S. 1816 — Improving Seniors’ Timely Access to Care Act of 2025

This section establishes prior authorization requirements for Medicare Advantage plans (i.e., private plans under Medicare Part C that provide Parts A and B benefits to enrollees) with respect to applicable items or services. Specifically, for plan years beginning on or after January 1, 2028, such plans must (1) implement a secure electronic prior authorization program for transmitting requests, responses, and supporting documentation (excluding faxes, non-compliant proprietary portals, or electronic forms) that complies with standards adopted by the Secretary of Health and Human Services; and (2) meet enrollee protection standards specified pursuant to statute. Additionally, for plan years beginning on or after January 1, 2027, such plans must meet transparency requirements, including (1) annually reporting to the Secretary detailed data on prior authorization requests (e.g., approval/denial rates and appeal outcomes by item or service, average/median decision times, use of decision-support or AI technologies, and related grievances); (2) providing prospective and contracted providers/suppliers with prior authorization lists, policies, criteria, and documentation requirements; and (3) providing enrollees, upon request, access to such criteria.