,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #icif  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,june #bc1 #bjbf,mr4  
,goldman ( ,texas introduc$ ! foll[+    
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce1 & 9 addition to !    
,committees on ,ways & ,means1 &        
,education & ,work=ce1 = 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 ,act1
 ! ,employee ,retirem5t ,income         
,security ,act ( #aigd1 & ! ,int]nal    
,rev5ue ,code ( #aihf to require !      
display+ ( claim d5ial rates4  #a4 ,%ort
 title ,?is ,act may be cit$ z ! ,prior 
,au?orization ,acc\ntability ,act4  #b4 
,display+ claim d5ial rates  7a7 ,,phsa 
,"p ,d ( title ,,xxvii ( ! ,public      
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#aaa et seq47 is am5d$ by add+  
at ! end ! foll[+ new section3          
#bgii;,a-#ab4 ,prior au?orization       

transp>5cy requirem5ts  7a7 ,9 g5]al ,9 
! case ( a gr\p heal? plan or heal?     
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age t imposes any   
prior au?orization requirem5t ) respect 
to an item or s]vice furni%$ "u su* plan
 or cov]age dur+ a plan ye> beg9n+ on or
 aft] ,janu>y #a1 #bjbg1 su* plan or    
issu] %all1 at a "t & 9 a mann] specifi$
 by ! ,secret>y1 submit to ! ,secret>y  
7&1 9 ! case ( gr\p or individual heal? 
insurance cov]age1 if su* cov]age 0 (f]$
 ?r\gh an ,ex*ange e/abli%$ "u subtitle 
,d ( title ,i ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act1 to su* ,ex*ange7 & 
make available on a public website ( !  
plan or issu] ! foll[+ in=mation3 7#a7  
,a li/ ( all items & s]vices t 7 subject
 to a prior au?orization requirem5t "u !
 plan or cov]age dur+ su* plan ye>4     
7#b7 ,! p]c5tage & numb] ( prior        
au?orization reque/s approv$ dur+ su*   
plan ye> by ! plan or issu] 9 an initial
 det]m9ation & ! p]c5tage & numb] (     
prior au?orization reque/s d5i$ dur+ su*

 plan ye> by su* plan or issu] 9 an     
initial det]m9ation 7bo? 9 ! aggregate &
 categoriz$ by ea* item & s]vice74  7#c7
 ,! p]c5tage & numb] ( prior            
au?orization reque/s t 7 d5i$ dur+ su*  
plan ye> by ! plan or issu] 9 an initial
 det]m9ation & t 7 subsequ5tly appeal$4 
7#d7 ,! p]c5tage & numb] ( resolv$      
appeals ( su* reque/s t result$ 9       
approval ( ! furni%+ ( ! item or s]vice 
t 0 ! subject ( su* reque/1 categoriz$  
by ea* item & s]vice & categoriz$ by ea*
 level ( appeal 7includ+ judicial       
review74  7#e7 ,! av]age & ! m$ian am\nt
 ( "t 79 h\rs7 t elaps$ dur+ su* plan   
ye> betwe5 ! submission ( a prior       
au?orization reque/ to ! plan or issu] &
 a det]m9ation by ! plan or issu] )     
respect to su* reque/ = ea* su* item &  
s]vice1 exclud+ any su* reque/s t 7 n   
submitt$ ) ! m$ical or o!r docum5tation 
requir$ to be submitt$ by ! plan or     
issu]4  7#f7 ,! p]c5tage & numb] ( prior
 au?orization reque/s t 7 d5i$1 & !     
p]c5tage & numb] ( prior au?orization   

reque/s t 7 approv$1 by ! plan or issu] 
dur+ su* plan ye> solely ?r\gh !        
utilization ( decision support          
te*nology1 artificial intellig5ce       
te*nology1 ma*9e-le>n+ te*nology1       
cl9ical decision-mak+ te*nology1 or any 
o!r te*nology specifi$ by ! ,secret>y4  
7#g7 ,a disclosure & description ( any  
te*nology describ$ 9 p>agraph 7#f7 t !  
plan or issu] utiliz$ dur+ su* plan ye> 
9 mak+ det]m9ations ) respect to prior  
au?orization reque/s4  7b7 ,mann] (     
publication ,in=mation submitt$ &       
publi%$ by a gr\p heal? plan or heal?   
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age "u subsection   
7a7 %all be s submitt$ & publi%$ on a   
gr\p heal? plan & heal? insurance       
cov]age level & %all 9 addition1 if     
det]m9$ appropriate by ! ,secret>y1 be s
 submitt$ & publi%$ 9 ! aggregate 9 su* 
mann] z specifi$ by ! ,secret>y 7su* z  
across all gr\p heal? plans ( ! sponsor 
( su* plan or all heal? insurance       
cov]age (f]$ by su* issu] t are (f]$ )9 

