Improving Seniors’ Timely Access to Care Act of 2025
Impact
The legislation introduces significant modifications to how Medicare Advantage plans operate with respect to prior authorizations. Starting January 1, 2028, plans will be required to adopt an electronic system that allows for secure and efficient handling of prior authorization requests. Additionally, transparency measures will be implemented to require plans to report on their approval and denial rates of prior authorization requests, which will help in identifying and addressing disparities in care among Medicare beneficiaries, particularly in rural and low-income communities.
Summary
House Bill 3514, titled the 'Improving Seniors’ Timely Access to Care Act of 2025', focuses on reforming the process of prior authorization in Medicare Advantage plans. The bill mandates certain requirements for the use of prior authorization, particularly emphasizing the establishment of an electronic prior authorization system, which aims to streamline the process and enhance accessibility for seniors. The changes are aimed to prevent delays in care and ensure timely access to necessary medical services for Medicare recipients.
Contention
Discussions surrounding the bill indicate potential contentions regarding the balance of efficiency and patient access. Opponents may argue that transitioning to a mainly automated system could overlook individual patient needs or complexities in care that require human oversight. Proponents believe that these modernized requirements will enhance patient safety and access to care, promoting the idea that technological advancements should complement, rather than obstruct, patient healthcare experiences. The bill also incorporates standards for evaluating prior authorization processes to ensure they are equitable and responsive to the needs of enrollees.