H.R. 10394 — Protecting Approved Care Act

This section prohibits Medicare Advantage organizations, beginning with plan years starting on or after January 1, 2028, from denying coverage of an approved item or service on the basis of medical necessity, reopening a coverage or payment determination except for good cause or reliable evidence of fraud, or reducing payment by changing the claim code except for good cause or fraud. The limitations apply both when a specified authorization (including prior authorization, concurrent review, or transfer approval) has been granted and when no authorization is required.