S.Amdt. 4385

The amendment, titled the Improving Seniors' Timely Access to Care Act of 2026, aims to change how Medicare Advantage plans handle prior authorization for items and services.

The purpose of this amendment is to add the following requirements to the bill:

• Electronic Programs: Starting in 2028, plans must use a secure electronic prior authorization program. This excludes the use of fax machines, electronic forms, or proprietary portals that do not meet the Secretary's standards.

• Transparency: Starting in 2027, plans must provide the Secretary with annual data, including lists of services requiring prior authorization, approval and denial rates, and the use of artificial intelligence or machine-learning technology in making decisions. This information will be published on a public website.

• Access to Information: Plans must provide providers and enrollees with access to the criteria used to make authorization determinations.

• Enrollee Protections: Plans must develop transparent programs in consultation with enrollees and providers, conduct annual reviews of authorization requirements, and allow for waivers based on provider performance.

• Accountability and Reporting: The amendment requires reports from the GAO, HHS, and the Medicare Payment Advisory Commission to evaluate how these requirements are working and to analyze the impact of automated decisions on patient access.

• Timely Responses: It gives the Secretary the authority to set specific timeframes (such as 24 hours) for plans to notify enrollees and physicians of authorization determinations.