A significant name in the DME/ HME space, AAHomecare has declared support for the Medicare Advantage Improvement Act of 2026, sponsored by Sen. Roger Marshall (R-KS) and Rep. John Joyce (R-PA).
What is the Medicare Advantage Improvement Act of 2026?
The Medicare Advantage Improvement Act of 2026 is bipartisan legislature designed to “deliver long overdue reforms to Medicare Advantage prior authorization, claims integrity, and transparency practices.”
According to AAHomecare, the bill would improve access to home medical equipment for Medicare beneficiaries and address challenges faced by AAHomecare’s members.
3 Key Identifiers of the Legislation
- Medicare Advantage plans must respond to standard prior authorization requests within 72 hours and expedited requests within 24 hours.
- S. 4384 and H.R. 8375 would prohibit Medicare Advantage organizations from denying coverage for authorized items and services on medical necessity grounds once approval has been granted.
- Medicare Advantage organizations must publicly report prior authorization denial rates, appeal outcomes, and approval timelines.
Tom Ryan, president of AAHomecare, states:
“This legislation represents a major step forward for patients and the home medical equipment providers who serve them. We appreciate the leadership behind S.4384 and H.R. 8375 and strongly support reforms that protect both beneficiaries and the providers who ensure access to medically necessary equipment.”
If interested, read the bill language in the House and Senate here!
What Could This Mean for DMEs/ HMEs?
Potential Benefits of the Medicare Advantage Improvement Act of 2026
As mentioned, the proposed Medicare Advantage Improvement Act of 2026 aims to reduce administrative burdens and improve patient access to care within Medicare Advantage plans.
If passed, it could have several positive implications for DME/ HME providers:
1. Faster Authorizations and Deliveries - The bill would establish stricter timelines for prior authorization decisions, helping suppliers get equipment approved and delivered more quickly.
2. Fewer Denials and Appeals - By aligning Medicare Advantage coverage decisions more closely with Traditional Medicare rules, the legislation could reduce unnecessary denials and the administrative work associated with appeals and resubmissions.
3. Better Cash Flow - Provisions related to prompt payment requirements and limits on retroactive claim denials could improve reimbursement predictability and strengthen cash flow for suppliers.
Is There A Potential Downside?
Always, right?
While the bill could reduce administrative friction, Medicare Advantage plans may respond by tightening network participation requirements, increasing documentation expectations, or renegotiating reimbursement rates to offset additional regulatory requirements.
