Radiology-supported law change would tighten screws on prior authorization requests
Physician members of Congress are proposing a bipartisan bill to ease the burden of prior authorization requests for imaging and other healthcare services.
Rep. Mark Green, MD, R-Tenn., and colleagues on March 27 reintroduced the Reducing Medically Unnecessary Delays in Care Act of 2025. Endorsed by 30 trade groups including the Society of Interventional Radiology, the bill would require payers to employ expert physicians to handle requests for procedures and other care.
Critics have complained that insurers often use nurses or other physicians with no expertise to decide if an MRI or interventional procedure is medically necessary and warrants payment. The proposal would apply to both traditional Medicare and Advantage plans, requiring that board-certified docs within the relevant specialty make prior-authorization decisions.
“Americans don’t want bureaucrats sitting in on their doctor’s appointments, and they don’t want them to determine their treatment plans,” Green, a trained emergency physician, said in a statement. “Burdensome regulations keeping patients from accessing lifesaving treatment, like colonoscopies, [are] not only inconvenient but life-threatening.”
About 23% of physicians surveyed said prior authorization has led to patient hospitalizations, according to the American Medical Association (AMA). Another 18% said PA has prompted a life-threatening incident, and 94% believe these requirements negatively impact patient care. Radiology faces one of the heaviest burdens from prior authorization, a 2021 study found, and it can lead to care delays, anxiety and more paperwork for cancer patients, according to another.
House Resolution 2433 has nine co-sponsors including Reps. Greg Murphy, MD, R-N.C., Kim Schrier, MD, D-Wash., John Joyce, MD, R-Pa., Rich McCormick, MD, R-Ga., Andy Harris, MD, R-Md., Mariannette Miller-Meeks, MD, R-Iowa, and Mike Kennedy, MD, R-Utah. The AMA, American Osteopathic Association (AOA) and Medical Group Management Association (MGMA) also have endorsed the measure.
The Reducing Medically Unnecessary Delays in Care Act would require Medicare plans to base restrictions on medical necessity and written clinical criteria, along with establishing other transparency obligations for insurers. Rep. Green and colleagues previously proposed the legislation in 2022 and 2023, but it failed to pass.
The MGMA noted that 97% of practices surveyed said their patients have experienced delays or denials for diagnostic tests and other care.
"Health plans' onerous and ever-increasing prior authorization requirements undermine clinical judgment and dangerously impede patient care,” said Anders Gilberg, senior VP of government affairs for the Medical Group Management Association, which represents over 15,000 practices in radiology and other specialties. “MGMA looks forward to working alongside our partners in Congress to ensure that no insurer can obstruct necessary healthcare for our most vulnerable seniors,” he added later.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.