I 
116TH CONGRESS 
1ST SESSION H. R. 3107 
To amend title XVIII of the Social Security Act to establish requirements 
with respect to the use of prior authorization under Medicare Advantage 
plans, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 5, 2019 
Ms. DELBENE (for herself, Mr. KELLY of Pennsylvania, Mr. MARSHALL, and 
Mr. BERA) introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to establish 
requirements with respect to the use of prior authoriza-
tion under Medicare Advantage plans, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Improving Seniors’ 
Timely Access to Care Act of 2019’’. 
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SEC. 2. SENSE OF CONGRESS. 
It is the sense of Congress that— 
(1) use of prior authorization should be stream-
lined through electronic transmissions for coverage 
of covered services for individuals enrolled in feder-
ally funded programs such as Medicare, Medicaid, 
and federally contracted managed care plans to im-
prove patient access to medically appropriate serv-
ices and reduce administrative burden through auto-
mation informed by clinical decision support; 
(2) there should be increased transparency for 
beneficiaries and providers and increased oversight 
by the Centers for Medicare & Medicaid Services on 
the processes used for prior authorization; and 
(3) prior authorization is a tool that can be 
used to responsibly prevent unnecessary care and 
promote safe and evidence-based care. 
SEC. 3. ESTABLISHING REQUIREMENTS WITH RESPECT TO 
THE USE OF PRIOR AUTHORIZATION UNDER 
MEDICARE ADVANTAGE PLANS. 
(a) IN GENERAL.—Section 1852 of the Social Secu-
rity Act (42 U.S.C. 1395w–22) is amended by adding at 
the end the following new subsection: 
‘‘(o) PRIOR AUTHORIZATION REQUIREMENTS.— 
‘‘(1) IN GENERAL.—In the case of a Medicare 
Advantage plan that imposes any prior authorization 
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requirement with respect to any benefit, such plan 
shall, beginning with the first plan year beginning 
on or after the date of the enactment of this sub-
section— 
‘‘(A) comply with the prohibition described 
in paragraph (2); 
‘‘(B) establish the electronic prior author-
ization program described in paragraph (3); 
‘‘(C) meet the transparency requirements 
specified in paragraph (4); and 
‘‘(D) meet the beneficiary protection stand-
ards specified pursuant to paragraph (5). 
‘‘(2) PROHIBITION ON PRIOR AUTHORIZATION 
WITH RESPECT TO CERTAIN ITEMS AND SERVICES.— 
A Medicare Advantage plan may not impose any ad-
ditional prior authorization requirement with respect 
to any surgical procedure or otherwise invasive pro-
cedure (as defined by the Secretary), and any item 
furnished as part of such surgical or invasive proce-
dure, if such procedure (or item) is furnished during 
the peroperative period of a procedure for which— 
‘‘(A) prior authorization was received from 
such plan before such surgical or otherwise 
invasive procedure (or item furnished as part of 
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such surgical or otherwise invasive procedure) 
was furnished; or 
‘‘(B) prior authorization was not required 
by such plan. 
‘‘(3) ELECTRONIC PRIOR AUTHORIZATION PRO-
GRAM.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1)(B), the electronic prior authorization 
program described in this paragraph is a prior 
authorization process implemented by a Medi-
care Advantage plan that provides for the se-
cure electronic transmission of— 
‘‘(i) a prior authorization request 
from a health care professional to such 
plan with respect to an item or service to 
be furnished to an individual, including 
such clinical information as the profes-
sional determines appropriate to support 
the furnishing of such item or service to 
such individual; and 
‘‘(ii) a response, in accordance with 
this paragraph, from such plan to such 
professional. 
‘‘(B) ELECTRONIC TRANSMISSION.— 
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