,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #bdde  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #af1 #bjag,mrs4  
,blackburn introduc$ ! foll[+ bill2 :i* 
0 ref]r$ to ! ,committee on ,en]gy &    
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide = a prior au?orization process  
"u ! ,m$ic>e program = c]ta9 high co/   
durable m$ical equipm5t1 pro/hetics1    
or?otics1 & supplies4  #a4 ,%ort title  
,?is ,act may be cit$ z ! ,,dmepos      
,access & ,transp>5cy ,act ( #bjag or ! 
,,data ,act ( #bjag4  #b4 ,prior        
au?orization process = c]ta9 high co/   
durable m$ical equipm5t1 pro/hetics1    
or?otics1 & supplies "u ! m$ic>e program
 ,section #ahcd7;a77#ae7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciem7a77#ae77 is am5d$--  7#a7 9 !    

p>agraph head+1 by /rik+ items & ins]t+ 
items2 prior au?orization process =     
c]ta9 high co/ durable m$ical equipm5t1 
pro/hetics1 or?otics1 & supplies2 &     
7#b7 by add+ at ! end ! foll[+ new      
subp>agraphs3  7,d7 ,prior au?orization 
process = c]ta9 high co/ durable m$ical 
equipm5t1 pro/hetics1 or?otics1 &       
supplies  7i7 ,9 g5]al ,n lat] ?an #a   
ye> aft] ! date ( ! enactm5t ( ?is      
subp>agraph1 ! ,secret>y %all develop & 
implem5t a prior au?orization process = 
c]ta9 durable m$ical equipm5t1          
pro/hetics1 or?otics1 & supplies4 ,a    
claim = an item ( durable m$ical        
equipm5t1 a pro/hetic1 an or?otic1 or a 
supply t has receiv$ prior approval     
?r\gh ! prior au?orization process %all 
be exempt f subsequ5t pre- & po/-paym5t 
audits & only subject to audits =       
sy/ematic fraud & abuse4  7ii7          
,consid]ation ( factors ,! ,secret>y    
%all consid] ! foll[+ factors 9 develop+
 & implem5t+ ! prior au?orization       
process "u ?is subp>agraph3  7,i7       

,b5efici>y access to timely c>e4  7,,ii7
 ,alignm5t ) ! be/ practices ( comm]cial
 manag$ c>e plans & ,m$ic>e ,advantage  
plans "u "p ,c t h exp]tise 9 prior     
au?orization processes4  7,,iii7        
,implem5tation ( /&>d m$ical necessity  
evaluation prior au?orization reque/s = 
physician & hospital ref]ral ag5ts &    
non-physician practition]s4  7,,iv7     
,acc\nt+ = same day deliv]y expectations
 by provid+ = exp$it$ em]g5cy review =  
c]ta9 items4  7iii7 ,implem5tation ,!   
,secret>y %all promulgate a regulation  
to c>ry out ! prior au?orization process
 "u ?is subp>agraph4 ,! regulation      
%all--  7,i7 ensure t /akehold]s        
p>ticipate 9 ! developm5t ( ! process2 &
  7,,ii7 place priority on prior        
au?orization ( items t are subject to a 
high numb] ( contractor audits4  7,e7   
,prior au?orization process = home      
respiratory !rapy  7i7 ,9 g5]al ,9 !    
case ( home respiratory !rapy 7z def9$ 9
 clause 7v77 furni%$ on or aft] ,janu>y 
#a1 #bjai1 ! ,secret>y %all e/abli% &   

implem5t a process "u :i* ! ,secret>y   
%all det]m9e1 9 advance ( furni%+ su*   
!rapy to an individual1 :e!r paym5t =   
su* !rapy may n be made "u ?is title    
because su* !rapy is n cov]$ "u ?is     
title or because ( ! application (      
section #ahfb7;a77#a74  7ii7 ,elem5ts ( 
process ,"u ! process describ$ 9 clause 
7i71 ) respect to home respiratory !rapy
 = an individual1 ! foll[+ %all apply3  
7,i7 ,9 ord] to obta9 a prior           
au?orization "u su* process1 ! prescrib+
 practition] 7z def9$ by ! ,secret>y7   
prescrib+ su* !rapy = su* individual    
%all submit1 = su* !rapy & individual-- 
7aa7 a prescription2  7bb7 9 ! case (   
home respiratory !rapy t is oxyg5 or    
oxyg5 equipm5t1 a c]tificate ( m$ical   
necessity2 &  7cc7 a prior au?orization 
=m t includes ! in=mation describ$ 9    
subclause 7,,ii74  ,a prescription      
describ$ 9 item 7aa7 ) respect to su*   
!rapy is n requir$ "u ?is subclause if a
 c]tificate ( m$ical necessity describ$ 
9 item 7bb7 ) respect to su* !rapy is   

