Congressmen Onder and Landsman Introduce Bipartisan Legislation to Protect Patients

FOR IMMEDIATE RELEASE
September 17, 2026
Contact: Brooke Morgan

WASHINGTON, D.C. - Today, Congressman Bob Onder (R-MO) and Congressman Greg Landsman (D-OH) introduced the bipartisan Protecting Approved Care Act.

This legislation ensures that when a Medicare Advantage plan approves care, that approval holds. It bars plans from reversing coverage, clawing back payment, or downcoding claims after the fact, giving patients and their doctors the certainty they need to move forward with treatment.

"As a physician, I know that when a plan approves a treatment, the doctor and the patient need to be able to count on it," said Congressman Bob Onder, M.D. "Reaching back months later to claw back payment for care a plan already approved undermines that certainty and makes it harder for physicians to keep seeing their patients. This bill makes Medicare Advantage plans keep their word, and I'm glad to work with Rep. Landsman on it."

"Even as health care costs rise, these insurance companies continue to take advantage of Americans by putting their business over patients. These predatory practices have to end. If coverage is approved, they need to keep their word," said Congressman Greg Landsman.

"As an orthopaedic surgeon, I applaud Rep. Onder and my fellow Ohioan Rep. Landsman for taking action to bring accountability and stability to the Medicare Advantage program. The AAOS is proud to support the Protecting Approved Care Act and looks forward to working alongside Congress to strengthen the prior authorization system for patients and physicians," said Joel L. Mayerson, M.D., Chair, American Academy of Orthopaedic Surgeons Advocacy Council.

ClickHERE to read the full bill text.

Background Information

The Protecting Approved Care Act provides greater certainty around prior authorization decisions made by Medicare Advantage plans and ensures providers can rely on an approval when delivering care to their patients.

Today, a Medicare Advantage plan can approve care before it's delivered, then later reverse that decision or recoup payment from the physician or hospital. Providers absorb those clawbacks, which creates financial uncertainty for practices and can discourage them from treating Medicare Advantage patients, ultimately limiting patients' access to care.

Under the Protecting Approved Care Act, once a Medicare Advantage plan approves an item or service, whether before treatment or while the patient is receiving care, the plan may not:

• Deny coverage based on lack of medical necessity.
• Reopen its coverage or payment decision, except for good cause or reliable evidence of fraud.
• Downcode the claim to reduce payment, except for good cause or reliable evidence of fraud.

If services do not require prior authorization:

• The service must be treated as if prior authorization was granted.
• The same protections apply, including no denial of coverage after the fact.
• The plan may not downcode a claim to reduce payment.
• The plan may not reopen determinations except for good cause or fraud.

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