Bipartisan coalition reaches supermajority, clears path for Medicare Advantage prior‑authorization limits

Medicare Advantage is the private-plan version of Medicare. Prior authorization is the insurer step where a doctor has to ask permission before a test, treatment, or procedure happens. Put those together and you get one of the most complained-about chokepoints in U.S. health care. What changed is political, not procedural — a bipartisan bill to limit those delays has piled up enough support to look unusually hard to ignore. (physicianspractice.com) ### What actually moved? The vehicle is the Improving Seniors’ Timely Access to Care Act of 2025 — H.R. 3514 in the House and S. 1816 in the Senate. Congress.gov shows 64 Senate cosponsors, and Congress.gov’s House pages show the bill deep into the hundreds of cosponsors as of late April a(physicianspractice.com)he practical threshold for most big legislation. (congress.gov) ### What would the bill make plans do? Basically, it tries to turn prior authorization from a fax-machine maze into a standardized digital process. The bill would require Medicare Advantage plans to use electronic prior authorization, publish data on denials and response times, and create a path for CMS to require real-time decisions for services that are routin(congress.gov)s starting on or after January 1, 2028. (physicianspractice.com) ### Why is this such a big deal for doctors? Because the burden is not abstract. The AMA says physician practices handle an average of 39 prior-authorization requests per doctor per week, eating about 13 hours of physician and staff time. In the same 2024 survey, 93% of physicians said pri(physicianspractice.com)nt for a patient in their care. (physicianspractice.com) ### Why does Medicare Advantage matter so much here? Because it is no longer a side program. More than half of Medicare beneficiaries are now in Medicare Advantage plans, so friction inside MA is no longer niche — it hits a huge share of older patients. And MA plans use prior authorization(physicianspractice.com)mish. (physicianspractice.com) ### Is there evidence the denials are excessive? Yes — and this is one of the sharpest points in the whole debate. An HHS inspector general report cited by reform backers found that 13% of prior-authorization requests denied by Medicare Advantage plans would have been approved under tradit(physicianspractice.com)plan behavior, not medical necessity. (physicianspractice.com) ### Why is the politics different now? Two reasons. First, the coalition is broad — physicians, hospitals, patient advocates, and beneficiary groups are all pushing in the same direction. Second, the public has gotten much more explicit about hating this process. KFF found 69% of insured a(physicianspractice.com)limbs to 39%. (physicianspractice.com) ### Why not just let CMS handle it by rule? CMS already finalized an interoperability rule in 2024 that picked up some of the same ideas. But the catch is durability. If Congress writes the requirements into statute, they are harder to unwind later — and that matters more after the Supreme Court’s 2024 Loper Bright decision narrowed agencies’ room to make policy through regulation alone. (physicianspractice.com) ### So what is the real bottom line? This is not a full ban on prior authorization. It is a cleanup bill — faster decisions, digital submission, more transparency, and more pressure on plans that overuse denials. But the unusual part is the coalition. When a Medicare Advantage bill gets this many Republicans and Democrats on board, it stops looking like a messaging exercise and starts looking like a live path to law. (physicianspractice.com)