[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5807 Introduced in House (IH)]
<DOC>
116th CONGRESS
2d Session
H. R. 5807
To amend title XXVII of the Public Health Service Act, the Internal
Revenue Code of 1986, the Employee Retirement Income Security Act of
1974, and title XI of the Social Security Act to improve the
availability and accuracy of provider directory information made
available by group health plans and health insurance issuers offering
group or individuals health insurance coverage.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 7, 2020
Mr. Larson of Connecticut (for himself and Mr. Wenstrup) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Ways and Means, and
Education and Labor, 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, the Internal
Revenue Code of 1986, the Employee Retirement Income Security Act of
1974, and title XI of the Social Security Act to improve the
availability and accuracy of provider directory information made
available by group health plans and health insurance issuers offering
group or individuals health insurance coverage.
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 ``Know Your Provider Act of 2020''.
SEC. 2. IMPROVING THE AVAILABILITY AND ACCURACY OF PROVIDER DIRECTORY
INFORMATION MADE AVAILABLE BY GROUP HEALTH PLANS AND
HEALTH INSURANCE ISSUERS OFFERING GROUP OR INDIVIDUALS
HEALTH INSURANCE COVERAGE.
(a) Group Health Plan and Health Insurance Issuer Requirements.--
(1) Public health service act.--Subpart II of part A of
title XXVII of the Public Health Service Act (42 U.S.C. 300gg-
11 et seq.) is amended by adding at the end the following new
section:
``SEC. 2730. PROVIDER DIRECTORY REQUIREMENTS.
``(a) In General.--Beginning not later than January 1, 2022, each
group health plan and health insurance issuer offering group or
individual health insurance coverage shall--
``(1) establish the verification process described in
subsection (b);
``(2) establish the response protocol described in
subsection (c);
``(3) establish the database described in subsection (d);
and
``(4) include in any directory (other than the database
described in paragraph (3)) containing provider directory
information with respect to such plan or such coverage the
information described in subsection (e).
``(b) Verification Process.--The verification process described in
this subsection is, with respect to a group health plan or a health
insurance issuer offering group or individual health insurance
coverage, a process--
``(1) under which such plan or such issuer (as applicable)
verifies and updates the provider directory information
included on the database described in subsection (d) of such
plan or issuer of--
``(A) not less frequently than once every 90 days,
a random sample of at least 10 percent of health care
providers and health care facilities included in such
database; and
``(B) any such provider or such facility included
in such database that has not submitted any claim to
such plan or such issuer (as applicable) during a 12-
month period;
``(2) that establishes a procedure for the removal from
such database of such a provider or facility with respect to
which such plan or issuer has been unable to verify such
information during a period specified by the plan or issuer;
and
``(3) that provides for the update of such database within
2 business days of such plan or such issuer (as applicable)
receiving from such a provider or facility information pursuant
to section 1150C of the Social Security Act.
``(c) Response Protocol.--The response protocol described in this
subsection is, in the case of an individual enrolled under a group
health plan or group or individual health insurance coverage offered by
a health insurance issuer who requests information through a telephone
call or email on whether a health care provider or health care facility
has a contractual relationship to furnish items and services under such
plan or such coverage, a protocol under which such plan or such issuer
(as applicable)--
``(1) responds to such individual as soon as practicable,
and in no case later than 1 business day after such call or
email is received, through a written electronic communication;
and
``(2) retains such communication in such individual's file
for at least 2 years following such response.
``(d) Database.--The database described in this subsection is, with
respect to a group health plan or health insurance issuer offering
group or individual health insurance coverage, a database on the public
website of such plan or issuer that contains--
``(1) a list of each health care provider and health care
facility with which such plan or such issuer has a contractual
relationship for furnishing items and services under such plan
or such coverage; and
``(2) provider directory information with respect to each
such provider and facility.
``(e) Information.--The information described in this subsection
is, with respect to a directory containing provider directory
information with respect to a group health plan or individual or group
health insurance coverage offered by a health insurance issuer, a
notification that such information contained in such directory was
accurate as of the date of publication of such directory and that an
individual enrolled under such plan or such coverage should consult the
database described in subsection (d) with respect to such plan or such
coverage or contact such plan or the issuer of such coverage to obtain
the most current provider directory information with respect to such
plan or such coverage.
``(f) Definition.--For purposes of this section, the term `provider
directory information' includes, with respect to a group health plan
and a health insurance issuer offering group or individual health
insurance coverage, the name, address, specialty, and telephone number
of each health care provider or health care facility with which such
plan or such issuer has a contractual relationship for furnishing items
and services under such plan or such coverage.''.
