UPDATE Act

I 116TH CONGRESS 1ST SESSION H. R. 4379 To amend the Patient Protection and Affordable Care Act to require qualified health plans to have in place a process to remove from publicly accessible provider directories of such plans providers that are no longer within the network of such plans, and for other purposes. IN THE HOUSE OF REPRESENTATIVES SEPTEMBER 18, 2019 Mrs. AXNE (for herself, Ms. STEVENS, Ms. MUCARSEL-POWELL, Mrs. LEE of Nevada, Ms. WILD, Ms. FINKENAUER, Ms. TORRES SMALL of New Mex- ico, and Ms. HOULAHAN) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend the Patient Protection and Affordable Care Act to require qualified health plans to have in place a proc- ess to remove from publicly accessible provider directories of such plans providers that are no longer within the network of such plans, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Under Performing Di- 4 rectories that Affect Treating Emergencies Act’’ or the 5 ‘‘UPDATE Act’’. 6 VerDate Sep 11 2014 21:44 Sep 20, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4379.IH H4379 kjohnson on DSK79L0C42 with BILLS 2 •HR 4379 IH SEC. 2. REQUIREMENT FOR QUALIFIED HEALTH PLANS TO 1 HAVE IN PLACE A PROCESS TO REMOVE 2 FROM PUBLICLY ACCESSIBLE PROVIDER DI- 3 RECTORIES OF SUCH PLANS PROVIDERS 4 THAT ARE NO LONGER WITHIN THE NET- 5 WORK OF SUCH PLANS. 6 (a) IN GENERAL.—Section 1311(c) of the Patient 7 Protection and Affordable Care Act (42 U.S.C. 18031(c)) 8 is amended— 9 (1) in paragraph (1)(B)— 10 (A) by striking ‘‘and provide’’ and insert- 11 ing ‘‘, provide’’; and 12 (B) by inserting before the semicolon at 13 the end the following: ‘‘, and have in place the 14 process described in paragraph (7) to remove 15 from any publicly accessible provider directory 16 of such plan providers that are no longer within 17 the network of such plan’’; and 18 (2) by adding at the end the following new 19 paragraph: 20 ‘‘(7) PROCESS TO REMOVE FROM PUBLICLY AC- 21 CESSIBLE PROVIDER DIRECTORIES PROVIDERS THAT 22 ARE NO LONGER IN-NETWORK.—For purposes of 23 paragraph (1)(B), the process described in this para- 24 graph, with respect to a qualified health plan, is a 25 process through which such plan does the following 26 VerDate Sep 11 2014 21:44 Sep 20, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4379.IH H4379 kjohnson on DSK79L0C42 with BILLS 3 •HR 4379 IH with respect to each provider listed in a publicly ac- 1 cessible provider directory of such plan that does not 2 submit any claims to such plan for at least a six- 3 month period in a calendar year: 4 ‘‘(A) Sends an inquiry to such provider re- 5 quiring such provider to verify, not later than 6 the date that is 30 days after such plan sends 7 such inquiry, whether such provider is still a 8 provider within the network of such plan. 9 ‘‘(B) In the case that such plan— 10 ‘‘(i) receives a response to such in- 11 quiry by the date described in subpara- 12 graph (A) that such provider is no longer 13 a provider within the network of such plan, 14 removes such provider from such publicly 15 accessible provider directory; or 16 ‘‘(ii) does not receive any response to 17 such inquiry by such date— 18 ‘‘(I) sends a subsequent inquiry 19 described in such subparagraph to 20 such provider; and 21 ‘‘(II) removes such provider from 22 such publicly accessible provider direc- 23 tory if such provider either submits to 24 such plan, not later than the date that 25 VerDate Sep 11 2014 21:44 Sep 20, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4379.IH H4379 kjohnson on DSK79L0C42 with BILLS 4 •HR 4379 IH is 30 days after such plan sends such 1 subsequent inquiry, a response de- 2 scribed in clause (i), or does not re- 3 spond to such subsequent inquiry by 4 such date.’’. 5 (b) EFFECTIVE DATE.—The amendments made by 6 subsection (a) shall apply with respect to plan years begin- 7 ning on or after January 1, 2021. 8 Æ VerDate Sep 11 2014 21:44 Sep 20, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\H4379.IH H4379 kjohnson on DSK79L0C42 with BILLS