[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3548 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 3548
To amend the Public Health Service Act to provide for hospital and
insurer price transparency.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 14, 2023
Mr. Braun (for himself, Mr. Sanders, Ms. Smith, and Mr. Hickenlooper)
introduced the following bill; which was read twice and referred to the
Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to provide for hospital and
insurer price transparency.
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 Care Prices Revealed and
Information to Consumers Explained Transparency Act'' or the ``Health
Care PRICE Transparency Act 2.0''.
SEC. 2. STRENGTHENING HOSPITAL PRICE TRANSPARENCY REQUIREMENTS.
(a) In General.--Section 2718(e) of the Public Health Service Act
(42 U.S.C. 300gg-18(e)) is amended to read as follows:
``(e) Standard Hospital Charges.--
``(1) In general.--
``(A) Disclosure of standard charges.--For purposes
of paragraph (1), the price transparency requirement
described in this paragraph is, with respect to a
hospital, that such hospital, in accordance with a
method and format established by the Secretary under
subparagraph (C), compile and make public (without
subscription and free of charge) for each month--
``(i) all of the hospital's standard
charges (including the information described in
subparagraph (B)) for each item and service
furnished by such hospital; and
``(ii) information in a consumer-friendly
format (as specified by the Secretary)--
``(I) on the hospital's prices
(including the information described in
subparagraph (B)) for as many of the
Centers for Medicare & Medicaid
Services-specified shoppable services
that are furnished by the hospital, and
as many additional hospital-selected
shoppable services (or all such
additional services, if such hospital
furnishes fewer than 300 shoppable
services) as may be necessary for a
combined total of at least 300
shoppable services through December 31,
2024, after which the hospital's prices
shall include all shoppable services;
and
``(II) that includes, with respect
to each Centers for Medicare & Medicaid
Services-specified shoppable service
that is not furnished by the hospital,
an indication that such service is not
so furnished.
``(B) Standard charges described.--For purposes of
subparagraph (A), the information described in this
subparagraph is, with respect to standard charges and
prices, as applicable, made public by a hospital, the
following:
``(i) A plain language description of each
item or service, accompanied by any applicable
billing codes, including modifiers, using
commonly recognized billing code sets,
including the Current Procedural Terminology
code, the Healthcare Common Procedure Coding
System code, the diagnosis-related group, the
National Drug Code, and other nationally
recognized identifier.
``(ii) The gross charge, as applicable,
expressed as a dollar amount, for each such
item or service, when provided in, as
applicable, the inpatient setting and
outpatient department setting.
``(iii) The discounted cash price, as
applicable, expressed as a dollar amount, for
each such item or service when provided in, as
applicable, the inpatient setting and
outpatient department setting (or, in the case
no discounted cash price is available for an
item or service, the minimum cash price
accepted by the hospital from self-pay
individuals for such item or service, expressed
as a dollar amount, as well as, with respect to
prices made public pursuant to subparagraph
(A)(ii), a link to a consumer-friendly document
that clearly explains the hospital's charity
care policy). The hospital shall accept the
discounted cash price as payment in full from
any patient that chooses to pay in cash without
regard to the patient's coverage.
``(iv) The payer-specific negotiated
charges, expressed as a dollar amount and
clearly associated with the name of the
applicable third party payer and name of each
plan, that apply to each such item or service
when provided in, as applicable, the inpatient
setting and outpatient department setting. If
the charges are based on an algorithm,
percentage of another amount, or other formula
or criteria, the hospital also shall disclose
such algorithm, percentage, formula, or
criteria as set forth in its contract and any
other terms, schedules, exhibits, data, or
other information referenced in any such
contract as shall be required to determine and
disclose the negotiated charge.
``(v) The de-identified maximum and minimum
negotiated charges, as applicable, for each
such item or service, expressed as a non-zero
dollar amount.
``(vi) Any other additional information the
Secretary may require for the purpose of
improving the accuracy of, or enabling
consumers to easily understand and compare,
standard charges and prices for an item or
service, except information that is duplicative
of any other reporting requirement under this
subsection. In the case of standard charges and
prices for an item or service included as part
of a bundled, per diem, episodic, or other
similar arrangement, the information described
in this subparagraph shall be made available as
determined appropriate by the Secretary.
``(C) Uniform method and format.--Not later than
January 1, 2025, the Secretary shall establish a
standard, uniform method and format for hospitals to
use in compiling and making public standard charges
pursuant to subparagraph (A)(i) and a standard, uniform
method and format for such hospitals to use in
compiling and making public prices pursuant to
subparagraph (A)(ii). Such methods and formats--
``(i) shall, in the case of such method and
format for making public standard charges
pursuant to subparagraph (A)(i), ensure that
such charges are made available in a machine-
readable spreadsheet format;
``(ii) may be similar to any template made
available by the Centers for Medicare &
Medicaid Services as of the date of the
enactment of this subparagraph;
``(iii) shall meet such standards as
determined appropriate by the Secretary in
order to ensure the accessibility and usability
of such charges and prices; and
``(iv) shall be updated as determined
appropriate by the Secretary, in consultation
with stakeholders.
``(2) No deemed compliance.--The availability of a price
estimator tool shall not be considered to deem compliance with
or otherwise vitiate the requirements of paragraph (2)(A)(ii)
or any other requirements of this section. Furthermore, the use
of an estimator tool shall not be used for purposes of
compliance with any provisions in this Section.
``(3) Monitoring compliance.--The Secretary shall, in
consultation with the Inspector General of the Department of
Health and Human Services, establish a process to monitor
compliance with this subsection. Such process shall ensure that
each hospital's compliance with this subsection is reviewed not
less frequently than once every year.
``(4) Attestation.--A senior official from each hospital
(the Chief Executive Officer, Chief Financial Officer, or an
official of equivalent seniority) shall attest to the accuracy
and completeness of the disclosures made in accordance with the
hospital price transparency requirements set forth in this
regulation. Such attestation shall be deemed to be material to
payment from the Federal Government to the hospital.
