Sec. 132. Clarification of the definition of pediatric medical necessity in qualifying group coverage
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/bill/116/hr/2452/ih/section-132·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
The following definition of pediatric medical necessity shall be incorporated into benefit standards of all plans subject to the requirements of section 1302 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18022 ) and all group plans by 2023. Pediatric medical necessity, or pediatric medically necessary care, shall be defined as health care interventions that are evidence based, evidence informed, or based on consensus advisory opinion and that are recommended by recognized health care professionals, to promote optimal growth and development in a child and to prevent, detect, diagnose, treat, ameliorate, or palliate the effects of physical, genetic, congenital, developmental, behavioral, or mental conditions, injuries, or disabilities.
The Secretary of Health and Human Services, in consultation with experts in the field of pediatric care and key stakeholders, including patient and family groups, shall review and update this definition on a biennial basis, consistent with up-to-date standards of pediatric healthcare practice that are based on— the views of pediatric healthcare providers and experts practicing in relevant clinical areas; recommendations of medical-specialty societies, other pediatric healthcare provider organizations, and family and patient groups, and credible scientific evidence published in peer-reviewed literature that is generally recognized by the relevant health care provider community.
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Sec. 132
Clarification of the definition of pediatric medical necessity in qualifying group coverage
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