,,ii  #aai? ,,congress  #b;d ,session   
,s4 #cgfb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,febru>y #c1 #bjbf,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 #bjbg1 ! ,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 ,may #a1 #bjbh1 
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 ! prior   
au?orization requirem5ts "u p>agraph    

7#b7 = ! 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 a provid] ( s]vices or    
suppli] t is p>ticipat+ 9 a two-sid$    
risk model te/$ or implem5t$ "u section 
#aaae;,a or ?is title1 includ+ an       
acc\ntable c>e organization "u section  
#ahii1 :]e ! model is at risk = bo?     
pot5tial losses & ga9s4  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