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.
The Doctor Knows Best Act of 2023 would prohibit health insurance companies and federal health care programs from requiring prior authorization, using utilization management techniques like step therapy protocols, or conducting medical necessity reviews before covering medical treatments and services. The bill affects private health insurance plans, individual and group coverage offered by insurance companies, as well as federal health programs including Medicare, Medicaid, and federal employee health benefits. The legislation would take effect on January 1, 2024, for private insurers and the same date for federal health programs. This bill essentially removes insurance company gatekeeping requirements that currently allow insurers to deny or delay coverage decisions by requiring doctors to get approval before certain treatments. The bill contains no specific funding provisions, as it primarily eliminates administrative requirements rather than authorizing new spending.
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