``(5) Enforcement.--
``(A) In general.--In the case of a hospital that
fails to comply with the requirements of this
subsection, not later than 30 days after the date on
which the Secretary determines such failure exists, the
Secretary shall submit to such hospital a notification
of such determination, which shall include a request
for a corrective action plan to comply with such
requirements.
``(B) Civil monetary penalty.--
``(i) In general.--In addition to any other
enforcement actions or penalties that may apply
under another provision of law, a hospital that
has received a request for a corrective action
plan under subparagraph (A) and fails to comply
with the requirements of this subsection by the
date that is 45 days after such request is made
shall be subject to a civil monetary penalty of
an amount specified by the Secretary for each
day (beginning with the day on which the
Secretary first determined that such hospital
was not complying with such requirements)
during which such failure was ongoing. Such
amount shall not exceed--
``(I) in the case of a hospital
with 30 or fewer beds, $300 per day;
``(II) in the case of a hospital
with more than 30 beds but fewer than
101 beds, $10 per bed per day (or, in
the case of such a hospital that has
been noncompliant with such
requirements for a 1-year period or
longer, beginning with the first day
following such 1-year period, $12.50
per bed per day);
``(III) in the case of a hospital
with more than 100 beds but fewer than
301 beds, $15 per bed per day (or, in
the case of such a hospital that has
been noncompliant with such
requirements for a 1-year period or
longer, beginning with the first day
following such 1-year period, $17.50
per bed per day);
``(IV) in the case of a hospital
with more than 300 beds but fewer than
501 beds, $20 per bed per day (or, in
the case of such a hospital that has
been noncompliant with such
requirements for a 1-year period or
longer, beginning with the first day
following such 1-year period, $25 per
bed per day); and
``(V) in the case of a hospital
with more than 500 beds, $25 per bed
per day (or, in the case of such a
hospital that has been noncompliant
with such requirements for a 1-year
period or longer, beginning with the
first day following such 1-year period,
$35 per bed per day).
``(ii) Increase authority.--In applying
this subparagraph with respect to violations
occurring in 2027 or a subsequent year, the
Secretary may through notice and comment
rulemaking increase--
``(I) the limitation on the per day
amount of any penalty applicable to a
hospital under clause (i)(I);
``(II) the limitations on the per
bed per day amount of any penalty
applicable under any of subclauses (II)
through (V) of clause (i); and
``(III) the limitation on the
increase of any penalty applied under
clause (iii) pursuant to the amounts
specified in subclause (II) of such
clause.
``(iii) Persistent noncompliance.--
``(I) In general.--In the case of a
hospital that the Secretary has
determined to be knowingly and
willfully noncompliant with the
provisions of this subsection two or
more times during a 1-year period, the
Secretary may increase any penalty
otherwise applicable under this
subparagraph by the amount specified in
subclause (II) with respect to such
hospital and may require such hospital
to complete such additional corrective
actions plans as the Secretary may
specify.
``(II) Specified amount.--For
purposes of subclause (I), the amount
specified in this subclause is, with
respect to a hospital--
``(aa) with more than 30
beds but fewer than 101 beds,
an amount that is not less than
$500,000 and not more than
$1,000,000;
``(bb) with more than 100
beds but fewer than 301 beds,
an amount that is greater than
$1,000,000 and not more than
$2,000,000;
``(cc) with more than 300
beds but fewer than 501 beds,
an amount that is greater than
$2,000,000 and not more than
$4,000,000; and
``(dd) with more than 500
beds, and amount that is not
less than $5,000,000 and not
more than $10,000,000.
``(iv) Provision of technical assistance.--
The Secretary may, to the extent practicable,
provide technical assistance relating to
compliance with the provisions of this section
to hospitals requesting such assistance.
``(v) Application of certain provisions.--
The provisions of section 1128A (other than
subsections (a) and (b) of such section) shall
apply to a civil monetary penalty imposed under
this subparagraph in the same manner as such
provisions apply to a civil monetary penalty
imposed under subsection (a) of such section.
``(C) No waiver.--The Secretary shall not grant or
extend any waiver, delay, tolling, or other mitigation
of a civil monetary penalty for violation of this
subsection.
``(6) Definitions.--For purposes of this subsection:
``(A) Discounted cash price.--The term `discounted
cash price' means the minimum charge that the hospital
accepts from an individual who pays cash, or cash
equivalent, for a hospital-furnished item or service.
``(B) Gross charge.--The term `gross charge' means
the charge for an individual item or service that is
reflected on a hospital's chargemaster, absent any
discounts.
``(C) Hospital.--The term `hospital' means a
hospital (as defined in section 1861(e) of the Social
Security Act), a critical access hospital (as defined
in section 1861(mmm)(1) of the Social Security Act), or
a rural emergency hospital (as defined in section
1861(kkk) of the Social Security Act), together with
any parent, subsidiary, or other affiliated provider or
supplier of health care items and services without
regard to whether such parent, subsidiary, or other
affiliated provider or supplier operates under separate
licensure, certification, or designation.
``(D) Payer-specific negotiated charge.--The term
`payer-specific negotiated charge' means the charge
that a hospital has negotiated with a third party payer
for an item or service.
``(E) Shoppable service.--The term `shoppable
service' means a service that can be scheduled by a
health care consumer in advance and includes all
ancillary items and services customarily furnished as
part of such service.
``(F) Third party payer.--The term `third party
payer' means an entity that is, by statute, contract,
or agreement, legally responsible for payment of a
claim for a health care item or service.''.
(b) Effective Date.--
(1) In general.--The amendments made by subsection (a)
shall apply beginning January 1, 2025.
(2) Continued applicability of rules for previous years.--
Nothing in the amendments made by this section may be construed
as affecting the applicability of the regulations codified at
part 180 of title 45, Code of Federal Regulations, before
January 1, 2025.
(c) Continued Applicability of State Law.--The provisions of this
Act shall not supersede any provision of State law that establishes,
implements, or continues in effect any requirement or prohibition
related to health care price transparency, except to the extent that
such requirement or prohibition prevents the application of a
requirement or prohibition of this Act.
SEC. 3. INCREASING PRICE TRANSPARENCY OF CLINICAL DIAGNOSTIC LABORATORY
TESTS UNDER THE MEDICARE PROGRAM.
