H.R. 6111: 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.

This bill proposes amendments to the Social Security Act concerning advertisements for Medicare Advantage (MA) plans. Its main requirement is that any advertisement for these plans must include specific information about prior authorization requests. The bill outlines the following key points:

1. Inclusion of Prior Authorization Information

Starting one year after the bill becomes law, advertisements for Medicare Advantage plans must disclose:

• The total number of prior authorization requests denied during the most recent plan year.
• The number of these denied requests that were later reconsidered and approved.
• The average number of days it took for those reconsidered requests to be approved after the initial denial.

The intent of these disclosures is to provide potential enrollees with clearer information about the likelihood of obtaining necessary approvals for medical services and treatments offered under Medicare Advantage plans.

2. Purpose of the Bill

The bill aims to enhance transparency in the advertising of Medicare Advantage plans, allowing beneficiaries to make better-informed decisions when selecting a healthcare plan. By including data on prior authorization denials and approvals, the advertisements will help consumers understand possible hurdles they may face when seeking healthcare services covered by their plan.

3. Implementation Timeline

The requirements set forth in this bill will take effect one year after it is enacted, providing time for MA plans to adjust their advertising practices accordingly.

4. Legislative Process

The bill has been introduced in the House of Representatives and has been referred to the Committee on Ways and Means, as well as the Committee on Energy and Commerce for further consideration.

Relevant Companies

• UNH - UnitedHealth Group: As a major provider of Medicare Advantage plans, this company could be significantly impacted by requirements to disclose prior authorization denial rates, potentially affecting how they market their plans.
• HUM - Humana Inc.: Similar to UnitedHealth, Humana offers Medicare Advantage plans and may need to adjust its advertising to comply with new transparency requirements regarding prior authorization.
• ANTM - Anthem, Inc.: This company is also a provider of Medicare Advantage plans and may face regulatory changes in its advertising strategies due to the bill's provisions.