Prior Authorization Accountability Act

Key Points

• Health insurance companies would have to publicly report how often they approve or deny requests for medical care through prior authorization. This includes both aggregate numbers and breakdowns by each specific item or service, giving patients and regulators a clear picture of denial patterns.
• Insurers must post a list of every medical service requiring prior authorization and disclose the average and median time it takes to process each request. This lets patients know upfront which treatments face extra hurdles and how long they might wait for a decision.
• The bill requires insurers to reveal when they use artificial intelligence, machine learning, or other automated technology to approve or deny care requests. They must disclose both how many decisions were made by these tools and describe the technology itself.
• Plans must report how many denied requests were appealed and how many of those appeals were ultimately successful, broken down by service and by each level of appeal including court review. This helps consumers see which insurers reverse their denials most often.
• Starting with plan years beginning January 1, 2027, this data must be posted on insurers' websites and submitted to the government. By 2029, people shopping on ACA marketplace exchanges will see these denial rates displayed alongside plan options, enabling side-by-side comparisons.