This legislation seeks to enhance the Medicare Advantage program by implementing several reforms aimed at improving enrollee access to timely care and strengthening oversight. Beginning January 1, 2028, it significantly reduces the timeframes for Medicare Advantage organizations to respond to standard authorization requests to 72 hours and expedited requests to 24 hours, with limited exceptions for extensions. Furthermore, it mandates **real-time authorization decisions** for specific services identified as low-risk or high-volume, requiring automated approvals through certified electronic health record technology. To improve transparency, the bill requires Medicare Advantage organizations to report prior authorization data at the plan, parent, and contract levels, making it publicly available and downloadable for research. It also prohibits requiring new authorizations for **clinically necessary modifications or extensions** to already approved items or services. The reconsideration process is streamlined, requiring MA organizations to submit affirmed denials to independent review entities within 14 days, and these entities must provide prompt notification and decision timeframes. A key provision is the establishment of an **MAO Compliance Scoring and Accountability Program**, effective January 1, 2028, which will assess organizations' adherence to various program requirements. Organizations failing to meet compliance thresholds will face payment reductions ranging from 1.0% to 2.0% of their monthly payments. This program's scores and assessments will be publicly disclosed, fostering greater accountability. The bill also expands the **MA Star Ratings Program** to include an "MA Program Compliance and Coverage Protection Domain," which will carry a higher weighting than other domains. This new domain will incorporate data from audits, complaint tracking systems, and appeals to evaluate compliance. These measures aim to provide a more comprehensive view of an MA plan's performance beyond traditional quality metrics. To protect providers and enrollees from retrospective denials, the legislation applies **prompt payment requirements** to all authorized items and services, deeming them "clean claims" that cannot be subsequently re-determined as unclean except for specific reasons. Once an item or service is approved via a specified authorization, MA organizations are generally prohibited from denying coverage based on lack of medical necessity or changing claim codes to reduce payment, except in cases of good cause or fraud. Additionally, it imposes strict **limitations on the use of third-party review entities**, prohibiting them from conducting medical necessity reviews for authorized services and banning compensation arrangements tied to approval or denial rates. Regarding coverage criteria, the bill codifies the **Two-Midnight Benchmark and Presumption Rules** for hospital admissions within Medicare Advantage, aligning them with traditional Medicare. Crucially, it mandates that MA plans cannot apply medical necessity criteria that are more restrictive than those used in **Original Medicare (Fee-for-Service)**. For services without national or local coverage determinations, MA organizations must use publicly available, evidence-based criteria published on their websites, enhancing transparency. Finally, the bill requires MA organizations to ensure **adequate access to long-term care hospitals and inpatient rehabilitation facilities** by meeting new network adequacy standards.