Section 2718 of the Public Health Service Act (42 U.S.C. 300gg-18)
is amended by adding at the end the following:
``(f) Clinical Diagnostic Laboratory Price Transparency.--
``(1) In general.--Beginning January 1, 2025, any
applicable laboratory that receives payment from a group health
plan or health insurance issuer for furnishing any specified
clinical diagnostic laboratory test shall--
``(A) make publicly available on an internet
website the information described in paragraph (2) with
respect to each such specified clinical diagnostic
laboratory test that such laboratory so furnishes; and
``(B) ensure that such information is updated not
less frequently than annually.
``(2) Information described.--For purposes of paragraph
(1), the information described in this paragraph is, with
respect to an applicable laboratory and a specified clinical
diagnostic laboratory test, the following:
``(A) A plain language description of each item or
service, accompanied by any applicable billing codes,
including modifiers, using commonly recognized billing
code sets, including the Current Procedural Terminology
code, the Healthcare Common Procedure Coding System
code, the diagnosis-related group, the National Drug
Code, and other nationally recognized identifier.
``(B) The gross charge, as applicable, expressed as
a dollar amount, for each such item or service.
``(C) The discounted cash price, as applicable,
expressed as a dollar amount, for each such item or
service (or, in the case no discounted cash price is
available for an item or service, the minimum cash
price accepted by the laboratory from self-pay
individuals for such item or service when provided in
such settings for the previous three years, expressed
as a dollar amount, as well as, with respect to prices
made public pursuant to subparagraph (A)(ii), a link to
a consumer-friendly document that clearly explains the
laboratory's charity care policy). The laboratory shall
accept the discounted cash price as payment in full
from any patient that chooses to pay in cash without
regard to the patient's coverage.
``(D) The payer-specific negotiated charges,
expressed as a dollar amount and clearly associated
with the name of the applicable third party payer and
name of each plan, that apply to each such item or
service when provided in, as applicable, the inpatient
setting and outpatient department setting. If the
charges are based on an algorithm, percentage of
another amount, or other formula or criteria, the
clinical diagnostic laboratory also shall disclose such
algorithm, percentage, formula, or criteria as set
forth in its contract and any other terms, schedules,
exhibits, data, or other information referenced in any
such contract as shall be required to determine and
disclose the negotiated charge.
``(E) The de-identified maximum and minimum
negotiated charges, as applicable, for each such item
or service, expressed as a non-zero dollar amount.
``(F) Any other additional information the
Secretary may require for the purpose of improving the
accuracy of, or enabling consumers to easily understand
and compare, standard charges and prices for an item or
service, except information that is duplicative of any
other reporting requirement under this subsection. In
the case of standard charges and prices for an item or
service included as part of a bundled, per diem,
episodic, or other similar arrangement, the information
described in this subparagraph shall be made available
as determined appropriate by the Secretary.
``(3) Uniform method and format.--Not later than January 1,
2025, the Secretary shall establish a standard, uniform method
and format for applicable laboratories to use in compiling and
making public information pursuant to paragraph (1). Such
method and format--
``(A) shall include a machine-readable spreadsheet
format containing the information described in
paragraph (2) for all items and services furnished by
each laboratory;
``(B) may be similar to any template made available
by the Centers for Medicare & Medicaid Services (as
described in subsection (e));
``(C) shall meet such standards as determined
appropriate by the Secretary in order to ensure the
accessibility and usability of such information; and
``(D) shall be updated as determined appropriate by
the Secretary, in consultation with stakeholders.
``(4) Inclusion of ancillary services.--Any price or rate
for a specified clinical diagnostic laboratory test available
to be furnished by an applicable laboratory made publicly
available in accordance with paragraph (1) shall include the
price or rate (as applicable) for any ancillary item or service
(such as specimen collection services) that would normally be
furnished by such laboratory as part of such test, as specified
by the Secretary.
``(5) Enforcement.--
``(A) In general.--In the case that the Secretary
determines that an applicable laboratory is not in
compliance with paragraph (1)--
``(i) not later than 30 days after such
determination, the Secretary shall notify such
laboratory of such determination; and
``(ii) if such laboratory continues to fail
to comply with such paragraph after the date
that is 90 days after such notification is
sent, the Secretary may impose a civil monetary
penalty in an amount not to exceed $300 for
each (beginning with the day on which the
Secretary first determined that such laboratory
was failing to comply with such paragraph)
during which such failure is ongoing.
``(B) Increase authority.--In applying this
paragraph with respect to violations occurring in 2025
or a subsequent year, the Secretary may through notice
and comment rulemaking increase the per day limitation
on civil monetary penalties under subparagraph (A)(ii).
``(C) Application of certain provisions.--The
provisions of section 1128A of the Social Security Act
(other than subsections (a) and (b) of such section)
shall apply to a civil monetary penalty imposed under
this paragraph in the same manner as such provisions
apply to a civil monetary penalty imposed under
subsection (a) of such section.
``(6) Provision of technical assistance.--The Secretary
shall, to the extent practicable, provide technical assistance
relating to compliance with the provisions of this subsection
to applicable laboratories requesting such assistance.
``(7) Definitions.--In this subsection:
``(A) Applicable laboratory.--The term `applicable
laboratory' has the meaning given such term in section
414.502, of title 42, Code of Federal Regulations (or a
successor regulation), except that such term does not
include a laboratory with respect to which standard
charges and prices for specified clinical diagnostic
laboratory tests furnished by such laboratory are made
available by a hospital pursuant to subsection (e).
``(B) Discounted cash price.--The term `discounted
cash price' means the charge that applies to an
individual who pays cash, or cash equivalent, for an
item or service.
``(C) Gross charge.--The term `gross charge' means
the charge for an individual item or service that is
reflected on an applicable laboratory's chargemaster,
absent any discounts.
``(D) Payer-specific negotiated charge.--The term
`payer-specific negotiated charge' means the charge
that an applicable laboratory has negotiated with a
third party payer for an item or service.
``(E) Specified clinical diagnostic laboratory
test.--The term `specified clinical diagnostic
laboratory test' means a clinical diagnostic laboratory
test that is included on the list of shoppable services
specified by the Centers for Medicare & Medicaid
Services (as described in subsection (e)), other than
such a test that is only available to be furnished by a
single provider of services or supplier.
