Prior Authorization Accountability Act

The "Prior Authorization Accountability Act" aims to enhance transparency in health care by requiring group health plans and health insurance issuers to publicly disclose comprehensive data on their prior authorization practices. This legislation amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to implement these new requirements, starting with plan years beginning on or after January 1, 2027. Plans and issuers must submit to the Secretary and make available on a public website various metrics related to prior authorizations. Key disclosures include a list of all items and services subject to prior authorization, along with the percentage and number of initial approvals and denials , both in aggregate and categorized by specific item or service. They must also report on the number of denied requests that were subsequently appealed and the outcomes of those appeals, including those resolved through judicial review. Furthermore, the bill requires reporting on the average and median processing times for prior authorization requests. A significant provision mandates disclosure of the percentage and number of prior authorization requests approved or denied *solely* through the use of decision support technology, artificial intelligence, or machine learning , along with a description of any such technology utilized. This information will also be incorporated into comparative data for qualified health plans offered through health insurance Exchanges for enrollments beginning on or after January 1, 2029, empowering consumers with critical insights into coverage practices.