Shortens MA prior authorization times and tightens plan oversight

Sets faster decision deadlines for specified prior authorizations: standard determinations generally within 72 hours and expedited determinations within 24 hours (for requests on or after Jan 1, 2028).

Requires real‑time authorization mechanisms for services on an annual CMS list when requests are submitted through certified EHRs, including tools for immediate automated approvals and provider notifications.

Expands transparency: requires plan-level and parent-level reporting of prior authorization data, provider- and service-category comparisons, downloadable public datasets, and quarterly reporting of real-time determinations.

Protects against retrospective denials and payment clawbacks for items/services that were authorized during care and restricts third‑party post-payment review practices and incentive arrangements.

Creates an MAO Compliance Program with plan-level scoring (0–100), public reporting, and payment reductions (1.0–2.0%) for lower compliance tiers beginning with plan years starting Jan 1, 2028.