Search Results: keywords:"prior authorization"

  • H. R. 2433 — To ensure that prior authorization medical decisions under Medicare are determined by physicians.
    Status:Introduced in House
    Words:1,947

    H. R. 2433 aims to improve how medical decisions are made under Medicare by ensuring such decisions are determined by physicians. The bill sets out specific rules for Medicare Administrative Contractors, Medicare Advantage plans, and prescription drug plans to follow when...

    Simple Explanation

    H. R. 2433 is trying to make sure that doctors, and not just anyone, are the ones who decide if people using Medicare can get certain medical treatments or medicines. It wants everyone to know how these decisions are made, kind of like showing their work in school.

  • H. R. 1227 — To amend title XVIII of the Social Security Act to ensure appropriate access to non-opioid pain management drugs under part D of the Medicare program.
    Status:Introduced in House
    Words:1,264

    H.R. 1227, known as the “Alternatives to Prevent Addiction in the Nation Act” or the “Alternatives to PAIN Act,” aims to change Medicare part D to make it easier for people to access non-opioid pain management drugs. Starting in 2026, this bill ensures these non-opioid drugs...

    Simple Explanation

    Medicare is a program that helps older people pay for medicine. This bill wants to make it cheaper and easier for them to get medicines that help with pain but aren't opioids, starting in 2026.

  • S. 4532 — To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans.
    Status:Introduced in Senate
    Words:2,925

    S. 4532 aims to amend the Social Security Act to set rules about how Medicare Advantage plans use prior authorization for covering services. It mandates that by 2027, Medicare Advantage plans must have an electronic prior authorization system and meet protection standards for...

    Simple Explanation

    S. 4532 is a bill that wants to make sure health plans for older people, called Medicare Advantage, have fair and easy rules when deciding if they'll pay for a doctor's service in the future, using computers to help. By 2027, these plans have to be quick and clear about their decisions and tell people when they say yes or no to paying for a service.

  • S. 4518 — To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans.
    Status:Introduced in Senate
    Words:2,770

    The bill S. 4518 seeks to amend the Social Security Act to set new rules for prior authorization under Medicare Advantage plans. It aims to establish an electronic system for handling prior authorization requests and enforce transparency by requiring plans to report various...

    Simple Explanation

    The bill wants to make it easier for older people to get the healthcare they need by using computers and new technology to decide quickly if their medical treatments are approved, and by being open about how these decisions are made.

  • S. 5612 — To amend part C of title XVIII of the Social Security Act to provide for prior authorization reforms under the Medicare Advantage program.
    Status:Introduced in Senate
    Words:681

    S. 5612 aims to change how prior authorizations work in the Medicare Advantage program. The bill requires an audit by January 1, 2026, to find items and drugs with high costs or complex authorization processes and calls for standardized requirements across all plans. By...

    Simple Explanation

    S. 5612 wants to make it easier for people to get special approvals (called "prior authorizations") for healthcare under a program called Medicare Advantage. The bill also suggests that by 2026, there should be new, simpler rules for everyone to follow, making healthcare easier to access without so many complicated steps.

  • H. R. 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.
    Status:Introduced in House
    Words:486

    H. R. 639, known as the “Doctor Knows Best Act of 2025,” seeks to prohibit certain health insurance practices by group health plans, health insurance issuers, and Federal health care programs. It disallows the use of prior authorization requirements, utilization management...

    Simple Explanation

    H. R. 639 is a rule that says doctors get to decide what care their patients need without anyone else checking if it’s necessary or okay to do it, starting in 2026. This means doctors can choose treatments for people, and insurance companies won’t have special steps to check things first.

  • H. R. 8702 — To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans.
    Status:Introduced in House
    Words:3,363

    H.R. 8702 aims to modify the Social Security Act to regulate prior authorization processes in Medicare Advantage plans. Starting in 2026, the bill requires these plans to meet specific transparency and electronic authorization standards by 2027. It includes provisions for...

    Simple Explanation

    Think of H.R. 8702 like a rule that makes sure when Grandma needs something called "Medicare Advantage" to help her see a doctor, everything happens quickly and clearly. By 2027, doctors and helpers need to use computers to talk to each other instead of sending papers, so Grandma doesn't wait too long for her care.

  • S. 3832 — To amend title XVIII of the Social Security Act to ensure appropriate access to non-opioid pain management drugs under part D of the Medicare program.
    Status:Introduced in Senate
    Words:1,203

    The bill, S. 3832, known as the "Alternatives to PAIN Act," aims to amend the Social Security Act to improve access to non-opioid pain management drugs under Medicare Part D. Starting in 2025, it requires these drugs to avoid deductibles and to be placed on the lowest cost-sharing tier. It...

    Simple Explanation

    The bill wants to make it easier for people on Medicare to get non-opioid medicines for pain, without extra costs or jumping through hoops, starting in 2025. This means they can choose certain pain medicines that aren't based on opioids, like pills you take if you have a headache, without needing to try stronger drugs first.

  • S. 4349 — To require private health plans to provide for secure electronic transmission of prior authorization requests for prescription drugs.
    Status:Introduced in Senate
    Words:1,365

    S. 4349 requires private health plans to electronically handle requests for prior authorization of prescription drugs through secure means. Starting in 2027, health plans must ensure these transactions meet specific technical standards set by authorities like the Secretary of Health and Human...

    Simple Explanation

    This bill wants to make sure that when doctors ask health insurance companies if it's okay to give someone certain medicine, they do it using computers in a safe way, not by sending paper or fax. Starting in 2027, they have to use special rules to keep everything secure and quick, so everyone works together smoothly.

  • H. R. 7142 — To amend title XVIII of the Social Security Act to ensure appropriate access to non-opioid pain management drugs under part D of the Medicare program.
    Status:Introduced in House
    Words:1,809

    H.R. 7142 aims to improve access to non-opioid pain management drugs for Medicare part D enrollees by removing cost-sharing barriers. It ensures these drugs are placed on the lowest cost-sharing tier and exempt from deductibles, starting January 1, 2025. The bill prohibits...

    Simple Explanation

    H.R. 7142 is a plan to make it easier for older people on Medicare to get medicine for pain that isn't from opioids, by making these medicines cheaper and removing some rules, starting in 2025.