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H.R. 3514: Improving Seniors’ Timely Access to Care Act of 2025

This bill, known as the Improving Seniors’ Timely Access to Care Act of 2025, aims to enhance the process of prior authorization in Medicare Advantage plans. Prior authorization is a protocol that requires healthcare providers to obtain approval from a health insurance company before delivering certain services or medications to patients. The goal of this bill is to streamline this process, thus ensuring that seniors receive timely access to necessary care.

Key Provisions of the Bill

Electronic Prior Authorization Program: The bill mandates the establishment of an electronic prior authorization system starting on January 1, 2028. This system will allow healthcare providers to submit prior authorization requests electronically and receive timely responses regarding the approval of these requests along with any required documentation.
Transparency Requirements: From January 1, 2027, Medicare Advantage plans will be required to provide transparency regarding their prior authorization practices. This includes submitting an annual report that details:
- A list of items and services that required prior authorization in the previous year.
- The approval and denial rates for these requests.
- Information on appeals and how many requests were ultimately approved after being denied initially.
Enrollee Protection Standards: The bill sets standards to protect patients (enrollees) from unfair prior authorization practices. This includes:
- Developing transparent prior authorization procedures in consultation with patients and providers.
- Allowing for modifications of prior authorization requirements based on provider performance.
- Conducting annual reviews of items and services for which prior authorization is required.
Timeframe for Responses: The bill authorizes the Secretary of Health and Human Services to set specific timeframes within which Medicare Advantage plans must respond to prior authorization requests. For example, expedited requests may be required to be addressed within 24 hours.
Reporting Obligations: The bill requires various reports to be submitted to Congress and published publicly, including analyses regarding the effectiveness and implementation of the new prior authorization processes.

Implementation Timeline

The electronic prior authorization program must be implemented by January 1, 2028.
New transparency requirements will go into effect from January 1, 2027.
Initial reports to Congress and public disclosures will start following the new systems' implementation.

Impact on Healthcare Providers and Seniors

The bill is designed to reduce the administrative burden on healthcare providers, improve communication between providers and insurance plans, and ultimately ensure that seniors can access necessary medical services without unnecessary delays. By enhancing the electronic processing of prior authorizations, it aims to reduce bureaucratic obstacles that can often lead to treatment delays.

Relevant Companies

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This is an AI-generated summary of the bill text. There may be mistakes.

Actions

2 actions

Date	Action
May. 20, 2025	Introduced in House
May. 20, 2025	Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

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