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: 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, certified registered nurse anesthetist, 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, certified registered nurse anesthetist, 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..