H.R. 3514: Improving Seniors’ Timely Access to Care Act of 2025
Sponsor
Mike Kelly
Republican · PA-16
Bill Progress
Latest Action · Jun 25, 2026
Forwarded by Subcommittee to Full Committee by Voice Vote.
Your doctor said yes — your insurer shouldn't get a veto
Why it matters
258 cosponsors — the most bipartisan health bill in the 119th Congress. Over 30 million Americans are on Medicare Advantage plans that routinely delay or deny treatments through prior authorization. H.R. 3514 forces those plans to go electronic, publish their approval and denial rates by plan, and let patients see the exact criteria used to decide their care.
Right now, Medicare Advantage plans can require pre-approval for tests, procedures, and medications — and there's no federal standard for how fast they have to respond, how they process requests, or what they have to tell you when they say no. Some plans still handle requests by fax.
H.R. 3514 changes that in three ways. First, starting in 2028, every plan that uses prior authorization must run it through a standardized electronic system — no more fax machines, no more proprietary portals that don't talk to each other. Second, starting in 2027, plans must publicly report their approval rates, denial rates, appeal outcomes, average decision times, and whether they used AI or algorithms to make those decisions. CMS publishes it all, plan by plan, on a public website. Third, plans must share their approval criteria with both doctors and patients — if you ask to see the rules they used to deny your treatment, they have to show you.
The bill also builds in accountability. Plans must consult with doctors and patients when designing their prior authorization programs. They have to review annually which services require pre-approval, using actual data from previous years. And providers with strong track records can earn waivers or streamlined requirements.
The Secretary of HHS gets new enforcement power to set response-time deadlines — including the authority to require 24-hour turnarounds for urgent requests. A GAO report is due by 2032 evaluating how well the whole system is working, and CMS must define what counts as a "real-time decision" for routinely approved services.
H.R. 3514 Bill Summary
What H.R. 3514 actually does.
No more fax-machine medicine
Starting in 2028, every Medicare Advantage plan must process prior authorization through a standardized electronic system. Fax, proprietary portals, and electronic forms that don't meet federal standards are explicitly banned.
Every plan's approval and denial rates go public
Starting in 2027, plans must report to CMS how often they approve and deny requests, how many denials get appealed, how many appeals succeed, and average decision times. CMS publishes it all on a public website, broken down by individual plan.
You can see the rules they used to deny you
Patients can request access to the exact criteria their plan used to make a prior authorization decision. Doctors get access to both the criteria and an itemized list of required documentation.
Plans must disclose when AI made the call
Plans must report what percentage of approvals and denials were made using AI, machine learning, or algorithmic decision-making — and describe the technology they used.
Good doctors get less red tape
Plans must allow waivers or streamlined prior authorization for providers who demonstrate compliance with evidence-based guidelines and quality criteria.
HHS can mandate 24-hour response times
The Secretary of HHS gains authority to set specific response deadlines for prior authorization decisions — including 24-hour turnarounds for urgent and expedited requests.
Who benefits from H.R. 3514?
Seniors on Medicare Advantage
Over 30 million enrollees who currently face unpredictable delays when their plans require pre-approval for doctor-ordered care. Faster electronic processing, clearer denial explanations, and public accountability data.
Family members managing care for aging parents
Anyone who has spent hours on the phone fighting a prior authorization denial. Transparent criteria and standardized electronic systems mean less guesswork and faster resolution.
Doctors and medical practices
Physicians spend an estimated 14 hours per week on prior authorization paperwork. Electronic standardization and provider-performance waivers cut administrative burden for practices that demonstrate quality care.
Patient advocacy organizations
Plan-level public data on denial rates, appeal outcomes, and AI usage creates a permanent accountability tool for groups pushing for better Medicare Advantage coverage.
Who is affected by H.R. 3514?
Medicare Advantage insurers
Must build or upgrade electronic prior authorization systems by 2028, publicly report denial and approval data starting in 2027, disclose AI usage, and share their criteria with patients and providers.
CMS and HHS
Must build a public website to host plan-level prior authorization data, set standards for electronic systems, define "real-time decisions," and potentially enforce new response-time deadlines.
