Bills · HR 6109
IN COMMITTEE· 119TH CONGRESS
House BillHR 6109Health
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.
INTRO NOV 18· LAST ACTION NOV 18
READING
3MIN
COSPONSORS
18
READER REACTIONS0 TOTAL
NO VOTES YET · BE THE FIRST
- Introduced only
LEGISLATIVE PROGRESS
STEP 2 / 8Introduced
In Committee
Reported
Passed House
Passed Senate
Conference
To President
Became Law
WHAT THE BILL DOES
AI-writtenVoters should care about this bill because it addresses a common frustration for many people relying on Medicare Advantage plans: the 'prior authorization' process. This process can sometimes delay or prevent access to necessary medical treatments, even if those treatments are eventually approved after an appeal. This bill aims to reduce the burden on patients and doctors by pressuring plans to make more accurate initial decisions.
If this bill becomes law, it could lead to more straightforward access to care for millions of Americans, potentially cutting down on bureaucratic hurdles and improving the overall patient experience. If it doesn't pass, Medicare Advantage plans would continue to operate without this specific federal guardrail on reversed prior authorization rates, meaning patients might continue to face similar challenges in getting timely approval for their medical needs.
KEY PROVISIONS
4AI-extractedPROVISION 01
Establishes a maximum allowable rate for reversed prior authorization denials in Medicare Advantage plans.
This sets a clear, measurable standard for how often a plan can initially deny a service and then reverse that decision, aiming to reduce unnecessary denials.
PROVISION 02
A plan exceeds the allowable rate if more than 25% of its prior authorization denials are later reversed upon reconsideration or appeal.
The 25% threshold provides a specific trigger for enforcement, giving plans a target to meet for their denial review processes.
PROVISION 03
Requires the Secretary of Health and Human Services to terminate the contract of a Medicare Advantage plan that exceeds the allowable rate.
This provision creates a strong, mandatory consequence for non-compliant plans, giving the rule significant enforcement power.
PROVISION 04
Includes a separate condition for violating the allowable rate if a plan significantly reduces reversals due to failing to appropriately reconsider denials.
This prevents plans from simply denying more requests and reducing reversals by making the reconsideration process more difficult or unfair.
SPONSORSHIP
1 + 18
D· Wisconsin
YRS IN OFFICE
13
BILLS LED
24
COSPONSOR BREAKDOWNBIPARTISAN · 0%
DEM 18 REP 0 IND 0
ACTION TIMELINE
2 EVENTSNOV 18
Introduced in House
NOV 18
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.
BILL INFO
TypeHouse Bill
NumberHR 6109
Congress119th
StatusIn Committee
IntroducedNov 18, 2025
Last actionNov 18, 2025
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IN COMMITTEE· 119TH CONGRESS · WAYS AND MEANS COMMITTEE · INTRODUCED NOV 18, 2025
House BillHR 6109Health
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.
INTRODUCED NOV 18, 2025· LAST ACTION NOV 18, 2025
PASSAGE CHANCES
—%
READING
3 min
COSPONSORS
18
COMPLEXITY
Moderate
