Healthcare Accountability and Transparency Act

The Healthcare Accountability and Transparency Act enhances oversight of health insurers to protect patients and ensure fair practices. It emphasizes transparency, accountability, and timely access to care through increased regulations and financial penalties for insurers. The Act creates a State Oversight Board and imposes limits on executive compensation for insurers receiving public funds.

Key Provisions

  • Public Disclosure Requirements: Insurers must publish quarterly data on coverage denials, categorized by service type and denial reasons, to improve transparency.

  • Prior Authorization Deadlines: Strict deadlines for authorization decisions ensure timely access to care, with automatic approval for delayed responses.

  • Financial Accountability: Insurers are liable for harm caused by delays or wrongful denials and must compensate patients through a streamlined claims process.

  • State Oversight Board: Establishes a board to monitor insurer compliance, investigate unfair practices, and recommend penalties for violations.

  • Executive Compensation Cap: Caps executive pay for insurers receiving public funds to ensure alignment with public interests.

Model Language

Section 1: Short Title: This Act shall be known as the “Healthcare Accountability & Transparency Act.”

Section 2: Findings and Declarations

  1. Patients have a right to timely and equitable access to medically necessary care.

  2. Insurance companies must be held accountable for practices that delay or deny necessary care, causing harm to patients.

  3. Increased transparency and oversight of insurance operations are necessary to protect public interests and ensure fair treatment of consumers.

Section 3: Definitions

  1. Prior Authorization: The process by which insurers approve or deny coverage for medical services before they are provided.

  2. Coverage Denial: A decision by an insurer to refuse payment for a medical service, medication, or procedure.

  3. Public Funds: Any state or federal funds received by an insurer to provide healthcare services or subsidies.

Section 4: Public Disclosure of Coverage Denials

  1. Health insurers must publicly disclose quarterly data on coverage denials, including:

    1. Total number of denials.

    2. Categories of denied services (e.g., prescriptions, procedures).

    3. Reasons for denials.

  2. Data must be published in a format accessible to the public and submitted to the State Oversight Board.

Section 5: Deadlines for Prior Authorization Decisions

  1. Insurers must respond to prior authorization requests within:

    1. 24 hours for urgent care requests.

    2. 72 hours for non-urgent care requests.

  2. Failure to meet these deadlines will result in automatic approval of the requested service.

Section 6: Financial Accountability for Delays and Denials

  1. Insurers shall be financially liable for patient harm caused by delays or wrongful denials of care.

  2. Patients harmed by insurer decisions may seek compensation through an expedited state-administered claims process.

Section 7: Establishment of a State Oversight Board

  1. A State Oversight Board shall be established to:

    1. Investigate patterns of unfair practices by insurers.

    2. Audit compliance with disclosure and prior authorization requirements.

    3. Recommend penalties for non-compliance.

  2. The Board shall publish an annual report on insurer performance and compliance.

    Section 8: Cap on Executive Compensation: Insurers receiving public funds must cap executive compensation at a multiple of no more than 15 times the median employee salary.

Section 9: Enforcement and Penalties: Non-compliance with provisions of this Act shall result in fines, suspension of licenses, or other penalties as determined by the State Oversight Board.

Section 10: Severability: If any provision of this Act is found invalid, the remaining provisions shall remain in full force and effect.

Download Model Bill Language