summary
Introduced
05/20/2025
05/20/2025
In Committee
05/20/2025
05/20/2025
Crossed Over
Passed
Dead
Introduced Session
119th Congress
Bill Summary
A bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans.
AI Summary
This bill, called the "Improving Seniors' Timely Access to Care Act of 2025," aims to improve the prior authorization process for Medicare Advantage plans by establishing new requirements and standards. Starting in 2027, Medicare Advantage plans will need to meet transparency requirements, including submitting annual reports to the Secretary of Health and Human Services detailing prior authorization requests, approval and denial rates, appeal outcomes, and the use of technology in decision-making. Beginning in 2028, these plans must implement an electronic prior authorization program that enables secure electronic transmission of authorization requests and supporting documentation, using standardized technical standards. The bill also requires plans to develop enrollee protection standards, such as creating transparent prior authorization programs in consultation with enrollees and providers, allowing waivers of requirements based on provider performance, and conducting annual reviews of prior authorization criteria. Plans must provide providers and enrollees access to their prior authorization criteria and submit detailed reports about their processes. The bill mandates government reports, including a GAO evaluation by 2032 and a CMS report by 2028 analyzing the potential for real-time decisions and their impact on patient access, particularly for rural and low-income beneficiaries. Additionally, the bill gives the Secretary authority to establish specific timeframes for plan responses to prior authorization requests, potentially as quick as 24 hours for certain types of requests.
Committee Categories
Budget and Finance
Sponsors (62)
Roger Marshall (R)*,
Tammy Baldwin (D),
Jim Banks (R),
Michael Bennet (D),
Marsha Blackburn (R),
Richard Blumenthal (D),
Cory Booker (D),
John Boozman (R),
Ted Budd (R),
Maria Cantwell (D),
Shelley Moore Capito (R),
Bill Cassidy (R),
Susan Collins (R),
Chris Coons (D),
John Cornyn (R),
Catherine Cortez Masto (D),
Kevin Cramer (R),
Tammy Duckworth (D),
Dick Durbin (D),
Joni Ernst (R),
John Fetterman (D),
Deb Fischer (R),
Ruben Gallego (D),
Kirsten Gillibrand (D),
Bill Hagerty (R),
Maggie Hassan (D),
Josh Hawley (R),
Martin Heinrich (D),
John Hickenlooper (D),
Mazie Hirono (D),
John Hoeven (R),
Cindy Hyde-Smith (R),
James Justice (R),
Tim Kaine (D),
Mark Kelly (D),
Andy Kim (D),
Amy Klobuchar (D),
James Lankford (R),
Ben Ray Luján (D),
Cynthia Lummis (R),
Jeff Merkley (D),
Jerry Moran (R),
Bernie Moreno (R),
Markwayne Mullin (R),
Patty Murray (D),
Alex Padilla (D),
Gary Peters (D),
Pete Ricketts (R),
Jacky Rosen (D),
Mike Rounds (R),
Adam Schiff (D),
Eric Schmitt (R),
Rick Scott (R),
Jeanne Shaheen (D),
Tim Sheehy (R),
Tina Smith (D),
Thom Tillis (R),
Mark Warner (D),
Raphael Warnock (D),
Elizabeth Warren (D),
Peter Welch (D),
Sheldon Whitehouse (D),
Last Action
Read twice and referred to the Committee on Finance. (on 05/20/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.congress.gov/bill/119th-congress/senate-bill/1816/all-info |
| BillText | https://www.congress.gov/119/bills/s1816/BILLS-119s1816is.pdf |
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