Improving Seniors’ Timely Access to Care Act of 2025
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed House
- Passed Senate
- To President
- Became Law
Overview
This bill, the Improving Seniors’ Timely Access to Care Act of 2025, aims to reduce delays in Medicare Advantage plans regarding prior authorization for medical services. It mandates electronic prior authorization programs, requires transparency in how these decisions are made, and establishes standards for enrollee protection. The bill also seeks to improve the speed of responses to prior authorization requests and promotes the use of real-time decision making for routinely approved items and services.
Key provisions
- Requires Medicare Advantage plans to implement electronic prior authorization programs.
- Mandates transparency regarding prior authorization processes, including lists of covered items/services, approval/denial rates, and decision timelines.
- Establishes enrollee protection standards for prior authorization programs, including consultation with enrollees and providers.
- Requires Medicare Advantage plans to provide access to prior authorization criteria to both providers and enrollees.
- Sets timelines for prior authorization responses, with potential for expedited determinations.
- Promotes the use of ‘real-time decisions’ for routinely approved items and services.
- Directs the Medicare Payment Advisory Commission to report on prior authorization use and make recommendations for improvement.
- Requires the GAO to evaluate the implementation of the bill’s requirements.
Who is affected
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