(2) Internal revenue code of 1986.--
(A) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by adding at
the end the following new section:
``SEC. 9816. PROVIDER DIRECTORY REQUIREMENTS.
``(a) In General.--Beginning not later than January 1, 2022, each
group health plan shall--
``(1) establish the verification process described in
subsection (b);
``(2) establish the response protocol described in
subsection (c);
``(3) establish the database described in subsection (d);
and
``(4) include in any directory (other than the database
described in paragraph (3)) containing provider directory
information with respect to such plan the information described
in subsection (e).
``(b) Verification Process.--The verification process described in
this subsection is, with respect to a group health plan, a process--
``(1) under which such plan verifies and updates the
provider directory information included on the database
described in subsection (d) of such plan of--
``(A) not less frequently than once every 90 days,
a random sample of at least 10 percent of health care
providers and health care facilities included in such
database; and
``(B) any such provider or such facility included
in such database that has not submitted any claim to
such plan during a 12-month period;
``(2) that establishes a procedure for the removal from
such database of such a provider or facility with respect to
which such plan has been unable to verify such information
during a period specified by the plan; and
``(3) that provides for the update of such database within
2 business days of such plan receiving from such a provider or
facility information pursuant to section 1150C of the Social
Security Act.
``(c) Response Protocol.--The response protocol described in this
subsection is, in the case of an individual enrolled under a group
health plan who requests information through a telephone call or email
on whether a health care provider or health care facility has a
contractual relationship to furnish items and services under such plan,
a protocol under which such plan--
``(1) responds to such individual as soon as practicable,
and in no case later than 1 business day after such call or
email is received, through a written electronic communication;
and
``(2) retains such communication in such individual's file
for at least 2 years following such response.
``(d) Database.--The database described in this subsection is, with
respect to a group health plan, a database on the public website of
such plan that contains--
``(1) a list of each health care provider and health care
facility with which such plan has a contractual relationship
for furnishing items and services under such plan; and
``(2) provider directory information with respect to each
such provider and facility.
``(e) Information.--The information described in this subsection
is, with respect to a directory containing provider directory
information with respect to a group health plan, a notification that
such information contained in such directory was accurate as of the
date of publication of such directory and that an individual enrolled
under such plan should consult the database described in subsection (d)
with respect to such plan or contact such plan to obtain the most
current provider directory information with respect to such plan.
``(f) Definition.--For purposes of this section, the term `provider
directory information' includes, with respect to a group health plan,
the name, address, specialty, and telephone number of each health care
provider or health care facility with which such plan has a contractual
relationship for furnishing items and services under such plan or such
coverage.''.
(B) Conforming amendment.--Section 9815(a) of the
Internal Revenue Code of 1986 is amended--
(i) in paragraph (1), by striking ``(as
amended by the Patient Protection and
Affordable Care Act)'' and inserting ``(other
than the provisions of section 2730 of such
Act)''; and
(ii) in paragraph (2), by inserting
``(other than the provisions of section 2730 of
such Act)'' after the first occurrence of
``such part A''.
(C) Clerical amendment.--The table of sections for
such subchapter is amended by adding at the end the
following new items:
``Sec. 9815. Additional market reforms.
``Sec. 9816. Provider directory requirements.''.
(3) Employee retirement income security act of 1974.--
(A) In general.--Subpart B of part 7 of subtitle B
of title I of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1185 et seq.) is amended by
adding at the end the following new section:
``SEC. 716. PROVIDER DIRECTORY REQUIREMENTS.
``(a) In General.--Beginning not later than January 1, 2022, each
group health plan and health insurance issuer offering group health
insurance coverage shall--
``(1) establish the verification process described in
subsection (b);
``(2) establish the response protocol described in
subsection (c);
``(3) establish the database described in subsection (d);
and
``(4) include in any directory (other than the database
described in paragraph (3)) containing provider directory
information with respect to such plan or such coverage the
information described in subsection (e).
``(b) Verification Process.--The verification process described in
this subsection is, with respect to a group health plan or a health
insurance issuer offering group health insurance coverage, a process--
``(1) under which such plan or such issuer (as applicable)
verifies and updates the provider directory information
included on the database described in subsection (d) of such
plan or issuer of--
``(A) not less frequently than once every 90 days,
a random sample of at least 10 percent of health care
providers and health care facilities included in such
database; and
``(B) any such provider or such facility included
in such database that has not submitted any claim to
such plan or such issuer (as applicable) during a 12-
month period;
``(2) that establishes a procedure for the removal from
such database of such a provider or facility with respect to
which such plan or issuer has been unable to verify such
information during a period specified by the plan or issuer;
and
``(3) that provides for the update of such database within
2 business days of such plan or such issuer (as applicable)
receiving from such a provider or facility information pursuant
to section 1150C of the Social Security Act.
