Reducing Medically Unnecessary Delays in Care Act of 2023

HR 5213 requires Medicare Advantage plans, Part D drug plans, and Medicare Administrative Contractors to base prior authorization decisions on evidence-based medical necessity standards, not arbitrary rules. It mandates input from practicing physicians when creating coverage rules, requires clear public posting of all preauthorization requirements on websites, and demands that coverage denials be reviewed by licensed physicians in the relevant specialty. This affects Medicare beneficiaries (primarily seniors and people with disabilities) by reducing arbitrary coverage denials for necessary care, while directly impacting healthcare providers and Medicare plans through new transparency and review requirements. The bill aims to streamline access to covered services by making coverage decisions more consistent, transparent, and clinically grounded.