Protecting Approved Care Act

This bill changes Medicare law to limit when Medicare Advantage plans can deny or reduce payment for care. Starting with plan years beginning on or after January 1, 2028, if a plan approves an item or service in advance or while the patient is receiving it, the plan may not later deny coverage for lack of medical necessity. The same limit applies to covered items or services that did not require approval. Plans also could not reopen coverage or payment decisions, or change billing codes to lower payment, unless there is good cause or reliable evidence of fraud or similar fault. Approvals for transfers between hospitals, or from a hospital to a post-acute care facility, are included.

Full text and official record on Congress.gov

Sponsors

• Greg Landsman Democrat sponsor
• 5 cosponsors