To amend title XVIII of the Social Security Act to require any advertisement of a Medicare Advantage plan to include information related to the rates of prior authorization denials under such plan.
Summary
H.R. 6111 aims to amend Title XVIII of the Social Security Act, mandating that Medicare Advantage (MA) plan advertisements include information on prior authorization denial rates. This includes the number of denials, reconsidered approvals, and the average time for approval after initial denial. The bill seeks to increase transparency in MA plans.
The goal is to provide consumers with more comprehensive information when choosing a Medicare Advantage plan. The bill requires both verbal and visual disclosures in advertisements.
This legislation intends to empower beneficiaries to make informed decisions about their healthcare coverage by understanding the likelihood and duration of prior authorization processes.
Expected Effects
If enacted, H.R. 6111 would require Medicare Advantage plans to disclose prior authorization denial rates in their advertisements. This would likely lead to increased awareness among consumers regarding the accessibility of care under different MA plans.
Plans with high denial rates may face pressure to improve their processes or risk losing enrollment. The change could also influence competition among MA plans, incentivizing them to streamline prior authorization and reduce denial rates.
Ultimately, the bill could lead to more informed consumer choices and potentially improved access to healthcare services for Medicare beneficiaries.
Potential Benefits
- Increased transparency in Medicare Advantage plans.
- Empowers beneficiaries to make informed healthcare decisions.
- May incentivize MA plans to reduce prior authorization denial rates.
- Could lead to improved access to healthcare services.
- Promotes competition among MA plans based on service accessibility.
Most Benefited Areas:
Potential Disadvantages
- Increased administrative burden for MA plans to track and report denial data.
- Potential for misleading advertising if data is not presented clearly and accurately.
- May increase advertising costs for MA plans, potentially passed on to consumers.
- Could create a disincentive for plans to offer certain benefits if they are associated with higher denial rates.
- Possible unintended consequences on plan offerings and beneficiary choices.
Constitutional Alignment
This bill appears to align with the general welfare clause of the Constitution, as it aims to improve healthcare access and information for senior citizens. While the Constitution does not explicitly address healthcare advertising, Congress has broad authority to regulate interstate commerce and to make laws necessary and proper for carrying out its enumerated powers.
The bill does not appear to infringe on any specific constitutional rights. It could be argued that requiring disclosure in advertising touches on commercial speech, but such regulations are permissible as long as they are not overly burdensome and serve a legitimate government interest.
Overall, the bill seems to fall within the scope of Congress's legislative authority and does not raise significant constitutional concerns.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).