HR 6111
To amend title XVIII of the Social Security Act to require any advertisement of a Medicare Advantage plan to include information related to the rates of prior authorization denials under such plan.
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Sign in to take action- Introduced
- Passed House
- Passed Senate
- To President
- Became Law
Bill overview
This bill would require Medicare Advantage plan advertisements to include information about how often the plan denies prior authorization requests. Advertisements would need to state the number of denials, the number of denials that were later approved, and the average time it takes for a denied request to be reconsidered and approved. This aims to provide potential beneficiaries with a clearer understanding of the plan’s prior authorization process.
Key provisions
- Medicare Advantage plan advertisements must disclose prior authorization denial rates.
- The disclosure must include the total number of denials.
- The disclosure must include the number of denials that were subsequently approved after reconsideration.
- The disclosure must include the average time between initial denial and approval.
- The requirements begin one year after the bill’s enactment.
Who is affected
- Medicare Advantage Plan Sponsors
- Potential Medicare Beneficiaries
- The Centers for Medicare & Medicaid Services (CMS)
Notable changes
- Currently, Medicare Advantage plan advertisements do not require disclosure of prior authorization denial rates.
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119th CONGRESS — 1st Session
H. R. 6111
IN THE HOUSE OF REPRESENTATIVES
A BILL
To amend title XVIII of the Social Security Act to require any advertisement of a Medicare Advantage plan to include information related to the rates of prior authorization denials under such plan.
Section 1852(c) of the Social Security Act (42 U.S.C. 1395w–22(c)) is amended by adding at the end the following new paragraph:
the number of requests for prior authorization that were denied under such plan during such plan year, including requests for prior authorization that were reconsidered and approved after being denied;
the number of requests for prior authorization described in subparagraph (A) that were reconsidered and approved after being denied; and
with respect to the requests for prior authorization described in subparagraph (B), the average number of days between the date on which such a request was initially denied and the date on which such request was approved.