Independent Medical Review Act of 1999

Summary

Independent Medical Review Act of 1999 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to require group health plans and health insurance issuers to provide for independent review of adverse coverage determinations. Requires group health plan claims procedures to include procedures for a fair, de novo determination of medical necessity by the independent review organization without regard to the definition used by the plan, as well as notifications to participants or beneficiaries of their rights to: (1) appeal adverse determinations to utilization review agents of the plan; (2) appeal adverse determinations of such utilization review agents to independent review organizations (with procedures for such appeal); and (3) obtain immediate review by an independent review organization in cases of life-threatening conditions (with procedures for obtaining such review). Sets forth requirements for: (1) procedures for appeals of adverse decisions to the plan's utilization review agent; (2) the independent review process; and (3) certification of independent review organizations by the Secretary of Labor. Treats the independent review organization's determination as the final decision of the plan, but allows a court to vacate or modify such determination under certain circumstances.

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Documents

3 official files

• Introduced in House (text)

  Introduced in House · EN · 22 June 1999

  ViewDownloadOpen at official source

• Introduced in House (PDF)

  Introduced in House · EN · 22 June 1999

  ViewDownloadOpen at official source

• Introduced in House

  summary · EN · 22 June 1999

  Open at official source

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