Improving Seniors’ Timely Access to Care Act of 2025

This legislation, titled the "Improving Seniors' Timely Access to Care Act of 2025," amends the Social Security Act to establish comprehensive requirements for prior authorization processes within Medicare Advantage plans. Its primary goal is to streamline access to medically necessary items and services for enrollees by modernizing and increasing oversight of these authorization procedures. The bill focuses on three key areas: mandating electronic prior authorization, enhancing transparency, and implementing enrollee protection standards. Beginning January 1, 2028, Medicare Advantage plans must implement an electronic prior authorization program for secure digital transmission of requests and responses, explicitly excluding faxes or non-standard proprietary portals. From January 1, 2027, plans must meet new transparency requirements , including annually submitting detailed data to the Secretary. This data encompasses approval and denial rates, appeal outcomes, processing times, and the use of artificial intelligence in decision-making, which will then be publicly published. Plans must also provide providers and enrollees with access to prior authorization criteria and required documentation. The bill also introduces enrollee protection standards , effective January 1, 2028, which include developing transparent prior authorization programs with input from enrollees and providers. These standards allow for the waiver or modification of prior authorization requirements based on provider performance and mandate annual reviews of services subject to prior authorization. Furthermore, the legislation grants the Secretary of Health and Human Services new authority to establish specific timeframes, such as 24 hours, for Medicare Advantage plans to respond to prior authorization requests, including expedited and "real-time" decisions for routinely approved items and services. Various reports to Congress from GAO, HHS, and CMS/ONC are also mandated to evaluate implementation and impact.