[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7140 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 7140
To amend the Public Health Service Act, the Employee Retirement Income
Security Act of 1974, and the Internal Revenue Code of 1986 to require
group health plans and health insurance issuers offering group or
individual health insurance coverage to disclose the percentage of in-
network participation for certain provider types, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 30, 2024
Mr. Horsford 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 the Workforce, 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 the Public Health Service Act, the Employee Retirement Income
Security Act of 1974, and the Internal Revenue Code of 1986 to require
group health plans and health insurance issuers offering group or
individual health insurance coverage to disclose the percentage of in-
network participation for certain provider types, 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 ``Mental Health Transparency Act''.
SEC. 2. REQUIRING DISCLOSURE OF PERCENTAGE OF IN-NETWORK PARTICIPATION
FOR CERTAIN PROVIDER TYPES.
(a) PHSA.--Part D of title XXVII of the Public Health Service Act
(42 U.S.C. 300g-111 et seq.) is amended by adding at the end the
following new section:
``SEC. 2799A-11. REQUIRED DISCLOSURE OF PERCENTAGE OF IN-NETWORK
PARTICIPATION FOR CERTAIN PROVIDER TYPES.
``(a) In General.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage shall,
along with any summary of benefits and coverage provided under section
2715 (and in accordance with the timing and manner specified under such
section and the implementing regulations of such section), and on the
public website of such plan or issuer, make available the following
information with respect to each type of provider specified in
subsection (b):
``(1) The number and percentage of providers of such type
located in the service area of such plan or coverage that have
a contractual relationship (as defined by the Secretary) in
effect with such plan or coverage for furnishing items and
services under such plan or coverage, determined in accordance
with information made available by the Secretary under
subsection (d).
``(2) The designation established by the Secretary under
subsection (c) corresponding to the percentage described in
paragraph (1).
``(b) Specified Providers.--For purposes of this section, the types
of providers and facilities specified in this subsection are the
following (as defined by the Secretary and broken down by subspecialty
as specified by the Secretary):
``(1) Behavioral health care providers and facilities.
``(2) Substance use disorder treatment providers and
facilities.
``(c) Establishment of Designations of In-Network Participation.--
``(1) In general.--Not later than 1 year after the date of
the enactment of this section, the Secretary, in consultation
with the Secretaries of Labor and of the Treasury, shall
establish a system of designations (such as `high', `medium',
and `low', a star rating, or such other designation determined
appropriate by the Secretary) that correspond to ranges of
percentages (from 0 to 100) described in subsection (a)(1) to
qualitatively reflect the breadth of the networks of group
health plans and group and individual health insurance coverage
with respect to each type of provider specified in subsection
(b).
``(2) Variation permitted.--Designations corresponding to
percentage ranges established under paragraph (1) may vary by
type of service area (such as rural or urban), size of service
area, and other factors determined appropriate by the Secretary
in consultation with the Secretaries of Labor and of the
Treasury.
``(d) Information on Providers.--
``(1) In general.--Not later than June 30, 2026, the
Secretary, in consultation with the Secretaries of Labor and of
the Treasury, shall, based on information submitted under
section 2799B-10, post on the public website of the Department
of Health and Human Services, a list of each specified provider
in the country, including--
``(A) the location of each such provider in which
such provider furnishes items and services;
``(B) each specialty designation (if any) of each
such provider;
``(C) whether such provider treats individuals
under the age of 19; and
``(D) whether such provider accepts telehealth
appointments. The Secretary shall update the
information published under the previous sentence not
less frequently than annually.
The Secretary shall update the information published under this
paragraph not less frequently than annually.
``(2) Treatment of group practices.--For purposes of the
list described in paragraph (1), the Secretary shall list each
individual health care provider separately, regardless of
whether such provider is part of a group practice.
``(e) Service Area Definition.--For purposes of this section, the
term `service area' means, with respect to a group health plan and
group or individual health insurance coverage, the area or areas in
which in-person participants and beneficiaries are covered, as
determined by the plan or issuer of such coverage in accordance with
rules specified by the Secretary in consultation with the Secretaries
of Labor and of the Treasury.''.
(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 is
amended by adding at the end the following new section:
``SEC. 726. REQUIRED DISCLOSURE OF PERCENTAGE OF IN-NETWORK
PARTICIPATION FOR CERTAIN PROVIDER TYPES.
