Medicare Advantage plans must speed up prior authorization or face transparency scrutiny
S. 1816 — Improving Seniors’ Timely Access to Care Act of 2025 · Filed by Roger Marshall (R-KS) · 71 cosponsors · Introduced May 20, 2025 · Referred to committee
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What it does
This bill requires Medicare Advantage plans to establish electronic systems for prior authorization requests (starting 2028), publish detailed data on approval/denial rates and decision times (starting 2027), and adopt enrollee protections including transparent criteria and annual reviews of which services require prior approval. It also gives the Secretary authority to set response timeframes (as short as 24 hours) for prior authorization decisions. The goal is to speed up access to care for seniors by reducing administrative delays and increasing transparency about how plans make coverage decisions.
Why we flagged it
The bill's core mechanism is a regulatory mandate requiring Medicare Advantage plans to adopt electronic prior authorization systems, publish detailed performance data, and meet response timeframes. It is fundamentally a transparency and procedural-efficiency measure, not a payment reform or benefit expansion.
What the text implies
- Plans may respond to 24-hour response requirements by automating denials or approvals without clinical review, shifting the burden to appeals rather than initial decisions.
- Real-time decision systems for 'routinely approved' items may create a two-tier system where some seniors get instant approval while others face delays for non-routine requests.
- Transparency data publication may enable competitive pressure on plans, potentially leading to approval-rate gaming rather than genuine clinical improvement.
- Plans may narrow the scope of items/services subject to prior authorization to reduce compliance burden, potentially shifting cost-control to other mechanisms (e.g., formulary restrictions for Part D drugs, which are explicitly excluded from this bill).
Section numbers refer to the bill text the analysis read — linked under Primary records below.
Who it affects
Seniors gain faster access to care through mandatory response timeframes, electronic systems, and transparency into plan decision-making. Providers and enrollees gain access to approval criteria and performance data. The compliance burden on plans is real but serves a legitimate public health purpose—reducing delays in medically necessary care.
Who stands to gain
- Medicare Advantage plans (operational efficiency from standardized electronic systems)
- Health IT vendors (electronic prior authorization system development and deployment)
- Providers and suppliers (faster approval decisions, reduced administrative burden)
Named in the bill
Medicare Advantage plans, Centers for Medicare & Medicaid Services (CMS), Secretary of Health and Human Services, Medicare Payment Advisory Commission (MedPAC), Government Accountability Office (GAO), Office of National Coordinator for Health Information Technology
Where it stands
71 cosponsors: 38 Democrats, 32 Republicans, 1 Independents.
- May 20, 2025 — Introduced · Congress.gov: “Introduced in Senate”
- May 20, 2025 — Referred to Senate Committee on Finance · Congress.gov: “Read twice and referred to the Committee on Finance”
Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.
Money around this bill
73 lobbying clients named this bill on 113 disclosure filings across 3 quarters, Dec 2025 to Jun 2026. Those filings disclosed $33,201,497 in lobbying spend. A filing names 12 bills on average, so that figure is what each filing reported, not a share belonging to this bill.
More lobbying clients named this bill than 99% of bills with at least one filing.
Roger Marshall, the sponsor, reported $1,777,391 in PAC receipts in the 2026 cycle. $7,500 of that came from 1 PAC tied to these lobbying clients.
- AARP — $5,300,000 on 1 filing
- American Hospital Association — $4,470,000 on 1 filing
- Hca Healthcare, Inc. — $2,100,000 on 2 filings
- Alzheimer's Association — $1,800,000 on 1 filing
- Mckesson Corporation & Affiliates U.S. Oncology and Rx Savings Solutions — $1,710,000 on 2 filings
Lobbying Disclosure Act filings through Jul 21, 2026. A filing shows who paid to lobby on a bill it names, not what changed.
How this was measured
Analysis — Quorum's AI read the bill text published by Congress.gov (13,387 characters) on May 21, 2026. Section numbers in the findings refer to that text, linked below; transparency and hidden-provision scores are compared against the median of 16,222 analysed bills.
Status and sponsors — Congress.gov's bill record — actions, committee referrals and cosponsors — loaded nightly. The timeline shows status changes, not every procedural action.
Money — Senate Lobbying Disclosure Act filings whose specific-issue field names this bill for quarters ending Dec 2025 to Jun 2026. A filing's amount is reported whole beside the median number of bills a filing names; it is never divided across them. PAC receipts are FEC-reported contributions to the sponsor's candidate committee in the 2026 cycle.
As of — lobbying records through Jul 21, 2026 · page rendered 2026-10-20.
“Medicare Advantage plans must speed up prior authorization or face transparency scrutiny” QuorumCivic. https://share.quorumcivic.app/bill/119/s1816 Report an error
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