H.R. 3514 — Improving Seniors’ Timely Access to Care Act of 2025

This section requires Medicare Advantage plans imposing prior authorization on applicable items or services to meet specified transparency requirements beginning with plan years on or after January 1, 2027, and to establish an electronic prior authorization program and meet enrollee protection standards beginning with plan years on or after January 1, 2028. (Medicare Advantage plans are private plans under Medicare Part C that provide Part A and B benefits to enrollees, and prior authorization is a utilization management tool requiring provider pre-approval for certain covered services.) The transparency requirements include (1) annual reporting to the Secretary on prior authorization usage, including lists of affected items and services; approval, denial, and appeal rates and numbers (aggregate and by item/service); use of decision support, artificial intelligence, or similar technologies; average and median determination times; intra-procedure changes in medical necessity; grievances; and other metrics specified by the Secretary; and (2) public disclosure to contracting providers and suppliers of prior authorization lists, policies, criteria, and documentation requirements, and to enrollees (upon request) of determination criteria. The electronic prior authorization program requires secure electronic transmission of requests, responses, and supporting documentation (excluding faxes, non-standard proprietary portals, and electronic forms), in compliance with standards adopted by the Secretary to promote standardization.