[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2861 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 2861
To require the Government Accountability Office to evaluate the effects
of anticompetitive contracting clauses in contracts between health
insurers and health care providers and to determine actions taken by
the Federal Trade Commission and the Department of Justice relating to
the use of such clauses in such contracts and to assess their ability
to effectively enforce the Federal antitrust laws with respect to such
use.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 25, 2023
Mrs. Spartz introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
the Judiciary, 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 require the Government Accountability Office to evaluate the effects
of anticompetitive contracting clauses in contracts between health
insurers and health care providers and to determine actions taken by
the Federal Trade Commission and the Department of Justice relating to
the use of such clauses in such contracts and to assess their ability
to effectively enforce the Federal antitrust laws with respect to such
use.
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 ``Addressing Anti-Competitive Health
Care Contract Clauses Act''.
SEC. 2. GAO STUDY.
(a) Study.--Not later than 18 months after the date of the
enactment of this Act, the Comptroller General of the United States, in
coordination with the Federal Trade Commission and the Assistant
Attorney General of the Antitrust Division of the Department of
Justice, shall carry out a study that--
(1) evaluates the effect of anticompetitive contract
clauses known as anti-steering clauses, anti-tiering clauses,
all-or-nothing clauses, and gag clauses in contracts between
health insurers and health care providers, including the
effects such contracts have on consolidation in the health care
industry, prices paid by consumers for medical services, and
consumer access to health care,
(2) contains a list of all actions the Federal Trade
Commission and the Department of Justice have taken directly or
indirectly related to use of such contract clauses in contracts
between health insurers and health care providers,
(3) contains an assessment of whether the Federal Trade
Commission and the Department of Justice have the resources and
the capability to effectively enforce the Federal antitrust
laws as applied to the use of such clauses in such contracts,
and
(4) includes recommendations for legislative or
administrative actions if necessary to increase such resources.
(b) Report.--The report containing the results of the study carried
out under subsection (a) shall be submitted timely by the Comptroller
General as follows:
(1) To--
(A) the Committee on Energy and Commerce,
(B) the Committee on Ways and Means,
(C) the Committee on Education and the Workforce,
and
(D) the Committee on the Judiciary,
of the House of Representatives.
(2) To--
(A) The Committee on Health, Education, Labor, and
Pensions, and
(B) The Committee on the Judiciary,
of the Senate.
SEC. 3. DEFINITIONS.
For purposes of this Act:
(1) All-or-nothing clause.--The term ``all-or-nothing
clause'' means a provision of a health care contract that
requires--
(A) a health insurance carrier or health plan
administrator to include all members of a health care
provider in a network plan; or
(B) a health insurance carrier or health plan
administrator to enter into an additional contract with
an affiliate of the health care provider as a condition
of entering into a contract with such health care
provider.
(2) Anti-steering clause.--The term ``anti-steering
clause'' means a provision of a health care contract that
restricts the ability of a health insurance carrier or a health
plan administrator from encouraging an enrollee to obtain a
health care service from a competitor of the hospital or health
system, including offering incentives to encourage enrollees to
utilize specific health care providers.
(3) Anti-tiering clause.--The term ``anti-tiering clause''
means a provision in a health care contract that--
(A) restricts the ability of a health insurance
carrier or a health plan administrator to introduce or
modify a tiered network plan or assign health care
providers into tiers; or
(B) requires the health insurance carrier or health
plan administrator to place all members of a health
care provider in the same tier of a tiered network
plan.
(4) Gag clause.--The term ``gag clause'' means a provision
of a health care contract that--
(A) restricts the ability of a health insurance
carrier, a health plan administrator, or a health care
provider to disclose a price or quality information,
including the allowed amount, negotiated rates or
discounts, fees for services, or any other claim-
related financial obligations included in the provider
contract to--
(i) a governmental entity as authorized by
law,
(ii) its contractors or agents,
(iii) an enrollee,
(iv) a treating health care provider of an
enrollee,
(v) a plan sponsor, or
(vi) potential eligible enrollees and plan
sponsors; or
(B) restricts the ability of a health insurance
carrier, a health plan administrator, or a health care
provider to disclose out-of-pocket costs to an
enrollee.
(5) Tiered network plan.--The term ``tiered network plan''
means a health benefit plan that sorts some or all types of
health care providers into specific groups to which different
provider reimbursement, enrollee cost sharing, health care
provider access requirements, or a combination thereof, are
applied for the same services.
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