``(F) Third party payer.--The term `third party
payer' means an entity that is, by statute, contract,
or agreement, legally responsible for payment of a
claim for a health care item or service.''.
SEC. 4. IMAGING TRANSPARENCY.
Section 2718 of the Public Health Service Act (42 U.S.C. 300gg-18),
as amended by section 3, is further amended by adding at the end the
following:
``(g) Imaging Services Price Transparency.--
``(1) In general.--Beginning January 1, 2025, each provider
of services and supplier that receives payment from a group
health plan or health insurance issuer for furnishing a
specified imaging service, other than such a provider or
supplier with respect to which standard charges and prices for
such services furnished by such provider or supplier are made
available by a hospital pursuant to subsection (e), shall--
``(A) make publicly available (in accordance with
paragraph (3)) on an internet website the information
described in paragraph (2) with respect to each such
service that such provider of services or supplier
furnishes; and
``(B) ensure that such information is updated not
less frequently than annually.
``(2) Information described.--For purposes of paragraph
(1), the information described in this paragraph is, with
respect to a provider of services or supplier and a specified
imaging service, the following:
``(A) A plain language description of each item or
service, accompanied by any applicable billing codes,
including modifiers, using commonly recognized billing
code sets, including the Current Procedural Terminology
code, the Healthcare Common Procedure Coding System
code, the diagnosis-related group, the National Drug
Code, and other nationally recognized identifier.
``(B) The gross charge, as applicable, expressed as
a dollar amount, for each such item or service.
``(C) The discounted cash price, as applicable,
expressed as a dollar amount, for each such item or
service (or, in the case no discounted cash price is
available for an item or service, the minimum cash
price accepted by the provider of services or supplier
from self-pay individuals for such item or service when
provided in such settings for the previous three years,
expressed as a dollar amount, as well as, with respect
to prices made public pursuant to subparagraph (A)(ii),
a link to a consumer-friendly document that clearly
explains the provider of services or supplier's charity
care policy). The provider of services or supplier
shall accept the discounted cash price as payment in
full from any patient that chooses to pay in cash
without regard to the patient's coverage.
``(D) The payer-specific negotiated charges,
expressed as a dollar amount and clearly associated
with the name of the applicable third party payer and
name of each plan, that apply to each such item or
service when provided in, as applicable, the inpatient
setting and outpatient department setting. If the
charges are based on an algorithm, percentage of
another amount, or other formula or criteria, the
provider or supplier also shall disclose such
algorithm, percentage, formula, or criteria as set
forth in its contract and any other terms, schedules,
exhibits, data, or other information referenced in any
such contract as shall be required to determine and
disclose the negotiated charge.
``(E) The de-identified maximum and minimum
negotiated charges, as applicable, for each such item
or service, expressed as a non-zero dollar amount.
``(F) Any other additional information the
Secretary may require for the purpose of improving the
accuracy of, or enabling consumers to easily understand
and compare, standard charges and prices for an item or
service, except information that is duplicative of any
other reporting requirement under this subsection. In
the case of standard charges and prices for an item or
service included as part of a bundled, per diem,
episodic, or other similar arrangement, the information
described in this subparagraph shall be made available
as determined appropriate by the Secretary.
``(3) Uniform method and format.--Not later than January 1,
2025, the Secretary shall establish a standard, uniform method
and format for providers of services and suppliers to use in
making public information described in paragraph (2). Any such
method and format--
``(A) shall include a machine-readable spreadsheet
format containing the information described in
paragraph (2) for all items and services furnished by
each provider of services and supplier described in
paragraph (1);
``(B) may be similar to any template made available
by the Centers for Medicare & Medicaid Services (as
described in subsection (e));
``(C) shall meet such standards as determined
appropriate by the Secretary in order to ensure the
accessibility and usability of such information; and
``(D) shall be updated as determined appropriate by
the Secretary, in consultation with stakeholders.
``(4) Monitoring compliance.--The Secretary shall, through
notice and comment rulemaking and in consultation with the
Inspector General of the Department of Health and Human
Services, establish a process to monitor compliance with this
subsection.
``(5) Enforcement.--
``(A) In general.--In the case that the Secretary
determines that a provider of services or supplier is
not in compliance with paragraph (1)--
``(i) not later than 30 days after such
determination, the Secretary shall notify such
provider or supplier of such determination;
``(ii) upon request of the Secretary, such
provider or supplier shall submit to the
Secretary, not later than 45 days after the
date of such request, a corrective action plan
to comply with such paragraph; and
``(iii) if such provider or supplier
continues to fail to comply with such paragraph
after the date that is 90 days after such
notification is sent (or, in the case of such a
provider or supplier that has submitted a
corrective action plan described in clause (ii)
in response to a request so described, after
the date that is 90 days after such
submission), the Secretary may impose a civil
monetary penalty in an amount not to exceed
$300 for each day (beginning with the day on
which the Secretary first determined that such
provider or supplier was failing to comply with
such paragraph) during which such failure to
comply or failure to submit is ongoing.
``(B) Increase authority.--In applying this
paragraph with respect to violations occurring in 2027
or a subsequent year, the Secretary may through notice
and comment rulemaking increase the amount of the civil
monetary penalty under subparagraph (A)(iii).
``(C) Application of certain provisions.--The
provisions of section 1128A of the Social Security Act
(other than subsections (a) and (b) of such section)
shall apply to a civil monetary penalty imposed under
this paragraph in the same manner as such provisions
apply to a civil monetary penalty imposed under
subsection (a) of such section.
``(D) No authority to waive or reduce penalty.--The
Secretary shall not grant or extend any waiver, delay,
tolling, or other mitigation of a civil monetary
penalty for violation of this subsection.
``(E) Provision of technical assistance.--The
Secretary shall, to the extent practicable, provide
technical assistance relating to compliance with the
provisions of this subsection to providers of services
and suppliers requesting such assistance.
``(F) Clarification of nonapplicability of other
enforcement provisions.--Notwithstanding any other
provision of this title, this paragraph shall be the
sole means of enforcing the provisions of this
subsection.
