Press Releases

Today, Representatives Suzan DelBene (WA-01), Mike Kelly (PA-16), Ami Bera, M.D. (CA-06), and John Joyce, M.D. (PA-13), and Senators Roger Marshall, M.D. (KS) and Mark Warner (VA) introduced an updated Improving Seniors’ Timely Access to Care Act. The bipartisan, zero-cost legislation would help get seniors the care they deserve and allow health care providers to spend more time with patients by streamlining and modernizing the prior authorization process under Medicare Advantage.

Prior authorization is a tool used by health plans to reduce unnecessary care by requiring health care providers to get pre-approval for medical services. However, the current system often results in multiple faxes or phone calls by clinicians, which takes precious time away from delivering care. Prior authorization continues to be the number one administrative burden identified by health care providers, and nearly three out of four Medicare Advantage enrollees are subject to unnecessary delays due to the practice.

“While we’ve made progress streamlining prior authorization, this practice still results in too many seniors facing harmful delays in their care and providers spending too much time justifying common procedures instead of treating patients,” said DelBene. “Our bipartisan bill builds on that progress by bringing the system into the 21st century and ensuring seniors can access the timely, high-quality care they deserve. When seniors are fighting deadly illnesses, they shouldn’t have to fight their insurance company.”

In 2025, 34.5 million people are enrolled in Medicare, including nearly 760,000 in Washington.

In 2024, the Congressional Budget Office determined that the legislation would result in a zero cost to American taxpayers. Patients would receive better access to necessary care, and providers would see a significant regulatory burden.  

In recent years, the U.S. Department of Health and Human Services (HHS) revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied. More recently, HHS released a report finding that MA plans incorrectly denied beneficiaries access to services even though they met Medicare coverage rules. The bill focuses on holding Medicare Advantage plans accountable and transparent to the American public.

The bill would:

• Establish an electronic prior authorization process for Medicare Advantage plans including a standardization for transactions and clinical attachments.
• Increase transparency around Medicare Advantage prior authorization requirements and its use.
• Clarify HHS’ authority to establish timeframes for e-prior authorization requests including expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests.
• Expand beneficiary protections to improve enrollee experiences and outcomes.
• Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-prior authorization process.

The Improving Seniors’ Timely Access to Care Act unanimously passed the House in the 117^th Congress and was cosponsored by a majority of members in the Senate and House of Representatives in the 118^th Congress. The bill also received endorsements from over 500 national and state organizations representing patients, physicians, Medicare Advantage plans, hospitals, and other key stakeholders in the health care industry. 

In January 2023, HHS finalized regulations that made many of the changes proposed in the legislation. The bill would codify these wins to ensure no future administration could undo them and make further improvements.