Insurance Accountability and Transparency Act

I 116TH CONGRESS 1ST SESSION H. R. 5144 To amend the Patient Protection and Affordable Care Act to require group health plans and health insurance coverage to have in place a process to self-audit information listed in publicly accessible provider directories of such plans and coverage. IN THE HOUSE OF REPRESENTATIVES NOVEMBER 18, 2019 Ms. DAVIDS of Kansas introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Labor, and Ways and Means, for a period to be subse- quently 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 Patient Protection and Affordable Care Act to require group health plans and health insurance cov- erage to have in place a process to self-audit information listed in publicly accessible provider directories of such plans and coverage. 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 ‘‘Insurance Account- 4 ability and Transparency Act’’. 5 VerDate Sep 11 2014 00:45 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5144.IH H5144 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 5144 IH SEC. 2. REQUIREMENT FOR GROUP HEALTH PLANS AND 1 HEALTH INSURANCE COVERAGE TO HAVE IN 2 PLACE A PROCESS TO SELF-AUDIT INFORMA- 3 TION LISTED IN PUBLICLY ACCESSIBLE PRO- 4 VIDER DIRECTORIES OF SUCH PLANS AND 5 COVERAGE. 6 (a) PHSA.— 7 (1) IN GENERAL.—Title XXVII of the Public 8 Health Service Act (42 U.S.C. 300gg et seq.) is 9 amended by adding at the end the following: 10 ‘‘PART D—OTHER MARKET REFORMS 11 ‘‘SEC. 2796. PROCESS TO SELF-AUDIT INFORMATION LISTED 12 IN PUBLICLY ACCESSIBLE PROVIDER DIREC- 13 TORIES. 14 ‘‘(a) IN GENERAL.—An entity specified in subsection 15 (b), with respect to a group health plan or health insur- 16 ance coverage offered in the group or individual market, 17 shall have in place a process under which, in order to self- 18 audit the information listed in any publicly accessible pro- 19 vider directory for such plan or coverage, such entity— 20 ‘‘(1) contacts, not less than once every 6 21 months during each plan year, each provider listed 22 in such directory to verify— 23 ‘‘(A) contact information listed in such di- 24 rectory with respect to such provider; and 25 VerDate Sep 11 2014 00:45 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5144.IH H5144 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 5144 IH ‘‘(B) the status of whether such provider is 1 a provider within the network of such plan or 2 coverage; and 3 ‘‘(2) in the case that such entity determines 4 that any of the information described in subpara- 5 graph (A) or (B) of paragraph (1) with respect to 6 a provider listed in such directory of such plan or 7 coverage is inaccurate, not later than 30 days after 8 making such determination, corrects and updates 9 such information in such directory. 10 ‘‘(b) ENTITY DESCRIBED.—For purposes of sub- 11 section (a), an entity described in this subsection is— 12 ‘‘(1) in the case of health insurance coverage or 13 a group health plan this is not a self-insured plan, 14 the health insurance issuer offering the health insur- 15 ance coverage or the group health plan, respectively; 16 and 17 ‘‘(2) in the case of a self-insured group health 18 plan, the designated administrator of the plan (as 19 such term is defined in section 3(16) of the Em- 20 ployee Retirement Income Security Act of 1974).’’. 21 (2) CONFORMING AMENDMENTS.— 22 (A) Section 2722 of the Public Health 23 Service Act (42 U.S.C. 300gg–21) is amend- 24 ed— 25 VerDate Sep 11 2014 00:45 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5144.IH H5144 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 5144 IH (i) in subsection (a)(1), by inserting 1 ‘‘and part D’’ after ‘‘subparts 1 and 2’’; 2 (ii) in subsection (b), by inserting 3 ‘‘and part D’’ after ‘‘subparts 1 and 2’’; 4 (iii) in subsection (c)(1), by inserting 5 ‘‘and part D’’ after ‘‘subparts 1 and 2’’; 6 (iv) in subsection (c)(2), by inserting 7 ‘‘and part D’’ after ‘‘subparts 1 and 2’’; 8 (v) in subsection (c)(3), by inserting 9 ‘‘and part D’’ after ‘‘this part’’; and 10 (vi) in subsection (d), in the matter 11 preceding paragraph (1), by inserting ‘‘and 12 part D’’ after ‘‘this part’’. 13 (B) Section 2723 of the Public Health 14 Service Act (42 U.S.C. 300gg–22) is amend- 15 ed— 16 (i) in subsection (a)(1), by inserting 17 ‘‘and part D’’ after ‘‘this part’’; 18 (ii) in subsection (a)(2), by inserting 19 ‘‘or part D’’ after ‘‘this part’’; 20 (iii) in subsection (b)(1), by inserting 21 ‘‘or part D’’ after ‘‘this part’’; 22 (iv) in subsection (b)(2)(A), by insert- 23 ing ‘‘or part D’’ after ‘‘this part’’; and 24 VerDate Sep 11 2014 00:45 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5144.IH H5144 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 5144 IH (v) in subsection (b)(2)(C)(ii), by in- 1 serting ‘‘and part D’’ after ‘‘this part’’. 2 (C) Section 2724 of the Public Health 3 Service Act (42 U.S.C. 300gg–23) is amend- 4 ed— 5 (i) in subsection (a)(1)— 6 (I) by striking ‘‘this part and 7 part C insofar as it relates to this 8 part’’ and inserting ‘‘this part, part 9 D, and part C insofar as it relates to 10 this part or part D’’; and 11 (II) by inserting ‘‘or part D’’ 12 after ‘‘requirement of this part’’; 13 (ii) in subsection (a)(2), by inserting 14 ‘‘or part D’’ after ‘‘this part’’; and 15 (iii) in subsection (c), by inserting ‘‘or 16 part D’’ after ‘‘this part (other than sec- 17 tion 2704)’’. 