Improving Seniors’ Timely Access to Care Act of 2025

Increased Transparency for Providers and Patients: Medicare Advantage plans would be required to submit detailed annual information to the Secretary regarding approved and denied requests, including the use of artificial intelligence or machine learning. This includes providing enrollees with access to the criteria used to make determination decisions upon request (Section 2, paragraph 3, subclause (A)(ii)(III)).

Improved Access to Information for Providers: Plans must provide prospective contracting providers with lists of items subject to prior authorization and their specific policies. They must also provide current contracting providers with the actual criteria used for determinations and a list of required documentation (Section 2, paragraph 3, subclause (A)(ii)(I) and (II)).

Standardized and Secure Communication: The bill requires the establishment of an electronic prior authorization program to allow for the secure electronic transmission of requests, responses, and supporting documentation between providers and plans (Section 2, paragraph 2, subclause (A)).

Enhanced Protections for Enrollees: Plans must adopt transparent prior authorization programs developed in consultation with enrollees and providers. They are also required to conduct annual reviews of items and services subject to these requirements, taking into account input from enrollees and providers (Section 2, paragraph 4, subclause (A) and (C)).

Potential for Faster Responses: The Secretary is granted the authority to establish specific timeframes—such as 24 hours—for plans to notify enrollees and physicians of determinations (Section 2, subsection (b), paragraph (6)).

Exclusion of Certain Communication Methods: The bill specifies that certain common methods, such as facsimiles, electronic forms, or proprietary payer portals that do not meet Secretary standards, will not be treated as valid electronic transmissions for the required electronic prior authorization program (Section 2, paragraph 2, subclause (A)(ii)(B)).

Potential for Documentation-Based Exclusions: The transparency and timing data may exclude certain requests if the plan determines that the medical or other required documentation was not submitted with the request (Section 2, paragraph 3, subclause (A)(i)(VI) and (VII)).