Improving Seniors’ Timely Access to Care Act of 2025
- Bill Number
- H.R. 3514
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-06-25: Forwarded by Subcommittee to Full Committee by Voice Vote.
- Last Updated
- 2026-06-30T08:06:22Z
AI-Generated Summary
Purpose of the Legislation
The "Improving Seniors' Timely Access to Care Act of 2025" (H.R. 3514) aims to improve access to healthcare services for Medicare Advantage enrollees by setting new rules for how these plans handle prior authorization. Prior authorization is a process where a health plan must approve certain medical items or services before they are provided, often to ensure medical necessity and control costs. The bill seeks to make this process more efficient, transparent, and protective of patients, reducing delays in care.
Key Provisions
- Electronic Prior Authorization Program (Effective January 1, 2028): Medicare Advantage plans must implement a secure electronic system for submitting and responding to prior authorization requests for covered items or services (excluding prescription drugs under Part D). This includes transmitting requests, responses, and supporting documents electronically, following standards set by the Secretary of Health and Human Services (HHS) to standardize and streamline the process. Faxes, proprietary portals, or basic electronic forms that don't meet these standards are not allowed.
- Transparency Requirements (Effective January 1, 2027): Plans must annually report detailed data to HHS, including:
- Lists of items/services requiring prior authorization.
- Approval/denial rates for requests, including breakdowns by item/service.
- Appeal statistics, including success rates at different levels (e.g., initial decisions, reviews, judicial appeals).
- Use of technologies like AI or decision-support tools in approvals/denials.
- Average/median response times for requests.
- Instances where approved services needed changes during procedures.
- Grievances related to prior authorization.
Plans must also share criteria and documentation requirements with contracted providers/suppliers and, upon request, with enrollees. HHS will publish this data publicly on a CMS website, at the plan level and possibly aggregated.
- Enrollee Protection Standards (Effective January 1, 2028): Plans must develop transparent prior authorization programs in consultation with enrollees and providers. This includes options to waive or modify requirements for high-performing providers (based on evidence-based guidelines and quality measures) and annual reviews of authorization rules using past data and stakeholder input.
- Timely Response Requirements: Amends existing law to give HHS authority to set specific timeframes (e.g., 24 hours) for plans to respond to prior authorization requests, including expedited cases and "real-time" decisions for routinely approved services. This builds on current 72-hour limits for non-expedited requests.
- Reporting and Oversight:
- HHS and the Office of the National Coordinator for Health Information Technology must report by January 1, 2028, on defining "real-time decisions," processes for routine approvals, and potential benefits like improved access and reduced disparities.
- The Medicare Payment Advisory Commission (MedPAC) will analyze prior authorization data and recommend improvements within three years of initial reporting.
- Government Accountability Office (GAO) report by January 1, 2032, evaluating implementation challenges for plans.
- Biennial HHS reports to Congress for 10 years post-enactment.
Significant Changes to Existing Law
- Adds a new subsection (o) to Section 1852 of the Social Security Act, introducing mandatory electronic processes, detailed transparency reporting, and enrollee protections specifically for Medicare Advantage prior authorizations—requirements not previously mandated at this level of detail.
- Modifies Section 1852(g) to empower HHS to enforce shorter, standardized response times beyond the current 72-hour standard for non-urgent requests, including real-time options, enhancing timeliness without fully replacing existing appeal processes.
- Excludes Part D drugs from these rules, focusing changes on non-drug services like medical procedures or equipment.
Potential Impacts
- On Citizens (Enrollees): Medicare Advantage beneficiaries, primarily seniors and people with disabilities, could experience faster access to care, fewer delays, and reduced administrative burdens, potentially improving health outcomes and addressing disparities in rural or low-income areas.
- On Government Agencies: Centers for Medicare & Medicaid Services (CMS) gains expanded oversight, data collection, and rulemaking authority, increasing administrative workload but enabling better monitoring of plan performance. HHS and other entities will produce multiple reports, informing future policy.
- On Healthcare Providers and Plans: Providers may benefit from streamlined electronic submissions and access to plan criteria, reducing paperwork. Medicare Advantage plans face new compliance costs for systems and reporting but could see operational efficiencies from real-time decisions and waivers for reliable providers.
- No Direct International Relations Impact: The bill is domestic, focused on U.S. Medicare programs.
