Environmental & Healthcare Legislative Watch50 States · D.C. · U.S. Congress
From official state and federal legislative records. Informational only, not legal advice.
Died
This idea didn't make it. It stopped moving and won't become a law this time.
In plain words
AI summaryWritten by AI from the bill text. Check the official text before relying on it.
Prohibits payment adjudicators from downcoding health care services under certain circumstances; requires health insurers to ensure that their downcoding policies are updated & to ensure compliance with specified provisions on downcoding; authorizes investigations & actions against noncompliance; provides certain presumption in favor of physicians' determination regarding patients' diagnoses & service orders; provides calculations of interests on health insurers' nonpayment & underpayment due to downcoding; provides causes of action for health care providers; prohibits utilization review entities from implementing new requirements, restrictions, & changes on prior authorizations under certain circumstances; provides requirements for adverse determinations made by such entities on health care providers' claims; revises requirements & timeframes for responses from health insurers & HMOs to submitted claims.
