LUGPA Policy Alert - House Ways and Means Committee Unanimously Advances Prior Authorization Reform

July 2026

At a Glance

On July 15, 2026, the House Ways and Means Committee unanimously approved (42-0) the Improving Seniors' Timely Access to Care Act (H.R. 3514). The bipartisan legislation, introduced by Representatives Mike Kelly (R-PA), Suzan DelBene (D-WA), Ami Bera, M.D. (D-CA), and John Joyce, M.D. (R-PA), would modernize prior authorization requirements in Medicare Advantage by streamlining approvals, increasing transparency, and reducing unnecessary administrative burdens.

During the markup, the Committee adopted a Chairman's Amendment in the Nature of a Substitute (AINS) that strengthens the legislation by expanding public reporting requirements, directing a federal study on the use of artificial intelligence (AI) in prior authorization, clarifying implementation timelines, and providing the Secretary of Health and Human Services with additional flexibility to establish faster decision timeframes. The legislation now advances to the full House of Representatives for consideration.

Key Provisions

As amended, H.R. 3514 would:

• Require Medicare Advantage organizations to implement electronic prior authorization (ePA) capabilities that integrate with electronic health records.
• Standardize electronic prior authorization transactions across Medicare Advantage plans to improve consistency and reduce administrative burden.
• Require plans to provide real-time prior authorization decisions for routinely approved items and services whenever feasible.
• Expand transparency by requiring Medicare Advantage organizations to publicly report detailed prior authorization metrics, including approval and denial rates, appeal outcomes, decision timeframes, and utilization data for specific items and services.
• Require prior authorization policies to be based on evidence-based clinical criteria that are reviewed and updated regularly.
• Strengthen CMS oversight to ensure prior authorization policies do not create unnecessary barriers to medically necessary care.
• Direct HHS to study how Medicare Advantage plans use automation and AI in prior authorization and evaluate its effects on patient access, provider burden, operational efficiency, and potential impacts on rural and underserved populations.
• Authorize the Secretary of HHS to establish expedited decision timeframes for certain requests and delay implementation until plan year 2029 to provide health plans sufficient time to comply with the new requirements.

LUGPA's Position

LUGPA strongly supports the Improving Seniors' Timely Access to Care Act and applauds the Ways and Means Committee for unanimously advancing this bipartisan legislation.

Prior authorization remains one of the most significant administrative challenges facing independent urology practices. Physicians and staff spend substantial time navigating inconsistent and often opaque Medicare Advantage requirements, which delay medically necessary care, increase practice costs, and divert valuable clinical resources from patients. While CMS has adopted important regulatory reforms in recent years, codifying these requirements into statute will provide greater certainty, consistency, and accountability across Medicare Advantage plans.

Why It Matters

More than half of all Medicare beneficiaries are now enrolled in Medicare Advantage, making prior authorization policies increasingly important to both patient access and physician practice operations.

For urology practices, prior authorization requirements frequently delay advanced imaging, diagnostic testing, specialty medications, cancer therapies, and surgical procedures. These delays can postpone treatment for patients with prostate cancer, bladder cancer, kidney stones, benign prostatic hyperplasia (BPH), and other serious urologic conditions, while increasing administrative costs and contributing to physician and staff burnout.

By modernizing electronic prior authorization, increasing transparency, strengthening oversight, and evaluating the growing use of AI in coverage determinations, H.R. 3514 would help ensure that utilization management supports high-quality, evidence-based care rather than creating unnecessary obstacles to timely treatment.

Next Steps

Following unanimous approval by the House Ways and Means Committee, H.R. 3514 now advances to the full House of Representatives for consideration. LUGPA will continue working with Congress and coalition partners to advance meaningful prior authorization reform and will keep members informed as the legislation progresses.

LUGPA remains committed to advocating for policies that reduce unnecessary administrative burden, preserve physician autonomy, and ensure Medicare beneficiaries receive timely access to medically necessary urologic care.