Main Stakeholders Affected
- Medicare Advantage Enrollees: Primary beneficiaries, gaining protections and timely access.
- Healthcare Providers and Suppliers: Doctors, hospitals, and others who submit requests; they receive more transparency and potential waivers.
- Medicare Advantage Plans (Insurers): Private companies offering these plans; must adapt operations and report data.
- Federal Agencies: CMS (implementation and publication), HHS (rulemaking and reporting), MedPAC (analysis), and GAO (evaluation).
- Congress: Receives reports to guide oversight and potential future legislation.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens patient rights under Medicare by mandating consultations and annual reviews, potentially reducing litigation over denials through better transparency. HHS's new rulemaking authority could lead to further regulations via notice-and-comment processes, ensuring due process.
- Constitutional: Aligns with equal protection principles by addressing potential disparities in access for vulnerable groups, without raising significant federalism concerns as it targets a federal program.
- Political: Bipartisan support (over 60 cosponsors from both parties) suggests broad appeal in improving senior care efficiency. It may influence debates on private vs. public healthcare roles, emphasizing accountability for privatized Medicare options without altering core funding structures. Implementation challenges could spark future amendments if costs or burdens on plans prove high.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (296)
Rep. DelBene, Suzan K. [D-WA-1], Rep. Joyce, John [R-PA-13], Rep. Bera, Ami [D-CA-6], Rep. Van Duyne, Beth [R-TX-24], Rep. Chu, Judy [D-CA-28], Rep. Crenshaw, Dan [R-TX-2], Rep. Clarke, Yvette D. [D-NY-9], Rep. Murphy, Gregory F. [R-NC-3], Rep. Moore, Gwen [D-WI-4], Rep. Balderson, Troy [R-OH-12], Rep. Schrier, Kim [D-WA-8], Rep. Yakym, Rudy [R-IN-2], Rep. Sewell, Terri A. [D-AL-7], Rep. Harshbarger, Diana [R-TN-1], Rep. Larson, John B. [D-CT-1], Rep. Carey, Mike [R-OH-15], Rep. Evans, Dwight [D-PA-3], Rep. Malliotakis, Nicole [R-NY-11], Rep. Beyer, Donald S. [D-VA-8], Rep. Tenney, Claudia [R-NY-24], Rep. Tokuda, Jill N. [D-HI-2], Rep. Miller, Carol D. [R-WV-1], Rep. Stevens, Haley M. [D-MI-11], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Costa, Jim [D-CA-21], Rep. Smucker, Lloyd [R-PA-11], Rep. Pressley, Ayanna [D-MA-7], Rep. LaHood, Darin [R-IL-16], Rep. Davis, Donald G. [D-NC-1], Rep. Meuser, Daniel [R-PA-9], Rep. Pocan, Mark [D-WI-2], Rep. Salazar, Maria Elvira [R-FL-27], Rep. Fields, Cleo [D-LA-6], Rep. Bacon, Don [R-NE-2], Rep. Foster, Bill [D-IL-11], Rep. Mann, Tracey [R-KS-1], Rep. Brownley, Julia [D-CA-26], Rep. Ciscomani, Juan [R-AZ-6], Rep. Conaway, Herbert C. [D-NJ-3], Rep. Finstad, Brad [R-MN-1], Rep. Bonamici, Suzanne [D-OR-1], Rep. Shreve, Jefferson [R-IN-6], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Kiggans, Jennifer A. [R-VA-2], Rep. Deluzio, Christopher R. [D-PA-17], Rep. Thompson, Glenn [R-PA-15], Rep. Mrvan, Frank J. [D-IN-1], Rep. Moulton, Seth [D-MA-6], Rep. Case, Ed [D-HI-1], Rep. McBride, Sarah [D-DE-At Large] and 246 more
Recent Actions
- 2026-06-25: Forwarded by Subcommittee to Full Committee by Voice Vote.
- 2026-06-25: Subcommittee Consideration and Mark-up Session Held
- 2025-05-20: Referred to the Subcommittee on Health.
- 2025-05-20: 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.
- 2025-05-20: 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.
- 2025-05-20: Introduced in House
- 2025-05-20: Introduced in House
Bill Versions
- Improving Seniors’ Timely Access to Care Act of 2025 — issued 2025-05-20 — PDF (17 pages)