Reducing Medically Unnecessary Delays in Care Act of 2025

This bill would require Medicare coverage decisions, including prior authorization requirements and adverse coverage determinations, to be based on written clinical criteria. These criteria must be developed in consultation with physicians to ensure medical standards are met.

This bill affects individuals enrolled in Medicare by requiring that coverage decisions and prior authorization requirements are based on specific clinical criteria. It also impacts physicians, who must be consulted during the development of the written clinical criteria used for these medical necessity determinations.

• Establishment of written clinical criteria for Medicare. Requires that Medicare coverage decisions, including those regarding prior authorization and adverse coverage determinations, be based on established written clinical criteria.
• Physician consultation in criteria development. Mandates that the written clinical criteria used for Medicare coverage decisions be developed in consultation with physicians.

This bill modifies the administration of the Medicare program by establishing new requirements for how coverage decisions and prior authorization criteria are developed.

The bill aims to ensure that Medicare coverage decisions and prior authorization requirements are based on written clinical criteria developed in consultation with physicians.