Prior Authorization Accountability Act

Bill Number: H.R. 9396
Origin Chamber: House
Congress: 119th Congress, Session 2
Policy Area: Health
Status: Introduced
Latest Action: 2026-06-25: Forwarded by Subcommittee to Full Committee by Voice Vote.
Last Updated: 2026-07-06T16:33:20Z

AI-Generated Summary

Prior Authorization Accountability Act (H.R. 9396)

Purpose

The legislation aims to increase transparency in health insurance prior authorization processes. It requires group health plans and health insurance issuers to publicly disclose data on how they handle prior authorization requests, including approval and denial rates.

Key Provisions

Data Reporting Requirements: Plans and issuers that use prior authorization must submit and post on their websites the following information for plan years beginning on or after January 1, 2027:
A list of all items and services subject to prior authorization.
Initial approval and denial rates (overall and broken down by item or service).
Rates of denied requests that are appealed.
Appeal outcomes, including approvals by appeal level (including judicial review).
Average and median decision times (in hours), excluding incomplete submissions.
Percentage of decisions made solely by automated technology such as artificial intelligence or machine learning.
Descriptions of any such technology used.
Submission and Publication: Data must be reported to the Secretary of Health and Human Services (and to Exchanges where applicable) and made publicly available. The Secretary may require aggregated reporting across plans or markets.
Exchange Comparability: Amends the Affordable Care Act to require qualified health plans on Exchanges to include the most recent prior authorization data in comparative plan information for enrollments starting in 2029.
Effective Dates: Requirements apply to plan years beginning January 1, 2027; Exchange display begins with 2029 enrollments.

Significant Changes to Existing Law

Adds new sections (2799A-12 to the Public Health Service Act, 727 to ERISA, and 9827 to the Internal Revenue Code) that impose prior authorization transparency obligations. No similar mandatory public disclosure of denial rates or technology use previously existed in these statutes.
Updates the Affordable Care Act’s plan comparison requirements to incorporate this new data.

Potential Impacts

Government Agencies: The Secretary of Health and Human Services gains authority to set reporting formats and timelines; federal agencies may use the data for oversight.
Citizens: Enrollees and consumers gain access to standardized information that could help compare plans and understand denial patterns before enrollment.
Health Plans and Issuers: Must develop systems to track, categorize, and publish detailed metrics, potentially increasing administrative costs.
No direct effects on international relations are addressed in the bill.

Main Stakeholders Affected

Group health plan sponsors and health insurance issuers.
Individuals enrolled in or shopping for health coverage.
The Department of Health and Human Services and state-based Exchanges.
Healthcare providers who submit prior authorization requests.

Notable Legal, Constitutional, or Political Implications

The bill operates within existing federal authority over health plans under the Public Health Service Act, ERISA, and tax code, with no apparent constitutional conflicts.
It promotes greater accountability for automated decision-making tools without restricting their use.
The requirements apply uniformly across insured and self-funded plans, aiming to create consistent transparency standards.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Goldman, Craig A. [R-TX-12]

Recent Actions

2026-06-25: Forwarded by Subcommittee to Full Committee by Voice Vote.
2026-06-25: Subcommittee Consideration and Mark-up Session Held
2026-06-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
2026-06-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
2026-06-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
2026-06-23: Referred to the Subcommittee on Health.
2026-06-23: Introduced in House
2026-06-23: Introduced in House

Bill Versions

Prior Authorization Accountability Act — issued 2026-06-23 — PDF (11 pages)