[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7267 Introduced in House (IH)]
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116th CONGRESS
2d Session
H. R. 7267
To amend title XXVII of the Public Health Service Act, the Employee
Retirement Income Security Act of 1974, and the Internal Revenue Code
of 1986 to prohibit a group health plan and a health insurance issuer
offering group or individual health insurance coverage from reducing
contracted rates, or terminating contracts, with health care providers
during a public health emergency.
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IN THE HOUSE OF REPRESENTATIVES
June 18, 2020
Ms. Porter (for herself and Ms. DeLauro) 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
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A BILL
To amend title XXVII of the Public Health Service Act, the Employee
Retirement Income Security Act of 1974, and the Internal Revenue Code
of 1986 to prohibit a group health plan and a health insurance issuer
offering group or individual health insurance coverage from reducing
contracted rates, or terminating contracts, with health care providers
during a public health emergency.
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 ``Patients Before Profits Act of
2020''.
SEC. 2. PROHIBITING A GROUP HEALTH PLAN AND A HEALTH INSURANCE ISSUER
OFFERING GROUP OR INDIVIDUAL HEALTH INSURANCE COVERAGE
FROM REDUCING CONTRACTED RATES, OR TERMINATING CONTRACTS,
WITH HEALTH CARE PROVIDERS DURING A PUBLIC HEALTH
EMERGENCY.
(a) PHSA.--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. PROHIBITION ON REDUCTION OF RATES AND TERMINATION OF
CONTRACTS DURING PUBLIC HEALTH EMERGENCIES.
``(a) In General.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage may not,
with respect to a health care provider located in an emergency area
during an emergency period that, as of the day before the date of the
beginning of such period, had in effect a contractual relationship for
furnishing items and services under such plan or coverage--
``(1) provide for an amount of reimbursement for any such
item or service furnished by such provider during such period
that is less than the amount of such reimbursement that would
have been payable under such plan or coverage had such item or
service been furnished by such provider on such day; or
``(2) terminate such relationship during such period;
unless such lesser reimbursement or such termination is based on fraud,
abuse, or other quality concerns with respect to such provider or such
provider being placed on the exclusion list maintained by the Inspector
General of the Department of Health and Human Services.
``(b) Definitions.--For purposes of this section, an `emergency
area' is a geographical area in which, and an `emergency period' is the
period during which, there exists a public health emergency declared by
the Secretary pursuant to section 319.''.
(b) ERISA.--
(1) 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. PROHIBITION ON REDUCTION OF RATES AND TERMINATION OF
CONTRACTS DURING PUBLIC HEALTH EMERGENCIES.
``(a) In General.--A group health plan and a health insurance
issuer offering group health insurance coverage may not, with respect
to a health care provider located in an emergency area during an
emergency period that, as of the day before the date of the beginning
of such period, had in effect a contractual relationship for furnishing
items and services under such plan or coverage--
``(1) provide for an amount of reimbursement for any such
item or service furnished by such provider during such period
that is less than the amount of such reimbursement that would
have been payable under such plan or coverage had such item or
service been furnished by such provider on such day; or
``(2) terminate such relationship during such period;
unless such lesser reimbursement or such termination is based on fraud,
abuse, or other quality concerns with respect to such provider or such
provider being placed on the exclusion list maintained by the Inspector
General of the Department of Health and Human Services.
``(b) Definitions.--For purposes of this section, an `emergency
area' is a geographical area in which, and an `emergency period' is the
period during which, there exists a public health emergency declared by
the Secretary pursuant to section 319.''.
(2) 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. Prohibition on reduction of rates and termination of
contracts during public health
emergencies.''.
(c) IRC.--
(1) 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. PROHIBITION ON REDUCTION OF RATES AND TERMINATION OF
CONTRACTS DURING PUBLIC HEALTH EMERGENCIES.
``(a) In General.--A group health plan may not, with respect to a
health care provider located in an emergency area during an emergency
period that, as of the day before the date of the beginning of such
period, had in effect a contractual relationship for furnishing items
and services under such plan--
``(1) provide for an amount of reimbursement for any such
item or service furnished by such provider during such period
that is less than the amount of such reimbursement that would
have been payable under such plan had such item or service been
furnished by such provider on such day; or
``(2) terminate such relationship during such period;
unless such lesser reimbursement or such termination is based on fraud,
abuse, or other quality concerns with respect to such provider or such
provider being placed on the exclusion list maintained by the Inspector
General of the Department of Health and Human Services.
``(b) Definitions.--For purposes of this section, an `emergency
area' is a geographical area in which, and an `emergency period' is the
period during which, there exists a public health emergency declared by
the Secretary pursuant to section 319.''.
(2) 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. Prohibition on reduction of rates and termination of
contracts during public health
emergencies.''.
(d) Effective Date.--The amendment made by this section shall apply
with respect to public health emergencies declared by the Secretary of
Health and Human Services on or after January 31, 2020, and items and
services furnished, and terminations occurring, on or after the date of
the enactment of this Act.
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