18 (b) ERISA.— 19 (1) IN GENERAL.—Subpart B of part 7 of sub- 20 title B of title I of the Employee Retirement Income 21 Security Act of 1974 (29 U.S.C. 1181 et seq.) is 22 amended by adding at the end the following new sec- 23 tion: 24 VerDate Sep 11 2014 00:45 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5144.IH H5144 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 5144 IH ‘‘SEC. 716. PROCESS TO SELF-AUDIT INFORMATION LISTED 1 IN PUBLICLY ACCESSIBLE PROVIDER DIREC- 2 TORIES. 3 ‘‘(a) IN GENERAL.—An entity specified in subsection 4 (b), with respect to a group health plan or health insur- 5 ance coverage offered in the group market, shall have in 6 place a process under which, in order to self-audit the in- 7 formation listed in any publicly accessible provider direc- 8 tory for such plan or coverage, such entity— 9 ‘‘(1) contacts, not less than once every 6 10 months during each plan year, each provider listed 11 in such directory to verify— 12 ‘‘(A) contact information listed in such di- 13 rectory with respect to such provider; and 14 ‘‘(B) the status of whether such provider is 15 a provider within the network of such plan or 16 coverage; and 17 ‘‘(2) in the case that such entity determines 18 that any of the information described in subpara- 19 graph (A) or (B) of paragraph (1) with respect to 20 a provider listed in such directory of such plan or 21 coverage is inaccurate, not later than 30 days after 22 making such determination, corrects and updates 23 such information in such directory. 24 ‘‘(b) ENTITY DESCRIBED.—For purposes of sub- 25 section (a), an entity described in this subsection is— 26 VerDate Sep 11 2014 00:45 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5144.IH H5144 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 5144 IH ‘‘(1) in the case of health insurance coverage or 1 a group health plan this is not a self-insured plan, 2 the health insurance issuer offering the health insur- 3 ance coverage or the group health plan, respectively; 4 and 5 ‘‘(2) in the case of a self-insured group health 6 plan, the designated administrator of the plan (as 7 such term is defined in section 3(16)).’’. 8 (2) CLERICAL AMENDMENT.—The table of sec- 9 tions for part 7 of subtitle B of title I of the Em- 10 ployee Retirement Income Security Act of 1974 is 11 amended by adding at the end the following: 12 ‘‘Sec. 716. Process to self-audit information listed in publicly accessible pro- vider directories.’’. (c) IRC.— 13 (1) IN GENERAL.—Subchapter B of chapter 14 100 of the Internal Revenue Code of 1986 is amend- 15 ed by adding at the end the following new section: 16 ‘‘SEC. 9816. PROCESS TO SELF-AUDIT INFORMATION LISTED 17 IN PUBLICLY ACCESSIBLE PROVIDER DIREC- 18 TORIES. 19 ‘‘(a) IN GENERAL.—An entity specified in subsection 20 (b), with respect to a group health plan, shall have in place 21 a process under which, in order to self-audit the informa- 22 tion listed in any publicly accessible provider directory for 23 such plan, such entity— 24 VerDate Sep 11 2014 00:45 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5144.IH H5144 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 5144 IH ‘‘(1) contacts, not less than once every 6 1 months during each plan year, each provider listed 2 in such directory to verify— 3 ‘‘(A) contact information listed in such di- 4 rectory with respect to such provider; and 5 ‘‘(B) the status of whether such provider is 6 a provider within the network of such plan; and 7 ‘‘(2) in the case that such entity determines 8 that any of the information described in subpara- 9 graph (A) or (B) of paragraph (1) with respect to 10 a provider listed in such directory of such plan is in- 11 accurate, not later than 30 days after making such 12 determination, corrects and updates such informa- 13 tion in such directory. 14 ‘‘(b) ENTITY DESCRIBED.—For purposes of sub- 15 section (a), an entity described in this subsection is— 16 ‘‘(1) in the case of a group health plan this is 17 not a self-insured plan, the health insurance issuer 18 offering the group health plan; and 19 ‘‘(2) in the case of a self-insured group health 20 plan, the designated administrator of the plan (as 21 such term is defined in section 3(16) of the Em- 22 ployee Retirement Income Security Act of 1974).’’. 23 (2) CLERICAL AMENDMENT.—The table of sec- 24 tions for subchapter B of chapter 100 of such Code 25 VerDate Sep 11 2014 00:45 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5144.IH H5144 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 5144 IH is amended by adding at the end the following new 1 item: 2 ‘‘Sec. 9816. Process to self-audit information listed in publicly accessible pro- vider directories.’’. (d) EFFECTIVE DATE.—The amendments made by 3 this section shall apply with respect to plan years begin- 4 ning on or after January 1, 2020. 5 Æ VerDate Sep 11 2014 00:45 Nov 27, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H5144.IH H5144 pamtmann on DSKBC07HB2PROD with BILLS