S-1816 — Improving Seniors’ Timely Access to Care Act of 2025

YourVoice.Now Summary

Your MoneyTransparency & AccountabilityCorporate Benefits

Medicare Advantage plans would have to handle care approvals electronically and post their denial records.

Your Money

Electronic prior authorization for your care — required from 2028

Plans would have to accept and answer prior authorization requests through a secure electronic system. A fax or a plan's own web portal would not satisfy the rule.

Transparency & Accountability

Public data on Medicare Advantage denials — posted plan by plan

Each plan would report how many requests it approved, denied, and overturned on appeal, plus how long decisions took. Medicare would publish it for each individual plan.

Disclosure when software decides your care request — counts reported yearly

Plans would have to say whether they used artificial intelligence or similar tools to approve or deny requests, and how many decisions those tools made.

Access to the rules behind a denial — for patients and doctors

Doctors under contract would get the plan's decision criteria and the paperwork list. Enrollees could ask for the criteria used on their own request.

Corporate Benefits

Medicare Advantage plans' leeway on approvals — new rules from 2027

Plans would have to review every year which items still need approval, build the program with patient and doctor input, and ease requirements for providers with strong records.

More about this bill

If you are on a Medicare Advantage plan, waiting on the plan to approve care would work differently. Starting in 2028, plans would have to take these requests electronically. Faxes and their own web portals would no longer count. Starting a year earlier, each plan would have to report how often it approves, denies, and reverses these requests, and how long it takes. Medicare would post that record for every plan on a public website. Plans would also have to say when a computer program made the call.

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

Administrative law and regulatory proceduresComputers and information technologyCongressional oversightDepartment of Health and Human ServicesGovernment information and archivesHealth care coverage and accessInternet, web applications, social mediaMedicare

Details

Congress: 119th
Chamber: Senate
Status: summarized
Action: Introduced in Senate
Action Date: 2025-05-20
Date Added: 2026-08-25
Source: Congress.gov →

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