Improving Seniors’ Timely Access to Care Act of 2025

This bill changes how Medicare Advantage plans use prior authorization. Plans would have to switch to secure electronic systems for sending and receiving requests and documents by 2028, and faxes or non‑standard web portals would not count; systems must meet federal tech standards. Starting in 2027, plans must report detailed data each year—like what services require prior authorization, approval and denial rates, how long decisions take, and when AI or other tech is used—and the government will post plan‑level results online . Plans must also build in protections for enrollees: involve patients and providers in setting rules, ease or waive prior authorization for high‑performing providers, and review these rules every year.

The bill lets the federal government set response deadlines—such as 24 hours—for prior authorization requests, including “real‑time” decisions for items and services that are routinely approved. Federal agencies must define how real‑time decisions should work and study how automation and AI affect access to care, including in rural and low‑income communities, with reports due starting in 2028 and beyond.

• Who is affected

  • People in Medicare Advantage; doctors, hospitals, and suppliers who submit requests; Medicare Advantage plans.
  • These rules apply to medical items and services covered by the plan, not Part D prescription drugs.

• What changes

  • Electronic prior authorization required; fax and non‑standard portals don’t qualify; systems must meet standards.
  • Plans must share their prior authorization criteria with contracted providers and, upon request, with enrollees; CMS will publish plan‑level data online .
  • Annual data reporting on approvals/denials, appeals, decision times, grievances, and the use of AI/decision tech.
  • Enrollee protections: involve patients/providers, allow waivers for high‑performing providers, and conduct yearly reviews of what needs prior authorization.
  • HHS can set fast response timeframes (e.g., 24 hours) and will work with other agencies on real‑time decision standards and studies of AI impacts .

• When

  • Transparency reporting starts with plan years on or after January 1, 2027.
  • Electronic prior authorization systems and enrollee protections start with plan years on or after January 1, 2028.
  • Federal report on real‑time decisions and AI is due by January 1, 2028; a GAO evaluation is due by January 1, 2032; additional HHS reports follow on a set schedule .