YourVoice.Now Summary
Average Household ImpactTransparency & AccountabilityMedicare Advantage plans would face electronic prior-authorization rules, response deadlines, and public reporting on denials and AI use.
Average Household Impact
- Prior authorization protections — Electronic processing and enrollee protection standards required of Medicare Advantage plans
- Decision timeframes — Secretary may set deadlines as short as 24 hours for approval requests
- Coverage-criteria access — Enrollees may request the criteria used to decide their request
Transparency & Accountability
- Prior authorization reporting — Plans must report approval, denial and appeal rates every year
- Prior authorization reporting — Plans must disclose and describe any AI or machine learning used to decide
- Prior authorization reporting — Average and median decision times must be submitted annually
- Public publication — Medicare posts the reported data plan by plan on a public website
- Independent review — MedPAC and GAO must analyze how prior authorization is being used
The details
Medicare Advantage plans would have to change how they run prior authorization. Prior authorization is the requirement that a plan approve a treatment before it will pay. Starting with plan year 2028, plans would have to run a secure electronic approval system. Faxes, plain electronic forms, and payer portals that miss federal standards would not count. Plans would also have to build the program with input from enrollees and doctors. They would have to review each year which items still need approval at all. Plans could waive the requirement for providers with a strong track record. Starting a year earlier, in 2027, plans would report their numbers to the government. That includes what needs approval, how often requests are approved or denied, how many denials are appealed, and how many appeals succeed. Plans would also report how long decisions take, on average and at the median. They would have to disclose how often they used artificial intelligence or machine learning to decide, and describe the technology. Medicare would publish all of it plan by plan on a public website. The Health Secretary could set response deadlines as short as 24 hours. Contracted doctors would get access to the criteria plans use, and enrollees could request them.
Congressional Summary
Improving Seniors' Timely Access to Care Act of 2025This bill establishes several requirements and standards relating to prior authorization processes under Medicare Advantage (MA) plans.Specifically, MA plans must (1) establish an electronic prior authorization program that meets specified standards; (2) annually submit to the CMS for publication specified prior authorization information, including the percentage of requests approved and the average response time; and (3) meet other standards, as set by the Centers for Medicare & Medicaid Services (CMS), relating to the quality and timeliness of prior authorization determinations.The CMS and the Office of the National Coordinator for Health Information Technology must publish on the CMS' website a report that analyzes the information received from MA plans, the feasibility of implementing real-time decision making with respect to prior authorization requests, and the impact of decisions that are made using artificial intelligence on patient access.
Legislative Subjects
Details
- Congress
- 119th
- Chamber
- House
- Status
- summarized
- Action
- Introduced in House
- Action Date
- 2025-05-20
- Date Added
- 2026-07-29
- Source
- Congress.gov →
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