Requires Medicare Advantage plans that use prior authorization to report approval and denial data starting in 2027 and to run electronic request systems and meet enrollee protection standards starting in 2028.

• Starting in 2027, plans that use prior authorization must report yearly to the Secretary of Health and Human Services on approvals, denials, appeals, decision times, and any artificial intelligence or similar technology used in decisions, and CMS must publish the data by plan.
• Starting in 2028, plans must run an electronic prior authorization program for requests, responses, and supporting documents, and must meet enrollee protection standards such as transparent program design and annual reviews of covered services.
• Plans must give contracted providers their prior authorization criteria and documentation lists, and must give enrollees access to the criteria on request.
• The Secretary may set response timeframes, such as 24 hours, for expedited requests and real-time decisions, and MedPAC, GAO, HHS, and CMS must report to Congress on implementation.

• Energy and Commerce Committee (House)
• Ways and Means Committee (House)

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