HR 6110
To amend title XVIII of the Social Security Act to require Medicare Advantage plans to automatically reconsider determinations denying coverage.
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Sign in to take action- Introduced
- Passed House
- Passed Senate
- To President
- Became Law
Bill overview
This bill aims to improve the appeals process for Medicare Advantage beneficiaries who have had their coverage denied. It requires Medicare Advantage plans to automatically review and reconsider any coverage denials made to patients. The goal is to ensure that individuals receive a fair opportunity to challenge a denial and potentially gain access to necessary healthcare services. This change focuses on streamlining the reconsideration process.
Key provisions
- Medicare Advantage plans must automatically reconsider coverage denials.
- The bill amends the Social Security Act to require automatic review.
- It mandates a reconsideration process for denied coverage determinations.
- The process involves re-examining the initial determination.
Who is affected
- Medicare beneficiaries
- Medicare Advantage plan members
- Individuals receiving healthcare through Medicare Advantage plans
Notable changes
- Requires automatic reconsideration of coverage denials by Medicare Advantage plans.
- Changes the process for requesting and receiving reconsideration.
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Primary sponsor
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119th CONGRESS — 1st Session
H. R. 6110
IN THE HOUSE OF REPRESENTATIVES
A BILL
To amend title XVIII of the Social Security Act to require Medicare Advantage plans to automatically reconsider determinations denying coverage.
Section 1852(g)(2)(A) of the Social Security Act (42 U.S.C. 1395–22(g)(2)(A)) is amended—
by striking a determination
and inserting each determination
;
by striking upon request by the enrollee involved
; and
by striking of the receipt of the request for reconsideration
and inserting on which the determination described in paragraph (1)(B) is made
.