Health IT vendors
Companies that build electronic health record systems and payer portals will need to support the new standardized electronic prior authorization format.
GAO and MedPAC
Both agencies are tasked with evaluating the system — MedPAC reports on prior authorization trends three years after data collection begins, and GAO delivers a full implementation review by 2032.
HR3514 Legislative Journey
House: Vote Held
Jun 25, 2026
Forwarded by Subcommittee to Full Committee by Voice Vote.
House: Committee Action
May 20, 2025
Referred to the Subcommittee on Health.
About the Sponsor
Mike Kelly
Republican, Pennsylvania's 16th congressional district · 15 years in Congress
Committees: Ways and Means
View full profile →
Cosponsors (296)
This bill has 296 cosponsors: 167 Democrats, 129 Republicans, reflecting bipartisan support. Cosponsors represent 48 states: Alabama, Arkansas, Arizona, and 45 more.
Suzan DelBene
Democrat · WA
John Joyce
Republican · PA
Ami Bera
Democrat · CA
Beth Van Duyne
Republican · TX
Judy Chu
Democrat · CA
Dan Crenshaw
Republican · TX
Yvette Clarke
Democrat · NY
Gregory Murphy
Republican · NC
Gwen Moore
Democrat · WI
Troy Balderson
Republican · OH
Kim Schrier
Democrat · WA
Rudy Yakym
Republican · IN
Cosponsor Coverage Map
Committee Sponsors
Energy and Commerce Committee
44 of 54 committee members cosponsored
Ways and Means Committee
38 of 45 committee members cosponsored
11 Republicans across these committees haven't cosponsored yet. Mobilize their constituents
What laws does H.R. 3514 change?
1 changes
Sections Amended
Section 1852 of Social Security Act (42 U.S.C. 1395w-22)
adding at the end the following new subsection: ``(o) Prior Authorization Requirements
H.R. 3514 Quick Facts
- Committee
- Energy and Commerce
- Chamber
- House
- Policy
- Health
- Introduced
- May 20, 2025
Forwarded by Subcommittee to Full Committee by Voice Vote.
Jun 25, 2026
Official Sources
H.R. 3514 Common Questions
When do Medicare Advantage plans have to switch to electronic prior authorization?
Plan years starting on or after January 1, 2028. Plans that use prior authorization must process requests through a standardized electronic system — fax, proprietary portals, and non-standard electronic forms no longer count.
Will I be able to see why my Medicare Advantage plan denied a treatment?
Yes. Under H.R. 3514, you can request access to the exact criteria your plan used to make a prior authorization decision. Doctors also get access to the criteria plus an itemized list of required documentation.
Does H.R. 3514 make Medicare Advantage denial rates public?
Yes. Starting with plan years on or after January 1, 2027, plans must report approval rates, denial rates, appeal outcomes, average decision times, and grievances to CMS. CMS publishes it all on a public website at the individual plan level.
Do Medicare Advantage plans have to disclose if they use AI to decide prior authorization?
Yes. Plans must report the percentage and number of requests approved or denied using AI, machine learning, or similar technology — and describe what that technology is. This data is included in the public reporting.
Can my doctor get prior authorization requirements waived under this bill?
Potentially. H.R. 3514 requires plans to allow waivers or modified requirements for providers who demonstrate compliance with evidence-based guidelines and quality criteria. The specifics are left to each plan's program design.
Does H.R. 3514 set a time limit for prior authorization decisions?
It gives the Secretary of HHS authority to set specific deadlines — including 24-hour turnarounds for urgent requests and real-time decisions for routinely approved services. The current 72-hour expedited standard stays as a baseline.
Does this bill cover prescription drugs under Medicare Part D?
No. H.R. 3514 applies to items and services covered under Medicare Advantage plans, but explicitly excludes covered Part D drugs. Prior authorization for prescriptions is governed by separate rules.
How many cosponsors does H.R. 3514 have?
258 cosponsors — 160 Democrats and 99 Republicans (including sponsor Rep. Mike Kelly, R-PA). It is one of the most bipartisan health bills in the 119th Congress.
Based on H.R. 3514 bill text
H.R. 3514 Bill Text
“To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans.”
Source: U.S. Government Publishing Office
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