Improving Seniors’ Timely Access to Care Act of 2025

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.
• 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.
• 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.
• 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.
• 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.
• 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.

Votes

No votes have been recorded for this legislation yet.