``(c) Response Protocol.--The response protocol described in this
subsection is, in the case of an individual enrolled under a group
health plan or group health insurance coverage offered by a health
insurance issuer who requests information through a telephone call or
email on whether a health care provider or health care facility has a
contractual relationship to furnish items and services under such plan
or such coverage, a protocol under which such plan or such issuer (as
applicable)--
``(1) responds to such individual as soon as practicable,
and in no case later than 1 business day after such call or
email is received, through a written electronic communication;
and
``(2) retains such communication in such individual's file
for at least 2 years following such response.
``(d) Database.--The database described in this subsection is, with
respect to a group health plan or health insurance issuer offering
group health insurance coverage, a database on the public website of
such plan or issuer that contains--
``(1) a list of each health care provider and health care
facility with which such plan or such issuer has a contractual
relationship for furnishing items and services under such plan
or such coverage; and
``(2) provider directory information with respect to each
such provider and facility.
``(e) Information.--The information described in this subsection
is, with respect to a directory containing provider directory
information with respect to a group health plan or group health
insurance coverage offered by a health insurance issuer, a notification
that such information contained in such directory was accurate as of
the date of publication of such directory and that an individual
enrolled under such plan or such coverage should consult the database
described in subsection (d) with respect to such plan or such coverage
or contact such plan or the issuer of such coverage to obtain the most
current provider directory information with respect to such plan or
such coverage.
``(f) Definition.--For purposes of this section, the term `provider
directory information' includes, with respect to a group health plan
and a health insurance issuer offering group health insurance coverage,
the name, address, specialty, and telephone number of each health care
provider or health care facility with which such plan or such issuer
has a contractual relationship for furnishing items and services under
such plan or such coverage.''.
(B) Conforming amendment.--Section 715(a) of the
Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185d(a)) is amended--
(i) in paragraph (1), by striking ``(as
amended by the Patient Protection and
Affordable Care Act)'' and inserting ``(other
than the provisions of section 2730 of such
Act)''; and
(ii) in paragraph (2), by inserting
``(other than the provisions of section 2730 of
such Act)'' after the first occurrence of
``such part A''.
(C) Clerical amendment.--The table of contents in
section 1 of the Employee Retirement Income Security
Act of 1974 is amended by inserting after the item
relating to section 714 the following new items:
``Sec. 715. Additional market reforms.
``Sec. 716. Provider directory requirements.''.
(b) Health Care Providers.--Part A of title XI of the Social
Security Act (42 U.S.C. 13010 et seq.) is amended by adding at the end
the following new section:
``SEC. 1150C. SUBMISSION OF INFORMATION TO HEALTH PLANS OF CERTAIN
PROVIDER INFORMATION.
``(a) In General.--Beginning not later than 1 year after the date
of the enactment of this section, each health care provider and health
care facility shall establish a process under which such provider or
facility transmits, to each health insurance issuer offering group or
individual health insurance coverage and group health plan with which
such provider or supplier has in effect a contractual relationship for
furnishing items and services under such coverage or such plan,
provider directory information (as defined in section 2730(e) of the
Public Health Service Act, section 716(e) of the Employee Retirement
Income Security Act of 1974, or section 9816(e) of the Internal Revenue
Code of 1986, as applicable) with respect to such provider or facility,
as applicable. Such provider or facility shall so transmit such
information to such issuer offering such coverage or such group health
plan--
``(1) when there are any material changes (including a
change in address, telephone number, or other contact
information) to such provider directory information of the
provider or facility with respect to such coverage offered by
such issuer or with respect to such plan; and
``(2) at any other time (including upon the request of such
issuer or plan) determined appropriate by the provider,
facility, or the Secretary.
``(b) Penalty.--
``(1) In general.--Each health care provider or health care
facility that fails to transmit information as required under
subsection (a) shall be subject to a civil monetary penalty of
$1,000 for each day such provider or facility (as applicable)
fails to so transmit such information.
``(2) Application of provisions.--The provisions of section
1128A (other than subsection (a), subsection (b), the first
sentence of subsection (c)(1), subsection (d), and subsection
(o)) shall apply with respect to a civil monetary penalty
imposed under this subsection in the same manner as such
provisions apply with respect to a penalty or proceeding under
subsection (a) of such section.
``(c) Definitions.--In this section, the terms `health insurance
issuer', `group health plan', `group health insurance coverage', and
`individual health insurance coverage' have the meaning given such
terms, respectively, in section 2791 of the Public Health Service Act
(42 U.S.C. 300gg-91 et seq.).''.
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