Protecting Approved Care Act amends Medicare Advantage plans to limit claims denials and prior authorization requirements.

The Protecting Approved Care Act amends title XVIII of the Social Security Act to establish requirements for the use of prior authorization and claims denial under Medicare Advantage plans. Beginning with plan years starting on or after January 1, 2028, contracts with Medicare Advantage organizations must ensure that certain actions cannot be taken regarding items or services. These actions include denying coverage based on lack of medical necessity and reopening a coverage determination for reasons other than changing the code assigned to the claim.

Protecting Approved Care Act amends Medicare Advantage plans to limit claims denials and prior authorization requirements.

The Protecting Approved Care Act amends title XVIII of the Social Security Act to establish requirements for the use of prior authorization and claims denial under Medicare Advantage plans. Beginning with plan years starting on or after January 1, 2028, contracts with Medicare Advantage organizations must ensure that certain actions cannot be taken regarding items or services. These actions include denying coverage based on lack of medical necessity and reopening a coverage determination for reasons other than changing the code assigned to the claim.