CIS/Index
Copyright © 1999, Congressional Information
Service, Inc.
99 CIS S 4315
TITLE: Medical
Necessity: From Theory to Practice
CIS-NO: 99-S431-5
SOURCE:
Committee on Health, Education, Labor, and Pensions. Senate
DOC-TYPE:
Hearing Retrieve
the full text of testimony
DOC-NO: S. Hrg. 106-9
DATE:
Mar. 2, 1999
LENGTH: iii+85 p.
CONG-SESS: 106-1
ITEM-NO: 1043-A; 1043-B
SUDOC: Y4.L11/4:S.HRG.106-9
MC-ENTRY-NO: 99-15020
CIS DOCUMENT ON DEMAND: 1-800-227-2477
(Full Text Reproductions)
SUMMARY:
Hearing to
consider section 151 of S. 6, the Patients' Bill of Rights Act,
to prohibit group health plans and health insurance companies from arbitrarily
interfering with or altering the manner or setting in which care is delivered if
that care is medically necessary or appropriate, and to define medical necessity
as care consistent with the generally-accepted standards of professional medical
practice.
CONTENT-NOTATION: Health plan interference
with medically necessary care, prohibition
BILLS: 106
S. 6
DESCRIPTORS:
MEDICAL REGULATION; HEALTH INSURANCE; PHYSICIANS; MANAGED HEALTH CARE; MEDICAL
ETHICS; PATIENTS' BILL OF RIGHTS ACT
99-S431-5
TESTIMONY NO: 1 Mar. 2, 1999 p. 4-18, 68-76, 79-80
WITNESSES (and witness notations):
WENNBERG, JOHN E.
(Dr.) (Director, Center for the Evaluative Clinical Sciences, Dartmouth College)
STATEMENT AND DISCUSSION:
Concerns with S.
6 section 151 definition of medical necessity, with recommendations (related
materials, p. 9-18).
CONTENT NOTATION:
Health plan interference with medically necessary care,
prohibition
99-S431-5 TESTIMONY NO: 2
Mar. 2, 1999 p. 19-51, 76-81
WITNESSES (and
witness notations):
ROSENBAUM, SARA (Director, Center for
Health Policy Research, George Washington University Medical Center)
BERGTHOLD, LINDA A. (Project Director, Decreasing
Variation in Medical Necessity Decisionmaking, Center for Health Policy,
Stanford University)
BROOK, ROBERT H. (Dr.) (Vice
President and Director, Health, RAND)
STATEMENTS AND DISCUSSION:
Need for legislation to ensure that quality of treatment
decisionmaking is judged by an objective, professional standard of review;
findings of study on the application of medical necessity terminology within
managed care organizations; need to improve delivery of necessary medical care.
CONTENT NOTATION:
Health plan interference
with medically necessary care, prohibition
99-S431-5
TESTIMONY NO: 3 Mar. 2, 1999 p. 52-68, 81-85
WITNESSES (and witness notations):
NEWCOMER, LEE N.
(Dr.) (Senior Vice President, Health Policy and Strategy, UnitedHealth Group)
MYERS, WOODROW A., JR. (Dr.) (Director, Healthcare
Management, Ford Motor Co)
CORLIN, RICHARD F. (Dr.)
(Speaker, House of Delegates, AMA)
STATEMENTS AND DISCUSSION:
Opposition to section 151, with feared unintended impact
of medical necessity definition on quality of managed care; recommendations to
ensure patient access to medically necessary health care.
CONTENT
NOTATION:
Health plan interference with medically
necessary care, prohibition
TESTIMONY DESCRIPTORS:
AMERICAN MEDICAL ASSOCIATION 
