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This bill amends Medicare Advantage regulations to establish requirements for prior authorization processes. Starting January 1, 2027, plans must meet transparency requirements including submitting data on prior authorization approvals, denials, appeal outcomes, and decision timelines to the Centers for Medicare & Medicaid Services. Beginning January 1, 2028, plans must implement electronic prior authorization systems using standardized technical standards and meet enrollee protection standards such as transparent programs developed with provider and enrollee input.
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