! same insurance m>ket 7z specifi$ 9    
subclause 7,i71 7,,ii71 7,,iii71 or     
7,,iv7 ( section                        
#bgii;,a-#a7;a77#c77;,e77iv7774  4  7b7 
,,erisa  7#a7 ,9 g5]al ,subp>t ,b ( "p  
#g ( subtitle ,b ( title ,i ( !         
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4 #aahe et    
seq47 is am5d$ by add+ at ! end ! foll[+
 new section3  #gbg4 ,prior au?orization
 transp>5cy requirem5ts  7a7 ,9 g5]al ,9
 ! case ( a gr\p heal? plan or heal?    
insurance issu] (f]+ gr\p heal?         
insurance cov]age t imposes any prior   
au?orization requirem5t ) respect to an 
item or s]vice furni%$ "u su* plan or   
cov]age dur+ a plan ye> beg9n+ on or    
aft] ,janu>y #a1 #bjbg1 su* plan or     
issu] %all1 at a "t & 9 a mann] specifi$
 by ! ,secret>y1 submit to ! ,secret>y &
 make available on a public website ( ! 
plan or issu] ! foll[+ in=mation3 7#a7  
,a li/ ( all items & s]vices t 7 subject
 to a prior au?orization requirem5t "u !
 plan or cov]age dur+ su* plan ye>4     

7#b7 ,! p]c5tage & numb] ( prior        
au?orization reque/s approv$ dur+ su*   
plan ye> by ! plan or issu] 9 an initial
 det]m9ation & ! p]c5tage & numb] (     
prior au?orization reque/s d5i$ dur+ su*
 plan ye> by su* plan or issu] 9 an     
initial det]m9ation 7bo? 9 ! aggregate &
 categoriz$ by ea* item & s]vice74  7#c7
 ,! p]c5tage & numb] ( prior            
au?orization reque/s t 7 d5i$ dur+ su*  
plan ye> by ! plan or issu] 9 an initial
 det]m9ation & t 7 subsequ5tly appeal$4 
7#d7 ,! p]c5tage & numb] ( resolv$      
appeals ( su* reque/s t result$ 9       
approval ( ! furni%+ ( ! item or s]vice 
t 0 ! subject ( su* reque/1 categoriz$  
by ea* item & s]vice & categoriz$ by ea*
 level ( appeal 7includ+ judicial       
review74  7#e7 ,! av]age & ! m$ian am\nt
 ( "t 79 h\rs7 t elaps$ dur+ su* plan   
ye> betwe5 ! submission ( a prior       
au?orization reque/ to ! plan or issu] &
 a det]m9ation by ! plan or issu] )     
respect to su* reque/ = ea* su* item &  
s]vice1 exclud+ any su* reque/s t 7 n   

submitt$ ) ! m$ical or o!r docum5tation 
requir$ to be submitt$ by ! plan or     
issu]4  7#f7 ,! p]c5tage & numb] ( prior
 au?orization reque/s t 7 d5i$1 & !     
p]c5tage & numb] ( prior au?orization   
reque/s t 7 approv$1 by ! plan or issu] 
dur+ su* plan ye> solely ?r\gh !        
utilization ( decision support          
te*nology1 artificial intellig5ce       
te*nology1 ma*9e-le>n+ te*nology1       
cl9ical decision-mak+ te*nology1 or any 
o!r te*nology specifi$ by ! ,secret>y4  
7#g7 ,a disclosure & description ( any  
te*nology describ$ 9 p>agraph 7#f7 t !  
plan or issu] utiliz$ dur+ su* plan ye> 
9 mak+ det]m9ations ) respect to prior  
au?orization reque/s4  7b7 ,mann] (     
publication ,in=mation submitt$ &       
publi%$ by a gr\p heal? plan or heal?   
insurance issu] (f]+ gr\p heal?         
insurance cov]age "u subsection 7a7 %all
 be s submitt$ & publi%$ on a gr\p heal?
 plan & heal? insurance cov]age level & 
%all 9 addition1 if det]m9$ appropriate 
by ! ,secret>y1 be s submitt$ & publi%$ 

9 ! aggregate 9 su* mann] z specifi$ by 
! ,secret>y 7su* z across all gr\p heal?
 plans ( ! sponsor ( su* plan or all    
heal? insurance cov]age (f]$ by su*     
issu] t are (f]$ )9 ! same insurance    
m>ket 7z specifi$ 9 subclause 7,i71     
7,,ii71 7,,iii71 or 7,,iv7 ( section    
#gaf7;a77#c77;,e77iv7774  4  7#b7       
,cl]ical am5dm5t ,! table ( cont5ts 9   
section #a ( ! ,employee ,retirem5t     
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #ajja note7 is am5d$ by ins]t+
 aft] ! item relat+ to section #gbf !   
foll[+ new item3  ,sec4 #gbg4 ,prior    
au?orization transp>5cy requirem5ts4  4 
7c7 ,,irc  7#a7 ,9 g5]al ,sub*apt] ,b ( 
*apt] #ajj ( ! ,int]nal ,rev5ue ,code ( 
#aihf is am5d$ by add+ at ! end ! foll[+
 new section3  #ihbg4 ,prior            
au?orization transp>5cy requirem5ts  7a7
 ,9 g5]al ,9 ! case ( a gr\p heal? plan 
t imposes any prior au?orization        
requirem5t ) respect to an item or      
s]vice furni%$ "u su* plan dur+ a plan  
ye> beg9n+ on or aft] ,janu>y #a1 #bjbg1

