H.R. 9396

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9396 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 9396

To amend title XXVII of the Public Health Service Act, the Employee 
Retirement Income Security Act of 1974, and the Internal Revenue Code 
of 1986 to require the displaying of claim denial rates.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

June 23, 2026

Mr. Goldman of Texas introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the 
Committees on Ways and Means, and Education and Workforce, 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 XXVII of the Public Health Service Act, the Employee 
Retirement Income Security Act of 1974, and the Internal Revenue Code 
of 1986 to require the displaying of claim denial rates.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Prior Authorization Accountability 
Act''.

SEC. 2. DISPLAYING CLAIM DENIAL RATES.

(a) PHSA.--Part D of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg-111 et seq.) is amended by adding at the end the 
following new section:

``SEC. 2799A-12. PRIOR AUTHORIZATION TRANSPARENCY REQUIREMENTS.

``(a) In General.--In the case of a group health plan or health 
insurance issuer offering group or individual health insurance coverage 
that imposes any prior authorization requirement with respect to an 
item or service furnished under such plan or coverage during a plan 
year beginning on or after January 1, 2027, such plan or issuer shall, 
at a time and in a manner specified by the Secretary, submit to the 
Secretary (and, in the case of group or individual health insurance 
coverage, if such coverage was offered through an Exchange established 
under subtitle D of title I of the Patient Protection and Affordable 
Care Act, to such Exchange) and make available on a public website of 
the plan or issuer the following information:
``(1) A list of all items and services that were subject to 
a prior authorization requirement under the plan or coverage 
during such plan year.
``(2) The percentage and number of prior authorization 
requests approved during such plan year by the plan or issuer 
in an initial determination and the percentage and number of 
prior authorization requests denied during such plan year by 
such plan or issuer in an initial determination (both in the 
aggregate and categorized by each item and service).
``(3) The percentage and number of prior authorization 
requests that were denied during such plan year by the plan or 
issuer in an initial determination and that were subsequently 
appealed.
``(4) The percentage and number of resolved appeals of such 
requests that resulted in approval of the furnishing of the 
item or service that was the subject of such request, 
categorized by each item and service and categorized by each 
level of appeal (including judicial review).
``(5) The average and the median amount of time (in hours) 
that elapsed during such plan year between the submission of a 
prior authorization request to the plan or issuer and a 
determination by the plan or issuer with respect to such 
request for each such item and service, excluding any such 
requests that were not submitted with the medical or other 
documentation required to be submitted by the plan or issuer.
``(6) The percentage and number of prior authorization 
requests that were denied, and the percentage and number of 
prior authorization requests that were approved, by the plan or 
issuer during such plan year solely through the utilization of 
decision support technology, artificial intelligence 
technology, machine-learning technology, clinical decision-
making technology, or any other technology specified by the 
Secretary.
``(7) A disclosure and description of any technology 
described in paragraph (6) that the plan or issuer utilized 
during such plan year in making determinations with respect to 
prior authorization requests.
``(b) Manner of Publication.--Information submitted and published 
by a group health plan or health insurance issuer offering group or 
individual health insurance coverage under subsection (a) shall be so 
submitted and published on a group health plan and health insurance 
coverage level and shall in addition, if determined appropriate by the 
Secretary, be so submitted and published in the aggregate in such 
manner as specified by the Secretary (such as across all group health 
plans of the sponsor of such plan or all health insurance coverage 
offered by such issuer that are offered within the same insurance 
market (as specified in subclause (I), (II), (III), or (IV) of section 
2799A-1(a)(3)(E)(iv))).''.
(b) ERISA.--
(1) In general.--Subpart B of part 7 of subtitle B of title 
I of the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1185 et seq.) is amended by adding at the end the 
following new section:

``SEC. 727. PRIOR AUTHORIZATION TRANSPARENCY REQUIREMENTS.

