I 
117TH CONGRESS 
1ST SESSION H. R. 3173 
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 
MAY 13, 2021 
Ms. DELBENE (for herself, Mr. KELLY of Pennsylvania, Mr. BERA, Mr. 
BUCSHON, Mr. RUSH, Mr. WENSTRUP, Mr. EVANS, Mr. BURGESS, Mr. 
MICHAEL F. DOYLE of Pennsylvania, Mr. SMUCKER, Mr. SUOZZI, Mr. 
DUNN, Ms. SCHRIER, Mr. ARRINGTON, Mr. PASCRELL, Mr. JOYCE of 
Pennsylvania, Ms. DEGETTE, Mr. FERGUSON, Mr. BRENDAN F. BOYLE 
of Pennsylvania, Mr. LONG, Mr. O’HALLERAN, Mr. LAHOOD, Mr. KIL-
DEE, Mr. PENCE, Mr. SCHRADER, Mr. SMITH of Missouri, Ms. SEWELL, 
Mr. ARMSTRONG, Ms. KELLY of Illinois, Mr. RICE of South Carolina, Mr. 
HIGGINS of New York, Mr. HARRIS, Ms. BARRAGA´N, Mrs. MILLER of 
West Virginia, Ms. MOORE of Wisconsin, Mr. MURPHY of North Carolina, 
Mr. WELCH, Mr. SCHWEIKERT, Mr. THOMPSON of California, Mr. KEL-
LER, Mr. BUTTERFIELD, Mrs. WALORSKI, Mr. LARSON of Connecticut, 
Mr. THOMPSON of Pennsylvania, Mr. SARBANES, Mr. KELLY of Mis-
sissippi, Mr. CARTWRIGHT, Mr. MEUSER, Ms. SCANLON, Mr. VAN DREW, 
Ms. WILD, Mr. FITZPATRICK, Mr. CICILLINE, Mr. GROTHMAN, Mr. LIEU, 
Mr. RESCHENTHALER, Mr. CONNOLLY, Ms. SALAZAR, Mr. MOULTON, 
Mr. FLEISCHMANN, Mrs. MCBATH, Mr. ALLEN, Mr. NADLER, Mr. 
BURCHETT, Mr. ALLRED, Mr. RUTHERFORD, Mr. RASKIN, Mr. POSEY, 
Mr. CLEAVER, Mr. JOHNSON of South Dakota, Mrs. AXNE, Mr. AUSTIN 
SCOTT of Georgia, Ms. LOIS FRANKEL of Florida, Mr. LAMBORN, Mr. 
LANGEVIN, Mr. NORMAN, Mr. KIM of New Jersey, Mr. MEIJER, Ms. PIN-
GREE, Mr. LYNCH, Mr. PAPPAS, Ms. ROSS, Mr. SMITH of Washington, 
Ms. STRICKLAND, Ms. TENNEY, Ms. DEAN, Ms. HOULAHAN, Ms. 
MCCOLLUM, Mr. GIBBS, Ms. HERRERA BEUTLER, Mr. LAMB, and Mr. 
BUCHANAN) 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 
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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 2021’’. 
SEC. 2. 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.—Beginning with the second 
plan year beginning after the date of the enactment 
of this subsection, in the case of a Medicare Advan-
tage plan that imposes any prior authorization re-
quirement with respect to any applicable item or 
service (other than a covered part D drug) during a 
plan year, such plan shall— 
‘‘(A) establish the electronic prior author-
ization program described in paragraph (2) and 
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issue real-time decisions with respect to prior 
authorization requests for items and services 
identified by the Secretary under subparagraph 
(C)(ii) of such paragraph; 
‘‘(B) meet the transparency requirements 
specified in paragraph (3); and 
‘‘(C) meet the beneficiary protection stand-
ards specified pursuant to paragraph (4). 
‘‘(2) ELECTRONIC PRIOR AUTHORIZATION PRO-
GRAM.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1)(A), the electronic prior authorization 
program described in this paragraph is a pro-
gram that provides for the secure electronic 
transmission of— 
‘‘(i) a prior authorization request 
from a health care professional to a Medi-
care Advantage plan with respect to an ap-
plicable item or service to be furnished to 
an individual, including such clinical infor-
mation necessary to evidence medical ne-
cessity; and 
‘‘(ii) a response, in accordance with 
this paragraph, from such plan to such 
professional. 
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‘‘(B) ELECTRONIC TRANSMISSION.— 
‘‘(i) EXCLUSIONS.—For purposes of 
this paragraph, a facsimile, a proprietary 
payer portal that does not meet standards 
specified by the Secretary, or an electronic 
form shall not be treated as an electronic 
transmission described in subparagraph 
(A). 
‘‘(ii) STANDARDS.— 
‘‘(I) IN GENERAL.—In order to 
ensure appropriate clinical outcome 
for individuals, for purposes of this 
paragraph, an electronic transmission 
described in subparagraph (A) shall 
comply 
with 
technical 
standards 
adopted by the Secretary in consulta-
tion with standard-setting organiza-
tions determined appropriate by the 
Secretary, health care professionals, 
Medicare 
Advantage 
organizations, 
and health information technology 
software vendors. In adopting such 
standards with respect to which an 
electronic transmission described in 
subparagraph (A) shall comply, the 
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Secretary shall ensure that such 
transmissions 
support 
attachments 
containing applicable clinical informa-
tion and shall prioritize the adoption 
of standards that support integration 
with interoperable health information 
technology certified under a program 
of voluntary certification kept or rec-
ognized by the National Coordinator 
for Health Information Technology 
consistent with section 3001(c)(5) of 
the Public Health Service Act. 
‘‘(II) 
TRANSACTION
STAND-
ARD.—The Secretary shall include in 
the standards adopted under sub-
clause (I) a standard with respect to 
the transmission of attachments de-
scribed in such subclause, and data 
elements and operating rules for such 
transmission, consistent with health 
care industry standards. 
‘‘(C) REAL-TIME DECISIONS.— 
‘‘(i) IN GENERAL.—The program de-
scribed in subparagraph (A) shall provide 
for real-time decisions (as defined by the 
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