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 t…
This bill requires group health plans and health insurance issuers to collect, submit to the federal government, and publish on public websites detailed prior authorization metrics. Required metrics include lists of items/services subject to prior authorization, approval and denial rates, appeal and overturn rates (by level), average and median decision times, and disclosure of any decision-support or AI technologies used.
Liberal emphasizes patient access and insurer accountability
Relative to its intended legislative type, this bill defines a substantial and specific set of prior-authorization transparency data elements and mandates submission and public posting across multiple statutory regimes, but it omits several common implementation ingredients: explicit administrative designation/coordination, data standards, timelines and submission frequency, enforcement and validation mechanisms, and fiscal provisions.
This bill requires group health plans and health insurance issuers to collect, submit to the federal government, and publish on public websites detailed prior authorization metrics.
Required metrics include lists of items/services subject to prior authorization, approval and denial rates, appeal and overturn rates (by level), average and median decision times, and disclosure of any decision-support or AI technologies used.
The requirements are added to the Public Health Service Act, ERISA, and the Internal Revenue Code, effective for plan years beginning January 1, 2027, and require Exchanges to include issuer-submitted prior authorization data in plan comparison tools starting for 2029 plan-year enrollments.
Content is administratively focused and broadly popular with consumers, but regulatory burden, lobbying, and Senate procedure reduce prospects.
Relative to its intended legislative type, this bill defines a substantial and specific set of prior-authorization transparency data elements and mandates submission and public posting across multiple statutory regimes, but it omits several common implementation ingredients: explicit administrative designation/coordination, data standards, timelines and submission frequency, enforcement and validation mechanisms, and fiscal provisions.
Liberal emphasizes patient access and insurer accountability
These are examples from the analysis, not a ranked list of the most-affected groups.
Liberal emphasizes patient access and insurer accountability
Likely supportive because the bill increases transparency about prior authorization decisions that can limit patient access.
It aligns with priorities to hold insurers accountable, reveal AI decision-making, and enable public oversight.
Supporters would seek stronger enforcement, demographic breakdowns, and safeguards to ensure transparency leads to improved access.
Generally favorable as a targeted transparency and accountability measure that is data-driven and incremental.
Views this as a pragmatic step to inform regulators and consumers while leaving operational choices to plans.
Concerns center on implementation details, reporting standardization, compliance costs, and clear guidance from the Secretary to avoid duplication or confusion.
Skeptical because it imposes new federal reporting mandates and potential disclosure of proprietary technologies.
May acknowledge consumer benefits from transparency but worries about regulatory overreach, administrative costs for employers and insurers, and trade-secret exposure.
Prefers protecting plan management discretion and limiting federal intrusion.
Reached or meaningfully advanced
Reached or meaningfully advanced
Still ahead
Still ahead
Still ahead
Content is administratively focused and broadly popular with consumers, but regulatory burden, lobbying, and Senate procedure reduce prospects.
The bill has not accumulated any surfaced votes yet.
Liberal emphasizes patient access and insurer accountability
Content is administratively focused and broadly popular with consumers, but regulatory burden, lobbying, and Senate procedure reduce prospe…
Relative to its intended legislative type, this bill defines a substantial and specific set of prior-authorization transparency data elements and mandates submission and public posting across multiple statutory regimes,…
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