US Rep. Mark Green, MD, Reintroduces Legislation Aimed at Reducing Delays in Medical Care Due to Prior Authorization Requirements
Bill has bipartisan support and, if passed, would require physician involvement in any decision of medical necessity
Harmful effects caused by delays in care due to payer preauthorization requirements are receiving renewed attention with the refiling of the Reducing Medically Unnecessary Delays in Care Act of 2025 in the US House of Representatives. The bill intends to “ensure that prior authorization medical decisions under Medicare are determined by physicians” and not by non-medical personnel.
Originally introduced by Representative Mark Green, MD, (R-TN) in 2022 and reintroduced in March 2025, the bill notes that “board-certified physicians in the same specialty are the ones making these important decisions. It would also direct Medicare, Medicare Advantage, and Medicare Part D plans to comply with requirements that restrictions must be based on medical necessity and written clinical criteria, as well as additional transparency obligations,” according to a press release from Green’s office.
Thus, to ensure physician involvement in determinations of medical necessity, the bill includes the following requirement:
“Prior to establishing, or substantially or materially altering, written clinical criteria for purpose of preauthorization review, the Medicare administrative contractor, Medicare Advantage plan, or prescription drug plan, respectively, shall obtain input from actively practicing physicians within the service area where the written clinical criteria are to be employed.”
The bill has bipartisan support. Green partnered with Doctor Caucus co-chair Greg Murphy, MD, (R-NC) and Congressional Democratic Doctors Caucus co-chair Kim Schrier, MD, (D-WA) to draft the bill.
“Americans don’t want bureaucrats sitting in on their doctor’s appointments, and they don’t want them to determine their treatment plans,” said House Representative Mark Green, MD, in a press release. (Photo copyright: Department of Homeland Security.)
‘Life Threatening Barriers’
Many major medical associations also support the bill. They include the:
- American Medical Association (AMA),
- American Osteopathic Association,
- American College of Emergency Physicians, and many more.
“According to the AMA, 23% of physicians report that prior authorization has led to a patient’s hospitalization, while 18% report that it has led to a life-threatening event. In the same 2024 survey, 94% of physicians believed that prior authorization requirements negatively impacted patient care,” Green’s press release states.
“As a physician myself, I’ve seen firsthand how prior authorization has created life threatening barriers to essential and standard care,” said Schrier in the press release. “This commonsense 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.”
Burdensome Regulations
The matter is also personal to Green. In the press release, he described his own experience in the healthcare system. “As a survivor of both colon and thyroid cancer, I know how critical it is to start treatment as soon as possible. Burdensome regulations keeping patients from accessing life-saving treatment, like colonoscopies, is not only inconvenient but life-threatening.”
Back in 2022 when he first introduced the bill, he said, “At their core, these determinations are medical decisions, and they should be made by those with the appropriate medical training and expertise. The doctor-patient relationship is vital to the practice of medicine, but the current practice of prior authorization amounts to placing a bureaucrat in the middle of the doctor’s office. Physicians are forced to jump through hours of unnecessary and arbitrary paperwork simply to prove to third-party administrators that a procedure is medically necessary. We need to remove the red tape and let doctors do what they do best—treating patients and saving lives.”
The resurrection of this bill is timely. At the end of March, Dark Daily reported KFF’s findings that in 2023 health insurers denied 19% of all in-network claims, including many in anatomic pathology and clinical laboratories.
Looking for more guidance on navigating prior authorization requests? Register for Dark Daily’s free webinar, “Changing the Narrative on Prior Authorization: A Collaborative, Programmatic Approach,” which takes place June 25 at 1 pm ET.
—Kristin Althea O’Connor