``(6) Specified imaging service defined.--the term
`specified imaging service' means an imaging service that is a
Centers for Medicare & Medicaid Services-specified shoppable
service (as described in subsection (e)).''.
SEC. 5. AMBULATORY SURGICAL CENTER PRICE TRANSPARENCY REQUIREMENTS.
Section 2718 of the Public Health Service Act (42 U.S.C. 300gg-18),
as amended by section 4, is further amended by adding at the end the
following:
``(h) Ambulatory Surgery Center Transparency.--
``(1) In general.--Beginning January 1, 2025, each
specified ambulatory surgical center that receives payment from
a group health plan or health insurance issuer for furnishing
items and services shall comply with the price transparency
requirement described in paragraph (2).
``(2) Requirement described.--
``(A) In general.--For purposes of paragraph (1),
the price transparency requirement described in this
subsection is, with respect to a specified ambulatory
surgical center, that such surgical center in
accordance with a method and format established by the
Secretary under subparagraph (C)), compile and make
public (without subscription and free of charge), for
each year--
``(i) one or more lists, in a machine-
readable format specified by the Secretary, of
the ambulatory surgical center's standard
charges (including the information described in
subparagraph (B)) for each item and service
furnished by such surgical center;
``(ii) information in a consumer-friendly
format (as specified by the Secretary) on the
ambulatory surgical center's prices (including
the information described in subparagraph (B))
for as many of the Centers for Medicare &
Medicaid Services-specified shoppable services
included on the list described in subsection
(e) that are furnished by such surgical center,
and as many additional ambulatory surgical
center-selected shoppable services (or all such
additional services, if such surgical center
furnishes fewer than 300 shoppable services) as
may be necessary for a combined total of at
least 300 shoppable services; and
``(iii) with respect to each Centers for
Medicare & Medicaid Services-specified
shoppable service (as described in clause (ii))
that is not furnished by the ambulatory
surgical center, an indication that such
service is not so furnished.
``(B) Information described.--For purposes of
subparagraph (A), the information described in this
subparagraph is, with respect to standard charges and
prices, as applicable, made public by a specified
ambulatory surgical center, the following:
``(i) A description of each item or
service, accompanied by, as applicable, the
Healthcare Common Procedure Coding System code,
the national drug code, or other identifier
used or approved by the Centers for Medicare
& Medicaid Services.
``(ii) The gross charge, expressed as a
dollar amount, for each such item or service.
``(iii) The discounted cash price,
expressed as a dollar amount, for each such
item or service (or, in the case no discounted
cash price is available for an item or service,
the minimum cash price accepted by the
specified ambulatory surgical center from self-
pay individuals for such item or service when
provided in such settings for the previous
three years, expressed as a dollar amount, as
well as, with respect to prices made public
pursuant to subparagraph (A)(ii), a link to a
consumer-friendly document that clearly
explains the provider of services or supplier's
charity care policy). The specified ambulatory
surgical center shall accept the discounted
cash price as payment in full from any patient
that chooses to pay in cash without regard to
the patient's coverage.
``(iv) The payer-specific negotiated
charges, expressed as a dollar amount and
clearly associated with the name of the
applicable third party payer and name of each
plan, that apply to each such item or service
when provided in, as applicable, the inpatient
setting and outpatient department setting. If
the charges are based on an algorithm,
percentage of another amount, or other formula
or criteria, the ambulatory surgical center
also shall disclose such algorithm, percentage,
formula, or criteria as set forth in its
contract and any other terms, schedules,
exhibits, data, or other information referenced
in any such contract as shall be required to
determine and disclose the negotiated charge.
``(v) The de-identified maximum and minimum
negotiated charges, as applicable, for each
such item or service, expressed as a non-zero
dollar amount.
``(vi) Any other additional information the
Secretary may require for the purpose of
improving the accuracy of, or enabling
consumers to easily understand and compare,
standard charges and prices for an item or
service, except information that is duplicative
of any other reporting requirement under this
subsection.
``(C) Uniform method and format.--Not later than
January 1, 2025, the Secretary shall establish a
standard, uniform method and format for specified
ambulatory surgical centers to use in making public
standard charges pursuant to subparagraph (A)(i) and a
standard, uniform method and format for such centers to
use in making public prices pursuant to subparagraph
(A)(ii). Any such method and format--
``(i) shall, in the case of such charges
made public by an ambulatory surgical center,
ensure that such charges are made available in
a machine-readable format;
``(ii) may be similar to any template made
available by the Centers for Medicare &
Medicaid Services (as described in subsection
(e));
``(iii) shall meet such standards as
determined appropriate by the Secretary in
order to ensure the accessibility and usability
of such charges and prices; and
``(iv) shall be updated as determined
appropriate by the Secretary, in consultation
with stakeholders.
``(3) No deemed compliance.--The availability of a price
estimator tool shall not be considered to deem compliance with
or otherwise vitiate the requirements of this subsection (aa).
Furthermore, the use of an estimator tool shall not be used for
purposes of compliance with any provisions in this subsection.
``(4) Monitoring compliance.--The Secretary shall, in
consultation with the Inspector General of the Department of
Health and Human Services, establish a process to monitor
compliance with this subsection. Such process shall ensure that
each specified ambulatory surgical center's compliance with
this subsection is reviewed not less frequently than once every
year.
``(5) Enforcement.--
``(A) In general.--In the case of a specified
ambulatory surgical center that fails to comply with
the requirements of this subsection--
``(i) the Secretary shall notify such
ambulatory surgical center of such failure not
later than 30 days after the date on which the
Secretary determines such failure exists; and
``(ii) upon request of the Secretary, the
ambulatory surgical center shall submit to the
Secretary, not later than 45 days after the
date of such request, a corrective action plan
to comply with such requirements.
``(B) Civil monetary penalty.--
``(i) In general.--A specified ambulatory
surgical center that has received a
notification under subparagraph (A)(i) and
fails to comply with the requirements of this
subsection by the date that is 90 days after
such notification (or, in the case of an
ambulatory surgical center that has submitted a
corrective action plan described in
subparagraph (A)(ii) in response to a request
so described, by the date that is 90 days after
such submission) shall be subject to a civil
monetary penalty of an amount specified by the
Secretary for each day (beginning with the day
on which the Secretary first determined that
such hospital was not complying with such
requirements) during which such failure is
ongoing (not to exceed $300 per day).
