[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6005 Introduced in House (IH)]
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116th CONGRESS
2d Session
H. R. 6005
To amend title XXVII of the Public Health Service Act to increase
transparency of group health plans and health insurance issuers
offering group or individual health insurance coverage by removing gag
clauses on price and quality information, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 27, 2020
Mr. Malinowski (for himself and Mr. Bucshon) introduced the following
bill; which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XXVII of the Public Health Service Act to increase
transparency of group health plans and health insurance issuers
offering group or individual health insurance coverage by removing gag
clauses on price and quality information, and for other purposes.
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 the Price Act''.
SEC. 2. INCREASING TRANSPARENCY BY REMOVING GAG CLAUSES ON PRICE AND
QUALITY INFORMATION.
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:
``SEC. 2729A. INCREASING TRANSPARENCY BY REMOVING GAG CLAUSES ON PRICE
AND QUALITY INFORMATION.
``(a) Increasing Price and Quality Transparency for Plan Sponsors
and Consumers.--
``(1) Group health plans.--A group health plan or a health
insurance issuer offering group health insurance coverage may
not enter into an agreement with a health care provider,
network or association of providers, third-party administrator,
or other service provider offering access to a network of
providers that would directly or indirectly restrict a group
health plan or health insurance issuer from--
``(A) providing provider-specific cost or quality
of care information, through a consumer engagement tool
or any other means, to referring providers, the plan
sponsor, enrollees, or eligible enrollees of the plan
or coverage;
``(B) electronically accessing de-identified claims
and encounter data for each enrollee in the plan or
coverage, upon request and consistent with the privacy
regulations promulgated pursuant to section 264(c) of
the Health Insurance Portability and Accountability
Act, the amendments to this Act made by the Genetic
Information Nondiscrimination Act of 2008, and the
Americans with Disabilities Act of 1990, with respect
to the applicable health plan or health insurance
coverage, including, on a per claim basis--
``(i) financial information, such as the
allowed amount, or any other claim-related
financial obligations included in the provider
contract;
``(ii) provider information, including name
and clinical designation;
``(iii) service codes; or
``(iv) any other data element normally
included in claim or encounter transactions
when received by a plan or issuer; or
``(C) sharing data described in subparagraph (A) or
(B) with a business associate as defined in section
160.103 of title 45, Code of Federal Regulations (or
successor regulations), consistent with the privacy
regulations promulgated pursuant to section 264(c) of
the Health Insurance Portability and Accountability
Act, the amendments to this Act made by the Genetic
Information Nondiscrimination Act of 2008, and the
Americans with Disabilities Act of 1990.
``(2) Individual health insurance coverage.--A health
insurance issuer offering individual health insurance coverage
may not enter into an agreement with a health care provider,
network or association of providers, or other service provider
offering access to a network of providers that would, directly
or indirectly restrict the health insurance issuer from--
``(A) providing provider-specific price or quality
of care information, through a consumer engagement tool
or any other means, to referring providers or the plan
sponsor, enrollees, or eligible enrollees of the plan
or coverage; or
``(B) sharing data described in subparagraph (A)
with a business associate as defined in section 160.103
of title 45, Code of Federal Regulations (or successor
regulations), consistent with the privacy regulations
promulgated pursuant to section 264(c) of the Health
Insurance Portability and Accountability Act, the
amendments to this Act made by the Genetic Information
Nondiscrimination Act of 2008, and the Americans with
Disabilities Act of 1990, for plan design, plan
administration, and plan, financial, legal, and quality
improvement activities.
``(3) Clarification regarding public disclosure of
information.--Nothing in paragraph (1)(A) or (2)(A) prevents a
health care provider, network or association of providers, or
other service provider from placing reasonable restrictions on
the public disclosure of the information described in such
paragraphs (1) and (2).
``(4) Attestation.--A group health plan or a health
insurance issuer offering group or individual health insurance
coverage shall annually submit to, as applicable, the
applicable authority described in section 2723 or the Secretary
of Labor, an attestation that such plan or issuer is in
compliance with the requirements of this subsection.
``(5) Rule of construction.--Nothing in this section shall
be construed to otherwise limit group health plan or plan
sponsor access to data currently permitted under the privacy
regulations promulgated pursuant to section 264(c) of the
Health Insurance Portability and Accountability Act, the
amendments to this Act made by the Genetic Information
Nondiscrimination Act of 2008, and the Americans with
Disabilities Act of 1990.''.
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