Bill 119 HR 639, also known as the "Prior Authorization Reform Act of 2021," aims to prevent group health plans, health insurance issuers, and Federal health care programs from using certain practices that can delay or restrict access to necessary medical care. Specifically, the bill seeks to prohibit the use of prior authorization requirements, utilization management techniques, and medical necessity reviews.
Prior authorization requirements are often used by insurance companies to determine if a certain medical treatment or service is covered under a patient's plan before it can be provided. Utilization management techniques involve strategies used by insurers to control costs and ensure appropriate use of healthcare services. Medical necessity reviews are assessments conducted by insurers to determine if a particular treatment is medically necessary for a patient.
By prohibiting these practices, the bill aims to streamline the process of receiving medical care and ensure that patients are able to access the treatments they need in a timely manner. This legislation is intended to protect patients from unnecessary delays or denials of care that can result from these practices.
Overall, Bill 119 HR 639 seeks to improve access to healthcare services and reduce barriers to receiving necessary medical treatment by limiting the use of prior authorization requirements, utilization management techniques, and medical necessity reviews by group health plans, health insurance issuers, and Federal health care programs.