This bill, known as the Improving Seniors' Timely Access to Care Act of 2025, aims to enhance the prior authorization process within Medicare Advantage plans. It mandates the implementation of a secure electronic prior authorization program by January 1, 2028, ensuring standardized electronic transmission of requests and responses, and explicitly excluding faxes or non-compliant proprietary portals.

Beginning January 1, 2027, the legislation imposes significant transparency requirements on Medicare Advantage plans. These plans must annually submit detailed data to the Secretary, including lists of services requiring prior authorization, approval and denial rates, appeal outcomes, and information on the use of artificial intelligence or other technologies in decision-making. This data will be publicly published, and plans must also provide providers and enrollees with access to the criteria used for prior authorization determinations.

Furthermore, the bill establishes enrollee protection standards, effective January 1, 2028. These standards require plans to develop transparent prior authorization programs in consultation with enrollees and providers, allow for waivers or modifications of requirements based on provider performance, and conduct annual reviews of services subject to prior authorization with stakeholder input.

The legislation also grants the Secretary of Health and Human Services new authority to establish and enforce specific timeframes for responses to all prior authorization requests, including expedited and "real-time" decisions for routinely approved items and services. Various reports to Congress are also mandated, including evaluations of implementation and analyses of real-time decision processes and the impact of automation on patient access.