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Congress·In Committee·10 months ago

House Bill Would Require Medicare Advantage Plans to Speed Up Treatment Approvals for Seniors

Also known as: Improving Seniors’ Timely Access to Care Act of 2025

Legislative Progress

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House
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Impact Analysis

Scores: 1 = low, 5 = highSentiment: -5 to +5 (net benefit)

Key Points

  • This bill changes how private Medicare plans handle "prior authorization." This is the process where a doctor must ask an insurance company for permission before providing certain medical tests, surgeries, or treatments to a patient.
  • Starting in 2028, insurance companies would be required to use a secure electronic system to handle these requests. This aims to replace slow, old-fashioned methods like fax machines and phone calls that often delay a patient's care.
  • Beginning in 2027, insurance companies must report data to the government showing how often they approve or deny care. They will also have to disclose if they use artificial intelligence (AI) to make these decisions and exactly how many hours it takes them to respond to doctors.
  • The policy encourages "real-time" decisions for common medical services that are routinely approved. It also allows insurance companies to skip the approval process for doctors who have a long history of following medical guidelines.
  • The goal is to stop insurance paperwork from getting in the way of necessary medical care. By making the process faster and more transparent, the bill seeks to ensure seniors get their treatments without waiting days or weeks for a response.
Healthcare

Milestones

2 milestones2 actions
May 20, 2025House

Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

May 20, 2025

Introduced in House

What Happens Next

Projected impacts based on AI analysis

2027-01-01

Medicare Advantage plans must start reporting prior authorization data to the government, including approval rates, denial rates, AI usage, and response times

Seniors and the public will be able to see how often each plan denies care and how long approvals take, helping people pick better plans

2028-01-01

Electronic prior authorization systems and enrollee protection standards take effect for Medicare Advantage plans

Doctors can submit approval requests electronically instead of by fax or phone, and plans must have transparent processes developed with input from patients and providers

Related News

3 articles
AMA News Wire·about 1 month ago

Now is time to reform prior authorization in Medicare Advantage

A bipartisan bill with overwhelming support from over 120 medical groups aims to codify protections for seniors. The legislation requires Medicare Advantage plans to implement electronic prior authorization and report approval/denial rates to CMS to ensure medical decisions are transparent.

C+
Radiology Business·3 months ago

Radiology groups renew push for bill to reform prior authorization

The Timely Access to Care Act would require Medicare Advantage plans to implement electronic systems instead of faxes. It also mandates public reporting of denial data and disclosure of AI use in coverage determinations, aiming to reduce the 93% of physicians reporting care delays.

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The Hill·9 months ago

Here's Why Medicare Advantage Fails America's Elderly

Medicare Advantage is under scrutiny for delays and denials that harm seniors. A growing consensus points to the need for reform, including the Improving Seniors’ Timely Access to Care Act, to ensure greater transparency and protection for vulnerable populations against administrative red tape.

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Source Information

Document Type

Congressional Bill

Official Title

Improving Seniors’ Timely Access to Care Act of 2025

Bill NumberHR 3514
Congress119th Congress
ChamberHouse of Representatives
Latest ActionReferred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Sponsor

Cosponsors

(250)
D: 155R: 95

Analysis generated by AI. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.