``(a) In General.--A group health plan and a health insurance
issuer offering group health insurance coverage shall, along with any
summary of benefits and coverage provided under section 2715 of the
Public Health Service Act (and in accordance with the timing and manner
specified under such section and the implementing regulations of such
section), and on the public website of such plan or issuer, make
available the following information with respect to each type of
provider specified in subsection (b):
``(1) The number and percentage of providers of such type
located in the service area of such plan or coverage that have
a contractual relationship (as defined by the Secretary) in
effect with such plan or coverage for furnishing items and
services under such plan or coverage, determined in accordance
with information made available by the Secretary under
subsection (d).
``(2) The designation established by the Secretary under
subsection (c) corresponding to the percentage described in
paragraph (1).
``(b) Specified Providers.--For purposes of this section, the types
of providers and facilities specified in this subsection are the
following (as defined by the Secretary and broken down by subspecialty
as specified by the Secretary):
``(1) Behavioral health care providers and facilities.
``(2) Substance use disorder treatment providers and
facilities.
``(c) Establishment of Designations of In-Network Participation.--
``(1) In general.--Not later than 1 year after the date of
the enactment of this section, the Secretary, in consultation
with the Secretaries of Health and Human Services and of the
Treasury, shall establish a system of designations (such as
`high', `medium', and `low', a star rating, or such other
designation determined appropriate by the Secretary) that
correspond to ranges of percentages (from 0 to 100) described
in subsection (a)(1) to qualitatively reflect the breadth of
the networks of group health plans and group health insurance
coverage with respect to each type of provider specified in
subsection (b).
``(2) Variation permitted.--Designations corresponding to
percentage ranges established under paragraph (1) may vary by
type of service area (such as rural or urban), size of service
area, and other factors determined appropriate by the Secretary
in consultation with the Secretaries of Health and Human
Services and of the Treasury.
``(d) Information on Providers.--
``(1) In general.--Not later than June 30, 2026, the
Secretary, in consultation with the Secretaries of Health and
Human Services and of the Treasury, shall, based on information
submitted under section 2799B-10, post on the public website of
the Department of Labor, a list of each specified provider in
the country, including--
``(A) the location of each such provider in which
such provider furnishes items and services;
``(B) each specialty designation (if any) of each
such provider;
``(C) whether such provider treats individuals
under the age of 19; and
``(D) whether such provider accepts telehealth
appointments. The Secretary shall update the
information published under the previous sentence not
less frequently than annually.
The Secretary shall update the information published under this
paragraph not less frequently than annually.
``(2) Treatment of group practices.--For purposes of the
list described in paragraph (1), the Secretary shall list each
individual health care provider separately, regardless of
whether such provider is part of a group practice.
``(e) Service Area Definition.--For purposes of this section, the
term `service area' means, with respect to a group health plan and
group health insurance coverage, the area or areas in which in-person
participants and beneficiaries are covered, as determined by the plan
or issuer of such coverage in accordance with rules specified by the
Secretary in consultation with the Secretaries of Health and Human
Services and of the Treasury.''.
(2) Technical amendment.--The table of contents in section
1 of such Act is amended by inserting after the item relating
to section 725 the following new item:
``Sec. 726. Required disclosure of percentage of in-network
participation for certain provider
types.''.
(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. 9826. REQUIRED DISCLOSURE OF PERCENTAGE OF IN-NETWORK
PARTICIPATION FOR CERTAIN PROVIDER TYPES.
``(a) In General.--A group health plan shall, along with any
summary of benefits and coverage provided under section 2715 of the
Public Health Service Act (and in accordance with the timing and manner
specified under such section and the implementing regulations of such
section), and on the public website of such plan, make available the
following information with respect to each type of provider specified
in subsection (b):
``(1) The number and percentage of providers of such type
located in the service area of such plan that have a
contractual relationship (as defined by the Secretary) in
effect with such plan for furnishing items and services under
such plan, determined in accordance with information made
available by the Secretary under subsection (d).
``(2) The designation established by the Secretary under
subsection (c) corresponding to the percentage described in
paragraph (1).
``(b) Specified Providers.--For purposes of this section, the types
of providers and facilities specified in this subsection are the
following (as defined by the Secretary and broken down by subspecialty
as specified by the Secretary):
``(1) Behavioral health care providers and facilities.