``(ii) Increase authority.--In applying
this subparagraph with respect to violations
occurring in 2027 or a subsequent year, the
Secretary may through notice and comment
rulemaking increase the limitation on the per
day amount of any penalty applicable to a
specified ambulatory surgical center under
clause (i).
``(iii) Application of certain
provisions.--The provisions of section 1128A of
the Social Security Act (other than subsections
(a) and (b) of such section) shall apply to a
civil monetary penalty imposed under this
subparagraph in the same manner as such
provisions apply to a civil monetary penalty
imposed under subsection (a) of such section.
``(iv) No authority to waive or reduce
penalty.--The Secretary shall not grant or
extend any waiver, delay, tolling, or other
mitigation of a civil monetary penalty for
violation of this subsection.
``(6) Provision of technical assistance.--The Secretary
shall, to the extent practicable, provide technical assistance
relating to compliance with the provisions of this subsection
to specified ambulatory surgical centers requesting such
assistance.
``(7) Definitions.--For purposes of this section:
``(A) Discounted cash price.--The term `discounted
cash price' means the charge that applies to an
individual who pays cash, or cash equivalent, for a
item or service furnished by an ambulatory surgical
center.
``(B) Gross charge.--The term `gross charge' means
the charge for an individual item or service that is
reflected on a specified surgical center's
chargemaster, absent any discounts.
``(C) Group health plan; group health insurance
coverage; individual health insurance coverage.--The
terms `group health plan', `group health insurance
coverage', and `individual health insurance coverage'
have the meaning given such terms in section 2791 of
the Public Health Service Act.
``(D) Payer-specific negotiated charge.--The term
`payer-specific negotiated charge' means the charge
that a specified surgical center has negotiated with a
third party payer for an item or service.
``(E) Shoppable service.--The term `shoppable
service' means a service that can be scheduled by a
health care consumer in advance and includes all
ancillary items and services customarily furnished as
part of such service.
``(F) Specified ambulatory surgical center.--The
term `specified ambulatory surgical center' means an
ambulatory surgical center with respect to which a
hospital (or any person with an ownership or control
interest (as defined in section 1124(a)(3) of the
Social Security Act) in a hospital) is a person with an
ownership or control interest (as so defined).
``(G) Third party payer.--The term `third party
payer' means an entity that is, by statute, contract,
or agreement, legally responsible for payment of a
claim for a health care item or service.''.
SEC. 6. STRENGTHENING HEALTH COVERAGE TRANSPARENCY REQUIREMENTS.
(a) Transparency in Coverage.--Section 1311(e)(3)(C) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031(e)(3)(C)) is
amended--
(1) by striking ``The Exchange'' and inserting the
following:
``(i) In general.--The Exchange'';
(2) in clause (i), as inserted by paragraph (1)--
(A) by striking ``participating provider'' and
inserting ``provider'';
(B) by inserting ``shall include the information
specified in clause (ii) and'' after ``such
information'';
(C) by striking ``an Internet website'' and
inserting ``a self-service tool that meets the
requirements of clause (iii)''; and
(D) by striking ``and such other'' and all that
follows through the period and inserting ``or, at the
option such individual, through a paper or phone
disclosure (as selected by such individual and provided
at no cost to such individual) that meets such
requirements as the Secretary may specify.''; and
(3) by adding at the end the following new clauses:
``(ii) Specified information.--For purposes
of clause (i), the information specified in
this clause is, with respect to benefits
available under a health plan for an item or
service furnished by a health care provider,
the following:
``(I) If such provider is a
participating provider with respect to
such item or service, the in-network
rate (as defined in subparagraph (F))
for such item or service.
``(II) If such provider is not
described in subclause (I), the maximum
allowed amount for such item or
service.
``(III) The amount of cost sharing
(including deductibles, copayments, and
coinsurance) that the individual will
incur for such item or service (which,
in the case such item or service is to
be furnished by a provider described in
subclause (II), shall be calculated
using the maximum amount described in
such subclause).
``(IV) The amount the individual
has already accumulated with respect to
any deductible or out of pocket maximum
under the plan (broken down, in the
case separate deductibles or maximums
apply to separate individuals enrolled
in the plan, by such separate
deductibles or maximums, in addition to
any cumulative deductible or maximum).
``(V) In the case such plan imposes
any frequency or volume limitations
with respect to such item or service
(excluding medical necessity
determinations), the amount that such
individual has accrued towards such
limitation with respect to such item or
service.
``(VI) Any prior authorization,
concurrent review, step therapy, fail
first, or similar requirements
applicable to coverage of such item or
service under such plan.
``(iii) Self-service tool.--For purposes of
clause (i), a self-service tool established by
a health plan meets the requirements of this
clause if such tool--
``(I) is based on an internet
website;
``(II) provides for real-time
responses to requests described in such
clause;
``(III) is updated in a manner such
that information provided through such
tool is timely and accurate;
``(IV) allows such a request to be
made with respect to an item or service
furnished by--
``(aa) a specific provider
that is a participating
provider with respect to such
item or service;
``(bb) all providers that
are participating providers
with respect to such plan and
such item or service; or
``(cc) a provider that is
not described in item (bb);
``(V) provides that such a request
may be made with respect to an item or
service through use of the billing code
for such item or service or through use
of a descriptive term for such item or
service; and
``(VI) holds a member harmless for
the amount of any difference in excess
of the amount of the individual's
responsibility generated by the self-
service tool and the amount ultimately
billed or charged to the individual.''.
(b) Disclosure of Additional Information.--Section 1311(e)(3) of
the Patient Protection and Affordable Care Act (42 U.S.C. 18031(e)(3))
is amended by adding at the end the following new subparagraphs:
``(E) Rate and payment information.--
``(i) In general.--Not later than January
1, 2025, and every month thereafter, each
health plan shall submit to the Exchange, the
Secretary, the State insurance commissioner,
and make available to the public, the rate and
payment information described in clause (ii) in
accordance with clause (iii).