 su* plan %all1 at a "t & 9 a mann]     
specifi$ by ! ,secret>y1 submit to !    
,secret>y & make available on a public  
website ( ! plan ! foll[+ in=mation3    
7#a7 ,a li/ ( all items & s]vices t 7   
subject to a prior au?orization         
requirem5t "u ! plan dur+ su* plan ye>4 
7#b7 ,! p]c5tage & numb] ( prior        
au?orization reque/s approv$ dur+ su*   
plan ye> by ! plan 9 an initial         
det]m9ation & ! p]c5tage & numb] ( prior
 au?orization reque/s d5i$ dur+ su* plan
 ye> by su* plan 9 an initial           
det]m9ation 7bo? 9 ! aggregate &        
categoriz$ by ea* item & s]vice74  7#c7 
,! p]c5tage & numb] ( prior au?orization
 reque/s t 7 d5i$ dur+ su* plan ye> by !
 plan 9 an initial det]m9ation & t 7    
subsequ5tly appeal$4  7#d7 ,! p]c5tage &
 numb] ( resolv$ appeals ( su* reque/s t
 result$ 9 approval ( ! furni%+ ( ! item
 or s]vice t 0 ! subject ( su* reque/1  
categoriz$ by ea* item & s]vice &       
categoriz$ by ea* level ( appeal        
7includ+ judicial review74  7#e7 ,!     

av]age & ! m$ian am\nt ( "t 79 h\rs7 t  
elaps$ dur+ su* plan ye> betwe5 !       
submission ( a prior au?orization reque/
 to ! plan & a det]m9ation by ! plan )  
respect to su* reque/ = ea* su* item &  
s]vice1 exclud+ any su* reque/s t 7 n   
submitt$ ) ! m$ical or o!r docum5tation 
requir$ to be submitt$ by ! plan4  7#f7 
,! p]c5tage & numb] ( prior au?orization
 reque/s t 7 d5i$1 & ! p]c5tage & numb] 
( prior au?orization reque/s t 7        
approv$1 by ! plan dur+ su* plan ye>    
solely ?r\gh ! utilization ( decision   
support te*nology1 artificial           
intellig5ce te*nology1 ma*9e-le>n+      
te*nology1 cl9ical decision-mak+        
te*nology1 or any o!r te*nology specifi$
 by ! ,secret>y4  7#g7 ,a disclosure &  
description ( any te*nology describ$ 9  
p>agraph 7#f7 t ! plan utiliz$ dur+ su* 
plan ye> 9 mak+ det]m9ations ) respect  
to prior au?orization reque/s4  7b7     
,mann] ( publication ,in=mation submitt$
 & publi%$ by a gr\p heal? plan "u      
subsection 7a7 %all be s publi%$ on a   

gr\p heal? plan level & %all 9 addition1
 if det]m9$ appropriate by ! ,secret>y1 
be s submitt$ & publi%$ 9 ! aggregate 9 
su* mann] z specifi$ by ! ,secret>y 7su*
 z across all gr\p heal? plans ( !      
sponsor ( su* plan t are (f]$ )9 ! same 
insurance m>ket 7z specifi$ 9 subclause 
7,i71 7,,ii71 7,,iii71 or 7,,iv7 (      
section #ihaf7;a77#c77;,e77iv7774  4    
7#b7 ,cl]ical am5dm5t ,! table (        
sections = sub*apt] ,b ( *apt] #ajj ( ! 
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by add+ at ! end ! foll[+ new item3     
,sec4 #ihbg4 ,prior au?orization        
transp>5cy requirem5ts4  4  #c4 ,promot+
 comp>ability ( qualifi$ heal? plans    
(f]$ ?r\gh an ,ex*ange ,section         
#acaa7;d77#d77;,c7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca7;d77#d77;,c77 is       
am5d$--  7#a7 by /rik+ website ?r\gh :i*
 & ins]t+ ! foll[+3 website--  7i7 ?r\gh
 :i*  2  7#b7 9 clause 7i71 z s ins]t$1 
by /rik+ ! semicolon & ins]t+ 2 &2 &    
7#c7 by add+ at ! end ! foll[+ new      

clause3  7ii7 t includes1 z "p ( su*    
comp>ative in=mation = enrollm5ts = plan
 ye>s beg9n+ on or aft] ,janu>y #a1     
#bjbi1 9 ! case a qualifi$ heal? plan   
(f]$ ?r\gh su* ,ex*ange = su* plan ye> 0
 (f]$ ?r\gh su* ,ex*ange = a previ\s    
plan ye>1 ! mo/ rec5t in=mation submitt$
 to su* ,ex*ange ) respect to su* plan  
by ! heal? insurance issu] ( su* plan "u
 section #bgii;,a-#ab ( ! ,public ,heal?
 ,s]vice ,act2  4