H.R. 3514: Improving Seniors’ Timely Access to Care Act of 2025

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.