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‘‘(B) OPTION FOR PLAN TO PROVIDE CER-
TAIN ADDITIONAL INFORMATION.—As part of 
the information described in subparagraph 
(A)(i) provided to the Secretary during a plan 
year, a Medicare Advantage plan may elect to 
include information regarding the percentage 
and number of specified requests made with re-
spect to an individual and an item or service 
that were denied by the plan during the pre-
ceding plan year in an initial determination 
based on such requests failing to demonstrate 
that such individuals met the clinical criteria 
established by such plan to receive such items 
or services. 
‘‘(C) REGULATIONS.—The Secretary shall, 
through notice and comment rulemaking, estab-
lish requirements for Medicare Advantage plans 
regarding the provision of— 
‘‘(i) access to criteria described in 
subparagraph (A)(ii)(II) to providers of 
services and suppliers in accordance with 
such subparagraph; and 
‘‘(ii) access to such criteria to enroll-
ees in accordance with subparagraph 
(A)(ii)(III). 
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‘‘(D) PUBLICATION
OF
INFORMATION.— 
The Secretary shall publish information de-
scribed in subparagraph (A)(i) and subpara-
graph (B) on a public website of the Centers 
for Medicare & Medicaid Services. Such infor-
mation shall be so published on an individual 
plan level and may in addition be aggregated in 
such manner as determined appropriate by the 
Secretary. 
‘‘(E) MEDPAC REPORT.—Not later than 3 
years after the date information is first sub-
mitted under subparagraph (A)(i), the Medicare 
Payment Advisory Commission shall submit to 
Congress a report on such information that in-
cludes a descriptive analysis of the use of prior 
authorization. As appropriate, the Commission 
should report on statistics including the fre-
quency of appeals and overturned decisions. 
The Commission shall provide recommenda-
tions, as appropriate, on any improvement that 
should be made to the electronic prior author-
ization programs of Medicare Advantage plans. 
‘‘(F) SPECIFIED REQUEST DEFINED.—For 
purposes of this paragraph, the term ‘specified 
request’ means a prior authorization request 
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made with respect to an applicable item or serv-
ice. 
‘‘(4) ENROLLEE
PROTECTION
STANDARDS.— 
For purposes of paragraph (1)(A)(ii), the Secretary 
shall, through notice and comment rulemaking, 
specify the following enrollee protection standards 
with respect to the use of prior authorization by 
Medicare Advantage plans for applicable items and 
services: 
‘‘(A) Adoption of transparent prior author-
ization programs developed in consultation with 
enrollees and with providers and suppliers with 
contracts in effect with such plans for fur-
nishing such items and services under such 
plans; 
‘‘(B) Allowing for the waiver or modifica-
tion of prior authorization requirements based 
on the performance of such providers and sup-
pliers in demonstrating compliance with such 
requirements, such as adherence to evidence- 
based medical guidelines and other quality cri-
teria; and 
‘‘(C) Conducting annual reviews of such 
items and services for which prior authorization 
requirements are imposed under such plans 
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through a process that takes into account input 
from enrollees and from providers and suppliers 
with such contracts in effect and is based on 
consideration of prior authorization data from 
previous plan years and analyses of current cov-
erage criteria. 
‘‘(5) APPLICABLE ITEM OR SERVICE.—For pur-
poses of this subsection, the term ‘applicable item or 
service’ means, with respect to a Medicare Advan-
tage plan, any item or service for which benefits are 
available under such plan, other than a covered part 
D drug. 
‘‘(6) REPORTS TO CONGRESS.— 
‘‘(A) GAO.—Not later than the end of the 
fourth plan year beginning on or after the date 
of the enactment of this subsection, the Comp-
troller General of the United States shall sub-
mit to Congress a report containing an evalua-
tion of the implementation of the requirements 
of this subsection and an analysis of issues in 
implementing such requirements faced by Medi-
care Advantage plans. 
‘‘(B) HHS.—Not later than the end of the 
fifth plan year beginning after the date of the 
enactment of this subsection, and biennially 
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thereafter through the date that is 10 years 
after such date of enactment, the Secretary 
shall submit to Congress a report containing a 
description of the information submitted under 
paragraph (3)(A)(i) during— 
‘‘(i) in the case of the first such re-
port, the fourth plan year beginning after 
the date of the enactment of this sub-
section; and 
‘‘(ii) in the case of a subsequent re-
port, the 2 plan years preceding the year 
of the submission of such report.’’. 
(b) ENSURING TIMELY RESPONSES FOR ALL PRIOR 
AUTHORIZATION REQUESTS SUBMITTED UNDER PART 
C.—Section 1852(g) of the Social Security Act (42 U.S.C. 
1395w–22(g)) is amended— 
(1) in paragraph (1)(A), by inserting ‘‘and in 
accordance with paragraph (6)’’ after ‘‘paragraph 
(3)’’; 
(2) in paragraph (3)(B)(iii), by inserting ‘‘(or, 
subject to subsection (o), with respect to prior au-
thorization requests submitted on or after the first 
day of the third plan year beginning after the date 
of the enactment of the Improving Seniors’ Timely 
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