To prohibit health insurers, including Medicaid managed care organizations and other private health plans, from imposing arbitrary time caps on reimbursement for anesthesia services and for other purposes.
Summary
What This Bill Does
The bill prohibits health insurers and Medicaid managed care organizations from imposing arbitrary time caps on reimbursement for anesthesia services, requiring payment based on medical necessity as determined by the attending and establishes oversight by the HHS Office of Inspector General to conduct periodic audits of health insurer compliance, investigate noncompliance allegations, and submit triennial reports to Congress. It relies on compliance mandates, product standards, and reporting requirements. The main policy areas are Healthcare and Finance.
Who Benefits and How
Certified Registered Nurse Anesthetists (CRNAs) could gain revenue opportunities, Anesthesiologists and anesthesia practices could gain revenue opportunities, and Patients requiring extended anesthesia procedures could see lower costs.
Who Bears the Burden and How
Medicaid managed care organizations would take on compliance duties, Health insurance companies offering group or individual coverage would take on compliance duties, and Health insurance companies would take on compliance duties.
Key Provisions
- Prohibits health insurers and Medicaid managed care organizations from imposing arbitrary time caps on reimbursement for anesthesia services, requiring payment based on medical necessity as determined by the attending...
- Establishes oversight by the HHS Office of Inspector General to conduct periodic audits of health insurer compliance, investigate noncompliance allegations, and submit triennial reports to Congress.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
The bill prohibits health insurers and Medicaid managed care organizations from imposing arbitrary time caps on reimbursement for anesthesia services, requiring payment based on medical necessity as determined by the attending and establishes oversight by the HHS Office of Inspector General to conduct periodic audits of health insurer compliance, investigate noncompliance allegations, and submit triennial reports to Congress.
Key Policy Areas
Healthcare, Finance
Primary Purpose
The bill prohibits health insurers and Medicaid managed care organizations from imposing arbitrary time caps on reimbursement for anesthesia services, requiring payment based on medical necessity as determined by the attending and establishes oversight by the HHS Office of Inspector General to conduct periodic audits of health insurer compliance, investigate noncompliance allegations, and submit triennial reports to Congress.
Policy Domains
Main - Anesthesia Reimbursement Prohibition
Identified Gains
- Certified Registered Nurse Anesthetists (CRNAs)
- Anesthesiologists and anesthesia practices
- Patients requiring extended anesthesia procedures
- Hospitals and surgical centers
Identified Costs
- Medicaid managed care organizations
- Health insurance companies offering group or individual coverage
- Health insurance companies
Legislative Progress
IntroducedMr. Torres of New York introduced the following bill; which …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Health insurance companies, Health insurance companies offering group or individual coverage, Medicaid managed care organizations
Anesthesiologists and anesthesia practices, Certified Registered Nurse Anesthetists (CRNAs), Hospitals and surgical centers
Patients requiring extended anesthesia procedures
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
- "the_inspector_general"
- → Inspector General of Department of Health and Human Services
Key Definitions
Terms defined in this bill
Medical care provided by an anesthesiologist, certified registered nurse anesthetist, or licensed anesthesia provider during medically necessary procedures
Necessity as assessed by the attending anesthesiologist, certified registered nurse anesthetist, or licensed anesthesia provider
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology