To amend title XVIII of the Social Security Act to require Medicare Advantage plans to automatically reconsider determinations denying coverage.

Bill Number

H.R. 6110

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-11-18: 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.

Last Updated

2025-12-17T09:06:32Z

AI-Generated Summary

Purpose

This bill (H.R. 6110) aims to improve access to Medicare coverage by requiring Medicare Advantage plans—private health insurance options under Medicare—to automatically review and reconsider any initial decision to deny coverage to enrollees, without waiting for the enrollee to request it. The goal is to ensure quicker and more consistent opportunities for coverage approvals for seniors and people with disabilities.

Key Provisions

• Automatic Reconsideration Requirement: Medicare Advantage plans must automatically initiate a reconsideration process for every determination that denies coverage (previously limited to one determination per case).
• Timing of Reconsideration: The review must begin on the same day the initial denial is made, rather than waiting for an enrollee's request.
• Legislative Amendment: The bill targets Section 1852(g)(2)(A) of the Social Security Act (which governs Medicare Advantage operations), making specific wording changes to enforce automatic reviews.

Significant Changes to Existing Law

• Under current law, Medicare Advantage plans only reconsider a denial if the enrollee explicitly requests it, and the process starts upon receiving that request.
• This bill eliminates the need for an enrollee request, mandates review for all denials (not just select ones), and shifts the start of the process to the denial date itself.
• These changes expand enrollee protections by making the appeals-like process proactive, reducing barriers for vulnerable patients who might not know to appeal or face health challenges in doing so.

Potential Impacts

• On Citizens (Medicare Enrollees): Seniors and disabled individuals in Medicare Advantage plans could benefit from faster coverage decisions, potentially leading to more approvals for needed medical services and reducing out-of-pocket costs or delays in care.
• On Government Agencies: The Centers for Medicare & Medicaid Services (CMS), which oversees Medicare, may need to update regulations, monitoring, and enforcement to ensure plans comply, possibly increasing administrative workload but improving program accountability.
• On Medicare Advantage Plans: Private insurers offering these plans will face an automatic review obligation for every denial, which could raise operational costs and require process changes, but it may also reduce later disputes or lawsuits.
• No Notable International Relations Impact: The bill is domestic, focused on U.S. healthcare policy.

Main Stakeholders Affected

• Medicare Enrollees: Primarily older adults and people with disabilities who rely on Medicare Advantage for health coverage.
• Medicare Advantage Plans: Private companies (e.g., UnitedHealth, Humana) that administer these plans and must implement the automatic review process.
• Federal Government (CMS): Responsible for regulating and enforcing compliance within the Medicare program.
• Healthcare Providers: Doctors and hospitals that treat Medicare patients, as faster reconsiderations could streamline payments for services.

Notable Legal, Constitutional, or Political Implications

• Legal Implications: Strengthens administrative due process under Medicare by making coverage denials subject to immediate internal review, potentially reducing the need for enrollees to escalate to external appeals (e.g., through Administrative Law Judges). This aligns with broader patient rights in federal health programs but could lead to more litigation if plans challenge the added requirements.
• Constitutional Implications: None directly; the bill operates within Congress's authority to regulate interstate commerce and social welfare programs like Medicare.
• Political Implications: Sponsored by a group of Democratic representatives focused on consumer protections, it highlights ongoing debates over privatized Medicare options versus traditional fee-for-service Medicare. If passed, it could influence future reforms to balance plan efficiency with beneficiary safeguards, amid concerns about denial rates in Medicare Advantage.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Pocan, Mark [D-WI-2]

Cosponsors (17)

Rep. Carson, André [D-IN-7], Rep. Cohen, Steve [D-TN-9], Rep. DeLauro, Rosa L. [D-CT-3], Rep. Doggett, Lloyd [D-TX-37], Rep. Jayapal, Pramila [D-WA-7], Rep. Khanna, Ro [D-CA-17], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Ocasio-Cortez, Alexandria [D-NY-14], Rep. Schakowsky, Janice D. [D-IL-9], Rep. Takano, Mark [D-CA-39], Rep. Thanedar, Shri [D-MI-13], Rep. Tlaib, Rashida [D-MI-12], Rep. Bell, Wesley [D-MO-1], Rep. Omar, Ilhan [D-MN-5], Rep. Dingell, Debbie [D-MI-6], Rep. Casar, Greg [D-TX-35], Rep. Pingree, Chellie [D-ME-1]

Recent Actions

• 2025-11-18: 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.
• 2025-11-18: 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.
• 2025-11-18: Introduced in House
• 2025-11-18: Introduced in House

Bill Versions

• To amend title XVIII of the Social Security Act to require Medicare Advantage plans to automatically reconsider determinations denying coverage. — issued 2025-11-18 — PDF (2 pages)