[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4527 Reported in House (RH)]
<DOC>
Union Calendar No. 210
118th CONGRESS
1st Session
H. R. 4527
[Report No. 118-260]
To amend the Employee Retirement Income Security Act of 1974 to ensure
plan fiduciaries may access de-identified information relating to
health claims, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 11, 2023
Mrs. Chavez-DeRemer (for herself, Mr. Takano, and Ms. Manning)
introduced the following bill; which was referred to the Committee on
Education and the Workforce
November 1, 2023
Reported with an amendment, committed to the Committee of the Whole
House on the State of the Union, and ordered to be printed
[Strike out all after the enacting clause and insert the part printed
in italic]
[For text of introduced bill, see copy of bill as introduced on July
11, 2023]
_______________________________________________________________________
A BILL
To amend the Employee Retirement Income Security Act of 1974 to ensure
plan fiduciaries may access de-identified information relating to
health claims, 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 ``Health Data Access, Transparency,
and Affordability Act of 2023'' or the ``Health DATA Act of 2023''.
SEC. 2. PLAN FIDUCIARY ACCESS TO INFORMATION.
(a) In General.--Paragraph (2) of section 408(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1108(b)) is amended
by adding at the end the following new subparagraph:
``(C) No contract or arrangement for services between a
group health plan and any other entity, such as a health care
provider, network or association of providers, third-party
administrator, or pharmacy benefit manager, is reasonable
within the meaning of this paragraph unless such contract or
agreement--
``(i) allows the responsible plan fiduciary to
audit all de-identified claims and encounter
information or data described in section 724(a)(1)(B)
to--
``(I) ensure that such entity complies with
the terms of the plan and any applicable law;
and
``(II) determine the reasonableness of
compensation paid by the plan; and
``(ii) does not--
``(I) unreasonably limit the number of
audits permitted during a given period of time;
``(II) limit the number of de-identified
claims and encounter information or data that
the responsible plan fiduciary may access
during an audit;
``(III) limit the disclosure of pricing
terms for value based payment arrangements,
including--
``(aa) payment calculations and
formulas;
``(bb) quality measures;
``(cc) contract terms;
``(dd) payment amounts;
``(ee) measurement periods for all
incentives; and
``(ff) other payment methodologies
furnished by a health care provider,
network or association of providers,
third-party administrator, or pharmacy
benefit manager;
``(IV) limit the disclosure of overpayments
and overpayment recovery terms;
``(V) limit the right of the responsible
plan fiduciary to select an auditor;
``(VI) otherwise limit or unduly delay by
greater than 60 days the responsible plan
fiduciary from auditing such information or
data; or
``(VII) charge a fee beyond the reasonable
direct costs to administer the operation of
conducting such audits.''.
(b) Civil Enforcement.--
(1) In general.--Subsection (c) of section 502 of such Act
(29 U.S.C. 1132) is amended by adding at the end the following
new paragraph:
``(13) In the case of an agreement between a group health plan and
a health care provider, network or association of providers, third-
party administrator, pharmacy benefit manager, or other service
provider that violates the provisions of section 724, the Secretary may
assess a civil penalty against such provider, network or association,
third-party administrator, pharmacy benefit manager, or other service
provider in the amount of $10,000 for each day during which such
violation continues. Such penalty shall be in addition to other
penalties as may be prescribed by law.''.
(2) Conforming amendment.--Paragraph (6) of section 502(a)
of such Act is amended by striking ``or (9)'' and inserting
``(9), or (13)''; and
(c) Existing Provisions Void.--Section 410 of such Act is amended
by adding at the end the following new subsection:
``(c) Any provision in an agreement or instrument shall be void as
against public policy if such provision--
``(1) unduly delays or limits a plan fiduciary from
accessing the de-identified claims and encounter information or
data described in section 724(a)(1)(B); or
``(2) violates the requirements of section 408(b)(2)(C).''.
(d) Technical Amendment.--Clause (i) of section 408(b)(2)(B) of
such Act is amended by striking ``this clause'' and inserting ``this
paragraph''.
SEC. 3. UPDATED ATTESTATION FOR PRICE AND QUALITY INFORMATION.
Section 724(a)(3) of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1185m(a)(3)) is amended to read as follows:
``(3) Attestation.--
``(A) In general.--Subject to subparagraph (C), the
fiduciary of a group health plan or issuer offering
group health insurance coverage shall annually submit
to the Secretary an attestation that such plan or
issuer of such coverage is in compliance with the
requirements of this subsection. Such attestation shall
also include a statement verifying that--
``(i) the information or data described
under subparagraphs (A) and (B) of paragraph
(1) is available upon request and provided to
the plan fiduciary, the plan administrator, or
the issuer in a timely manner; and
``(ii) there are no terms in the agreement
under such paragraph (1) that directly or
indirectly restrict or unduly delay a plan
fiduciary, the plan administrator, or the
issuer from auditing, reviewing, or otherwise
accessing such information.
``(B) Limitation on submission.--Subject to clause
(ii), a group health plan or issuer offering group
health insurance coverage may not enter into an
agreement with a third-party administrator or other
service provider to submit the attestation required
under subparagraph (A).
``(C) Exception.--In the case of a group health
plan or issuer offering group health insurance coverage
that is unable to obtain the information or data needed
to submit the attestation required under subparagraph
(A), such plan or issuer may submit a written statement
in lieu of such attestation that includes--
``(i) an explanation of why such plan or
issuer was unsuccessful in obtaining such
information or data, including whether such
plan or issuer was limited or prevented from
auditing, reviewing, or otherwise accessing
such information or data;
``(ii) a description of the efforts made by
the plan fiduciary to remove any gag clause
provisions from the agreement under paragraph
(1); and
``(iii) a description of any response by
the third-party administrator or other service
provider with respect to efforts to comply with
the attestation requirement under subparagraph
(A).''.
SEC. 4. STUDY ON PLAN ASSETS.
Not later than 1 year after the date of enactment of this Act, the
Secretary of Labor shall submit to the Committee on Education and the
Workforce of the House of Representatives a report on the status of de-
identified claims and encounter information or data described in
section 724(a)(1)(B) of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1185m), including information on the following:
(1) Circumstances under current law where such information
or data could be deemed a group health plan asset (as defined
under section 3(42) of such Act).
(2) Whether restrictions on the ability of a plan fiduciary
to access such information or data violates a requirement of
current law.
(3) The existing regulatory authority of the Secretary to
clarify whether such information or data belongs to a group
health plan, rather than a service provider.
(4) Legislative actions that may be taken to establish that
such information or data related to a plan belongs to a group
health plan and is handled in the best interests of plan
participants and beneficiaries.
Union Calendar No. 210
118th CONGRESS
1st Session
H. R. 4527
[Report No. 118-260]
_______________________________________________________________________
A BILL
To amend the Employee Retirement Income Security Act of 1974 to ensure
plan fiduciaries may access de-identified information relating to
health claims, and for other purposes.
_______________________________________________________________________
November 1, 2023
Reported with an amendment, committed to the Committee of the Whole
House on the State of the Union, and ordered to be printed