``(a) In General.--In the case of a group health plan or health 
insurance issuer offering group health insurance coverage that imposes 
any prior authorization requirement with respect to an item or service 
furnished under such plan or coverage during a plan year beginning on 
or after January 1, 2027, such plan or issuer shall, at a time and in a 
manner specified by the Secretary, submit to the Secretary and make 
available on a public website of the plan or issuer the following 
information:
``(1) A list of all items and services that were subject to 
a prior authorization requirement under the plan or coverage 
during such plan year.
``(2) The percentage and number of prior authorization 
requests approved during such plan year by the plan or issuer 
in an initial determination and the percentage and number of 
prior authorization requests denied during such plan year by 
such plan or issuer in an initial determination (both in the 
aggregate and categorized by each item and service).
``(3) The percentage and number of prior authorization 
requests that were denied during such plan year by the plan or 
issuer in an initial determination and that were subsequently 
appealed.
``(4) The percentage and number of resolved appeals of such 
requests that resulted in approval of the furnishing of the 
item or service that was the subject of such request, 
categorized by each item and service and categorized by each 
level of appeal (including judicial review).
``(5) The average and the median amount of time (in hours) 
that elapsed during such plan year between the submission of a 
prior authorization request to the plan or issuer and a 
determination by the plan or issuer with respect to such 
request for each such item and service, excluding any such 
requests that were not submitted with the medical or other 
documentation required to be submitted by the plan or issuer.
``(6) The percentage and number of prior authorization 
requests that were denied, and the percentage and number of 
prior authorization requests that were approved, by the plan or 
issuer during such plan year solely through the utilization of 
decision support technology, artificial intelligence 
technology, machine-learning technology, clinical decision-
making technology, or any other technology specified by the 
Secretary.
``(7) A disclosure and description of any technology 
described in paragraph (6) that the plan or issuer utilized 
during such plan year in making determinations with respect to 
prior authorization requests.
``(b) Manner of Publication.--Information submitted and published 
by a group health plan or health insurance issuer offering group health 
insurance coverage under subsection (a) shall be so submitted and 
published on a group health plan and health insurance coverage level 
and shall in addition, if determined appropriate by the Secretary, be 
so submitted and published in the aggregate in such manner as specified 
by the Secretary (such as across all group health plans of the sponsor 
of such plan or all health insurance coverage offered by such issuer 
that are offered within the same insurance market (as specified in 
subclause (I), (II), (III), or (IV) of section 716(a)(3)(E)(iv))).''.
(2) Clerical amendment.--The table of contents in section 1 
of the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1001 note) is amended by inserting after the item 
relating to section 726 the following new item:

``Sec. 727. Prior authorization transparency requirements.''.
(c) IRC.--
(1) In general.--Subchapter B of chapter 100 of the 
Internal Revenue Code of 1986 is amended by adding at the end 
the following new section:

``SEC. 9827. PRIOR AUTHORIZATION TRANSPARENCY REQUIREMENTS.

``(a) In General.--In the case of a group health plan that imposes 
any prior authorization requirement with respect to an item or service 
furnished under such plan during a plan year beginning on or after 
January 1, 2027, such plan shall, at a time and in a manner specified 
by the Secretary, submit to the Secretary and make available on a 
public website of the plan the following information:
``(1) A list of all items and services that were subject to 
a prior authorization requirement under the plan during such 
plan year.
``(2) The percentage and number of prior authorization 
requests approved during such plan year by the plan in an 
initial determination and the percentage and number of prior 
authorization requests denied during such plan year by such 
plan in an initial determination (both in the aggregate and 
categorized by each item and service).
``(3) The percentage and number of prior authorization 
requests that were denied during such plan year by the plan in 
an initial determination and that were subsequently appealed.
``(4) The percentage and number of resolved appeals of such 
requests that resulted in approval of the furnishing of the 
item or service that was the subject of such request, 
categorized by each item and service and categorized by each 
level of appeal (including judicial review).
``(5) The average and the median amount of time (in hours) 
that elapsed during such plan year between the submission of a 
prior authorization request to the plan and a determination by 
the plan with respect to such request for each such item and 
service, excluding any such requests that were not submitted 
with the medical or other documentation required to be 
submitted by the plan.
``(6) The percentage and number of prior authorization 
requests that were denied, and the percentage and number of 
prior authorization requests that were approved, by the plan 
during such plan year solely through the utilization of 
decision support technology, artificial intelligence 
technology, machine-learning technology, clinical decision-
making technology, or any other technology specified by the 
Secretary.
``(7) A disclosure and description of any technology 
described in paragraph (6) that the plan utilized during such 
plan year in making determinations with respect to prior 
authorization requests.
``(b) Manner of Publication.--Information submitted and published 
by a group health plan under subsection (a) shall be so published on a 
group health plan level and shall in addition, if determined 
appropriate by the Secretary, be so submitted and published in the 
aggregate in such manner as specified by the Secretary (such as across 
all group health plans of the sponsor of such plan that are offered 
within the same insurance market (as specified in subclause (I), (II), 
(III), or (IV) of section 9816(a)(3)(E)(iv))).''.
(2) Clerical amendment.--The table of sections for 
subchapter B of chapter 100 of the Internal Revenue Code of 
1986 is amended by adding at the end the following new item:

``Sec. 9827. Prior authorization transparency requirements.''.

SEC. 3. PROMOTING COMPARABILITY OF QUALIFIED HEALTH PLANS OFFERED 
THROUGH AN EXCHANGE.

Section 1311(d)(4)(C) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18031(d)(4)(C)) is amended--
(1) by striking ``website through which'' and inserting the 
following: ``website--
``(i) through which'';
(2) in clause (i), as so inserted, by striking the 
semicolon and inserting ``; and''; and
(3) by adding at the end the following new clause:
``(ii) that includes, as part of such 
comparative information for enrollments for 
plan years beginning on or after January 1, 
2029, in the case a qualified health plan 
offered through such Exchange for such plan 
year was offered through such Exchange for a 
previous plan year, the most recent information 
submitted to such Exchange with respect to such 
plan by the health insurance issuer of such 
plan under section 2799A-12 of the Public 
Health Service Act;''.
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