,,ii  #aaith ,,congress  #b;d ,session  
,s4 #cgfb  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,february #c1  
#bjbf,mr4 ,whitehouse introduced the    
following bill2 which was read twice and
 referred to the ,committee on ,finance 
,a ,,bill  ,to amend part ,c of title   
,,xviii of the ,social ,security ,act to
 provide for prior authorization reforms
 under the ,medicare ,advantage program4
  #a4 ,short title ,this ,act may be    
cited as the ,prior ,authorization      
,relief ,act4  #b4 ,medicare ,advantage 
program prior authorization reforms  7a7
 ,medicare ,advantage ,section #ahei of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#bh7 is amended by     
adding at the end the following new     
subsection3  7j7 ,prior authorization   
requirements  7#a7 ,audit ,not later    
than ,january #a1 #bjbg1 the ,secretary 
shall conduct an audit of prior         
authorization requirements for items and
 services furnished1 and covered part ,d
 drugs prescribed1 to enrollees under   

this part in order to identify the items
 and services and covered part ,d drugs 
that the ,secretary determines meet each
 of the following criteria3 7,a7        
,reimbursement for such item or service 
or covered part ,d drug under this part 
is in the top #aj percent of            
reimbursements for all items and        
services and covered part ,d drugs under
 this part4  7,b7 ,there is sufficient  
clinical evidence to establish a        
standard medical policy for the prior   
authorization process for such item or  
service or covered part ,d drug4  7,c7  
,prior authorization for such item or   
service or covered part ,d drug requires
 an excessive number of steps to        
complete the required protocols4  7#b7  
,standardized requirements ,not later   
than ,may #a1 #bjbh1 taking into account
 the results of the audit conducted     
under paragraph 7#a71 the ,secretary    
shall promulgate a final rule to        
standardize the prior authorization     
requirements 7including supplemental    

forms7 for items and services and       
covered part ,d drugs identified under  
paragraph 7#a7 across all ,medicare     
,advantage plans1 including ,,ma-,,pd   
plans4  7#c7 ,exemption from            
requirements  7,a7 ,in general ,subject 
to subparagraph 7,b71 the prior         
authorization requirements under        
paragraph 7#b7 for the items and        
services and covered part ,d drugs      
identified under paragraph 7#a7 shall   
not apply when such items and services  
are furnished by1 or such covered part  
,d drugs are prescribed by1 a provider  
of services or supplier that is         
participating in a two-sided risk model 
tested or implemented under section     
#aaae;,a or this title1 including an    
accountable care organization under     
section #ahii1 where the model is at    
risk for both potential losses and      
gains4  7,b7 ,limitation ,the ,secretary
 shall establish a process under which  
an ,,ma organization offering a         
,medicare ,advantage plan 7including an 

,,ma-,,pd plan7 may request that the    
exemption under subparagraph 7,a7 not   
apply with respect to items and services
 and covered part ,d drugs furnished to 
enrollees under the plan and that the   
prior authorization requirements that   
would otherwise apply under the plan for
 such items and services and covered    
part ,d drugs continue to apply4  4