,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ajjbd  ,,9 ,,! ,,h\se ,,(         
,,repres5tatives  ,augu/ #c1 #bjbf,mrs4 
,h9son introduc$ ! foll[+ bill2 :i* 0   
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xxvii ( ! ,public ,heal? ,s]vice ,act 
& title ,,xviii ( ! ,social ,security   
,act to require heal? insurance issu]s &
 ,,ma organizations to make publicly    
available c]ta9 in=mation ) respect to  
cov]age reque/ rejection4  #a4 ,%ort    
title  ,?is ,act may be cit$ z ! ,heal? 
,insurance ,transp>5cy = ,pati5ts ,act4 
#b4 ,requir+ disclosure ( c]ta9         
in=mation ) respect to cov]age reque/   
rejection  7a7 ,requirem5t = heal?      
insurance issu]s  7#a7 ,9 g5]al ,subp>t 
,,ii ( "p ,a ( title ,,xxvii ( ! ,public
 ,heal? ,s]vice ,act 7#db ,u4,s4,c4     

#cjj;gg et seq47 is am5d$ by add+ at !  
end ! foll[+ new section3  #bgcj4       
,requir+ disclosure ( c]ta9 in=mation ) 
respect to cov]age reque/ rejection  7a7
 ,9 g5]al ,a heal? insurance issu] (f]+ 
gr\p or individual heal? insurance      
cov]age = a plan ye> %all1 n lat] ?an #a
 ye> aft] ! la/ day ( ea* su* plan ye>1 
submit to ! ,secret>y & make publicly   
available on a website ( ! issu]1 )     
respect to su* plan ye>--  7#a7 !       
deid5tifi$ in=mation describ$ 9         
subsection 7b71 disaggregat$ 9          
accordance ) subsection 7c71 9 a        
consum]-fri5dly mann] t is simple &     
und]/&able2 &  7#b7 a li/ ( all cov]$   
items or s]vices t are subject to prior 
au?orization4  7b7 ,in=mation describ$  
,= purposes ( subsection 7a71 !         
in=mation describ$ 9 ?is subsection is1 
) respect to a heal? insurance issu]    
(f]+ gr\p or individual heal? insurance 
cov]age & a plan ye>1 ! p]c5tage & numb]
 ( ea* ( ! foll[+3 7#a7 ,cov]age reque/s
 d5i$1 9 :ole or 9 "p1 by ! issu] on    

initial review4  7#b7 ,cov]age reque/s  
approv$ by ! issu] on initial review4   
7#c7 ,appeals ( cov]age reque/s d5i$ by 
! issu] & any su* appeals t result$ 9   
rev]sal1 9 :ole or 9 "p1 ( su* d5ials4  
7c7 ,disaggregation ( in=mation ,!      
in=mation describ$ 9 subsection 7b7 %all
 be disaggregat$ by-- 7#a7 ! type (     
cov]age reque/2  7#b7 ! reason = !      
d5ial2  7#c7 ! process by :i* d5i$      
cov]age reque/s 7 review$1 includ+ :e!r 
! d5ial det]m9ation 0 ! result ( a fully
 automat$ review process 7su* z         
artificial intellig5ce71 an algori?mic  
review1 or review by an individual2     
7#d7 ! type ( cov]$ item or s]vice2     
7#e7 ! "t t elaps$ betwe5 :5 ! cov]age  
reque/ or ! appeal ( a d5ial ( a cov]age
 reque/ 7z applicable7 0 fil$ & :5 !    
heal? insurance issu] (f]+ gr\p or      
individual heal? insurance cov]age rea*$
 a det]m9ation z to su* cov]age reque/  
or appeal1 express$ 9 days & h\rs2 &    
7#f7 9 ! case ( an appeal ( a d5ial ( a 
cov]age reque/1 :e!r su* appeal 0       

exp$it$4  7d7 ,/&>ds = publication ,!   
,secret>y %all e/abli% /&>d def9itions &
 report+ =mats = ! in=mation describ$ 9 
subsection 7b7 to--  7#a7 ensure t su*  
in=mation is accurate1 easy to comp>e1 &
 consum]-fri5dly2 &  7#b7 to ! greate/  
ext5t practicable1 ensure t ! submission
 ( su* in=mation does n require a heal? 
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age to seek         
additional in=mation f a heal? c>e      
provid]4  7e7 ,publication by ,secret>y 
,on an annual basis1 ! ,secret>y %all   
make available on ! website ( !         
,dep>tm5t ( ,heal? & ,human ,s]vices !  
in=mation submitt$ to ! ,secret>y "u    
subsection 7a74  7f7 ,def9itions ,9 ?is 
section3  7#a7 ,cov]age reque/ ,! t]m   
cov]age reque/ means-- 7,a7 a claim = a 
cov]$ item or s]vice2 &  7,b7 a prior   
au?orization reque/ = a cov]$ item or   
s]vice4  7#b7 ,cov]$ item or s]vice ,!  
t]m cov]$ item or s]vice means1 )       
respect to a heal? insurance issu] (f]+ 
gr\p or individual heal? insurance      

