S.1816 - Improving Seniors’ Timely Access to Care Act of 2025 (119th Congress)
Summary
S.1816, the "Improving Seniors’ Timely Access to Care Act of 2025," aims to amend Title XVIII of the Social Security Act, focusing on prior authorization requirements within Medicare Advantage plans. The bill mandates the establishment of electronic prior authorization programs and sets transparency requirements for these plans. These measures are intended to streamline the prior authorization process and enhance enrollee protection.
The bill requires Medicare Advantage plans to adopt electronic prior authorization systems by 2028 and meet transparency standards starting in 2027. It also empowers the Secretary to establish timeframes for responses to prior authorization requests, potentially expediting access to care.
Furthermore, the legislation directs the GAO and HHS to submit reports to Congress evaluating the implementation and impact of these requirements, ensuring ongoing oversight and potential improvements.
Expected Effects
This bill will likely lead to more efficient processing of prior authorization requests in Medicare Advantage plans. It will also increase transparency regarding prior authorization practices. Ultimately, this could result in seniors having more timely access to necessary medical care.
Providers may experience changes in their administrative processes as they adapt to the new electronic systems and transparency requirements. The Secretary's authority to set timeframes for responses could also lead to faster decision-making.
The increased data collection and reporting requirements will likely provide valuable insights into the effectiveness of prior authorization programs, potentially leading to further policy adjustments.
Potential Benefits
- Streamlined prior authorization processes through electronic transmission.
- Increased transparency in prior authorization practices of Medicare Advantage plans.
- Potentially faster access to care due to established timeframes for responses.
- Enhanced enrollee protection standards.
- Data-driven insights into the effectiveness of prior authorization programs through required reports.
Most Benefited Areas:
Potential Disadvantages
- Implementation of electronic systems may pose challenges for some providers, particularly smaller practices.
- Increased administrative burden for Medicare Advantage plans due to reporting requirements.
- Potential for delays if the established timeframes for responses are not realistic.
- The definition of 'real-time decision' may be subject to interpretation and technological advancements, causing confusion.
- The reliance on technology and automation could potentially lead to disparities in access for certain beneficiaries if not carefully monitored.
Constitutional Alignment
The bill's alignment with the US Constitution is primarily through the General Welfare Clause (Preamble). By aiming to improve healthcare access for seniors, the bill promotes the general welfare.
Congress's authority to regulate Medicare Advantage plans falls under its power to legislate for the general welfare and to make laws necessary and proper for carrying out its enumerated powers (Article I, Section 8).
The bill does not appear to infringe upon any specific individual rights or liberties protected by the Bill of Rights.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).