H.R. 10394
Bars Medicare Advantage from reversing approved claims
Starting in 2028, Medicare Advantage plans could not deny or reduce payment for care they already approved, or for care that needed no approval, except for fraud or good cause.
- Applies to plan years starting on or after January 1, 2028
- Once a plan approves an item or service, it cannot later deny it as not medically necessary
- Plans also cannot change a claim code to pay less, unless there is fraud or good cause
- Covers care approved in advance or while a person is receiving it, including hospital transfers
In committee