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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10331 Introduced in House (IH)]

<DOC>

118th CONGRESS
  2d Session
                               H. R. 10331

     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.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                            December 9, 2024

    Mr. Torres of New York introduced the following bill; which was 
            referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL

 
     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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Anesthesia for All Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Anesthesia care is essential and must be determined by 
        medical necessity, not arbitrary limits.
            (2) Time caps on reimbursement jeopardize patient safety, 
        impose financial burdens, and interfere with informed medical 
        decisions.
            (3) Prohibiting such practices protects patients, promotes 
        fairness, and ensures equitable access to essential healthcare 
        services.

SEC. 3. PROHIBITION ON ARBITRARY TIME CAPS FOR ANESTHESIA SERVICES.

    (a) In General.--Part A of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg et seq.) is amended by adding at the end the 
following new section:

``SEC. 2730. PROHIBITION ON ARBITRARY TIME CAPS FOR ANESTHESIA 
              SERVICES.

    ``(a) Prohibition on Time Limits.--A group health plan, and a 
health insurance issuer offering group or individual health insurance 
coverage, may not impose arbitrary time caps on reimbursement for 
anesthesia services provided during medically necessary procedures.
    ``(b) Requirement for Reimbursement Based on Medical Necessity.--
Reimbursement for anesthesia services shall be determined based on 
medical necessity as assessed by the attending anesthesiologist or 
licensed anesthesia provider.
    ``(c) Denial of Payment.--A group health plan, and a health 
insurance issuer offering group or individual health insurance 
coverage, are prohibited from denying payment for anesthesia services 
solely because the duration of care exceeded a pre-set time limit.''.
    (b) Medicaid.--Section 1902(a) of the Social Security Act (42 
U.S.C. 1396a(a)) is amended--
            (1) in paragraph (86), by striking ``and'' at the end;
            (2) in paragraph (87), by striking the period and inserting 
        ``; and''; and
            (3) by inserting after paragraph (87) the following new 
        paragraph:
            ``(88) provide that medical assistance consisting of 
        anesthesia, including such assistance furnished through a 
        managed care organization, is not subject to arbitrary time 
        caps on reimbursement when furnished during medically necessary 
        procedures (as determined by the attending anesthesiologist or 
        other provider of such anesthesia) and that payment is not 
        denied for such assistance solely because the duration of such 
        assistance exceeded a pre-set time limit.''.

SEC. 4. OVERSIGHT BY INSPECTOR GENERAL.

    (a) Monitoring and Audits.--The Office of the Inspector General of 
the Department of Health and Human Services shall--
            (1) conduct periodic audits of health insurers to assess 
        compliance with the provisions of this Act; and
            (2) investigate allegations of noncompliance submitted by 
        patients, providers, or other stakeholders.
    (b) Reporting to Congress.--Not later than one year after the date 
of enactment of this Act, and every 3 years thereafter, the Inspector 
General described in subsection (a) shall submit a report to Congress 
that includes--
            (1) the findings of audits conducted under subsection (a);
            (2) the number and nature of violations referred to the 
        Secretary of Health and Human Services; and
            (3) recommendations, if any, for improving compliance with 
        the provisions of this Act.
                                 <all>
```