H.R. 3514 · In committee · Health

Improving Seniors’ Timely Access to Care Act of 2025

Sponsor: Mike Kelly (R-PA)

What it does

• Require Medicare Advantage plans to establish electronic prior authorization systems that meet CMS-specified standards.
• Mandate annual disclosure by MA plans to CMS of prior authorization approval rates and average response times for public reporting.
• Direct CMS to set additional standards for MA plans regarding quality and timeliness of prior authorization decisions.
• Require CMS and the National Coordinator for Health Information Technology to publish a report analyzing MA prior authorization data, real-time decision-making feasibility, and the impact of AI-driven decisions on patien

Official summary

Improving Seniors' Timely Access to Care Act of 2025 This 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.

Latest action

Jul 15, 2026: Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 42 - 0.

Committee: House Ways and Means