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H.R. 7247 (115th): Incentivizing Shared Risk in Medicare Advantage Act

The text of the bill below is as of Dec 11, 2018 (Introduced).


I

115th CONGRESS

2d Session

H. R. 7247

IN THE HOUSE OF REPRESENTATIVES

December 11, 2018

(for himself and Mr. Shimkus) 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 clarify the authority of MA organizations to provide waivers from Medicare Advantage plans’ prior authorization requirements.

1.

Short title

This Act may be cited as the Incentivizing Shared Risk in Medicare Advantage Act.

2.

Authority of MA organizations to provide waivers from Medicare Advantage plans’ prior authorization requirements

Section 1857(e) of the Social Security Act (42 U.S.C. 1395w–27(e)) is amended by adding at the end the following new paragraph:

(5)

Authority to provide waivers from plan prior authorization requirements

In the case of an MA organization with a contract under this section that applies a prior authorization requirement with respect to any item or service covered under the Medicare Advantage plan offered by such organization, such organization may provide for a waiver from such requirement for any provider of services or supplier, as specified by the organization, furnishing such an item or service, including a provider of services or supplier that participates in a risk-sharing arrangement or value-based payment arrangement, as such terms are defined by the organization.

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