Federal legislators have renewed the bipartisan push for prior authorization reform for Medicare Advantage, backed by the Texas Medical Association, other state medical associations, and national medical specialty societies.
The Improving Seniors’ Timely Access to Care Act of 2025 (H.R. 3514/S. 1816), filed by Rep. Mike Kelly (R-Pa.), is similar to legislation he filed in 2024. If passed, it would streamline and standardize the use of prior authorization within Medicare Advantage.
“Prior authorization continues to be a leading source of care delays and frustration for patients and physicians alike … often resulting in treatment delays, denials of medically necessary care, poorer patient health outcomes, and significant administrative burden,” said a Dec. 9 American Medical Association letter to congressional leadership, which TMA signed onto.
AMA cited statistics from its 2024 national prior auth survey, which found:
- 93% of physicians cited care delays linked to prior authorization;
- 82% reported that the prior authorization process sometimes causes patients to abandon recommended treatment; and
- 29% of physicians witnessed prior authorization leading to a serious adverse event for a patient, including hospitalization, disability, or death.
Additionally, the letter cites a 2022 Department of Health and Human Services Office of Inspector General report, which found13 percent of prior authorization requests denied under Medicare Advantage would have been approved for the same beneficiaries under traditional Medicare. Similarly, 18 percent of denied requests met standard Medicare coverage and billing rules.
AMA stated the proposed legislation offers solutions to the “multi-faceted problem of prior authorization.” For instance, the bill has potential to strengthen oversight, increase transparency, and ensure Medicare Advantage beneficiaries aren’t harmed by slow or inconsistent prior authorization processes, in line with what medicine has long advocated for, the letter summarizes.
“By replacing outdated faxes, proprietary portals, and inconsistent processes, the bill would simplify and accelerate prior authorization decisions by requiring a standard electronic process that integrates with physicians’ electronic health records,” signatories noted.
As of this writing, the proposed House legislation has 238 cosponsors, including 13 members of the Texas congressional delegation, while the Senate companion bill, introduced by Sen. Roger Marshall, MD (R-Kan.), has 63 cosponsors, including Sen. John Cornyn (R-Texas).
Learn more about how Texas helped advance AMA policy at its annual Interim Meeting in November.
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.