This bill requires that all prior authorization medical decisions for Medicare patients be made by licensed physicians rather than non-physician staff. The legislation applies to Medicare Administrative Contractors, Medicare Advantage plans, and prescription drug plans, and takes effect 90 days after enactment. The bill mandates that these organizations base their coverage decisions on written clinical criteria developed with input from board-certified physicians in relevant specialties, make their approval and denial statistics publicly available on their websites, and provide healthcare providers 60 days' notice before implementing new authorization requirements. Additionally, the bill requires that physicians making coverage denials be board-certified in the same specialty as the treating provider and work under the supervision of the plan's medical directors. The legislation aims to reduce delays in patient care by ensuring medical professionals, rather than administrative reviewers, make decisions about whether treatments are medically necessary.
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