Congress mandates AI-driven Medicare approvals—with a 24-hour clock
S. 1816 — Improving Seniors’ Timely Access to Care Act of 2025 · Filed by Roger Marshall (R-KS) · 70 cosponsors · Introduced May 20, 2025 · Referred to committee
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What it does
This bill requires Medicare Advantage plans to adopt electronic prior authorization systems and publish detailed data on approval/denial rates, response times, and use of AI in coverage decisions. Starting in 2027–2028, plans must meet transparency and enrollee-protection standards, allow real-time approvals for routine items, and respond to expedited requests within 24 hours. The goal is to reduce delays in seniors' access to care and give patients and providers visibility into how plans make coverage decisions.
Why we flagged it
The bill establishes standardized electronic prior authorization processes and transparency requirements for Medicare Advantage plans, focusing on reducing administrative delays and improving enrollee access to care through data reporting and real-time decision frameworks.
What the text implies
- Mandatory electronic prior authorization systems may impose significant IT infrastructure costs on MA plans, potentially passed to enrollees through higher premiums or reduced plan offerings in rural/underserved markets.
- Real-time decision automation and AI-driven approvals could reduce human clinical review, potentially increasing inappropriate denials if algorithms are not properly validated for diverse patient populations.
The full analysis lists 5 implications of this text.
Who stands to gain
health IT vendors (electronic prior authorization platforms); clinical decision-support software companies; AI/machine-learning healthcare technology firms