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Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
The separation between authorization bills and appropriations bills dates back to colonial legislatures and even the British Parliament. [8] At first, this was an informal separation. In the 1830s, however, in reaction to a sharp increase in the number of riders added to appropriations measures, the House and then the Senate added formal rules ...
Congress established mandatory programs under authorization laws. Congress legislates spending for mandatory programs outside of the annual appropriations bill process. Congress can only reduce the funding for programs by changing the authorization law itself. This normally requires a 60-vote majority in the Senate to pass. Discretionary ...
The House and Senate now consider appropriations bills simultaneously, although originally the House went first. The House Committee on Appropriations usually reports the appropriations bills in May and June and the Senate in June. Any differences between appropriations bills passed by the House and the Senate are resolved in the fall. [11]
PPO. The Preferred Provider Organization plan is the most popular for those with employment-based insurance (currently 47% of them, in fact). PPOs allow the most flexibility in that people can ...
These are normally covered in authorization and appropriation legislation. Generally, this legislation does not affect the acquisition process itself, although the appropriation process has been used to amend procurement laws, notably with the Federal Acquisition Reform Act (FARA) and the Federal Acquisitions Streamlining Act (FASA).
Insurance regulatory law is the body of statutory law, administrative regulations and jurisprudence that governs and regulates the insurance industry and those engaged in the business of insurance. Insurance regulatory law is primarily enforced through regulations, rules and directives by state insurance departments as authorized and directed ...
An appropriation bill is used for actually providing money for "discretionary" programs. Appropriations are generally done on an annual basis, but multi-year appropriations are occasionally passed. According to the US Constitution (Article I, Section 8, clause 12), Army appropriations cannot be for more than two years at a time. An annual ...