Recent Congressional Actions Seek to Address Medicare LCD, MA, and NSA Enforcement Reforms

A suite of bills recently introduced in Congress seek to address issues underlying Medicare local coverage determinations (LCDs), Medicare Advantage (MA), and the No Surprises Act (NSA) enforcement.

The Timely Access to Coverage Decisions Act of 2026 (H.R. 8500) was introduced in the House by Reps. Neal Dunn (R-Fla.) and Nanette Barragán (D-Calif.) on April 27. The bill seeks to increase transparency in the Medicare LCD process through the inclusion of appropriate stakeholder input, creation of a formal review process for reconsideration decisions, and requirement of timely request completion.

The Medicare Advantage Improvement Act of 2026 (H.R. 8375/S. 4384) was introduced in both chambers of Congress on April 27. This bill would provide a slew of reforms to address critical issues within MA, including prior authorizations, prompt pay, payment clawbacks, and transparency. Standard prior authorization decisions would be required within 72 hours of submission, while expedited decisions would be required within 24 hours. There would be a 14-day window for general appeal reconsideration and 24 hours for expedited appeals. Additionally, public reporting of prior authorization data would be required.

Finally, the No Surprises Act Enforcement Act (H.R. 4710/S. 2420) was introduced in both chambers on July 23, 2025, to bolster enforcement of the NSA’s payment requirements, specifically increasing penalties for group health plans and health insurance carriers for practices that violate balance billing requirements in the Independent Dispute Resolution process.

This final bill is gaining momentum following a letter of support sent to congressional leaders on May 11 and signed by the American Medical Association along with 50 state medical societies and 46 health care groups. The undersigned organizations state they “remain deeply invested in this law’s successful implementation and in achieving the balanced framework Congress intended.” This letter of support follows an earlier letter, dated April 28, warning about health plans undermining the NSA and urging federal regulators to crack down on clear violations of the law.

All three bills have been referred to relevant committees within the respective chambers and await further deliberation.

Sources:

https://dunn.house.gov/news/documentsingle.aspx?DocumentID=526

https://www.ahcancal.org/News-and-Communications/Blog/Pages/Medicare-Advantage-Improvement-Act-of-2026-Introduced.aspx

https://www.ama-assn.org/press-center/ama-press-releases/ama-health-groups-urge-congress-bolster-no-surprises-act