Senator Marshall & the Trump Administration to Streamline the Prior Authorization Process in Medicare

Washington – On Monday, U.S. Senator Roger Marshall, M.D. (R-Kansas) joined Department of Health and Human Services Secretary (HHS) Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz in laying out six specific pillars of agreement on plans to improve patient outcomes and reduce administrative burdens in Medicare Advantage.

“I am grateful for the Trump Administration’s support of my legislation, the Improving Seniors’ Timely Access to Care Act, which will greatly benefit the speed and quality of care that our Seniors rely upon,” said Senator Marshall. “Likewise, I am proud to support the administration in its noble goal to streamline the prior authorization process and remove burdensome regulations from the patient-doctor relationship.”

In the six pillars of agreement, the Trump Administration and Senator Marshall have the following overlap, thanks to the Senator’s Improving Seniors’ Timely Access to Care Act:

• Standardizing Electronic Prior Authorization – establishing an electronic prior authorization program and requiring MA plans to adopt electronic prior authorization capabilities.  
• Reducing the Scope of Claims Subject to Prior Authorization – streamlining the prior authorization process for routinely approved services.
• Ensuring Continuity of Care When Patients Change Plans – protecting patients from disruptions in care due to prior authorization requirements when transitioning plans
• Enhancing Communication and Transparency on Determinations – increasing transparency around prior authorization use.
• Expanding real-time responses – requiring HHS to review items and services eligible for real-time decisions.
• Ensuring Medical Review of Non-Approved Requests – ensuring prior authorization requests are reviewed by qualified medical personnel.

Background:

• Senator Marshall reintroduced the Improving Seniors’ Timely Access to Care Act in May 2025. The full text of the legislation can be found here.
• 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. However, the current system often results in multiple faxes or phone calls by clinicians, which takes time away from delivering care.
• Prior authorization continues to be the number-one administrative burden identified by health care providers, and nearly three out of four Medicare Advantage enrollees are subject to unnecessary delays due to the practice.
• The bill would codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization Processes (e-PA) rule that was finalized by the Centers for Medicare & Medicaid Services (CMS) on January 17, 2024.
• Last Congress, the bill was supported by a super majority of members in the Senate (60) and a majority in the House (232), and was unanimously passed by the House in 2022.
• In 2018, 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.
• In 2022, the HHS Office of Inspector General released a report finding that MA plans incorrectly denied beneficiaries’ access to services even though they met Medicare coverage rules.

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Contact: Payton Fuller