MGMA outlines healthcare policy progress in Congress for 2026

Telehealth extension offers stability

One of the most significant changes was a longer-term extension of Medicare telehealth coverage policies that were originally expanded during the COVID-19 pandemic. Since COVID these telehealth payments have been extended but not made permanent, as it has become a standard of care at many practices and health systems.

Gilberg said Congress recently approved an extension through 2027 allowing physicians to provide telehealth services regardless of a patient’s geographic location and eliminating previous restrictions that required patients to travel to designated "originating site" healthcare facilities for these virtual visits.

“Back before COVID, telehealth wasn't even covered by Medicare outside of rural areas. And even if you had it, you had to go to an originating site and nothing like what we've experienced now,” Gilberg said.

MGMA had strongly supported extending the pandemic-era policies because the short-term funding extensions used by Congress over the past year created uncertainty for healthcare providers. Gilberg said practices had to quickly change how they delivered care when telehealth funding temporarily lapsed, often converting to in-person visits, which can be a big disruption for physician offices and for patients.

“So the gyrations and the short-term fixes cause a lot of problems,” he said.

Payment policies and rural protections

The appropriations legislation also addressed several reimbursement issues affecting physician practices.

Gilberg said Congress approved a 3.1% bonus for physicians participating in advanced alternative payment models (APMs) for the remainder of 2026, helping support practices transitioning to value-based care arrangements such as accountable care organizations (ACOs).

Lawmakers also prevented scheduled cuts of up to 15% to laboratory payments, and extended protections tied to the geographic practice cost index (GPCI) that help prevent reduced physician reimbursement in rural areas.

MGMA said these measures provide at least short-term stability for practices navigating federal payment policies.

Shutdown disruptions affected patient care

Gilberg said repeated government funding crises in 2024 and 2025 created significant operational problems for healthcare providers, particularly when telehealth coverage temporarily expired during a federal shutdown.

“During that shutdown period, our members had to shift all their patients off of telehealth because we didn't know if it was going to be temporarily extended again,” he said. “You could do two things. One, hold all of your telehealth claims during that period, or you could just shift your patients from telehealth into in-person and cause fairly significant inconvenience to those patients.”

Gilberg said the system needs a permanent fix to prevent this type of policy instability that costs the U.S. healthcare system more money in staff time and administrative tasks

Prior authorization reform remains priority

Looking ahead, MGMA is continuing to advocate for federal reforms aimed at reducing prior authorization burdens in Medicare Advantage plans.

Gilberg said legislation known as the Seniors Act could establish guardrails on how prior authorization is used by Medicare Advantage insurers. At the same time, federal regulators are implementing new rules requiring greater transparency from managed care plans.

“Prior authorization is one of the most frustrating things for medical practices,” Gilberg said.

New transparency requirements scheduled to take effect later this year will require Medicare Advantage and Medicaid plans to publicly report their prior authorization activity. Gilberg said those data could reveal how frequently requests are ultimately approved after administrative delays.

“The unfortunate thing is after they put patients and medical practices and doctors running through the hoops, they typically approve these things,” he said. He added prior authorizations raise clinician and patient frustration levels, cost staff and physician time, delays patient care, and sometimes prevent patient care when patients or practices give up on appeals.

Growing scrutiny of Medicare Advantage

Prior authorization requirements have become a major issue for many healthcare providers and some health systems have begun reconsidering participation in certain Medicare Advantage networks.

Gilberg cited data indicating that Medicare Advantage beneficiaries were subject to an average of 1.7 prior authorization requests per year in 2024, significantly higher than in traditional Medicare.

He said many patients choose Medicare Advantage plans for expanded benefits such as dental or prescription coverage, but may not realize the tradeoffs involving narrower provider networks and utilization prior authorization review requirements. As a result, he said Congress and federal agencies are increasingly examining insurer practices.

“Stay tuned on that, but there's now growing scrutiny with Congress and the administration on Medicare Advantage plans too. And so that's something we think is needed,” Gilberg said.

MGMA said it expects policy debates around prior authorization, Medicare Advantage oversight and physician payment policies to continue through 2026, though Gilberg noted that major legislation may be limited during an election year.