Policy Brief:
Reducing Medically Unnecessary Delays in Care Act of 2025
April 2025
Prior authorization (PA) has emerged as a significant barrier to timely and effective patient care, burdening physicians and delaying necessary treatments. Originally intended to control costs, PA requirements often lead to care delays, administrative inefficiencies, and adverse impacts on patient outcomes.
In response to these challenges, Rep. Mark Green, M.D., (R-TN), alongside Doctor Caucus Co-chair Greg Murphy, M.D. (R-NC) and the Congressional Democratic Doctors Caucus Co-chair Kim Schrier, M.D. (D-WA), reintroduced the Reducing Medically Unnecessary Delays in Care Act of 2025 on March 27. This legislation aims to reform how insurers utilize PA, particularly in Medicare and Medicare Advantage plans, by mandating expert physician involvement in PA decision-making processes.
Key Provisions of the Bill
The Reducing Medically Unnecessary Delays in Care Act proposes several critical reforms:
- Expert Physician Decision-Making: The bill mandates that payers utilize board-certified physicians within the relevant specialty to assess PA requests. This requirement aims to ensure that decisions regarding the medical necessity of procedures are made by qualified experts rather than non-specialist personnel, such as nurses or general practitioners.
- Transparency and Accountability: Medicare plans would be required to base PA restrictions on established medical necessity and written clinical criteria. Additionally, insurers must adhere to new transparency obligations, enhancing visibility into the PA process and criteria used for decision-making.
- Impact on Patient Care: Addressing concerns raised by healthcare providers and organizations, the legislation seeks to mitigate the adverse effects of PA on patient care. According to the American Medical Association (AMA), PA requirements have led to patient hospitalizations and life-threatening incidents in significant percentages of cases, underscoring the urgency for reform.
LUGPA has been a vocal advocate for reducing PA requirements, emphasizing their detrimental effects on specialty care providers and patient outcomes. LUGPA supports legislative efforts, including the Reducing Medically Unnecessary Delays in Care Act, as part of broader initiatives aimed at streamlining PA processes and improving access to timely care for patients.
LUGPA recommends the following enhancements to PA reform efforts:
- Timely Decision-Making: Prior authorization decisions should be expedited to ensure that patients receive necessary care promptly.
- Reduced Documentation Burden: Simplification of documentation requirements, especially for routine or low-risk procedures, to alleviate administrative burdens on healthcare providers.
- Specialty Care Focus: Collection of data on PA requests for specialty services, including urology, to monitor and address the specific challenges faced by high-cost and complex treatments.
The Reducing Medically Unnecessary Delays in Care Act represents a pivotal step towards alleviating the burdens associated with PA requirements. By promoting expert physician involvement, enhancing transparency, and prioritizing patient care, this legislation addresses critical concerns voiced by healthcare providers and patient advocacy groups alike. LUGPA stands ready to collaborate with policymakers to advance these reforms, ensuring that PA no longer impedes timely and appropriate patient care.
Policy Brief: Reducing Medically Unnecessary Delays in Care Act of 2025
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