Prior Authorization Accountability Act
Sponsored By: Representative Goldman, Craig A. [R-TX-12]
In Committee
Summary
The Prior Authorization Accountability Act requires public, standardized reporting by group health plans and insurers to create clear, comparable visibility into who gets prior authorization approvals, denials, appeals, processing times, and whether AI or decision-support tools influence decisions. It adds matching reporting rules across the Public Health Service Act, ERISA, and the tax code, with reporting required for plan years beginning on or after January 1, 2027 and Exchange comparability links beginning for plan years on or after January 1, 2029.
Show full summary
- Patients and families: Get plan-level lists of services that need prior authorization, approval and denial rates, appeals outcomes, and average and median time-to-decision. This makes it easier to compare plan behavior when choosing coverage or pursuing appeals.
- Clinicians and providers: See which plans have higher denial or slower decision rates and whether determinations rely on artificial intelligence or other decision tools. That information can guide preauthorization workflows and appeals.
- Employers, issuers, Exchanges, and regulators: Must publish standardized data that can be aggregated across plans or markets, enabling monitoring of plan performance and cross-plan comparisons starting in 2027 and Exchange integration in 2029.
Personalized for You
How does this bill affect your finances?
Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
2 provisions identified: 2 benefits, 0 costs, 0 mixed.
Health plans must publish prior authorization data
If enacted, group health plans and issuers that require prior authorization would need to submit and publish standard prior-authorization data. This reporting would start for plan years beginning January 1, 2027. Plans would send the data to the Secretary and, for Exchange coverage, to the Exchange. Required data would include a list of every item or service needing prior authorization. Plans would report counts and percentages of initial approvals and denials overall and by item. They would report how many denials were appealed and how resolved appeals ended, by item and appeal level including judicial review. Plans would report average and median hours from submission to decision, excluding requests missing required documentation. They would report the share and number of decisions made only by AI or similar technology and describe any such technology used. The Secretary would set the timing and format and could allow aggregation across plans or markets.
Exchanges must show prior authorization data
If enacted, Exchanges would include prior-authorization transparency data on plan comparison pages. This would start for plan years beginning January 1, 2029. It would apply when the same qualified health plan was offered on that Exchange in a prior plan year. Exchanges would show the most recent prior-authorization information the issuer submitted to the Exchange under the new reporting rules.
Sponsors & CoSponsors
Sponsor
Goldman, Craig A. [R-TX-12]
TX • R
Cosponsors
Rep. Pfluger, August [R-TX-11]
TX • R
Sponsored 7/21/2026
Rep. Wittman, Robert J. [R-VA-1]
VA • R
Sponsored 7/21/2026
Rep. Schrier, Kim [D-WA-8]
WA • D
Sponsored 7/21/2026
Rep. Norcross, Donald [D-NJ-1]
NJ • D
Sponsored 7/21/2026
Rep. Panetta, Jimmy [D-CA-19]
CA • D
Sponsored 7/21/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov