,i #aaith ,,congress #b;d ,session ,h4 ,r4 #icif ,,in ,,the ,,house ,,of ,,representatives ,june #bc1 #bjbf,mr4 ,goldman of ,texas introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 and ,education and ,workforce1 for a period to be subsequently determined by the ,speaker1 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 ,act1 the ,employee ,retirement ,income ,security ,act of #aigd1 and the ,internal ,revenue ,code of #aihf to require the displaying of claim denial rates4 #a4 ,short title ,this ,act may be cited as the ,prior ,authorization ,accountability ,act4 #b4 ,displaying claim denial rates 7a7 ,,phsa ,part ,d of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aaa et seq47 is amended by adding at the end the following new section3 #bgii;,a-#ab4 ,prior authorization transparency requirements 7a7 ,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 #a1 #bjbg1 such plan or issuer shall1 at a time and in a manner specified by the ,secretary1 submit to the ,secretary 7and1 in the case of group or individual health insurance coverage1 if such coverage was offered through an ,exchange established under subtitle ,d of title ,i of the ,patient ,protection and ,affordable ,care ,act1 to such ,exchange7 and make available on a public website of the plan or issuer the following information3 7#a7 ,a list of all items and services that were subject to a prior authorization requirement under the plan or coverage during such plan year4 7#b7 ,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 7both in the aggregate and categorized by each item and service74 7#c7 ,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 appealed4 7#d7 ,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 request1 categorized by each item and service and categorized by each level of appeal 7including judicial review74 7#e7 ,the average and the median amount of time 7in hours7 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 service1 excluding any such requests that were not submitted with the medical or other documentation required to be submitted by the plan or issuer4 7#f7 ,the percentage and number of prior authorization requests that were denied1 and the percentage and number of prior authorization requests that were approved1 by the plan or issuer during such plan year solely through the utilization of decision support technology1 artificial intelligence technology1 machine-learning technology1 clinical decision-making technology1 or any other technology specified by the ,secretary4 7#g7 ,a disclosure and description of any technology described in paragraph 7#f7 that the plan or issuer utilized during such plan year in making determinations with respect to prior authorization requests4 7b7 ,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 7a7 shall be so submitted and published on a group health plan and health insurance coverage level and shall in addition1 if determined appropriate by the ,secretary1 be so submitted and published in the aggregate in such manner as specified by the ,secretary 7such 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 7as specified in subclause 7,i71 7,,ii71 7,,iii71 or 7,,iv7 of section #bgii;,a-#a7;a77#c77;,e77iv7774 4 7b7 ,,erisa 7#a7 ,in general ,subpart ,b of part #g of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe et seq47 is amended by adding at the end the following new section3 #gbg4 ,prior authorization transparency requirements 7a7 ,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 #a1 #bjbg1 such plan or issuer shall1 at a time and in a manner specified by the ,secretary1 submit to the ,secretary and make available on a public website of the plan or issuer the following information3 7#a7 ,a list of all items and services that were subject to a prior authorization requirement under the plan or coverage during such plan year4 7#b7 ,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 7both in the aggregate and categorized by each item and service74 7#c7 ,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 appealed4 7#d7 ,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 request1 categorized by each item and service and categorized by each level of appeal 7including judicial review74 7#e7 ,the average and the median amount of time 7in hours7 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 service1 excluding any such requests that were not submitted with the medical or other documentation required to be submitted by the plan or issuer4 7#f7 ,the percentage and number of prior authorization requests that were denied1 and the percentage and number of prior authorization requests that were approved1 by the plan or issuer during such plan year solely through the utilization of decision support technology1 artificial intelligence technology1 machine-learning technology1 clinical decision-making technology1 or any other technology specified by the ,secretary4 7#g7 ,a disclosure and description of any technology described in paragraph 7#f7 that the plan or issuer utilized during such plan year in making determinations with respect to prior authorization requests4 7b7 ,manner of publication ,information submitted and published by a group health plan or health insurance issuer offering group health insurance coverage under subsection 7a7 shall be so submitted and published on a group health plan and health insurance coverage level and shall in addition1 if determined appropriate by the ,secretary1 be so submitted and published in the aggregate in such manner as specified by the ,secretary 7such 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 7as specified in subclause 7,i71 7,,ii71 7,,iii71 or 7,,iv7 of section #gaf7;a77#c77;,e77iv7774 4 7#b7 ,clerical amendment ,the table of contents in section #a of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajja note7 is amended by inserting after the item relating to section #gbf the following new item3 ,sec4 #gbg4 ,prior authorization transparency requirements4 4 7c7 ,,irc 7#a7 ,in general ,subchapter ,b of chapter #ajj of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new section3 #ihbg4 ,prior authorization transparency requirements 7a7 ,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 #a1 #bjbg1 such plan shall1 at a time and in a manner specified by the ,secretary1 submit to the ,secretary and make available on a public website of the plan the following information3 7#a7 ,a list of all items and services that were subject to a prior authorization requirement under the plan during such plan year4 7#b7 ,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 7both in the aggregate and categorized by each item and service74 7#c7 ,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 appealed4 7#d7 ,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 request1 categorized by each item and service and categorized by each level of appeal 7including judicial review74 7#e7 ,the average and the median amount of time 7in hours7 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 service1 excluding any such requests that were not submitted with the medical or other documentation required to be submitted by the plan4 7#f7 ,the percentage and number of prior authorization requests that were denied1 and the percentage and number of prior authorization requests that were approved1 by the plan during such plan year solely through the utilization of decision support technology1 artificial intelligence technology1 machine-learning technology1 clinical decision-making technology1 or any other technology specified by the ,secretary4 7#g7 ,a disclosure and description of any technology described in paragraph 7#f7 that the plan utilized during such plan year in making determinations with respect to prior authorization requests4 7b7 ,manner of publication ,information submitted and published by a group health plan under subsection 7a7 shall be so published on a group health plan level and shall in addition1 if determined appropriate by the ,secretary1 be so submitted and published in the aggregate in such manner as specified by the ,secretary 7such as across all group health plans of the sponsor of such plan that are offered within the same insurance market 7as specified in subclause 7,i71 7,,ii71 7,,iii71 or 7,,iv7 of section #ihaf7;a77#c77;,e77iv7774 4 7#b7 ,clerical amendment ,the table of sections for subchapter ,b of chapter #ajj of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new item3 ,sec4 #ihbg4 ,prior authorization transparency requirements4 4 #c4 ,promoting comparability of qualified health plans offered through an ,exchange ,section #acaa7;d77#d77;,c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;d77#d77;,c77 is amended-- 7#a7 by striking website through which and inserting the following3 website-- 7i7 through which 2 7#b7 in clause 7i71 as so inserted1 by striking the semicolon and inserting 2 and2 and 7#c7 by adding at the end the following new clause3 7ii7 that includes1 as part of such comparative information for enrollments for plan years beginning on or after ,january #a1 #bjbi1 in the case a qualified health plan offered through such ,exchange for such plan year was offered through such ,exchange for a previous plan year1 the most recent information submitted to such ,exchange with respect to such plan by the health insurance issuer of such plan under section #bgii;,a-#ab of the ,public ,health ,service ,act2 4