WASHINGTON - Today, U.S. Sens. Mark R. Warner (D-VA) and Roger Marshall (R-KS) and U.S. Reps. Mike Kelly (PA-16), Suzan DelBene (WA-01), John Joyce, M.D. (PA-13), and Ami Bera, M.D. (CA-06), co-leads of the bipartisan Improving Seniors’ Timely Access to Care Act, released the following joint statement after an announcement Monday from U.S. Health & Human Services (HHS) Secretary Robert F. Kennedy, Jr. and Centers for Medicare and Medicaid (CMS) Administrator Dr. Mehmet Oz that pledges to ease the Medicare Advantage prior authorization process.

The pledge, which includes several provisions contained in their legislation, follows years of legislative progress led by Kelly and Congressional colleagues.

"We applaud these commitments, which aims 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."

Under the commitment, participating health plans would:

• Standardize electronic prior authorization submissions using Fast Healthcare Interoperability Resources (FHIR®)-based application programming interfaces.
• Reduce the volume of medical services subject to prior authorization by January 1, 2026.
• Honor existing authorizations during insurance transitions to ensure continuity of care.
• Enhance transparency and communication around authorization decisions and appeals.
• Expand real-time responses to minimize delays in care with real-time approvals for most requests by 2027.
• Ensure medical professionals review all clinical denials.
   

In May 2025, Sen. Warner reintroduced the Improving Seniors’ Timely Access to Care Act. 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. But it’s not without fault. The current system often results in unconfirmed faxes of a patient’s medical information or phone calls by clinicians which takes precious time away from delivering quality and timely care. Prior authorization continues to be the #1 administrative burden identified by health care providers, and three out of four Medicare Advantage enrollees are subject to unnecessary delays due to prior authorization. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied. More recently, HHS OIG released a report finding that MA plans incorrectly denied beneficiaries’ access to services even though they met Medicare coverage rules.

Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization.

Specifically, the legislation would:

• Establish an electronic prior authorization process for MA plans including a standardization for transactions and clinical attachments.
• Increase transparency around MA 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-PA process.
• Previously, Rep. Kelly led similar legislation in the 118th Congress. The Improving Seniors’ Timely Access to Care Act unanimously passed the House in the 117th Congress and was cosponsored by a majority of members in the Senate and House of Representatives. 

Text of the bill can be found here and a section-by-section can be found here.