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 juris-
diction 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. 
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 ‘‘The Better Prior Au-
thorization Notification Act’’. 
VerDate Sep 11 2014 
23:05 Dec 13, 2018
Jkt 089200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H7249.IH
H7249
kjohnson on DSK79L0C42 with BILLS
SEC. 2. PRIOR AUTHORIZATION NOTIFICATIONS REQUIRED 
TO BE MADE BY MEDICARE ADVANTAGE OR-
GANIZATIONS. 
(a) NOTIFICATION
TO
PROVIDERS
AND
PRE-
SCRIBERS.—Section 1852(j) of the Social Security Act (42 
U.S.C. 1395w–22(j)) is amended by adding at the end the 
following: 
‘‘(8) PRIOR AUTHORIZATION NOTIFICATION.— 
For each plan year, beginning with plan year 2021, 
a Medicare Advantage organization offering an MA 
plan shall provide to physicians and other providers 
who are prescribers who have in effect for such plan 
year an agreement of participation with the organi-
zation— 
‘‘(A) at the beginning of such plan year, 
information (such as through a public website, 
mail, electronic communications, or payor’s web 
portal (as defined by the Secretary)) on items 
and services (which in the case of an MA–PD 
plan shall include covered part D drugs) cov-
ered under the plan that are subject to a prior 
authorization; and 
‘‘(B) before implementing any additional 
prior authorization requirement under the plan 
during such plan year applicable to such items 
VerDate Sep 11 2014 
23:05 Dec 13, 2018
Jkt 089200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H7249.IH
H7249
kjohnson on DSK79L0C42 with BILLS
or services, notification of such additional re-
quirement.’’. 
(b) NOTIFICATION
TO
BENEFICIARIES.—Section 
1852(c) of the Social Security Act (42 U.S.C. 1395w– 
22(c)) is amended by adding at the end the following new 
paragraph: 
‘‘(3) PRIOR AUTHORIZATION INFORMATION.— 
‘‘(A) IN GENERAL.—For each plan year, 
beginning with plan year 2021, a Medicare Ad-
vantage organization offering an MA plan shall 
provide (such as through a public website, mail, 
or electronic communication) to each enrollee in 
such plan, before implementing under the plan 
any new prior authorization requirement appli-
cable to an item or service (which in the case 
of an MA–PD plan shall include covered part D 
drugs) offered under the plan that was utilized 
by the enrollee during the previous 12-month 
period (or such other period specified by the 
Secretary), notification of such additional re-
quirement and information regarding an alter-
native to such item or service, if appropriate, 
that is not subject to a prior authorization re-
quirement under the plan and that may have a 
VerDate Sep 11 2014 
23:05 Dec 13, 2018
Jkt 089200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H7249.IH
H7249
kjohnson on DSK79L0C42 with BILLS
lower out-of-pocket cost than the item or service 
subject to the prior authorization requirement. 
‘‘(B) HOTLINE.—Beginning with plan year 
2021, a Medicare Advantage organization offer-
ing an MA plan shall maintain a hotline for en-
rollees in such plan to inquire about and receive 
information regarding prior authorization re-
quirements under such plan.’’. 
Æ 
VerDate Sep 11 2014 
23:05 Dec 13, 2018
Jkt 089200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6301
E:\BILLS\H7249.IH
H7249
kjohnson on DSK79L0C42 with BILLS