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 (259)
Mike Kelly (R)*,
Alma Adams (D),
Robert Aderholt (R),
Pete Aguilar (D),
Rick Allen (R),
Gabe Amo (D),
Jodey Arrington (R),
Jake Auchincloss (D),
Don Bacon (R),
Jim Baird (R),
Troy Balderson (R),
Becca Balint (D),
Andy Barr (R),
Nanette Barragán (D),
Michael Baumgartner (R),
Joyce Beatty (D),
Cliff Bentz (R),
Ami Bera (D),
Don Beyer (D),
Stephanie Bice (R),
Gus Bilirakis (R),
Sanford Bishop (D),
Suzanne Bonamici (D),
Mike Bost (R),
Brendan Boyle (D),
Robert Bresnahan (R),
Shontel Brown (D),
Julia Brownley (D),
Nikki Budzinski (D),
Janelle Bynum (D),
Kat Cammack (R),
Salud Carbajal (D),
Mike Carey (R),
Buddy Carter (R),
Troy Carter (D),
Ed Case (D),
Kathy Castor (D),
Joaquin Castro (D),
Sheila Cherfilus-McCormick (D),
Judy Chu (D),
Juan Ciscomani (R),
Gil Cisneros (D),
Yvette Clarke (D),
Emanuel Cleaver (D),
Ben Cline (R),
Steve Cohen (D),
Tom Cole (R),
Herbert Conaway (D),
Lou Correa (D),
Jim Costa (D),
Joe Courtney (D),
Angie Craig (D),
Dan Crenshaw (R),
Jasmine Crockett (D),
Jason Crow (D),
Sharice Davids (D),
Danny Davis (D),
Don Davis (D),
Madeleine Dean (D),
Suzan DelBene (D),
Chris Deluzio (D),
Mark DeSaulnier (D),
Maxine Dexter (D),
Debbie Dingell (D),
Neal Dunn (R),
Veronica Escobar (D),
Adriano Espaillat (D),
Ron Estes (R),
Dwight Evans (D),
Randy Feenstra (R),
Cleo Fields (D),
Shomari Figures (D),
Brad Finstad (R),
Michelle Fischbach (R),
Brian Fitzpatrick (R),
Chuck Fleischmann (R),
Lizzie Fletcher (D),
Mike Flood (R),
Bill Foster (D),
Valerie Foushee (D),
Lois Frankel (D),
Maxwell Frost (D),
John Garamendi (D),
Laura Gillen (D),
Marie Gluesenkamp Pérez (D),
Craig Goldman (R),
Dan Goldman (D),
Jimmy Gomez (D),
Vicente Gonzalez (D),
Maggie Goodlander (D),
Josh Gottheimer (D),
Sam Graves (R),
Al Green (D),
Glenn Grothman (R),
Michael Guest (R),
Josh Harder (D),
Pat Harrigan (R),
Andy Harris (R),
Diana Harshbarger (R),
Jahana Hayes (D),
Pablo Jose Hernandez (D),
Jim Himes (D),
Ashley Hinson (R),
Steven Horsford (D),
Erin Houchin (R),
Chrissy Houlahan (D),
Val Hoyle (D),
Bill Huizenga (R),
Glenn Ivey (D),
Jonathan Jackson (D),
Ronny Jackson (R),
Dusty Johnson (R),
Julie Johnson (D),
Dave Joyce (R),
John Joyce (R),
Tom Kean (R),
Bill Keating (D),
Robin Kelly (D),
Mike Kennedy (R),
Timothy Kennedy (D),
Ro Khanna (D),
Jen Kiggans (R),
Young Kim (R),
Raja Krishnamoorthi (D),
Darin LaHood (R),
Greg Landsman (D),
Nick Langworthy (R),
Rick Larsen (D),
John Larson (D),
George Latimer (D),
Bob Latta (R),
Mike Lawler (R),
Laurel Lee (R),
Julia Letlow (R),
Mike Levin (D),
Ted Lieu (D),
Barry Loudermilk (R),
Stephen Lynch (D),
Ryan Mackenzie (R),
Seth Magaziner (D),
Nicole Malliotakis (R),
Tracey Mann (R),
John Mannion (D),
Doris Matsui (D),
Lucy McBath (D),
Sarah McBride (D),
April McClain-Delaney (D),
Jenn McClellan (D),
Betty McCollum (D),
Kristen McDonald Rivet (D),
Morgan McGarvey (D),
John McGuire (R),
Rob Menendez (D),
Grace Meng (D),
Mark Messmer (R),
Dan Meuser (R),
Kweisi Mfume (D),
Carol Miller (R),
Max Miller (R),
Mariannette Miller-Meeks (R),
John Moolenaar (R),
Blake Moore (R),
Gwen Moore (D),
Tim Moore (R),
Joe Morelle (D),
Kelly Morrison (D),
Jared Moskowitz (D),
Seth Moulton (D),
Frank Mrvan (D),
Kevin Mullin (D),
Greg Murphy (R),
Jerry Nadler (D),
Joe Neguse (D),
Dan Newhouse (R),
Donald Norcross (D),
Eleanor Holmes Norton (D),
Zach Nunn (R),
Jay Obernolte (R),
Ilhan Omar (D),
Robert Onder (R),
Burgess Owens (R),
Jimmy Panetta (D),
Chris Pappas (D),
Scott Peters (D),
August Pfluger (R),
Chellie Pingree (D),
Mark Pocan (D),
Nellie Pou (D),
Ayanna Pressley (D),
Mike Quigley (D),
Emily Randall (D),
Jamie Raskin (D),
Josh Riley (D),
John Rose (R),
Deborah Ross (D),
David Rouzer (R),
Raul Ruiz (D),
Michael Rulli (R),
John Rutherford (R),
Pat Ryan (D),
María Salazar (R),
Andrea Salinas (D),
Linda Sánchez (D),
Mary Gay Scanlon (D),
Jan Schakowsky (D),
Derek Schmidt (R),
Brad Schneider (D),
Hillary Scholten (D),
Kim Schrier (D),
David Schweikert (R),
David Scott (D),
Pete Sessions (R),
Terri Sewell (D),
Brad Sherman (D),
Jefferson Shreve (R),
Lateefah Simon (D),
Adam Smith (D),
Adrian Smith (R),
Chris Smith (R),
Lloyd Smucker (R),
Eric Sorensen (D),
Darren Soto (D),
Melanie Stansbury (D),
Greg Stanton (D),
Greg Steube (R),
Haley Stevens (D),
Marilyn Strickland (D),
Suhas Subramanyam (D),
Tom Suozzi (D),
Emilia Sykes (D),
David Taylor (R),
Claudia Tenney (R),
Shri Thanedar (D),
Bennie Thompson (D),
G.T. Thompson (R),
Mike Thompson (D),
Dina Titus (D),
Rashida Tlaib (D),
Jill Tokuda (D),
Paul Tonko (D),
Ritchie Torres (D),
Lori Trahan (D),
Lauren Underwood (D),
David Valadao (R),
Jeff Van Drew (R),
Beth Van Duyne (R),
Derrick Van Orden (R),
Gabe Vasquez (D),
Marc Veasey (D),
Eugene Vindman (D),
Tim Walberg (R),
James Walkinshaw (D),
Debbie Wasserman Schultz (D),
Frederica Wilson (D),
Joe Wilson (R),
Rob Wittman (R),
Steve Womack (R),
Rudy Yakym (R),
Ryan Zinke (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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