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 aims to improve the prior authorization process for Medicare Advantage plans by establishing new requirements and transparency standards. The legislation mandates that starting in 2027, Medicare Advantage plans must provide more detailed reporting about their prior authorization practices, including the number of requests approved or denied, appeal rates, and the use of technology like artificial intelligence in decision-making. Beginning in 2028, plans must implement an electronic prior authorization program that allows secure electronic transmission of authorization requests and supporting documentation, with specific standards to ensure standardization and streamlining of these transactions. The bill requires plans to develop transparent prior authorization programs in consultation with enrollees and healthcare providers, and to allow for modifications of authorization requirements based on provider performance. Medicare Advantage plans will need to submit annual reports to the Secretary of Health and Human Services detailing their prior authorization processes, and the Centers for Medicare & Medicaid Services (CMS) will be required to analyze how these processes impact patient access, particularly for rural and low-income beneficiaries. The legislation also 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, with the goal of improving seniors' timely access to medical care.
Committee Categories
Budget and Finance
Sponsors (133)
Mike Kelly (R)*,
Robert Aderholt (R),
Pete Aguilar (D),
Gabe Amo (D),
Jodey Arrington (R),
Jake Auchincloss (D),
Don Bacon (R),
Troy Balderson (R),
Becca Balint (D),
Nanette Barragán (D),
Michael Baumgartner (R),
Ami Bera (D),
Don Beyer (D),
Suzanne Bonamici (D),
Mike Bost (R),
Brendan Boyle (D),
Shontel Brown (D),
Julia Brownley (D),
Nikki Budzinski (D),
Salud Carbajal (D),
Mike Carey (R),
Ed Case (D),
Kathy Castor (D),
Judy Chu (D),
Juan Ciscomani (R),
Yvette Clarke (D),
Steve Cohen (D),
Herbert Conaway (D),
Jim Costa (D),
Angie Craig (D),
Dan Crenshaw (R),
Jason Crow (D),
Sharice Davids (D),
Don Davis (D),
Suzan DelBene (D),
Chris Deluzio (D),
Maxine Dexter (D),
Debbie Dingell (D),
Dwight Evans (D),
Randy Feenstra (R),
Cleo Fields (D),
Brad Finstad (R),
Michelle Fischbach (R),
Brian Fitzpatrick (R),
Mike Flood (R),
Bill Foster (D),
Lois Frankel (D),
Marie Gluesenkamp Pérez (D),
Dan Goldman (D),
Jimmy Gomez (D),
Vicente Gonzalez (D),
Maggie Goodlander (D),
Josh Gottheimer (D),
Glenn Grothman (R),
Josh Harder (D),
Diana Harshbarger (R),
Jim Himes (D),
Chrissy Houlahan (D),
Julie Johnson (D),
John Joyce (R),
Bill Keating (D),
Robin Kelly (D),
Mike Kennedy (R),
Jen Kiggans (R),
Young Kim (R),
Raja Krishnamoorthi (D),
Darin LaHood (R),
John Larson (D),
Mike Levin (D),
Ted Lieu (D),
Stephen Lynch (D),
Nicole Malliotakis (R),
Tracey Mann (R),
John Mannion (D),
Doris Matsui (D),
Sarah McBride (D),
April McClain-Delaney (D),
Jenn McClellan (D),
Betty McCollum (D),
Morgan McGarvey (D),
Grace Meng (D),
Mark Messmer (R),
Dan Meuser (R),
Carol Miller (R),
Mariannette Miller-Meeks (R),
John Moolenaar (R),
Blake Moore (R),
Gwen Moore (D),
Seth Moulton (D),
Frank Mrvan (D),
Greg Murphy (R),
Jerry Nadler (D),
Eleanor Holmes Norton (D),
Robert Onder (R),
Jimmy Panetta (D),
Chris Pappas (D),
Scott Peters (D),
Mark Pocan (D),
Ayanna Pressley (D),
Mike Quigley (D),
Emily Randall (D),
Deborah Ross (D),
David Rouzer (R),
John Rutherford (R),
Pat Ryan (D),
María Salazar (R),
Linda Sánchez (D),
Kim Schrier (D),
David Scott (D),
Terri Sewell (D),
Jefferson Shreve (R),
Adam Smith (D),
Adrian Smith (R),
Lloyd Smucker (R),
Eric Sorensen (D),
Melanie Stansbury (D),
Greg Stanton (D),
Greg Steube (R),
Haley Stevens (D),
Marilyn Strickland (D),
Suhas Subramanyam (D),
Claudia Tenney (R),
Shri Thanedar (D),
Bennie Thompson (D),
G.T. Thompson (R),
Jill Tokuda (D),
Ritchie Torres (D),
Beth Van Duyne (R),
Gabe Vasquez (D),
Eugene Vindman (D),
Debbie Wasserman Schultz (D),
Rob Wittman (R),
Rudy Yakym (R),
Last Action
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. (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/house-bill/3514/all-info |
BillText | https://www.congress.gov/119/bills/hr3514/BILLS-119hr3514ih.pdf |
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