Reducing Medically Unnecessary Delays in Care Act of 2025

This bill aims to speed up care for people on Medicare by making prior authorization and coverage decisions more doctor-led and transparent. It says decisions must be based on medical necessity and clear, written clinical criteria, not just plan rules. If there is no widely accepted evidence standard for a service, a plan cannot deny it only for that reason.

Plans must involve actively practicing doctors when setting the rules they use to approve or deny care. Those rules must follow national standards, reflect community care, be flexible when needed, and be reviewed at least once a year. Plans also must post their prior authorization rules online in plain language, give doctors 60 days’ notice before adding new rules, and publish easy-to-read stats on approvals and denials, including reasons for denials. All prior authorization and denial decisions must be made by a licensed physician in the same specialty as the treating doctor.

• Who is affected: People with Medicare, their doctors, Medicare Advantage plans, Medicare prescription drug plans, and Medicare contractors.
• What changes: Decisions must be based on written clinical criteria; practicing doctors help set those rules; rules and statistics must be posted online; 60-day notice for new requirements; doctor-to-doctor decisions for approvals and denials .
• When: Applies to relevant Medicare contracts starting 90 days after the bill becomes law.