The House of Representatives is considering legislation that would reform the way payers use prior authorization. Which payers would the bill affect and how?
A bipartisan group of legislators, led by Rep. Mark Green, MD (R-Tennessee) introduced the Reducing Medically Unnecessary Delays in Care Act of 2025 legislation in the House of Representatives last month.
The bill would affect payers participating in federal health programs and transform the way that they are allowed to use prior authorization to deny claims.
Check out the infographic below to learn more about the bill, or read HealthLeaders' earlier coverage here.
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
Congress is considering a bill that would place limitations on payers' use of prior authorization.
The legislation would require physician review for prior authorization and adverse decisions, and increase transparency around claim denial rates and clinical criteria for prior authorization.