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To prohibit group health plans, health insurance issuers, and Federal health care programs from applying prior authorization requirements, utilization management techniques, and medical necessity reviews.
2/4/2025, 4:54 PM
Summary of Bill HR 639
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.
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.
Congressional Summary of HR 639
Doctor Knows Best Act of 2025
This bill prohibits health insurance plans (including federal health care programs) from imposing a prior authorization requirement, utilization management technique (e.g., step therapy or fail-first protocol), or medical necessity review for any item or service for which benefits are available under the plan.
The prohibition is effective for plan years beginning on or after January 1, 2026.
Current Status of Bill HR 639
Bill HR 639 is currently in the status of Bill Introduced since January 22, 2025. Bill HR 639 was introduced during Congress 119 and was introduced to the House on January 22, 2025. Bill HR 639's most recent activity was Referred to the Committee on Energy and Commerce, and in addition to the Committee on Oversight and Government Reform, 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. as of January 22, 2025
Bipartisan Support of Bill HR 639
Total Number of Sponsors
3Democrat Sponsors
0Republican Sponsors
3Unaffiliated Sponsors
0Total Number of Cosponsors
0Democrat Cosponsors
0Republican Cosponsors
0Unaffiliated Cosponsors
0Policy Area and Potential Impact of Bill HR 639
Primary Policy Focus
Alternate Title(s) of Bill HR 639
To prohibit group health plans, health insurance issuers, and Federal health care programs from applying prior authorization requirements, utilization management techniques, and medical necessity reviews.
To prohibit group health plans, health insurance issuers, and Federal health care programs from applying prior authorization requirements, utilization management techniques, and medical necessity reviews.
Comments
Sponsors and Cosponsors of HR 639
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