“A bill to amend part C of title XVIII of the Social Security Act to provide for prior authorization reforms under the Medicare Advantage program.”
No CRS summary available for this bill.
This section directs the Secretary of Health and Human Services to (1) conduct, not later than January 1, 2027, an audit of prior authorization requirements under Medicare Advantage (MA) plans for items and services furnished and covered Part D drugs prescribed to identify those meeting all of the following criteria: in the top 10% of MA reimbursements; supported by sufficient clinical evidence for a standard medical policy; and requiring an excessive number of steps; (2) promulgate, not later than May 1, 2028 and based on the audit, a final rule standardizing such prior authorization requirements (including supplemental forms) across all MA plans, including MA-PD plans; and (3) exempt such standardized requirements when items/services are furnished or Part D drugs prescribed by providers/suppliers in two-sided risk models (e.g., accountable care organizations under Medicare), unless the MA organization requests continued application of its own prior authorization processes.