The Improving Seniors’ Timely Access to Care Act of 2025 would change how Medicare Advantage plans use prior authorization for covered items and services. Starting with plan years on or after January 1, 2027, plans would have to meet new transparency rules, and beginning January 1, 2028, they would also need to use an electronic prior authorization system and satisfy enrollee protection standards. The bill affects Medicare Advantage enrollees, doctors, hospitals, and other providers that must seek approval before furnishing certain care. It also requires public reporting to the Centers for Medicare & Medicaid Services and a later MedPAC report to Congress.
What This Bill Does
- Medicare Advantage plans with prior authorization would face new rules beginning in 2027 and 2028.
- Plans would need a secure electronic prior authorization program for requests and supporting documentation.
- Plans must report denial, approval, appeal, time-to-decision, and AI/technology-use data to CMS each year.
- Providers would get plan policies, criteria, and documentation requirements; enrollees could request criteria too.
- MedPAC would have to report to Congress within 3 years after the first data submission.
Who This Bill Affects
If you are enrolled in a Medicare Advantage plan, or you provide care to people who are, this bill would likely make prior authorization more transparent and more standardized. Starting in 2027 and 2028, plans would have to disclose more data, use an electronic prior authorization process, and give providers and enrollees better access to the criteria used for approvals and denials. That could mean fewer surprises and less time spent waiting for decisions, but it would also mean plans and providers have to adjust to new federal requirements.
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- Medicare Advantage enrollees, especially seniors with ongoing medical needs They are likely to support faster, clearer authorization rules because delays or denials can interrupt treatment. Public reporting of approval and appeal data may also make plans easier to compare and hold accountable.
- Doctors, hospitals, and other contracted providers Providers may favor the bill because it gives them access to plan criteria and documentation requirements, which can reduce guesswork and resubmissions. An electronic process could also reduce faxing and manual follow-up.
- Patient advocates and caregiver groups They may see the bill as a way to curb opaque denials and to create a record of how often prior authorization is used, denied, appealed, and overturned. That data could support future reforms if access problems persist.
- Medicare Advantage insurers and plan administrators They may argue the bill adds significant compliance and reporting burdens and could limit their ability to manage costs and utilization. The required electronic systems, annual disclosures, and criteria-sharing could raise administrative expenses.
- Organizations that rely on flexible utilization management tools They may worry that limiting how plans use prior authorization, or requiring waivers based on provider performance, could reduce a plan’s ability to enforce coverage standards consistently. They may also object to public reporting of detailed plan-level operational data.
- Technology and claims-processing vendors Some vendors may oppose strict federal standards if they require redesigning proprietary portals or workflows. The bill excludes facsimiles and noncompliant electronic forms from the required electronic transmission framework, which could force system changes.
Key Implications
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““beginning with plan years beginning on or after January 1, 2028””
This sets the compliance date for the biggest operational changes, including the electronic prior authorization program and enrollee protection standards. Plans and providers would have time to adjust, but the requirements would eventually become mandatory for affected Medicare Advantage plans.
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““secure electronic transmission””
Prior authorization requests and supporting documents would need to move through a secure electronic process. In practice, that could reduce reliance on fax-based workflows and make submissions and responses more standardized.
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““facsimile... shall not be treated as an electronic transmission””
The bill explicitly rules out fax as the required electronic method. This is important because many prior authorization processes still rely on fax, and the bill would push plans toward modern digital systems.
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““submit to the Secretary” annual information”
Plans would have to report approval rates, denial rates, appeals, time-to-decision data, and technology use. That creates a public oversight trail that can reveal how often prior authorization slows or blocks care.
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““access to the criteria used by the plan””
Both providers and enrollees could obtain the standards used to make prior authorization decisions. That should make it easier to prepare requests correctly, but it also reduces how much discretion plans can keep behind the scenes.
Official Source & Bill Facts
BillBoard checks this page against public Congress.gov metadata, then adds plain-English analysis where available.
- Bill
- HR 3514
- Congress
- 119th Congress
- Official title
- Improving Seniors’ Timely Access to Care Act of 2025
- Policy area
- Healthcare
- Latest action
- Forwarded by Subcommittee to Full Committee by Voice Vote. (June 25, 2026)
- Last updated
- June 27, 2026
Latest Status
June 25, 2026
Forwarded by Subcommittee to Full Committee by Voice Vote.
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Ask AI about this billData sourced from api.congress.gov.