Bipartisan lawmakers have introduced a bill that aims to more closely align Medicare insurers’ prior authorization denials with medical need, as determined by board-certified specialist physicians.
The Reducing Medically Unnecessary Delays in Care Act of 2025 was introduced in the House Thursday by Rep. Mark Green, M.D., R-Tennessee, and referred to committee. It is a reintroduction of similar bills brought by the lawmaker in 2023 and 2022.
Green—along with Reps. Greg Murphy, M.D., R-North Carolina, and Kim Schrier, M.D., D-Washington, who also backed the bill—said the legislation will help streamline necessary care and reduce administrative burden and burnout among providers.
“Prior authorization can be a roadblock that costs lives,” Green said in a release. “Doctors need to be able to make fast, life-saving decisions without a jungle of red tape to cut through.”
The bill, according to its text (PDF), would require all Medicare Administrative Contractor (MAC), Medicare Advantage plan and Part D prescription drug plan preauthorizations and adverse determinations to be made by a licensed, board-certified physician of the relevant specialty.
Additionally, it brings requirements that these plans establish and publish online written clinical criteria on their preauthorization standards that are in line with current standards of care and are evaluated or updated at least once a year. These standards would also be developed with evidence-based standards with input from specialist physicians, with the caveat that a lack of independently developed evidence-based standards for a particular service may not be used as justification to deny coverage.
Across the board, any restrictions, preauthorizations, adverse determinations or final adverse determinations made by the Medicare plans “shall be based on the medical necessity or appropriateness of such service and on written clinical criteria,” according to the bill’s text.
The lawmakers said these measures would help remove non-expert decision makers—“bureaucrats,” nurses, physicians outside of the relevant specialty and even artificial intelligence algorithms—from the delivery of care, particularly when a physician provider has already deemed a service to be necessary for their patient. Doing so will make healthcare more efficient and effective, they said.
“I will work alongside any of my colleagues to ensure the best healthcare outcomes for my constituents, and neither they nor their doctors should have to fight insurance companies in their moment of need,” Schrier said in a release. “This common sense legislation is something everyone should get behind to ensure patients can access the treatment they need when they need it by putting medical decisions back in their physician’s hands.”
Beyond underscoring the potential delays to patient care, provider organizations have been steadfast in their position that prior authorization imposes unnecessary and costly administrative burdens.
Physician survey data (PDF) gathered by the American Medical Association (AMA) found that 93% at least “sometimes” saw care delays tied to prior authorization. Doctors and their staffs reported an average of 13 hours per week spent completing prior authorization paperwork for a single physician, and 89% of physicians said prior authorization somewhat or significantly increases physician burnout.
“The result? Higher physician burnout, lower practice productivity tied to diverted time and resources, and higher practice costs,” AMA President Bruce Scott, M.D., wrote in a blog post on prior authorization earlier this week.
The Medical Group Management Association (MGMA), which represents medical group practices, said in a statement it supports the lawmakers’ legislation and views it as “a critical step” toward reform.
“Health plans’ onerous and ever-increasing prior authorization requirements undermine clinical judgment and dangerously impede patient care,” the MGMA said. “[Ninety-seven percent] of medical groups report patients having experienced delays or denials for essential care, such as prescription medicine, diagnostic tests or medical services. MGMA looks forward to working alongside our partners in Congress to ensure that no insurer can obstruct necessary healthcare for our most vulnerable seniors.”