Congress Reintroduces Improving Seniors' Timely Access to Care Act

The Improving Seniors' Timely Access to Care Act, reintroduced in Congress in June 2024, represents the most significant federal legislative effort to reform prior authorization in Medicare Advantage. The bipartisan bill would require MA plans to implement electronic prior authorization, establish real-time decision-making processes, meet specific response deadlines, and report PA data publicly. For the growing number of physician practices serving MA beneficiaries — now over 30 million Americans — this legislation addresses the payer segment where prior authorization friction has been most acute and least transparent.

What the Bill Would Require

The legislation targets Medicare Advantage specifically because MA plans operate under CMS oversight but have historically faced fewer PA constraints than traditional Medicare. Key provisions include:

• Electronic prior authorization: MA plans would be required to implement electronic PA systems, aligning with the CMS interoperability rule's direction but with statutory force
• Real-time decisions: For routine services, MA plans would need to provide PA determinations in real time — eliminating the multi-day waiting periods that delay patient care
• Transparency reporting: MA plans would be required to report PA approval rates, denial rates, and appeal outcomes publicly, giving practices and CMS visibility into PA patterns
• HHS oversight: The bill would direct HHS to establish standards for PA processes and monitor MA plan compliance

Bipartisan Support and Its Significance

The bill's bipartisan support is not incidental. Prior authorization reform is one of the rare healthcare issues that crosses party lines because the problem is understood across the political spectrum. Physicians in both conservative and progressive districts report the same PA burdens. Patients in rural Republican-leaning areas experience the same care delays as those in urban Democratic-leaning areas. The AMA, AHA, and over 450 healthcare organizations have endorsed the bill, creating a coalition that spans the ideological spectrum of healthcare stakeholders.

For practices, this bipartisan support suggests that some form of federal PA reform is increasingly likely, even if the specific timeline remains uncertain. The question is not whether Congress will act on prior authorization, but when and in what form.

Why Medicare Advantage Matters Disproportionately

Medicare Advantage now covers over half of all Medicare beneficiaries, and that share continues to grow. For many physician practices — particularly in primary care, cardiology, orthopedics, and oncology — MA patients represent a significant and growing portion of their payer mix. The OIG has documented that MA plans deny prior authorization at rates that would not meet traditional Medicare coverage standards, with 13% of reviewed denials involving services that met Medicare coverage rules.

The volume is staggering: KFF data shows MA insurers processed nearly 53 million prior authorization determinations in 2024. Each determination represents administrative work by a physician practice — clinical documentation, submission, follow-up, and potentially appeals. Legislation that reduces the friction and increases the transparency of this process would have an outsized impact on practices with significant MA patient populations.

What This Means for Practice Strategy

The Improving Seniors' Timely Access to Care Act reinforces a trajectory that practices should build toward: electronic PA submission, structured documentation workflows, and systematic denial tracking. Whether this specific bill passes or its provisions are incorporated into broader legislation or CMS regulation, the direction is clear. MA plans will face increasing pressure to speed up PA decisions, publish their criteria, and justify their denials. Practices that are ready to operate in that environment — with organized clinical evidence, timely appeals, and data on their PA outcomes — will convert that regulatory pressure into operational improvement. Those without these capabilities will continue to absorb the costs of a system that is slowly, but definitively, being reformed.