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AMA Policies

Find all American Medical Association House of Delegates policies and Council on Ethical and Judicial Affairs ethical opinions applicable to managed care contracting and the relationship between contracted physicians and health insurers and other payers.

To search for an exact phrase, you should enclose the entire phrase in quotation marks. For example, "patient care".
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Ama Policy

Prior Authorization Requirements for Post-Operative Opioids: H-95.919

10/14/2019
ERISA-Med. Nec. Decisions-Deadlines, Med. Adv.-Med. Nec. Appeals-Deadlines, Step Therapy Override
Federal Law

Title 42-Chapter 7-Subchapter XVIII-Part C. Medicare+Choice Program

08/30/2023 42 USC Section 1395w-22

Benefits and beneficiary protections

Anti-gag clause-Med. Adv., Directories-Med. Adv., Liability-insurer shifting to physician-Med. Adv., Med. Adv.-Med. Nec. Appeals-Deadlines, Med. Adv.-Med. Nec. Decisions-Deadlines, Network Adequacy-Med. Adv., Prohibited financial incentives-Med. Adv., Risk-Physicians Taking-Med. Adv.
Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart M. Grievances, Organization Determinations and Appeals

08/30/2023 42 CFR 422.584

Expediting certain reconsiderations

Anti-retaliation-Med. Adv., Med. Adv.-Med. Nec. Appeals-Deadlines
Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart M. Grievances, Organization Determinations and Appeals

08/30/2023 42 CFR 422.590

Timeframes and responsibility for reconsiderations

Med. Adv.-Med. Nec. Appeals-Deadlines
Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart M. Grievances, Organization Determinations and Appeals

08/30/2023 42 CFR 422.618

How an MA organization must effectuate standard reconsidered determinations or decisions.

Med. Adv.-Med. Nec. Appeals-Deadlines, Prompt Payment Deadlines-Med. Adv.
Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart M. Grievances, Organization Determinations and Appeals

08/30/2023 42 CFR 422.619

How an MA organization must effectuate expedited reconsidered determinations

Med. Adv.-Med. Nec. Appeals-Deadlines