``(ii) Rate and payment information
described.--For purposes of clause (i), the
rate and payment information described in this
clause is, with respect to a health plan, the
following:
``(I) With respect to each item or
service for which benefits are
available under such plan (expressed as
a dollar amount), including
prescription drugs, identified by CPT,
HCPCS, DRG, NDC, or other applicable
nationally recognized identifier,
including any applicable code
modifiers, and accompanied by a brief
description of the item or service, the
in-network rate in effect as of the
date of the submission of such
information with each provider
(identified by national provider
identifier) that is a participating
provider with respect to such item or
service, other than such a rate in
effect with a provider that has
submitted no claims for such item or
service to such plan.
``(II) With respect to each drug
(identified by National Drug Code, J-
code, or other commonly recognized
billing code used for drugs) for which
benefits are available under such plan:
``(aa) The in-network rate
(expressed as a dollar amount),
including the individual and
total amounts for any bundled
rates, in effect as of the
first day of the month in which
such information is made public
with each provider that is a
participating provider with
respect to such drug.
``(bb) The historical net
price paid by such plan (net of
rebates, discounts, and price
concessions) (expressed as a
dollar amount) for such drug
dispensed or administered
during the 90-day period
beginning 180 days before such
date of submission to each
provider that was a
participating provider with
respect to such drug, broken
down by each such provider
(identified by national
provider identifier), other
than such an amount paid to a
provider that has submitted no
claims for such drug to such
plan.
``(III) With respect to each item
or service for which benefits are
available under such plan (expressed as
a dollar amount), identified by CPT,
DRG, HCPCS, NDC, or other applicable
nationally recognized identifier,
including any applicable code
modifiers, and accompanied by a brief
description of the item or service, the
amount billed or charged by the
provider, and the amount allowed by the
plan, for each such item or service
furnished during the 90-day period
beginning 180 days before such date of
submission by each provider that was
not a participating provider with
respect to such item or service, broken
down by each such provider (identified
by national provider identifier), other
than items and services with respect to
which no claims for such item or
service were submitted to such plan
during such period.
``(iii) Manner of submission.--Rate and
payment information required to be submitted
and made available under this subparagraph
shall be so submitted and so made available as
follows:
``(I) Information shall be
contained in 3 separate machine-
readable files corresponding to the
information described in each of
subclauses (I) through (III) of clause
(ii) that meet such requirements as
specified by the Secretary through
rulemaking, in consultation with the
Secretaries of Labor and the Treasury
to apply comparable requirements to
group health plans and to entities
providing benefit management or other
third-party administration services on
a contractual basis with a group health
plan.
``(II) Requirements specified by
the Secretary through rulemaking shall
ensure that:
``(aa) Such files are
limited to an appropriate size,
are made available in a widely
available format that allows
for information contained in
such files to be compared
across health plans, and are
accessible to individuals at no
cost and without the need to
establish a user account or
provider other credentials.
``(bb) The rates, amounts,
and prices to be disclosed
include contractual terms
containing calculation
formulae, pricing
methodologies, and other
information necessary to
determine the dollar value of
reimbursement.
``(cc) Each such file
includes each of the following
data elements:
``(AA) A numerical
identifier for the
group health plan and/
or health insurance
issuer (such as a
Health Insurance
Oversight System
identifier).
``(BB) A plain-
language description of
the item or service
(including, for drugs,
the proprietary and
nonproprietary name
assigned).
``(CC) The billing
code, including any
applicable modifiers,
associated with such
item or service,
including the
Healthcare Common
Procedure Coding System
code, diagnosis-related
group, national drug
code, or other commonly
recognized code set.
``(DD) The place of
service code.
``(EE) The National
Provider Identifier or
provider Tax
Identification Number.
``(III) The rate and payment
information disclosed under subclauses
(I) through (III) of clause (ii) shall
be separately delineated for each item
or service, regardless of whether such
item or service is reimbursed as a part
of a bundle, episode, or other grouping
of items and services.
``(IV) An officer or executive of
competent authority shall attest to the
accuracy and completeness of
information submitted and made
available under this subparagraph. Such
attestation shall be deemed material to
payments from the Federal Government
received by the group health plan or
health insurance issuer.
``(V) Regulations promulgated
pursuant to this section shall provide
that:
``(aa) The Secretary shall
audit the three machine-
readable files required by
subparagraph (E)(ii) posted by
no fewer than 20 group health
plans or health insurance
issuers.
``(bb) The Secretary of
Labor shall audit the three
machine-readable files required
by subparagraph (E)(ii) posted
by no fewer than 200 group
health plans or service
providers furnishing third-
party administrator services to
a group health plan.
``(cc) Findings,
conclusions, and enforcement
actions taken based on audits
of the machine-readable files
shall be reported annually to
Congress no later than July 1
of the calendar year during
which the files were audited.
Such report to Congress shall
be accessible to the public.
``(iv) User guide.--Each health plan shall
make available to the public instructions
written in plain language explaining how
individuals may search for information
described in clause (ii) in files submitted in
accordance with clause (iii).
``(F) Definitions.--In this paragraph:
``(i) Participating provider.--The term
`participating provider' has the meaning given
such term in section 2799A-1 of the Public
Health Service Act.
``(ii) In-network rate.--The term `in-
network rate' means, with respect to a health
plan and an item or service furnished by a
provider that is a participating provider with
respect to such plan and item or service, the
contracted rate in effect between such plan and
such provider for such item or service. If the
rate is based on an algorithm, percentage of
another amount, or other formula or criteria,
the health plan also shall disclose such
algorithm, percentage, formula, or criteria as
set forth in its contract and any other terms,
schedules, exhibits, data, or other information
referenced in any such contract as shall be
required to determine and disclose the
negotiated rate.
``(G) Applicability to accountable care
organizations.--An applicable ACO participating in the
Medicare Shared Savings Program, as defined in Section
1899 of the Social Security Act (42 U.S.C. Sec.
1395jjj), shall be subject to the requirements of this
paragraph as if such applicable ACO is a group health
plan or health insurance issuer.
