditional fee-for-service. That shift has put skilled nursing facilities in a bind: they’re treating more complex patients, but navigating more denials and shorter approved stays.
Data cited in industry reports showed that between 2019 and 2022, top MA insurers denied post-acute care requests more frequently than other types of services — and that the friction was pushing more older adults to leave Medicare Advantage plans entirely in their final year of life.
Whether this bill advances through a divided Congress is far from certain. But with co-sponsors from both parties and a group of physician-lawmakers leading the charge, it’s one of the more credible legislative attempts in recent memory to address what the long-term care industry has spent years calling a systemic problem.
