To amend title XVIII of the Social Security Act to establish certain requirements with respect to rates of reversed prior authorization coverage determinations under Medicare Advantage plans.

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 6109 Introduced in House (IH)] <DOC> 119th CONGRESS 1st Session H. R. 6109 To amend title XVIII of the Social Security Act to establish certain requirements with respect to rates of reversed prior authorization coverage determinations under Medicare Advantage plans. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES November 18, 2025 Mr. Pocan (for himself, Mr. Carson, Mr. Cohen, Ms. DeLauro, Mr. Doggett, Ms. Jayapal, Mr. Khanna, Ms. Norton, Ms. Ocasio-Cortez, Ms. Schakowsky, Mr. Takano, Mr. Thanedar, Ms. Tlaib, Ms. Johnson of Texas, Ms. McBride, and Ms. Omar) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned _______________________________________________________________________ A BILL To amend title XVIII of the Social Security Act to establish certain requirements with respect to rates of reversed prior authorization coverage determinations under Medicare Advantage plans. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. ESTABLISHING REQUIREMENTS WITH RESPECT TO RATES OF REVERSED PRIOR AUTHORIZATION COVERAGE DETERMINATIONS UNDER MEDICARE ADVANTAGE PLANS. Section 1857 of the Social Security Act (42 U.S.C. 1395w-27) is amended-- (1) in subsection (e), by adding at the end the following new paragraph: ``(6) Requirement on rates of reversed prior authorization coverage determinations.-- ``(A) In general.--In the case of a Medicare Advantage plan that imposes any prior authorization requirement with respect to items or services furnished during a plan year beginning on or after the date that is 1 year