Kelly, Colleagues Reintroduce Critical Prior Authorization Reform Bill

WASHINGTON, D.C. -- Yesterday, Representative Mike Kelly (PA-16) reintroduced H.R. 3514, the Improving Seniors’ Timely Access to Care Act along with Representatives Suzan DelBene (WA-01),and Ami Bera, M.D. (CA-06), and John Joyce, M.D. (PA-13) and Senators Roger Marshall, M.D. (KS) and Mark Warner (VA).

“With nearly 33 million Americans enrolled in Medicare Advantage, modernization of the prior authorization process is long overdue. Lawmakers on both sides of the aisle, hundreds of health care organizations, and Americans from all corners of the country agree – streamlining this process will allow our Nation’s seniors to receive the care they are entitled to more efficiently. I am proud to reintroduce the Improving Seniors’ Timely Access to Care Act of 2025, which would move the health care sector into the 21st century by giving doctors and Medicare Advantage plans the tools to make health coverage decisions in a timely manner. I thank my House and Senate colleagues for their years of hard work and for joining me on the reintroduction of this critical legislation,” said Representative Mike Kelly (PA-16).

“We’ve made important incremental headway in helping seniors get the medical care they deserve with the administration’s prior authorization regulations. However, we must go further and enshrine these advancements into law. By passing the bipartisan, bicameral Improving Seniors’ Timely Access to Care Act, we can make it much easier for seniors to receive the care they’re entitled to while also alleviating unnecessary burdens on physicians and hospitals,” said Congresswoman Suzan DelBene (WA-01).  

“When decisions on patient care are made by bureaucrats with no experience treating patients, care is often delayed or denied altogether, which results in worse outcomes for patients,” said Rep. John Joyce, M.D. (PA-13). “By streamlining the prior authorization process through the bipartisan Improving Seniors’ Timely Access to Care Act, we can ensure that American patients receive the care they need without unnecessary barriers.”

“As a doctor, I’ve seen firsthand how the broken prior authorization process delays needed care and frustrates both seniors and their physicians,” said Representative Ami Bera, M.D. (CA-06). “The Improving Seniors’ Timely Access to Care Act cuts through red tape and makes it easier for seniors on Medicare Advantage to access the treatments and services they need, when they need them. This bipartisan legislation is a common-sense fix that puts patients over paperwork, restores trust in the system and helps physicians focus on delivering quality care. I’m proud to reintroduce this bill alongside my colleagues and am grateful for the broad coalition of support behind it.”

BACKGROUND

Prior authorization is a tool used by health plans to reduce unnecessary care by requiring health care providers to get pre-approval for medical services. But it’s not without fault. The current system often results in unconfirmed faxes of a patient’s medical information or phone calls by clinicians which takes precious time away from delivering quality and timely care. Prior authorization continues to be the #1 administrative burden identified by health care providers, and three out of four Medicare Advantage enrollees are subject to unnecessary delays due to prior authorization. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied. More recently, HHS OIG released a report finding that MA plans incorrectly denied beneficiaries’ access to services even though they met Medicare coverage rules.

Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization.

Specifically, the bill would:

- Establish an electronic prior authorization process for MA plans including a standardization for transactions and clinical attachments.
- Increase transparency around MA prior authorization requirements and its use.
- Clarify HHS’ authority to establish timeframes for e-prior authorization requests including   expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests.
- Expand beneficiary protections to improve enrollee experiences and outcomes.
- Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process.
- Previously, Rep. Kelly led similar legislation in the 118th Congress. The Improving Seniors’ Timely Access to Care Act unanimously passed the House in the 117th Congress and was cosponsored by a majority of members in the Senate and House of Representatives. 

The bill text can be found here and a section-by-section can be found here.