``(2) Substance use disorder treatment providers and
facilities.
``(c) Establishment of Designations of In-Network Participation.--
``(1) In general.--Not later than 1 year after the date of
the enactment of this section, the Secretary, in consultation
with the Secretaries of Health and Human Services and of Labor,
shall establish a system of designations (such as `high',
`medium', and `low', a star rating, or such other designation
determined appropriate by the Secretary) that correspond to
ranges of percentages (from 0 to 100) described in subsection
(a)(1) to qualitatively reflect the breadth of the networks of
group health plans with respect to each type of provider
specified in subsection (b).
``(2) Variation permitted.--Designations corresponding to
percentage ranges established under paragraph (1) may vary by
type of service area (such as rural or urban), size of service
area, and other factors determined appropriate by the Secretary
in consultation with the Secretaries of Health and Human
Services and of Labor.
``(d) Information on Providers.--
``(1) In general.--Not later than June 30, 2026, the
Secretary, in consultation with the Secretaries of Health and
Human Services and of Labor, shall, based on information
submitted under section 2799B-10, post on the public website of
the Department of the Treasury, a list of each specified
provider in the country, including--
``(A) the location of each such provider in which
such provider furnishes items and services;
``(B) each specialty designation (if any) of each
such provider;
``(C) whether such provider treats individuals
under the age of 19; and
``(D) whether such provider accepts telehealth
appointments. The Secretary shall update the
information published under the previous sentence not
less frequently than annually.
The Secretary shall update the information published under this
paragraph not less frequently than annually.
``(2) Treatment of group practices.--For purposes of the
list described in paragraph (1), the Secretary shall list each
individual health care provider separately, regardless of
whether such provider is part of a group practice.
``(e) Service Area Definition.--For purposes of this section, the
term `service area' means, with respect to a group health plan, the
area or areas in which in-person participants and beneficiaries are
covered, as determined by the plan in accordance with rules specified
by the Secretary in consultation with the Secretaries of Health and
Human Services and of Labor.''.
(2) Technical amendment.--The table of sections for such
subchapter is amended by adding at the end the following new
item:
``Sec. 9826. Required disclosure of percentage of in-network
participation for certain provider
types.''.
(d) Provider Requirements.--Part E of title XXVII of the Public
Health Service Act (42 U.S.C. 300gg-131 et seq.) is amended by adding
at the end the following new section:
``SEC. 2799B-10. PROVISION OF CERTAIN INFORMATION TO THE SECRETARY.
``(a) In General.--Subject to subsection (b), in the case of a
health care provider or health care facility that is a specified
provider (as described in subsection (b) of section 2799A-11), such
provider or facility shall, annually at a time and in a manner
specified by the Secretary, provide to the Secretary such information
as the Secretary determines necessary to carry out subsection (d) of
such section.
``(b) Exception.--Subsection (a) shall not apply in the case of a
specified provider that has not, during the 1-year period ending on the
date that information described in subsection (a) would be required to
be submitted to the Secretary by such provider without application of
this subsection, submitted any claim for an item or service under a
Federal health care program (as defined in section 1128B of the Social
Security Act), the program established under chapter 89 of title 5,
United States Code, or a group health plan or group or individual
health insurance coverage.''.
(e) Report.--Not later than December 31, 2027, and annually
thereafter, the Secretary of Health and Human Services shall submit to
Congress a report on the participation of behavioral health care and
substance use disorder treatment providers in networks established by
group health plan and health insurance issuers offering group or
individual health insurance coverage (as such terms are defined in
section 2791 of the Public Health Service Act (42 U.S.C. 300gg-91)).
Each such report shall include data and analysis relating to service
areas (as defined in section 2799A-11 of such Act) of such plans and
issuers that the Secretary has identified as having low participation
rates with respect to such providers' participation in such networks.
(f) Implementation.--The Secretaries of Labor, Health and Human
Services, and the Treasury may implement the amendments made by this
section through interim final rule, subregulatory guidance, program
instruction, or otherwise.
(g) Funding.--In addition to amounts otherwise available for such
purposes, there is appropriated $15,000,000, to remain available until
expended, for purposes of carrying out this section.
(h) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2027.
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