A bill to reform prior authorization requirements for Medicare Advantage (MA) – a massive burden that nursing home operators have been trying to change for some time – was reintroduced on Capitol Hill Thursday. Nursing homes have long argued that this aspect of MA needs to be right-sized through legislation.

The Reducing Medically Unnecessary Delays in Care Act of 2025 seeks to reform prior authorization for Medicare and Part D prescription drug plans in addition to MA, according to a report from The Hill. Only specialty board certified physicians would be able to make important decisions about treatment, according to the legislation reintroduced by Rep. Mark Green (R-Tenn.).

Restrictions to care would need to be based on medical necessity and written clinical criteria, and MA plans would be held to additional transparency obligations as part of the bill.

The reintroduced legislation follows the Centers for Medicare & Medicaid Services (CMS)’s Interoperability and Prior Authorization final rule published in January 2024, requiring MA plans to respond to expedited prior authorizations requests within 72 hours and standard requests in seven calendar days.

This rule is due to be implemented by CMS in January 2026.

“We’ve got to let doctors focus on treating patients. True peer-to-peer deliberations will help to reduce stress and frustration in the prior authorization process—and that’s why I’m introducing the Medically Unnecessary Delays in Care Act of 2025,” Green told The Hill. “Doctors need to be able to make fast, life-saving decisions without a jungle of red tape to cut through.”

About 12 states have put prior authorization reform in place, and there’s pending legislation in 13 more states as of last October. More broadly, MA behemoths are also being scrutinized by the Senate Finance Committee for use of predictive AI tools.

The Department of Health and Human Services’ Office of the Inspector General (OIG) was raising concerns over denials of prior authorization requests, and more generally a denial of services as far back as April 2022.

“If the health plans are not willing to do it voluntarily, it’s going to be thrust upon them by legislators,” Dr. Bruce Scott, president of the American Medical Association (AMA) said during a health summit at the time

About 23% of physicians have said prior authorizations have led to hospitalizations, while 94% said they believed prior authorization requirements negatively impacted patient care, according to a 2024 survey published by the AMA.

Other supporters of the legislation include GOP Reps. John Joyce (Pa.), Rich McCormick (Ga.), Andy Harris (Md.), Tim Burchett (Tenn.), Greg Murphy (N.C.) and Brian Babin (Texas), who co-sponsored the legislation in addition to Democratic co-lead Kim Schrier (Wash.).