I 

115TH CONGRESS 

2D SESSION H. R. 7250 

To direct the Secretary of Health and Human Services to conduct a study 

and submit to Congress a report on the feasibility of using certain 

technologies to facilitate the administration of prior authorization requirements under part C of the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 11, 2018 

Mr. KELLY of Pennsylvania (for himself and Mr. GUTHRIE) introduced the 

following bill; which was referred to the Committee on Ways and Means, 

and in addition to the Committee on Energy and Commerce, for a period 

to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee 

concerned 

A BILL 

To direct the Secretary of Health and Human Services to 

conduct a study and submit to Congress a report on 

the feasibility of using certain technologies to facilitate 

the administration of prior authorization requirements 

under part C of the Medicare program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Prior Authorization 

5 Process Improvement Act’’. 


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1 SEC. 2. STUDY ON APPLYING CERTAIN TECHNOLOGIES TO 

2 THE ADMINISTRATION OF PART C PRIOR AU3 THORIZATION REQUIREMENTS UNDER THE 

4 MEDICARE PROGRAM. 

5 (a) IN GENERAL.—Not later than 12 months after 

6 the date of the enactment of this Act, the Secretary of 

7 Health and Human Services (in this section referred to 

8 as the ‘‘Secretary’’) shall conduct a study and submit to 

9 Congress a report on the feasibility of Medicare Advantage 

10 organizations and providers and suppliers of services (as 

11 defined in section 1861 of the Social Security Act (42 

12 U.S.C. 1395x)) using certain technologies to facilitate the 

13 administration of prior authorization requirements under 

14 Medicare Advantage plans offered by such organizations 

15 under part C of title XVIII of the Social Security Act (42 

16 U.S.C. 1395w–21 et seq.). 

17 (b) ADVISORY PANEL.— 

18 (1) IN GENERAL.—In conducting the study de19 scribed in subsection (a), the Secretary shall consult 

20 with an advisory panel convened by the Secretary. 

21 (2) SELECTION.—The Secretary shall select 

22 members of the panel convened under paragraph 

23 (1). Such members shall include representatives of— 

24 (A) Medicare Advantage organizations; 

25 (B) providers and suppliers of services; 

26 (C) technology vendors; 


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1 (D) entities advocating on behalf of indi2 viduals entitled to benefits under part A of title 

3 XVIII of the Social Security Act (42 U.S.C. 

4 1395c et seq.) or enrolled under part B of such 

5 title of such Act (42 U.S.C. 1395j et seq.); and 

6 (E) standard setting organizations (as de7 fined in section 1171(8) of such Act (42 U.S.C. 

8 1320d–1(8))). 

9 (c) REPORT CONTENTS.—The report described in 

10 subsection (a) shall include the following: 

11 (1) A description of existing technologies that 

12 may be used to facilitate the administration of prior 

13 authorization requirements under part C of title 

14 XVIII of the Social Security Act. 

15 (2) An evaluation of the utilization of such 

16 technologies by providers and suppliers of services 

17 and Medicare Advantage organizations with respect 

18 to individuals described in subsection (b)(2)(D) or 

19 not described in such subsection. 

20 (3) A cost-benefit analysis with respect to the 

21 use of such technologies by such providers and sup22 pliers of services and such Medicare Advantage orga23 nizations. 

24 (4) An evaluation of the feasibility of Medicare 

25 Advantage organizations and providers and suppliers 


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1 of services potentially using such technologies under 

2 part C of the Medicare program. 

3 (5) Recommendations on how to improve the 

4 administration of such requirements through the use 

5 of technology. 

Æ 


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