AHA Offers Support for Senate Medicare Advantage Improvement Act

May 7, 2026

The Honorable Roger Marshall, M.D.
United States Senate
479A Russell Senate Office Building
Washington, DC 20510

The Honorable Sheldon Whitehouse
United States Senate
530 Hart Senate Office Building
Washington, DC 20510

Dear Sens. Marshall and Whitehouse:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) writes to express our support for the Medicare Advantage Improvement Act (S. 4384).

More than half of all Medicare beneficiaries rely on the Medicare Advantage (MA) program for their health coverage. While hospitals and health systems have long supported the choice and innovation that a strong commercial health insurance market can provide, we are concerned about the growing number of MA plan policies designed to reduce access to care for Medicare beneficiaries, delay or deny payments to providers and ultimately drive up the cost of care. Your bipartisan legislation would curb many of these practices and help ensure that seniors receive access to the timely, reliable care they deserve.

Your bill builds upon many of the policies that hospitals and health systems have long supported to hold commercial insurers accountable. The improper use of prior authorization is one of the greatest pain points in the U.S. health care system, leading to inappropriate delays and denials for patients and a significant administrative burden for providers. The Medicare Advantage Improvement Act addresses many of these concerns by requiring standard prior authorization approvals within 72 hours, expedited decisions within 24 hours and real-time approvals for routine low-risk services integrated with electronic health records. It also requires MA plans to publicly report detailed prior authorization data to ensure plans continue to comply with these requirements. Additionally, the bill responds to growing concerns about automated denials by prohibiting the use of automated denial algorithms. The bill would strengthen patient and provider protections by ensuring that coverage determinations remain grounded in Medicare standards and appropriate clinical review, while providing critical protection to limit retroactive denials after care has been authorized.

We are also pleased to see that this bill includes provisions remedying some of the specific challenges post-acute care providers face with MA plans. Despite steps taken by the Centers for Medicare & Medicaid Services in recent years, post-acute care providers have seen little to no meaningful change in MA plan behavior and no increased access for beneficiaries. As MA enrollment continues to grow, it is imperative that Congress continue to rein in practices like improper prior authorization that can inappropriately limit access to needed post-hospital care and ensure that beneficiaries are not denied the care to which they are entitled. In addition to prior authorization concerns, post-acute care providers also face challenges obtaining network agreements with MA plans. We appreciate that this bill takes steps to ensure network requirements include access to long-term care hospitals and inpatient rehabilitation facilities.

Lastly, there are no existing prompt payment standards that require MA plans to provide timely payment to contracted providers. As a result, an AHA survey found that 50% of hospitals and health systems reported having more than $100 million in unpaid claims, which were more than six months old. These payment delays prevent hospitals from investing in patient care and exacerbate the current financial challenges facing many hospitals. Your bill addresses this issue by requiring all qualifying claims for authorized items and services to be deemed as clean claims and paid consistent with Original Medicare’s prompt payment timelines.

We thank you for your leadership on this important issue and look forward to working with you to enact this important legislation.

Sincerely,

/s/

Stacey Hughes
Executive Vice President