,i  #aadth ,,congress  #ast ,session    
,h4 ,r4 #bdcg  ,,in ,,the ,,house ,,of  
,,representatives  ,may #ai1 #bjae ,mrs4
 ,blackburn introduced the following    
bill2 which was referred to the         
,committee on ,energy and ,commerce1 and
 in addition to the ,committee on ,ways 
and ,means1 for a period to be          
subsequently determined by the ,speaker1
 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to amend part ,b of title   
,,xviii of the ,social ,security ,act   
regarding high cost durable medical     
equipment1 and for other purposes4  4   
,prior authorization process for certain
 high cost durable medical equipment1   
prosthetics1 orthotics1 and supplies    
under the ,medicare program ,section    
#ahcd7;a77#ae7 of the ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7a77#ae77 is  
amended-- 7#a7 in the paragraph heading1
 by striking itemsand inserting items2  
prior authorization process for certain 

high cost durable medical equipment1    
prosthetics1 orthotics1 and supplies2   
and  7#b7 by adding at the end the      
following new subparagraph3  7,d7 ,prior
 authorization process for certain high 
cost durable medical equipment1         
prosthetics1 orthotics1 and supplies    
7i7 ,in general ,not later than #a year 
after the date of the enactment of this 
subparagraph1 the ,secretary shall begin
 the process to develop and implement a 
prior authorization process for certain 
durable medical equipment1 prosthetics1 
orthotics1 and supplies4 ,a claim for an
 item of durable medical equipment1 a   
prosthetic1 an orthotic1 or a supply    
that has received prior approval through
 the prior authorization process shall  
be exempt from subsequent pre- and      
post-payment audits and only subject to 
audits for systematic fraud and abuse4  
7ii7 ,consideration of factors ,the     
,secretary shall consider the following 
factors in developing and implementing  
the prior authorization process under   

this subparagraph3 7,i7 ,beneficiary    
access to timely care4  7,,ii7          
,alignment with the best practices of   
commercial managed care plans and       
,medicare ,advantage plans under part ,c
 that have expertise in prior           
authorization processes4  7,,iii7       
,implementation of standard medical     
necessity evaluation prior authorization
 requests for physician and hospital    
referral agents and non-physician       
practitioners4  7,,iv7 ,accounting for  
same day delivery expectations by       
providing for expedited emergency review
 for certain items1 including oxygen4   
7iii7 ,implementation ,the ,secretary   
shall promulgate a regulation to carry  
out the prior authorization process     
under this subparagraph4 ,the regulation
 shall--  7,i7 ensure that stakeholders 
participate in the development of the   
process2 and  7,,ii7 place priority on  
prior authorization of items that are   
subject to a high number of contractor  
audits1 including oxygen4  4