Congress·In Committee·S. 1816

Sen. Marshall Introduces the Improving Seniors’ Timely Access to Care Act to Speed Up Medicare Approvals

Improving Seniors’ Timely Access to Care Act of 2025

10 months ago·View on Congress.gov

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Key Points

This bill overhauls prior authorization in Medicare Advantage — the process where insurance plans must approve treatments before doctors can provide them. It requires plans to set up electronic systems, meet transparency standards, and follow enrollee protection rules.
From policy text
“To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans.”
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Starting in 2028, Medicare Advantage plans must use a secure electronic system for prior authorization requests and responses. Faxes, proprietary portals that don't meet federal standards, and electronic forms would no longer count.
From policy text
“a facsimile, a proprietary payer portal that does not meet standards specified by the Secretary, or an electronic form shall not be treated as an electronic transmission described in subparagraph (A).”
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Starting in 2027, plans must report detailed data to the government each year, including denial rates, appeal outcomes, average response times, and whether they used AI or other technology to make decisions. This data will be published publicly.
From policy text
“The Secretary shall publish information described in subparagraph (A)(i) and subparagraph (B) on a public website of the Centers for Medicare & Medicaid Services.”
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The government gains authority to set faster deadlines — potentially as short as 24 hours — for plans to respond to prior authorization requests, including urgent and routine cases.
From policy text
“the Secretary may establish, for purposes of an organization determination made with respect to a prior authorization request for an item or service to be furnished to an individual, timeframes, such as 24 hours”
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Plans could waive or loosen prior authorization requirements for doctors and providers who consistently follow evidence-based guidelines and meet quality standards, reducing red tape for trusted providers.
From policy text
“allowing for the waiver or modification of prior authorization requirements based on the performance of such providers and suppliers in demonstrating compliance with such requirements, such as adherence to evidence-based medical guidelines and other quality criteria”
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The bill requires analysis of how these changes could reduce health disparities for Medicare Advantage enrollees in rural and low-income communities, and examines the impact of AI-driven decisions on patient access for these populations.

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Impact Analysis

Personal Impact

Who is affectedScoreImpactCertaintyScopeDurationSentiment

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

Milestones

2 milestones2 actions

May 20, 2025Senate

Read twice and referred to the Committee on Finance.

May 20, 2025

Introduced in Senate

Related News

7 articles

MedPage Today·6 months ago

Prior Authorization Continues To Bedevil Congress

Lawmakers reintroduced the Improving Seniors' Timely Access to Care Act in May 2025 to rein in prior authorizations. While both parties express interest in the reform, the bill's path remains complicated by broader budget battles and the implementation of related CMS regulations.

KFF Health News·about 2 months ago

Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024

New data shows Medicare Advantage plans denied 4.1 million requests in 2024. The report highlights the high rate of overturned denials on appeal, a key issue the Improving Seniors’ Timely Access to Care Act seeks to address through increased transparency and electronic processing requirements.

AMA News Wire·about 2 months ago

Now is time to reform prior authorization in Medicare Advantage

A bipartisan bill with support from over 240 House members and a Senate supermajority aims to modernize Medicare Advantage. The legislation would mandate electronic prior authorization and require plans to report denial rates and their use of AI in making medical necessity determinations.

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Related Bills

1 bill

H.R. 3514Identical bill

Improving Seniors’ Timely Access to Care Act of 2025

May 20 — 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.