Bill > HR8078

This bill, titled the "Reducing Medically Unnecessary Delays in Care Act of 2022," aims to ensure that prior authorization medical decisions under Medicare are determined by physicians. The key provisions of the bill include: 1. Requiring Medicare administrative contractors, Medicare Advantage plans, and prescription drug plans to base any restriction, preauthorization, adverse determination, or final adverse determination on the medical necessity or appropriateness of the health care service and on written clinical criteria. 2. Prohibiting denials of coverage solely on the grounds that a health care service does not meet an evidence-based standard if no such standards exist. 3. Mandating that these entities obtain input from actively practicing physicians within the service area before establishing or altering written clinical criteria for preauthorization review. 4. Requiring the written clinical criteria to be based on nationally recognized standards, developed in accordance with national accreditation entities, reflective of community standards of care, evidence-based, and sufficiently flexible to allow deviations from norms when justified. 5. Mandating these entities to make preauthorization requirements and restrictions readily accessible on their websites and provide 60-day written notice to contracted health care providers before implementing any new or amended requirements or restrictions. 6. Requiring that all preauthorizations and adverse determinations be made by a physician who is board-certified or eligible in the same specialty as the health care provider who typically manages the medical condition or provides the health care service.