provid$ & if su* c]tificate conta9s a   
n>rative description t includes !       
elem5ts = a prescription1 z set =? by ! 
,secret>y4  7,,ii7 ,! ,secret>y %all    
provide a prior au?orization =m         
7initially on pap] &1 n lat] ?an #c ye>s
 aft] ! date ( ! enactm5t ( ?is         
subp>agraph1 9 an electronic =mat7 =    
prescrib+ practition]s 7z s def9$ by !  
,secret>y7 to complete :5 reque/+ a     
prior au?orization "u ?is subp>agraph4  
,! =m %all con/itute ! complete reque/ =
 in=mation to det]m9e m$ical necessity &
 require ! prescrib+ practition] 7z s   
def9$ by ! ,secret>y7 to provide ea* ( !
 foll[+3  7aa7 ,! date t ! individual 0 
se5 by a prescrib+ practition] 7z s     
def9$ by ! ,secret>y7 )9 ! appropriate  
timeframes = c]tification ( ! ne$ = !   
!rapy4  7bb7 ,! result ( ! orig9al blood
 gas1 saturation te/ results1 or sleep  
/udy results1 z applicable4  7cc7 ,a    
/atem5t t ! individual ne$s or is us+ ! 
!rapy4  7,,iii7 ,! ,secret>y %all       
respond to ! prescrib+ practition] 7z s 

def9$ by ! ,secret>y7 mak+ ! prior      
au?orization reque/ )9 #gb h\rs 7#c     
cal5d> days7 ( receiv+ ! reque/4 ,=     
hospital dis*>ges1 9 ! case ( home      
respiratory !rapy consi/+ ( equipm5t or 
supplies1 ! ,secret>y %all e/abli% an   
exp$it$ review process to all[ = !      
equipm5t or supplies to be deliv]$ on ! 
same day x is ord]$4  7,,iv7 ,!         
,secret>y %all communicate ! response to
 ! prescrib+ practition] 7z s def9$ by !
 ,secret>y7 mak+ ! prior au?orization   
reque/ & to ! suppli] designat$ on !    
c]tificate ( m$ical necessity4  7,v7 ,a 
prior au?orization approv$ "u ! process 
%all be deem$ to con/itute m$ical       
necessity = cov]age & paym5t "u ?is     
title b %all n elim9ate ! pro( ( deliv]y
 docum5tation requirem5t "u section     
#dbd4eg7;c77#ab7 ( title #db1 ,code (   
,f$]al ,regulations4  7,,vi7 ,a suppli] 
( home respiratory !rapy %all n be      
requir$ to provide su* !rapy if a prior 
au?orization reque/ "u ?is subp>agraph =
 su* !rapy has n be5 approv$4  7iii7    

,effect ( prior au?orization ,! approval
 ( a prior au?orization reque/ "u ?is   
subp>agraph %all con/itute a f9d+ (     
m$ical necessity4 ,! ,secret>y may n    
subject claims ) su* a prior            
au?orization to pre- or po/-paym5t audit
 = ! purpose ( det]m9+ m$ical necessity 
or improp] paym5t reviews z !y relate to
 docum5t+ m$ical necessity4  7iv7       
,implem5tation ,! ,secret>y may c>ry out
 ?is subp>agraph ?r\gh notice & comm5t  
rulemak+ or by int]im f9al rule ) comm5t
 p]iod4 ,9 e/abli%+ & implem5t+ !       
process "u ?is subp>agraph1 ! ,secret>y 
%all consult ) /akehold]s ?r\gh =mal &  
in=mal me*anisms4  7v7 ,home respiratory
 !rapy def9$ ,= purposes ( ?is          
subp>agraph1 ! t]m home respiratory     
!rapy means-- 7,i7 equipm5t1 supplies1 &
 s]vices = home oxyg51 home sleep1 &    
me*anical v5tilation2 &  7,,ii7 any o!r 
equipm5t1 supply1 or s]vice specifi$ by 
! ,secret>y by regulation4  4