cov]age1 an item or s]vice = :i* b5efits
 are available "u su* cov]age4  4  7#b7 
,effective date ,! am5dm5ts made by ?is 
subsection %all apply ) respect to plan 
ye>s beg9n+ on or aft] ,janu>y #a ( !   
fir/ ye> beg9n+ aft] ! date ( enactm5t (
 ?is subsection4  7b7 ,requirem5t = ,,ma
 organizations ,section #aheg7;e7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bg7;e77 is am5d$ by add+ at !   
end ! foll[+ new p>agraph3  7#g7        
,requir+ disclosure ( c]ta9 in=mation ) 
respect to cov]age reque/ rejection     
7,a7 ,9 g5]al ,= plan ye>s beg9n+ on or 
aft] ,janu>y #a ( ! fir/ ye> beg9n+ aft]
 ! date ( enactm5t ( ?is p>agraph1 a    
contract "u ?is section ) an ,,ma       
organization %all require su*           
organization1 n lat] ?an #a ye> aft] !  
la/ day ( ea* su* plan ye>1 to submit to
 ! ,secret>y & make publicly available  
on a website ( su* organization1 )      
respect to ea* ,,ma plan (f]$ by su*    
organization dur+ su* plan ye>-- 7i7 !  
deid5tifi$ in=mation describ$ 9         

subp>agraph 7,b71 disaggregat$ 9        
accordance ) subp>agraph 7,c71 9 a      
consum]-fri5dly mann] t is simple &     
und]/&able2 &  7ii7 a li/ ( all cov]$   
items or s]vices t are subject to prior 
au?orization4  7,b7 ,in=mation describ$ 
,= purposes ( subp>agraph 7,a71 !       
in=mation describ$ 9 ?is subp>agraph is1
 ) respect to an ,,ma plan (f]$ by an   
,,ma organization & a plan ye>1 !       
p]c5tage & numb] ( ea* ( ! foll[+3  7i7 
,cov]age reque/s d5i$1 9 :ole or 9 "p1  
by ! ,,ma organization on initial       
review4  7ii7 ,cov]age reque/s approv$  
by ! ,,ma organization on initial       
review4  7iii7 ,appeals ( cov]age       
reque/s d5i$ by ! ,,ma organization &   
any su* appeals t result$ 9 rev]sal1 9  
:ole or 9 "p1 ( su* d5ials4  7,c7       
,disaggregation ( in=mation ,! in=mation
 describ$ 9 subp>agraph 7,b7 %all be    
disaggregat$ by--  7i7 ! type ( cov]age 
reque/2  7ii7 ! reason = ! d5ial2  7iii7
 ! process by :i* d5i$ cov]age reque/s 7
 review$1 includ+ :e!r ! d5ial          

det]m9ation 0 ! result ( a fully        
automat$ review process 7su* z          
artificial intellig5ce71 an algori?mic  
review1 or review by an individual2     
7iv7 ! type ( cov]$ item or s]vice2  7v7
 ! "t t elaps$ betwe5 :5 ! cov]age      
reque/ or ! appeal ( a d5ial ( a cov]age
 reque/ 7z applicable7 0 fil$ & :5 !    
,,ma organization rea*$ a det]m9ation z 
to su* cov]age reque/ or appeal1        
express$ 9 days & h\rs2 &  7vi7 9 ! case
 ( an appeal ( a d5ial ( a cov]age      
reque/1 :e!r su* appeal 0 exp$it$4  7,d7
 ,/&>ds = publication ,! ,secret>y %all 
e/abli% /&>d def9itions & report+ =mats 
= ! in=mation describ$ 9 subp>agraph    
7,b7 to-- 7i7 ensure t su* in=mation is 
accurate1 easy to comp>e1 &             
consum]-fri5dly2 &  7ii7 to ! greate/   
ext5t practicable1 ensure t ! submission
 ( su* in=mation does n require an ,,ma 
organization to seek additional         
in=mation f a heal? c>e provid]4  7,e7  
,publication by ,secret>y ,on an annual 
basis1 ! ,secret>y %all make available  

on ! website ( ! ,dep>tm5t ( ,heal? &   
,human ,s]vices ! in=mation submitt$ to 
! ,secret>y "u subp>agraph 7,a74  7,f7  
,def9itions ,9 ?is p>agraph3 7i7        
,cov]age reque/ ,! t]m cov]age reque/   
means--  7,i7 a claim = a cov]$ item or 
s]vice2 &  7,,ii7 a prior au?orization  
reque/ = a cov]$ item or s]vice4  7ii7  
,cov]$ item or s]vice ,! t]m cov]$ item 
or s]vice means1 ) respect to an ,,ma   
plan1 an item or s]vice = :i* b5efits   
are available "u su* plan4  4