``(H) Enforcement.--Each year, the Secretary shall
audit the three machine-readable files required by
subparagraph (E)(ii) posted by no fewer than 20 group
health plans or health insurance issuers.''.
(c) Effective Date.--
(1) In general.--The amendments made by subsection (a)
shall apply beginning January 1, 2025.
(2) Continued applicability of rules for previous years.--
Nothing in the amendments made by this section may be construed
as affecting the applicability of the rule entitled
``Transparency in Coverage'' published by the Department of the
Treasury, the Department of Labor, and the Department of Health
and Human Services on November 12, 2020 (85 Fed. Reg. 72158)
before January 1, 2025.
SEC. 7. INCREASING GROUP HEALTH PLAN ACCESS TO HEALTH DATA.
(a) Group Health Plan Access to Information.--
(1) 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
subparagraphs:
``(C) No contract or arrangement for services
between a group health plan and any other entity,
including a health care provider (including a health
care facility), network or association of providers,
service provider offering access to a network of
providers, third-party administrator, or pharmacy
benefit manager (collectively, `Covered Service
Providers'), is reasonable within the meaning of this
paragraph unless such contract or arrangement--
``(i) allows the responsible group health
plan access to all claims and encounter
information, and any documentation supporting
claim payments, including, but not limited to,
medical records and policy documents, or data
described in section 724(a)(1)(B) to--
``(I) enable such entity to comply
with the terms of the plan and any
applicable law; and
``(II) determine the accuracy or
reasonableness of payment; and
``(ii) does not--
``(I) unreasonably limit or delay
access to such information or data;
``(II) limit the volume of claims
and encounter information or data that
the group health plan may access during
an audit;
``(III) limit the disclosure of
pricing terms for value-based payment
arrangements or capitated 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 used by an
entity, including a health care
provider (including a health
care facility), network or
association of providers,
service provider offering
access to a network 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 group
health plan to select an auditor or
define audit scope or frequency;
``(VI) otherwise limit or unduly
delay the group health plan from
accessing claims and encounter
information or data in a daily batch.
``(VII) limit the disclosure of
fees charged to the group health plan
related to plan administration and
claims processing, including
renegotiation fees, access fees,
repricing fees, or enhanced review
fees;
``(VIII) limit the right of the
group health plan to request action on
any suspect claim payments; or
``(IX) limit public disclosure of
de-identified or aggregate information.
``(D) Privacy requirements.--Covered Service
Providers shall provide information under this
paragraph in a manner consistent with the privacy and
security regulations promulgated under the Health
Insurance Portability and Accountability Act (HIPAA).
This subparagraph shall not be read to abridge or limit
the disclosure requirements under this paragraph or to
impose additional privacy or security requirements on
Covered Service Providers or plan sponsors.
``(E) Disclosure and redisclosure; limitation to
business associates.--A group health plan receiving
information or data under this paragraph may disclose
such information only to the entity from which the
information or data was received, the group health plan
or plan sponsor to which the information or data
pertains, or to that entity's business associates as
defined in section 160.103 of title 45, Code of Federal
Regulations, or as otherwise permitted by the HIPAA
Privacy Rule (45 CFR parts 160 and 164, subparts A and
E).
``(F) Data standards.--Information made available
under this section shall conform to the following
standards:
``(i) Institutional, professional, and
dental claims received from a healthcare
provider shall be made available to the group
health plan as ASC X12N 837 files. The files
shall be unmodified copies of the files sent
from the provider. In the event that paper
claims are sent by the provider, they shall be
converted to the ASC X12N 837 electronic
format. Files shall be accessible to the plan
at no cost to the group health plan.
``(ii) All claim payment (or EFT,
electronic funds transfer) and electronic
remittance advice (ERA) notices sent by a
Covered Service Provider shall be made
available to the group health plan as ASC X12N
835 files. The files shall be unmodified copies
of the files sent by the Covered Service
Provider to the healthcare provider. Files
shall be accessible at no cost to the group
health plan.
``(iii) The contractual terms containing
calculation formulae, pricing methodologies,
and other information used to determine the
dollar value of reimbursement.
``(iv) All non-claim costs shall be
itemized and made available to the group health
plan in real time through a web-based portal,
through an API, and through a downloadable CSV
file.''.
(2) Civil enforcement.--
(A) 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 (including a health care facility),
network or association of providers, service provider
offering access to a network of providers, third-party
administrator, or pharmacy benefit manager, that
violates the provisions of section 724, the Secretary
may assess a civil penalty against such provider,
network or association, service provider offering
access to a network of providers, 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.
(B) Conforming amendment.--Paragraph (6) of section
502(a) of such Act is amended by striking ``or (9)''
and inserting ``(9), or (13)''.
(3) Existing provisions void.--Section 410 of such Act is
amended by adding at the end the following:
``(c) Any provision in an agreement or instrument shall be void as
against public policy if such provision--
``(1) unduly delays or limits a group health plan from
accessing the claims and encounter information or data
described in section 724(a)(1)(B); or
``(2) violates the requirements of section 408(b)(2)(C).''.
(4) Technical amendment.--Clause (i) of section
408(b)(2)(B) of such Act is amended by striking ``this clause''
and inserting ``this paragraph''.
(b) 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
group health plan or health insurance 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 group health plan, 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 group
health plan, the plan administrator, or the
issuer from auditing, reviewing, or otherwise
accessing such information, except as permitted
under section 408(b)(2)(C).
``(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 group health plan 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).''.
(c) Effective Date.--The amendments made by subsections (a) and (b)
shall apply with respect to a plan beginning with the first plan year
that begins on or after the date that is 1 year after the date of
enactment of this Act.
SEC. 8. PREEMPTION ONLY IN EVENT OF CONFLICT.
The provisions of sections 2 through 5 of this Act (including the
amendments made by such sections) shall not supersede any provision of
State law which establishes, implements, or continues in effect any
requirement or prohibition related to health care price transparency,
except to the extent that such requirement or prohibition prevents the
application of a requirement or prohibition of such sections (or
amendment). Nothing in this section shall be construed to affect health
plans established under the Employee Retirement Income Security Act of
1974.
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