Medicare Advantage prior authorization rules tightened
In markupH.R. 3514Latest action
Sponsor: Mike Kelly · Representative · PA
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Official title: Improving Seniors’ Timely Access to Care Act of 2025
119th Congress
Topics: Health care
Introduced:
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Starting in 2027, Medicare Advantage plans must report prior authorization data publicly; by 2028, use electronic systems and new patient protections.
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What does this do?
This bill sets new rules for Medicare Advantage plans around prior authorization, which is when a plan must approve a treatment, test, or medication before a patient can get it. Beginning in 2027, plans must report yearly data to the federal government — such as approval and denial rates, decision times, and how often AI was used — and that data must be posted online. Starting in 2028, plans must use secure electronic systems for these requests, regularly review which services still need prior authorization, and allow high-performing doctors to skip some requirements.
Who does it affect?
Seniors and people with disabilities enrolled in Medicare Advantage plans are most directly affected. Doctors, hospitals, and other health care providers who treat those patients are also affected.
Why does it matter?
More detailed public data could make it easier to see patterns in how plans approve or deny care. Faster electronic systems and tighter response time limits could change how quickly patients and doctors get decisions on care requests.
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Where does it stand?
- IntroducedMay 20, 2025
- House committeeYou are here · Jul 15, 2026
- House vote
- Senate
- The president's desk
Right now: a House committee is reviewing it. If the Senate changes it, it goes back to the House before reaching the president.
Latest action: — Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 42 - 0.
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