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To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to require health insurance issuers and MA organizations to make publicly available certain information with respect to coverage request rejection.
Introduced Aug 3, 2026 · Last action Aug 3, 2026 — Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
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Summary
This legislation is called the To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to require health insurance issuers and MA organizations to make publicly available certain information with respect to coverage request rejection. It is being reviewed by a committee.
Full bill text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10024 Introduced in House (IH)]
<DOC>
119th CONGRESS
2d Session
H. R. 10024
To amend title XXVII of the Public Health Service Act and title XVIII
of the Social Security Act to require health insurance issuers and MA
organizations to make publicly available certain information with
respect to coverage request rejection.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 3, 2026
Mrs. Hinson introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, 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
_______________________________________________________________________
A BILL
To amend title XXVII of the Public Health Service Act and title XVIII
of the Social Security Act to require health insurance issuers and MA
organizations to make publicly available certain information with
respect to coverage request rejection.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Insurance Transparency for
Patients Act''.
SEC. 2. REQUIRING DISCLOSURE OF CERTAIN INFORMATION WITH RESPECT TO
COVERAGE REQUEST REJECTION.
(a) Requirement for Health Insurance Issuers.--
(1) In general.--Subpart II of part A of title XXVII of the
Public Health Service Act (42 U.S.C. 300gg et seq.) is amended
by adding at the end the following new section:
``SEC. 2730. REQUIRING DISCLOSURE OF CERTAIN INFORMATION WITH RESPECT
TO COVERAGE REQUEST REJECTION.
``(a) In General.--A health insurance issuer offering group or
individual health insurance coverage for a plan year shall, not later
than 1 year after the last day of each such plan year, submit to the
Secretary and make publicly available on a website of the issuer, with
respect to such plan year--
``(1) the deidentified information described in subsection
(b), disaggregated in accordance with subsection (c), in a
consumer-friendly manner that is simple and understandable; and
``(2) a list of all covered items or services that are
subject to prior authorization.
``(b) Information Described.--For purposes of subsection (a), the
information described in this subsection is, with respect to a health
insurance issuer offering group or individual health insurance coverage
and a plan year, the percentage and number of each of the following:
``(1) Coverage requests denied, in whole or in part, by the
issuer on initial review.
``(2) Coverage requests approved by the issuer on initial
review.
``(3) Appeals of coverage requests denied by the issuer and
any such appeals that resulted in reversal, in whole or in
part, of such denials.
``(c) Disaggregation of Information.--The information described in
subsection (b) shall be disaggregated by--
``(1) the type of coverage request;
``(2) the reason for the denial;
``(3) the process by which denied coverage requests were
reviewed, including whether the denial determination was the
result of a fully automated review process (such as artificial
intelligence), an algorithmic review, or review by an
individual;
``(4) the type of covered item or service;
``(5) the time that elapsed between when the coverage
request or the appeal of a denial of a coverage request (as
applicable) was filed and when the health insurance issuer
offering group or individual health insurance coverage reached
a determination as to such coverage request or appeal,
expressed in days and hours; and
``(6) in the case of an appeal of a denial of a coverage
request, whether such appeal was expedited.
``(d) Standards for Publication.--The Secretary shall establish
standard definitions and reporting formats for the information
described in subsection (b) to--
``(1) ensure that such information is accurate, easy to
compare, and consumer-friendly; and
``(2) to the greatest extent practicable, ensure that the
submission of such information does not require a health
insurance issuer offering group or individual health insurance
coverage to seek additional information from a health care
provider.
``(e) Publication by Secretary.--On an annual basis, the Secretary
shall make available on the website of the Department of Health and
Human Services the information submitted to the Secretary under
subsection (a).
``(f) Definitions.--In this section:
``(1) Coverage request.--The term `coverage request'
means--
``(A) a claim for a covered item or service; and
``(B) a prior authorization request for a covered
item or service.
``(2) Covered item or service.--The term `covered item or
service' means, with respect to a health insurance issuer
offering group or individual health insurance coverage, an item
or service for which benefits are available under such
coverage.''.
(2) Effective date.--The amendments made by this subsection
shall apply with respect to plan years beginning on or after
January 1 of the first year beginning after the date of
enactment of this subsection.
(b) Requirement for MA Organizations.--Section 1857(e) of the
Social Security Act (42 U.S.C. 1395w-27(e)) is amended by adding at the
end the following new paragraph:
``(7) Requiring disclosure of certain information with
respect to coverage request rejection.--
``(A) In general.--For plan years beginning on or
after January 1 of the first year beginning after the
date of enactment of this paragraph, a contract under
this section with an MA organization shall require such
organization, not later than 1 year after the last day
of each such plan year, to submit to the Secretary and
make publicly available on a website of such
organization, with respect to each MA plan offered by
such organization during such plan year--
``(i) the deidentified information
described in subparagraph (B), disaggregated in
accordance with subparagraph (C), in a
consumer-friendly manner that is simple and
understandable; and
``(ii) a list of all covered items or
services that are subject to prior
authorization.
``(B) Information described.--For purposes of
subparagraph (A), the information described in this
subparagraph is, with respect to an MA plan offered by
an MA organization and a plan year, the percentage and
number of each of the following:
``(i) Coverage requests denied, in whole or
in part, by the MA organization on initial
review.
``(ii) Coverage requests approved by the MA
organization on initial review.
``(iii) Appeals of coverage requests denied
by the MA organization and any such appeals
that resulted in reversal, in whole or in part,
of such denials.
``(C) Disaggregation of information.--The
information described in subparagraph (B) shall be
disaggregated by--
``(i) the type of coverage request;
``(ii) the reason for the denial;
``(iii) the process by which denied
coverage requests were reviewed, including
whether the denial determination was the result
of a fully automated review process (such as
artificial intelligence), an algorithmic
review, or review by an individual;
``(iv) the type of covered item or service;
``(v) the time that elapsed between when
the coverage request or the appeal of a denial
of a coverage request (as applicable) was filed
and when the MA organization reached a
determination as to such coverage request or
appeal, expressed in days and hours; and
``(vi) in the case of an appeal of a denial
of a coverage request, whether such appeal was
expedited.
``(D) Standards for publication.--The Secretary
shall establish standard definitions and reporting
formats for the information described in subparagraph
(B) to--
``(i) ensure that such information is
accurate, easy to compare, and consumer-
friendly; and
``(ii) to the greatest extent practicable,
ensure that the submission of such information
does not require an MA organization to seek
additional information from a health care
provider.
``(E) Publication by secretary.--On an annual
basis, the Secretary shall make available on the
website of the Department of Health and Human Services
the information submitted to the Secretary under
subparagraph (A).
``(F) Definitions.--In this paragraph:
``(i) Coverage request.--The term `coverage
request' means--
``(I) a claim for a covered item or
service; and
``(II) a prior authorization
request for a covered item or service.
``(ii) Covered item or service.--The term
`covered item or service' means, with respect
to an MA plan, an item or service for which
benefits are available under such plan.''.
<all>Official legislative text sourced from the public record (cached on CivicsHQ).
Official source
View the original bill, actions, and full legislative record on Congress.gov.
Status
In Committee
- 1Introduced
- 2Committee
- 3Floor
- 4Passed
- 5Signed
Timeline reflects current normalized status only. Full action history is not yet stored in the API.
Sponsors
- Rep. Hinson, Ashley [R-IA-2]RHouseIA
Cosponsors
No cosponsors on record.
Votes
Voting records are not yet available for this bill.