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.

# HR 6109 Summary **What the Bill Does** This bill would change rules for Medicare Advantage plans (private insurance plans that serve Medicare beneficiaries) regarding "prior authorization"—the process where insurance companies must approve treatments before they're provided. Specifically, the bill would establish requirements about how often insurance companies' initial denials of coverage get overturned on appeal. The goal appears to be ensuring that when patients or doctors challenge a denied claim, those appeals are being decided fairly. **Who It Affects** The bill directly affects Medicare Advantage plan members (seniors and some younger disabled individuals on Medicare who choose private plans), doctors and hospitals that treat these patients, and the insurance companies offering these plans.

Indirectly, it could affect Medicare's overall costs and healthcare access. **Current Status** HR 6109 was introduced by Rep. Mark Pocan (D-Wisconsin) in the 119th Congress and is currently in committee, meaning it has not yet been debated or voted on by the full House. The bill's specific provisions regarding what "rates of reversed determinations" should be are not detailed in the available summary.