Today, U.S. Representatives Mike Kelly (PA-16), Suzan DelBene (WA-01), John Joyce, M.D. (PA-13), Ami Bera, M.D. (CA-06), and Senators Roger Marshall, M.D. (KS) and Mark Warner (VA) issued a joint statement following an announcement by U.S. Health & Human Services Secretary Robert F. Kennedy, Jr. and Centers for Medicare and Medicaid Administrator Dr. Mehmet Oz regarding changes to the Medicare Advantage prior authorization process.
The announcement aligns with provisions in the Improving Seniors’ Timely Access to Care Act, a bipartisan effort led by these congressional members to improve healthcare access by streamlining prior authorizations in Medicare Advantage plans.
“We applaud these commitments, which aim to improve health care access for millions of Americans by easing the Medicare Advantage prior authorization process,” the Members said. “We encourage our House and Senate colleagues to carry this momentum forward and to pass our life-changing legislation, the Improving Seniors’ Timely Access to Care Act, to ensure this progress becomes law.”
Key elements of the commitment include standardizing electronic submissions using Fast Healthcare Interoperability Resources-based application programming interfaces, reducing services subject to prior authorization by January 1, 2026, honoring existing authorizations during insurance transitions for continuity of care, enhancing transparency around decisions and appeals, expanding real-time responses for quicker approvals by 2027, and ensuring medical professionals review all clinical denials.
In May 2025, Representative Mike Kelly reintroduced H.R. 3514 along with his colleagues from both chambers of Congress. The bill seeks to address issues with the current system where unconfirmed faxes or phone calls often delay patient care due to administrative burdens associated with prior authorization.
Prior authorization has been identified as a significant administrative burden for healthcare providers. The Office of Inspector General at HHS found that many initially denied requests are later approved upon further review under current practices.
The proposed legislation aims to establish an electronic process for prior authorizations within MA plans while increasing transparency about requirements and clarifying authority on timeframes for expedited determinations and real-time decisions on routine items and services.
Health plans agree on the need for improvement in serving patients more effectively while reducing unnecessary burdens on clinicians.
