Contact Congress about H.R. 6109: 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.

Medicare Advantage plans could lose their federal contract if they deny too many care requests that later get approved. The rule would apply to plans that require prior approval before covering some care.

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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. is a House bill in committee. The latest recorded action: 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.

Latest action on H.R. 6109: 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.

Who this affects: This bill mainly affects people in Medicare Advantage plans, the insurers that run those plans, and doctors or other providers who request approval for care. Patients could face fewer wrongly denied requests if plans improve first decisions. Insurers would face a clear limit and the risk of losing a plan contract. Doctors and providers could spend less time fighting denials if the rule works as intended.

Why this matters: This matters because a wrong first denial can delay care and create extra work for patients and doctors. The bill tries to push Medicare Advantage plans to make better decisions the first time. It uses a strong penalty: loss of the plan’s federal contract. The real effect would depend on how plans respond and how the Secretary applies the rule.

Key provisions in H.R. 6109

• Only Medicare Advantage plans that use prior authorization would be covered. Prior authorization means the plan must approve care before paying for it.
• The Secretary of Health and Human Services must count how often plans deny prior approval first and then reverse the denial later.
• A plan fails the rule if more than 25% of its prior authorization decisions are denials that later get reversed in the same plan year. The reversal can happen after reconsideration or appeal.
• A plan also fails if reversals drop sharply because the Secretary finds the plan did not review cases the right way.
• The Secretary must end the federal contract for any Medicare Advantage plan that goes over the allowed reversal rate in a plan year.

How Modern Action helps you take action on H.R. 6109

You do not have to start with a blank letter. Modern Action turns the bill, your position, and the relevant congressional context into a message you can edit and send. The goal is to make contacting Congress clear, specific, and useful without forcing you to parse bill text or figure out the right office on your own.

Questions people ask about H.R. 6109

What is H.R. 6109?

Medicare Advantage plans could lose their federal contract if they deny too many care requests that later get approved. The rule would apply to plans that require prior approval before covering some care.

How do I support or oppose H.R. 6109?

Choose support, oppose, or ask for changes on Modern Action. The action flow drafts the message for you and keeps the wording tied to this bill.

Who should I contact about H.R. 6109?

Modern Action uses your location to route the action to the congressional offices relevant to the bill and your representation.

Can Modern Action explain H.R. 6109 before I act?

Yes. Modern Action gives you a plain-English summary, current status, and action context before you send anything.