The Secretary shall issue a request for information for purposes of initially identifying applicable items and services under clause (ii)(I). (iv) Exception for extenuating circumstances In the case of a prior authorization request submitted to a Medicare Advantage plan for an individual enrolled in such plan during a plan year with respect to an item or service identified by the Secretary pursuant to clause (ii) for such plan year, such plan may, in lieu of providing a real-time decision with respect to such request in accordance with clause (i), delay such decision under extenuating circumstances (as specified by the Secretary), provided that such decision is provided no later than 72 hours after receipt of such request (or, in the case that the provider of services or supplier submitting such request has indicated that such delay may seriously jeopardize such individual’s life, health, or ability to regain maximum function, no later than 24 hours after receipt of such request). (v) Definition of real-time decision In establishing the definition of a real-time decision for purposes of clause (i), the Secretary shall take into account current medical practice, technology, health care industry standards, and other relevant information relating to how quickly a Medicare Advantage plan may provide responses with respect to prior authorization requests. (vi) Implementation The Secretary shall use notice and comment rulemaking for each of the following: (I) Establishing the definition of a real-time decision for purposes of clause (i). (II) Updating such definition. (III) Initially identifying applicable items or services pursuant to clause (ii)(I). (IV) Updating applicable items and services so identified as described in clause (ii)(II). (3) Transparency requirements (A) In general For purposes of paragraph (1)(B), the transparency requirements specified in this paragraph are, with respect to a Medicare Advantage plan, the following: (i) The plan, annually and in a manner specified by the Secretary, shall submit to