To amend title XVIII of the Social Security Act to require Medicare Advantage plans to automatically reconsider determinations denying coverage. | ChamberLight
Bills · HR 6110
IN COMMITTEE· 119TH CONGRESS
House BillHR 6110Health
To amend title XVIII of the Social Security Act to require Medicare Advantage plans to automatically reconsider determinations denying coverage.
INTRO NOV 18· LAST ACTION NOV 18
READING
1MIN
COSPONSORS
17
READER REACTIONS0 TOTAL
NO VOTES YET · BE THE FIRST
Introduced only
LEGISLATIVE PROGRESS
STEP 2 / 8
Introduced
In Committee
Reported
Passed House
Passed Senate
Conference
To President
Became Law
WHAT THE BILL DOES
AI-written
This bill matters because it aims to reduce a significant burden on Medicare Advantage enrollees when their healthcare is denied. Currently, many patients might not know they have the right to request a reconsideration, or they might miss the deadlines, leading to them paying out-of-pocket for services that could have been covered.
If this bill becomes law, it would streamline the initial appeal process, potentially leading to faster resolutions for denied claims and possibly overturning more denials without patient intervention. This could ensure more timely access to necessary medical care and reduce unexpected costs for patients. Without this bill, the current system remains in place, requiring patients to actively initiate the first step of appealing a denial, which can be a barrier to care.
KEY PROVISIONS
3AI-extracted
PROVISION 01
Medicare Advantage plans must automatically review every decision to deny coverage for medical services or items.
This ensures that all denials receive an immediate internal review without the patient needing to initiate the process.
PROVISION 02
The bill removes the requirement for a Medicare Advantage enrollee to request a reconsideration of a denial.
This reduces the administrative burden on patients, making the appeals process more accessible and less confusing.
PROVISION 03
The timeline for this automatic reconsideration begins on the date the original denial decision is made.
This ensures the review process starts promptly, potentially speeding up resolution for denied claims.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
This bill matters because it aims to reduce a significant burden on Medicare Advantage enrollees when their healthcare is denied. Currently, many patients might not know they have the right to request a reconsideration, or they might miss the deadlines, leading to them paying out-of-pocket for services that could have been covered.
If this bill becomes law, it would streamline the initial appeal process, potentially leading to faster resolutions for denied claims and possibly overturning more denials without patient intervention. This could ensure more timely access to necessary medical care and reduce unexpected costs for patients. Without this bill, the current system remains in place, requiring patients to actively initiate the first step of appealing a denial, which can be a barrier to care.
KEY PROVISIONS
AI-extracted
high
Medicare Advantage plans must automatically review every decision to deny coverage for medical services or items.
This ensures that all denials receive an immediate internal review without the patient needing to initiate the process.
high
The bill removes the requirement for a Medicare Advantage enrollee to request a reconsideration of a denial.
This reduces the administrative burden on patients, making the appeals process more accessible and less confusing.
med
The timeline for this automatic reconsideration begins on the date the original denial decision is made.
This ensures the review process starts promptly, potentially speeding up resolution for denied claims.
GLOSSARY
AI-written
Medicare Advantage
A type of Medicare health plan offered by private companies that contract with Medicare. It provides all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.
Social Security Act
A law passed in 1935 that established social insurance programs, including Medicare and Social Security, providing benefits for retirees, people with disabilities, and families with dependent children.
Reconsideration
The first step in the Medicare appeals process where a health plan reviews its initial decision to deny coverage or payment for a service or item.
Enrollee
A person who is signed up for or covered by a health insurance plan.
Determination
An official decision made by a health insurance plan, in this context, usually referring to a decision to deny coverage for a medical service or item.
ACTION TIMELINE
2 EVENTS
NOV 18, 25
Introduced in House
INTROREFERRAL
NOV 18, 25
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.