ALZHEIMER ON THE HILL
On September 16, 2026, the House Ways and Means committee advanced a bipartisan Alzheimer bill, "Alzheimer's Screening and Prevention Act ASAP."
See a dedicated website: https://alzimpact.org/ASAP_Act
It's numbered as, H.R. 6130 / S. 3267.
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MEDICARE ADVANTAGE CLAIMS - ON THE HILL
Tired of Medicare Advantage payment nightmares? Congress would like to help. See Medicare Advantange Improvement Act of 2026, and Medicare Advantage Prompt Pay Act, and the Protecting Approved Care Act.
Read about MAIA-2026 here. It's numbered as, HR 8375/S 4384.
For the Prompt Pay Act PPA-2026, see HR5454 here.
Read about Medicare Advamtage "Protecting Approved Care Act" PACA here and here. See the langhage here. (It was just announced and may not be numbered yet.)
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ALL ABOUT ALZHEIMER (ASAP)
Alzheimer’s Blood Tests: Congress Moves Toward Screening Coverage as Diagnostics Expand Access
The Alzheimer’s Screening and Prevention (ASAP) Act has advanced unanimously through the House Ways and Means Committee, highlighting a growing policy question: how should Medicare accommodate blood tests that can identify Alzheimer’s pathology earlier? Alongside the legislation, increasingly accessible diagnostic platforms could help more patients reach evaluation and treatment. These developments reinforce one another, but an important distinction remains: diagnosing patients with cognitive symptoms and screening people without symptoms involve different clinical evidence and coverage questions.
On September 16, the Ways and Means Committee voted 40–0 to advance H.R. 6130, the ASAP Act. The bipartisan legislation has a Senate counterpart, S. 3267. This is a significant committee milestone, although the legislation has not become law.
The introduced version would establish Medicare coverage for Alzheimer’s disease and related dementias early-detection screening tests furnished beginning January 1, 2028. It expressly includes detection at the presymptomatic and early stages, requires FDA clearance, classification, or approval, and adds the tests to Medicare’s clinical laboratory payment provision. An important version caveat: the supplied Congress.gov page records approval of a committee substitute, but the displayed legislative text is still the November 2025 introduced bill. These details therefore describe that version.
For diagnostics readers, the drafting is striking. Although promoted as a blood-test bill, it begins with a “genomic sequencing blood or blood product test,” then allows other equivalent technologies—including single-analyte tests and protein expression—as the Secretary determines appropriate. The list even includes medical imaging. The proposed statutory category is considerably broader than a single Alzheimer’s blood biomarker, although its sequencing-first structure is an unusual starting point for a field where protein biomarkers such as pTau217 are attracting attention.
The Alzheimer’s Impact Movement describes this as a “mammogram moment”: a chance for Medicare policy to accelerate adoption of earlier detection. That is an effective advocacy frame. However, the analogy expresses an aspiration; it does not itself establish that screening asymptomatic people for Alzheimer’s will produce benefits comparable to mammography. The clinical question remains what happens after detection—and whether that sequence of care improves outcomes.
A complementary commercial perspective comes from Yiqi Seow’s commentary on Roche and Lilly’s pTau217 collaboration. Seow argues that diagnostics can expand access to a therapeutic market by overcoming the difficulty of identifying eligible patients. When evaluation depends on PET imaging or lumbar puncture, diagnostic capacity can constrain treatment access. A blood assay deployed on widely installed laboratory instruments could ease that constraint. The contrast with oncology is not absolute, but the central insight is useful: diagnostic infrastructure can be essential to realizing a drug’s clinical and commercial potential.
Roche and Lilly’s Elecsys pTau217 test received FDA clearance in August for people aged 55 and older with cognitive decline. It helps assess Alzheimer’s-related pathology and must be interpreted with other clinical information; it is not a standalone diagnosis. That symptomatic population should not be conflated with population screening before symptoms appear. (reuters.com)
Taken together, these developments show Alzheimer’s diagnostics advancing on two fronts: the practical capacity to test more patients and the proposed Medicare authority to cover screening earlier in disease. Their convergence could reshape access. The policy challenge is to connect each testing use to a clearly defined population, a meaningful next clinical step, and evidence that earlier knowledge improves care.
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ALL ABOUT MEDICARE ADVANTAGE
Three Medicare Advantage Reform Proposals: Faster Decisions, Reliable Approvals, and Timely Payment
[For links see top of blog].
Three legislative proposals address different parts of the same Medicare Advantage problem: obtaining authorization, relying on that authorization once care is delivered, and getting paid afterward. The Medicare Advantage Prompt Pay Act focuses on payment deadlines. The Protecting Approved Care Act targets retrospective denials and payment reductions. The broader Medicare Advantage Improvement Act combines administrative reforms with coverage standards and financial accountability. Together, they would make plans more accountable for how coverage works in practice.
The discussion below reflects the supplied legislative versions: two introduced bills and an unnumbered September 2026 draft of the Protecting Approved Care Act. Their proposed requirements should not be mistaken for current law.
The Prompt Pay Act: Put a clock on payment. H.R. 5454, introduced by Representatives Jodey Arrington and Linda Sánchez, would require Medicare Advantage organizations to pay at least 95% of clean claims within specified deadlines, covering both contracted and noncontracted providers. Electronic claims from contracted providers would have a 14-calendar-day deadline; other claims would have a 30-calendar-day deadline.
The bill also defines a clean claim through standardized billing-data requirements, establishes presumptions for when a claim was received, requires interest on late payments, and authorizes civil monetary penalties of up to $25,000 per determination of noncompliance. Reporting would disclose payment timeliness and interest paid. Its proposed effective date is January 1, 2027. The central idea is straightforward: make timely payment a measurable federal obligation across provider relationships.
The Protecting Approved Care Act: Make coverage decisions dependable. The supplied Landsman draft would restrict retrospective medical-necessity denials, reopening of coverage or payment determinations, and downcoding that reduces payment. It preserves specified exceptions for reopening and downcoding, including regulatory “good cause” and reliable evidence of fraud or similar fault. Its proposed requirements begin with 2028 plan years.
One especially consequential provision extends protections to covered services for which the plan requires no authorization. That reaches beyond the familiar argument that a plan should honor its prior approval: it would also limit retrospective challenges when the plan did not require an approval process in the first place. A drafting detail merits attention—the definition includes prior and concurrent authorizations, while the operative approval clause refers to authorization made “during” receipt of care. That wording warrants clarification before assuming every preservice approval receives identical protection.
The Medicare Advantage Improvement Act: Connect access, payment, and enforcement. H.R. 8375, led by Representative John Joyce with bipartisan cosponsors, is the most comprehensive proposal. Its principal reforms, generally beginning in 2028, include:
Faster authorization: generally 72 hours for standard requests and 24 hours for expedited requests, with specified extensions and timing qualifications.
Less repetitive administration: real-time authorization capabilities for designated services and restrictions on requiring another authorization for clinically necessary changes to approved care.
Stronger payment protections: qualifying claims documenting authorization would be deemed clean, with a 100% prompt-payment standard, alongside restrictions on retrospective denials, downcoding, and third-party reviews.
Coverage accountability: medical-necessity criteria no more restrictive than traditional Medicare’s, public criteria where Medicare guidance is absent, and additional hospital and post-acute-care protections.
Its enforcement provisions are particularly notable. A new compliance score would trigger 1%, 1.5%, or 2% reductions in plan payments for progressively lower performance below a score of 90. A separate compliance and coverage-protection domain would enter Star Ratings, with its measures weighted more heavily than those in other domains. Administrative behavior would therefore affect the plan’s own revenue.
