; and (ii) a response, in accordance with this paragraph, from such plan to such professional. (B) Electronic transmission (i) Exclusions For purposes of this paragraph, a facsimile, a proprietary payer portal that does not meet standards specified by the Secretary, or an electronic form shall not be treated as an electronic transmission described in subparagraph (A). (ii) Standards (I) In general In order to ensure appropriate clinical outcome for individuals, for purposes of this paragraph, an electronic transmission described in subparagraph (A) shall comply with technical standards adopted by the Secretary in consultation with standard-setting organizations determined appropriate by the Secretary, health care professionals, MA organizations, and health information technology software vendors. In adopting such standards, the Secretary shall ensure that such transmissions support attachments containing applicable clinical information and shall prioritize the adoption of standards that encourage integration of the electronic prior authorization program into established electronic health record systems. (II) Transaction standard The Secretary shall include in the standards adopted under subclause (I) a standard with respect to the transmission of attachments described in such subclause, and data elements and operating rules for such transmission, consistent with health care industry standards. (C) Real-time decisions (i) In general The program described in subparagraph (A) shall provide for real-time decisions (as defined by the Secretary) with respect to requests identified by the Secretary pursuant to clause (ii) for a plan year if such requests contain all information required by an MA plan to evaluate the criteria described in paragraph (4)(A)(iii)(II). (ii) Identification of requests For purposes of clause (i) and with respect to a plan year, the Secretary shall identify, not later than the date on which the initial announcement described in section 1853(b)(1)(B)(i) for such plan year is required to be