I 

115TH CONGRESS 

2D SESSION H. R. 7249 

To amend title XVIII of the Social Security Act to provide for certain 

prior authorization notifications by Medicare Advantage organizations. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 11, 2018 

Mr. REED 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 amend title XVIII of the Social Security Act to provide 

for certain prior authorization notifications by Medicare 

Advantage organizations. 

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 ‘‘The Better Prior Au5 thorization Notification Act’’. 


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1 SEC. 2. PRIOR AUTHORIZATION NOTIFICATIONS REQUIRED 

2 TO BE MADE BY MEDICARE ADVANTAGE OR3 GANIZATIONS. 

4 (a) NOTIFICATION TO PROVIDERS AND PRE5 SCRIBERS.—Section 1852(j) of the Social Security Act (42 

6 U.S.C. 1395w–22(j)) is amended by adding at the end the 

7 following: 

8 ‘‘(8) PRIOR AUTHORIZATION NOTIFICATION.— 

9 For each plan year, beginning with plan year 2021, 

10 a Medicare Advantage organization offering an MA 

11 plan shall provide to physicians and other providers 

12 who are prescribers who have in effect for such plan 

13 year an agreement of participation with the organi14 zation— 

15 ‘‘(A) at the beginning of such plan year, 

16 information (such as through a public website, 

17 mail, electronic communications, or payor’s web 

18 portal (as defined by the Secretary)) on items 

19 and services (which in the case of an MA–PD 

20 plan shall include covered part D drugs) cov21 ered under the plan that are subject to a prior 

22 authorization; and 

23 ‘‘(B) before implementing any additional 

24 prior authorization requirement under the plan 

25 during such plan year applicable to such items 


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1 or services, notification of such additional re2 quirement.’’. 

3 (b) NOTIFICATION TO BENEFICIARIES.—Section 

4 1852(c) of the Social Security Act (42 U.S.C. 1395w– 

5 22(c)) is amended by adding at the end the following new 

6 paragraph: 

7 ‘‘(3) PRIOR AUTHORIZATION INFORMATION.— 

8 ‘‘(A) IN GENERAL.—For each plan year, 

9 beginning with plan year 2021, a Medicare Ad10 vantage organization offering an MA plan shall 

11 provide (such as through a public website, mail, 

12 or electronic communication) to each enrollee in 

13 such plan, before implementing under the plan 

14 any new prior authorization requirement appli15 cable to an item or service (which in the case 

16 of an MA–PD plan shall include covered part D 

17 drugs) offered under the plan that was utilized 

18 by the enrollee during the previous 12-month 

19 period (or such other period specified by the 

20 Secretary), notification of such additional re21 quirement and information regarding an alter22 native to such item or service, if appropriate, 

23 that is not subject to a prior authorization re24 quirement under the plan and that may have a 


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1 lower out-of-pocket cost than the item or service 

2 subject to the prior authorization requirement. 

3 ‘‘(B) HOTLINE.—Beginning with plan year 

4 2021, a Medicare Advantage organization offer5 ing an MA plan shall maintain a hotline for en6 rollees in such plan to inquire about and receive 

7 information regarding prior authorization re8 quirements under such plan.’’. 

Æ 


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