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US SB1816
Bill
AI Summary
- Medicare Advantage plans must establish electronic prior authorization programs by January 1, 2028, enabling secure digital transmission of requests and responses between providers and plans
- Plans must annually report to HHS detailed prior authorization data including approval/denial rates, appeal outcomes, average response times, use of AI/automation in decisions, and grievances received
- Plans must provide transparency to providers and enrollees by sharing lists of items requiring prior authorization, decision-making criteria, and documentation requirements
- Secretary of HHS gains authority to establish faster response timeframes for prior authorization decisions, potentially as short as 24 hours for expedited requests and real-time decisions for routinely approved items
- Plans must adopt enrollee protection standards including consulting with providers on authorization programs, allowing waivers based on provider performance, and conducting annual reviews of prior authorization requirements
Legislative Description
Improving Seniors’ Timely Access to Care Act of 2025
Health
Last Action
Read twice and referred to the Committee on Finance.
5/20/2025
Committee Referrals
Finance5/20/2025
Full Bill Text
No bill text available