,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #hcgg  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,april #bj1 #bjbf,mr4 
,khanna 7= himself1 ,ms4 ,jayapal1 ,mr4 
,coh51 ,mrs4 ,d+ell1 ,mr4 ,jackson (    
,ill9ois1 ,ms4 ,norton1 & ,mr4 ,pocan7  
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,ways & ,means1 & 9    
addition to ! ,committee on ,en]gy &    
,comm]ce1 = 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 prohibit ! use
 ( prior au?orization "u ,m$ic>e        
,advantage plans1 to am5d title ,,xi ( !
 ,social ,security ,act to limit !      
implem5tation ( paym5t models te/+ prior
 au?orization "u traditional ,m$ic>e1 & 
= o!r purposes4  #a4 ,%ort title ,?is   
,act may be cit$ z ! ,/op ,deadly       
,d5ials ,act ( #bjbf4  #b4 ,prohibit+   
prior au?orization requirem5ts 9 ,m$ic>e
 ,advantage  7a7 ,9 g5]al ,section #aheb

 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #aciew-#bb7 is am5d$ by add+  
at ! end ! foll[+ new subsection3  7o7  
,limitation on prior au?orization  7#a7 
,9 g5]al ,subject to p>agraph 7#b71 =   
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbg1 a ,m$ic>e ,advantage plan may n  
impose any prior au?orization requirem5t
 ) respect to any specifi$ item or      
s]vice4  7#b7 ,exception ,p>agraph 7#a7 
%all n apply ) respect to a specifi$    
item or s]vice = a plan ye> 9 ! case t1 
dur+ su* ye>1 su* item or s]vice is     
subject to prior au?orization pursuant  
to subsection 7t77#b77;,f7 or 7aa7 (    
section #ahcc1 subsection 7a77#ae71     
7l77#af71 7q77#f71 or 7u77#d7 ( section 
#ahcd1 or any o!r provision ( "p ,a or  
"p ,b ( ?is title4  7#c7 ,specifi$ item 
or s]vice def9$ ,= purposes ( ?is       
subsection1 ! t]m specifi$ item or      
s]vice means1 ) respect to a ,m$ic>e    
,advantage plan1 any item or s]vice =   
:i* b5efits are available "u su* plan t 
is n-- 7,a7 a cov]$ "p ,d drug2 or  7,b7

 a supplem5tal heal? c>e b5efit 7z      
describ$ 9 subsection 7a77#c774  4  7b7 
,p]mitt+ int]m$iate sanctions 9 ! case (
 noncompliance ,section #aheg7;g77#a7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciew-#bg7;g77#a77 is am5d$--  7#a7 9  
subp>agraph 7,j71 by /rik+ or at ! end2 
7#b7 9 subp>agraph 7,k71 by /rik+       
subp>agraphs 7,a7 ?r\gh 7,j7 & ins]t+   
subp>agraphs 7,a7 ?r\gh 7,k72  7#c7 by  
r$esignat+ subp>agraph 7,k7 z           
subp>agraph 7,l72 &  7#d7 by ins]t+ aft]
 subp>agraph 7,j7 ! foll[+ new          
subp>agraph3  7,k7 imposes a prior      
au?orization requirem5t ) respect to an 
item or s]vice 9 violation ( section    
#aheb7o72 or  4  7c7 ,con=m+ *ange      
,section #aheb7;c77#a77;,g7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#bb7;c77#a77;,g77 is am5d$--     
7#a7 9 ! subp>agraph head+1 by /rik+    
,prior au?orization & ins]t+ ,review2 & 
7#b7 by ins]t+ = plan ye>s end+ be=e    
,janu>y #a1 #bjbg1 aft] ,rules reg>d+   
prior au?orization4  #c4 ,limit+        

implem5tation ( ,c5t] = ,m$ic>e &       
,m$icaid ,innovation models te/+ prior  
au?orization "u traditional ,m$ic>e  7a7
 ,prohibit+ implem5tation ( ,w,i,se,r   
model ,! ,secret>y ( ,heal? & ,human    
,s]vices may n implem5t ! innovative    
paym5t & s]vice deliv]y model describ$ 9
 ! notice titl$ ,m$ic>e ,program2       
,implem5tation ( ,prior ,au?orization = 
,select ,s]vices = ! ,wa/eful &         
,inappropriate ,s]vices ,r$uction       
7,w,i,se,r7 ,model 7#ij ,f$4 ,reg4      
#bhgdi 7,july #a1 #bjbe771 or any       
sub/antially simil> model4  7b7 ,limit+ 
implem5tation ( future ,,cmi models te/+
 prior au?orization "u traditional      
,m$ic>e ,section #aaae;,a7b77#b7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acae;a7b77#b77 is am5d$--  7#a7 9      
subp>agraph 7,a71 by /rik+ ,! ,secret>y 
%all select & ins]t+ ,subject to !      
limitation "u subp>agraph 7,d71 !       
,secret>y %all select2 &  7#b7 by add+  
at ! end ! foll[+ new subp>agraph3  7,d7
 ,limitation on models to be te/$       

,beg9n+ on ! date ( ! enactm5t ( ?is    
subp>agraph1 ! ,secret>y may n select a 
model to be te/$ "u subp>agraph 7,a7 if 
su* model-- 7i7 w\ld provide = !        
implem5tation ( prior au?orization )    
respect to items or s]vices = :i* paym5t
 may be made "u "p ,a or "p ,b ( title  
,,xviii2 &  7ii7 w\ld provide =-- 7,i7  
issu+ any d5ial ( cov]age or paym5t t-- 
7aa7 is bas$ on a decision made ?r\gh ! 
use ( artificial intellig5ce1 ma*9e     
le>n+1 algori?mic-d]iv$ decision logic1 
or any o!r simil> te*nological process1 
)\t review & approval ( su* d5ial2 &    
7bb7 has n be5 individually review$ &   
approv$ by a physician on ! basis ( !   
physician's indep5d5t m$ical judgm5t1   
tak+ into acc\nt relevant docum5tation  
provid$ by ! individual receiv+ su*     
items or s]vices or ! provid] furni%+   
su* items or s]vices2 or  7,,ii7 !      
process+ ( reque/s = prior au?orization 
by any entity o!r ?an a m$ic>e          
adm9i/rative contractor ) a contract "u 
section #ahgd;,a4  4  7c7 ,requir+      

notice & comm5t = all future ,,cmi      
models ,section #aaae;,a7b77#b77;,a7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acae;a7b77#b77;,a771 z am5d$ by        
subsection 7b71 is fur!r am5d$ by add+  
at ! end ! foll[+ new s5t5ce3 ,beg9n+   
,janu>y #a1 #bjbg1 a model may only be  
select$ "u ?is subp>agraph aft] notice &
 opportunity = public comm5t44