Other
Improving Seniors’ Timely Access to Care Act of 2025
This bill requires Medicare Advantage plans to streamline and speed up the pre-approval process for medical treatments, tests, and medical equipment. Starting in 2027, private insurers must publicly report their approval and denial rates, wait times, and how often they use artificial intelligence to decide coverage. By 2028, insurers must replace faxes and paper forms with standardized electronic systems and allow doctors with strong compliance records to bypass certain approval rules. The measure also empowers federal regulators to enforce strict decision deadlines, including real-time approvals for routine care.
People affected—not determinable from the text provided; applies to all Medicare Advantage enrollees and contracted healthcare providers subject to prior authorization, but no specific population count is stated in the text.
Fiscal magnitude—no CBO estimate published
Reach58provisional · pending reviewrigor: heuristic llm
What this bill touches.
Market protections+45Government role in coverage+35AI & emerging tech+25
Who it helps · who it burdens.
Who it helps
- Healthcare providers and suppliersGain access to streamlined electronic prior authorization systems (excluding faxes/proprietary non-standard portals), mandatory upfront disclosure of prior authorization rules and clinical criteria, and the potential for waived or reduced prior authorization requirements based on strong compliance.
- Medicare Advantage enrolleesGain the right to access the clinical criteria used for prior authorization determinations upon request, benefit from publicly available plan approval/denial data, and receive faster coverage decisions under new enrollee protection standards and potential real-time/24-hour response timeframes.
Who it burdens
- Medicare Advantage plansMust implement standardized electronic prior authorization programs by 2028, publicly report extensive annual prior authorization and appeal data starting in 2027, disclose clinical review criteria to providers and patients, adopt enrollee protection standards, and comply with HHS-enforced response deadlines.
- Department of Health and Human Services and CMSTasked with setting technical standards, regulating and publishing plan-level prior authorization disclosures online, conducting studies on real-time decision-making and AI usage, submitting recurring reports to Congress, and establishing enforceable decision timeframes.