“I still have hope,” said Peggy Tighe, legislative counsel for the Regulatory Relief Coalition, a group of physician specialty organizations advocating for regulatory burden reduction in Medicare, when she was asked about the Improving Seniors’ Timely Access to Care Act, which was approved last week by the House Ways & Means Health Subcommittee.
The measure, which seeks more transparency and accountability from Medicare Advantage plans on their prior authorization decisions, must still be approved by the full Ways & Means and House Energy & Commerce committees before it hits the House floor for a vote.
“What’s different this year is that there is much more limited committee time and House floor time because of the … drama on the House floor and the paucity of votes,” Tighe said in a phone interview with MedPage Today. “So with everything else going on, I still have hope that we could pass this bill out of Energy & Commerce and Ways & Means before the August recess, but every day that Congress gets canceled, it makes it more difficult to find that time to accomplish what I think should be a very easy goal of passing legislation that is zero cost and widely supported.”
This version of the bill, which was introduced in May 2025 by Rep. Mike Kelly (R-Fla.), currently has 296 House cosponsors, including 167 Democrats and 129 Republicans. A companion bill in the Senate that was introduced by Sen. Roger Marshall, MD (R-Kansas), has 70 cosponsors — 37 Democrats, 32 Republicans, and one Independent.
The measure aims to address three areas, explained Tighe. The first is transparency: “Medicare Advantage plans, you have to give us information about how you’re doing [prior authorization] denials,” she said. The second is oversight: the bill also requires that the Centers for Medicare & Medicaid Services (CMS) post each plan’s track record on denials on a public-facing website. In addition, both the Medicare Payment Advisory Commission (MedPAC) and the Government Accountability Office have to issue reports on how the plans are handling prior authorization. And finally, “the third element is … a requirement that electronic prior authorization is used systemically for Medicare Advantage, which is really critical because the game some of the insurers are playing is, ‘Where’s the fax?'”
The bill’s history is somewhat complex, Tighe noted. It was first introduced in 2019 and did not see any action, but it was reintroduced in 2021 and passed the House but was not taken up by the Senate. That 2021 version of the bill would have cost an estimated $16.2 billion over 10 years, according to the Congressional Budget Office.
Then, in January 2024, the Biden administration, which liked many of the bill’s provisions, finalized a regulation that included much of what was in the bill, so the bill’s estimated cost plummeted to $4 billion, according to Tighe. The regulation, which became effective this year, requires Medicare Advantage plans to issue prior authorization decisions within 72 hours for urgent requests and within 7 calendar days for non-urgent requests. Meanwhile, the bill’s sponsors then made further changes to zero out the cost and reintroduced it in June 2024, but the measure still did not pass.
“Now we’re back, saying ‘We’ve done everything right,'” said Tighe. “We’ve played by all of the rules, and we think this is a present to anybody who’s willing to pass it. It is something that is thought through and beloved.”
Why does Congress need to pass this bill if much of it already has been put into a regulation?
“An agency just doing something in their own volition isn’t as strong as a law from Congress codifying that same action,” Tighe explained.
In addition, the bill contains several provisions that aren’t in the rule. “The rule says that the insurers can post how they’re doing on prior authorization; we don’t trust the insurers, so the bill says that CMS takes the information and posts it on a public website,” Tighe said. “Otherwise, seniors have to go to Cigna’s, Humana’s, whoever’s website to try to compare. We want seniors to be able to go to CMS and say, ‘OK, how are they doing on prior auth? Because that matters to me.'”
Rep. Suzan DelBene (D-Wash.), one of the bill’s chief sponsors, told MedPage Today in an email that she is enthusiastic about the bill’s chances this time around.
“We’ve never been in a better position to finally get this important piece of legislation over the finish line,” she said. “Delivering the care seniors need when they need it by reforming prior authorization in Medicare Advantage has broad bipartisan consensus in Congress. The bill recently reached the critical 290 cosponsor threshold again. That’s why I’m pushing for a quick vote in the House to get this legislation over the finish line before the end of this Congress.”
Health groups are also taking an interest in the bill.
“The American Medical Association (AMA) commends the House Ways and Means Health Subcommittee for its swift action to advance the Improving Seniors’ Timely Access to Care Act,” CEO John Whyte, MD, MPH, said in a statement. “This bipartisan legislation would eliminate unnecessary administrative red tape in Medicare Advantage to ensure that critical, lifesaving care is no longer delayed by an overused prior authorization process. We … look forward to working with lawmakers to enact this vital reform.”
John Knapp, vice president for advocacy at Premier, a healthcare improvement firm, pointed out that “antiquated, manual processes continue to delay care in time-sensitive clinical situations, adding unnecessary burden for clinicians and patients alike.”
“Codifying and enhancing regulations that accelerate the move to electronic prior authorization will help ensure more timely, efficient care for seniors while improving quality and reducing administrative strain,” he noted.
Knapp cited his own firm’s survey of 516 hospitals across 36 states, which found that Medicare Advantage prior authorization delays “cost providers an estimated $19.7 billion annually to manage. Greater transparency and streamlined, technology-enabled processes are critical to addressing these challenges.”
