,,ii  #aah? ,,congress  #b;d ,session   
,s4 #efab  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #ai           
7legislative day1 ,decemb] #af71        
#bjbd,mr4 ,:iteh\se introduc$ ! foll[+  
bill2 :i* 0 read twice & ref]r$ to !    
,committee on ,f9ance  ,a ,,bill  ,to   
am5d "p ,c ( title ,,xviii ( ! ,social  
,security ,act to provide = prior       
au?orization re=ms "u ! ,m$ic>e         
,advantage program4  #a4 ,%ort title    
,?is ,act may be cit$ z ! ,prior        
,au?orization ,relief ,act4  #b4 ,m$ic>e
 ,advantage program prior au?orization  
re=ms  7a7 ,m$ic>e ,advantage ,section  
#ahei ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #aciew-#bh7 is am5d$ by add+  
at ! end ! foll[+ new subsection3  7j7  
,prior au?orization requirem5ts  7#a7   
,audit ,n lat] ?an ,janu>y #a1 #bjbf1 ! 
,secret>y %all conduct an audit ( prior 
au?orization requirem5ts = items &      
s]vices furni%$1 & cov]$ "p ,d drugs    
prescrib$1 to enrollees "u ?is "p 9 ord]
 to id5tify ! items & s]vices & cov]$ "p

 ,d drugs t ! ,secret>y det]m9es meet   
ea* ( ! foll[+ crit]ia3 7,a7            
,reimbursem5t = su* item or s]vice or   
cov]$ "p ,d drug "u ?is "p is 9 ! top   
#aj p]c5t ( reimbursem5ts = all items & 
s]vices & cov]$ "p ,d drugs "u ?is "p4  
7,b7 ,!re is suffici5t cl9ical evid5ce  
to e/abli% a /&>d m$ical policy = !     
prior au?orization process = su* item or
 s]vice or cov]$ "p ,d drug4  7,c7      
,prior au?orization = su* item or s]vice
 or cov]$ "p ,d drug requires an        
excessive numb] ( /eps to complete !    
requir$ protocols4  7#b7 ,/&>diz$       
requirem5ts ,n lat] ?an ,octob] #a1     
#bjbf1 tak+ into acc\nt ! results ( !   
audit conduct$ "u p>agraph 7#a71 !      
,secret>y %all promulgate a f9al rule to
 /&>dize ! prior au?orization           
requirem5ts 7includ+ supplem5tal =ms7 = 
items & s]vices & cov]$ "p ,d drugs     
id5tifi$ "u p>agraph 7#a7 across all    
,m$ic>e ,advantage plans1 includ+       
,,ma-,,pd plans4  7#c7 ,exemption f     
requirem5ts  7,a7 ,9 g5]al ,subject to  

subp>agraph 7,b71 if an acc\ntable c>e  
organization satisfies ! sav+s          
requirem5ts "u section                  
#ahii7;d77#a77;,b7 = a p]=mance ye>     
beg9n+ on or aft] ,janu>y #a1 #bjbf1 9 !
 case ( an ,,aco pr(essional 7z def9$ 9 
section #ahii7;h77#a77 p>ticipat+ 9 su* 
,,aco ) a pati5t load t includes at lea/
 #bj p]c5t ( ,m$ic>e fee-=-s]vice       
b5efici>ies 7z def9$ 9 section          
#ahii7;h77#b77 assign$ to su* acc\ntable
 c>e organization1 ! prior au?orization 
requirem5ts = ! items & s]vices & cov]$ 
"p ,d drugs id5tifi$ "u p>agraph 7#a7   
%all n apply :5 su* items & s]vices are 
furni%$ by1 or su* cov]$ "p ,d drugs are
 prescrib$ by1 su* ,,aco pr(essional    
dur+ ! succe$+ ye> to an enrollee "u ?is
 "p4  7,b7 ,limitation ,! ,secret>y %all
 e/abli% a process "u :i* an ,,ma       
organization (f]+ a ,m$ic>e ,advantage  
plan 7includ+ an ,,ma-,,pd plan7 may    
reque/ t ! exemption "u subp>agraph 7,a7
 n apply ) respect to items & s]vices & 
cov]$ "p ,d drugs furni%$ to enrollees  

"u ! plan & t ! prior au?orization      
requirem5ts t w\ld o!rwise apply "u !   
plan = su* items & s]vices & cov]$ "p ,d
 drugs cont9ue to apply4  4