Bill

HR 10331

Anesthesia for All Act

118th Congress Introduced by Sheila Cherfilus-McCormick and 2 co-sponsors

Prohibits arbitrary time caps on anesthesia reimbursement; requires payment based on medical necessity for all plans and Medicaid, with HHS OIG audits to enforce.

Introduced in House

WeVote Research Nonpartisan

Bill Summary · HR 10331

Summary: HR 10331 – Anesthesia for All Act

Overview

HR 10331, introduced in the House on December 9, 2024 by Representative Ritchie Torres (New York) and co-sponsored by Eleanor Holmes Norton and Sheila Cherfilus-McCormick, is designed to prohibit health insurers and Medicaid managed care organizations from imposing arbitrary time caps on reimbursement for anesthesia services. The bill would require reimbursement to be based on medical necessity as determined by the attending anesthesiologist or licensed anesthesia provider and would extend these protections to Medicaid, including managed care arrangements. The bill creates new oversight and reporting requirements through the Department of Health and Human Services (HHS) Inspector General.

Key Provisions

Short Title: The act may be cited as the “Anesthesia for All Act.”
Findings: The bill asserts that anesthesia care is essential and must be determined by medical necessity, not arbitrary limits; time caps can jeopardize patient safety, create financial burdens, and hamper informed medical decisions; prohibiting such practices aims to improve equity and access to essential care.
Prohibition on Arbitrary Time Caps (Sec. 2730, added to the Public Health Service Act):
- Group health plans and health insurance issuers offering group or individual coverage may not impose arbitrary time caps on reimbursement for anesthesia services during medically necessary procedures.
- Reimbursement for anesthesia services must be based on medical necessity as assessed by the attending anesthesiologist or other licensed anesthesia provider.
- Plans may not deny payment for anesthesia services solely because the duration exceeded a preset time limit.
Medicaid Provisions (amendment to Section 1902(a) of the Social Security Act):
- Adds a new paragraph (88) stating that medical assistance for anesthesia (including anesthesia furnished through a managed care organization) is not subject to arbitrary time caps on reimbursement, and payment cannot be denied solely due to duration exceeding a preset limit.
Oversight and Monitoring (Sec. 4):
- The Office of the Inspector General (OIG) of HHS will conduct periodic audits of health insurers to assess compliance and investigate allegations of noncompliance.
- OIG must report to Congress not later than one year after enactment and then every three years, detailing audit findings, violations referred to the secretary, and recommendations for improving compliance.

Who Is Affected

Private Sector: Group health plans and health insurance issuers offering group or individual coverage would be prohibited from imposing arbitrary time caps on anesthesia reimbursement.
Public Sector (Medicaid): Medicaid programs, including those administered through managed care organizations, would be required to reimburse anesthesia based on medical necessity and would be protected from denial due to duration caps.
Patients and Providers: Attending anesthesiologists and licensed anesthesia providers would determine medical necessity for reimbursement; patients would gain protection against arbitrary duration-based denials.

Procedural and Timeline Aspects

Status and Action: Introduced in the House on December 9, 2024; referred to the Committee on Energy and Commerce.
Legislative Actions:
- 2024-12-09: Introduced and referred to the House Committee on Energy and Commerce.
Enforcement and Reporting Timeline: OIG review and Congress reporting begin within one year of enactment, with ongoing reports every three years thereafter.

Potential Impact

Aligns anesthesia reimbursement with medical necessity rather than preset time limits.
Aims to reduce patient safety risks and financial barriers associated with duration-based reimbursement caps.
Expands protections to Medicaid and managed-care settings, potentially increasing consistency in coverage practices across private and public programs.
Establishes formal oversight and accountability through the HHS Inspector General.

Compiled from official sources — confirm details with the bill’s official record.