Title: Better Prior Authorization Notification Act
Policy area: Health

Summary:
The Better Prior Authorization Notification Act
This bill requires Medicare Advantage (MA) organizations to notify providers and enrollees about items and services that are subject to prior authorization requirements. MA organizations must also establish a hotline through which enrollees may inquire about such requirements.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7249 Introduced in House (IH)]

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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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``The Better Prior Authorization 
Notification Act''.

SEC. 2. PRIOR AUTHORIZATION NOTIFICATIONS REQUIRED TO BE MADE BY 
              MEDICARE ADVANTAGE ORGANIZATIONS.

    (a) Notification to Providers and Prescribers.--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 
        organization--
                    ``(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) covered 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 or services, 
                notification of such additional requirement.''.
    (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 Advantage 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 
                applicable 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 requirement and information 
                regarding an alternative to such item or service, if 
                appropriate, that is not subject to a prior 
                authorization requirement under the plan and that may 
                have a 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 offering an MA plan 
                shall maintain a hotline for enrollees in such plan to 
                inquire about and receive information regarding prior 
                authorization requirements under such plan.''.
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