Know Your Provider Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 5807 To amend title XXVII of the Public Health Service Act, the Internal Revenue Code of 1986, the Employee Retirement Income Security Act of 1974, and title XI of the Social Security Act to improve the availability and accuracy of provider directory information made available by group health plans and health insurance issuers offering group or individuals health insurance coverage. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 7, 2020 Mr. LARSON of Connecticut (for himself and Mr. WENSTRUP) introduced the following bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committees on Ways and Means, and Edu- cation and Labor, 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 title XXVII of the Public Health Service Act, the Internal Revenue Code of 1986, the Employee Retire- ment Income Security Act of 1974, and title XI of the Social Security Act to improve the availability and accu- racy of provider directory information made available by group health plans and health insurance issuers offer- ing group or individuals health insurance coverage. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 20:11 Feb 12, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5807.IH H5807 lotter on DSKBCFDHB2PROD with BILLS 2 •HR 5807 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Know Your Provider 2 Act of 2020’’. 3 SEC. 2. IMPROVING THE AVAILABILITY AND ACCURACY OF 4 PROVIDER DIRECTORY INFORMATION MADE 5 AVAILABLE BY GROUP HEALTH PLANS AND 6 HEALTH INSURANCE ISSUERS OFFERING 7 GROUP OR INDIVIDUALS HEALTH INSUR- 8 ANCE COVERAGE. 9 (a) GROUP HEALTH PLAN AND HEALTH INSURANCE 10 ISSUER REQUIREMENTS.— 11 (1) PUBLIC HEALTH SERVICE ACT.—Subpart II 12 of part A of title XXVII of the Public Health Serv- 13 ice Act (42 U.S.C. 300gg–11 et seq.) is amended by 14 adding at the end the following new section: 15 ‘‘SEC. 2730. PROVIDER DIRECTORY REQUIREMENTS. 16 ‘‘(a) IN GENERAL.—Beginning not later than Janu- 17 ary 1, 2022, each group health plan and health insurance 18 issuer offering group or individual health insurance cov- 19 erage shall— 20 ‘‘(1) establish the verification process described 21 in subsection (b); 22 ‘‘(2) establish the response protocol described in 23 subsection (c); 24 ‘‘(3) establish the database described in sub- 25 section (d); and 26 VerDate Sep 11 2014 20:11 Feb 12, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5807.IH H5807 lotter on DSKBCFDHB2PROD with BILLS 3 •HR 5807 IH ‘‘(4) include in any directory (other than the 1 database described in paragraph (3)) containing pro- 2 vider directory information with respect to such plan 3 or such coverage the information described in sub- 4 section (e). 5 ‘‘(b) VERIFICATION PROCESS.—The verification 6 process described in this subsection is, with respect to a 7 group health plan or a health insurance issuer offering 8 group or individual health insurance coverage, a process— 9 ‘‘(1) under which such plan or such issuer (as 10 applicable) verifies and updates the provider direc- 11 tory information included on the database described 12 in subsection (d) of such plan or issuer of— 13 ‘‘(A) not less frequently than once every 90 14 days, a random sample of at least 10 percent 15 of health care providers and health care facili- 16 ties included in such database; and 17 ‘‘(B) any such provider or such facility in- 18 cluded in such database that has not submitted 19 any claim to such plan or such issuer (as appli- 20 cable) during a 12-month period; 21 ‘‘(2) that establishes a procedure for the re- 22 moval from such database of such a provider or fa- 23 cility with respect to which such plan or issuer has 24 VerDate Sep 11 2014 20:11 Feb 12, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5807.IH H5807 lotter on DSKBCFDHB2PROD with BILLS 4 •HR 5807 IH been unable to verify such information during a pe- 1 riod specified by the plan or issuer; and 2 ‘‘(3) that provides for the update of such data- 3 base within 2 business days of such plan or such 4 issuer (as applicable) receiving from such a provider 5 or facility information pursuant to section 1150C of 6 the Social Security Act. 7 ‘‘(c) RESPONSE PROTOCOL.—The response protocol 8 described in this subsection is, in the case of an individual 9 enrolled under a group health plan or group or individual 10 health insurance coverage offered by a health insurance 11 issuer who requests information through a telephone call 12 or email on whether a health care provider or health care 13 facility has a contractual relationship to furnish items and 14 services under such plan or such coverage, a protocol 15 under which such plan or such issuer (as applicable)— 16 ‘‘(1) responds to such individual as soon as 17 practicable, and in no case later than 1 business day 18 after such call or email is received, through a writ- 19 ten electronic communication; and 20 ‘‘(2) retains such communication in such indi- 21 vidual’s file for at least 2 years following such re- 22 sponse. 23 ‘‘(d) DATABASE.—The database described in this 24 subsection is, with respect to a group health plan or health 25 VerDate Sep 11 2014 20:11 Feb 12, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5807.IH H5807 lotter on DSKBCFDHB2PROD with BILLS 5 •HR 5807 IH insurance issuer offering group or individual health insur- 1 ance coverage, a database on the public website of such 2 plan or issuer that contains— 3 ‘‘(1) a list of each health care provider and 4 health care facility with which such plan or such 5 issuer has a contractual relationship for furnishing 6 items and services under such plan or such coverage; 7 and 8 ‘‘(2) provider directory information with respect 9 to each such provider and facility. 10 ‘‘(e) INFORMATION.—The information described in 11 this subsection is, with respect to a directory containing 12 provider directory information with respect to a group 13 health plan or individual or group health insurance cov- 14 erage offered by a health insurance issuer, a notification 15 that such information contained in such directory was ac- 16 curate as of the date of publication of such directory and 17 that an individual enrolled under such plan or such cov- 18 erage should consult the database described in subsection 19 (d) with respect to such plan or such coverage or contact 20 such plan or the issuer of such coverage to obtain the most 21 current provider directory information with respect to 22 such plan or such coverage. 23 ‘‘(f) DEFINITION.—For purposes of this section, the 24 term ‘provider directory information’ includes, with re- 25 VerDate Sep 11 2014 20:11 Feb 12, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5807.IH H5807 lotter on DSKBCFDHB2PROD with BILLS 6 •HR 5807 IH spect to a group health plan and a health insurance issuer 1 offering group or individual health insurance coverage, the 2 name, address, specialty, and telephone number of each 3 health care provider or health care facility with which such 4 plan or such issuer has a contractual relationship for fur- 5 nishing items and services under such plan or such cov- 6 erage.’’. 7 (2) INTERNAL REVENUE CODE OF 1986.— 8 (A) IN GENERAL.—Subchapter B of chap- 9 ter 100 of the Internal Revenue Code of 1986 10 is amended by adding at the end the following 11 new section: 12 ‘‘SEC. 9816. PROVIDER DIRECTORY REQUIREMENTS. 13 ‘‘(a) IN GENERAL.—Beginning not later than Janu- 14 ary 1, 2022, each group health plan shall— 15 ‘‘(1) establish the verification process described 16 in subsection (b); 17 ‘‘(2) establish the response protocol described in 18 subsection (c); 19 ‘‘(3) establish the database described in sub- 20 section (d); and 21 ‘‘(4) include in any directory (other than the 22 database described in paragraph (3)) containing pro- 23 vider directory information with respect to such plan 24 the information described in subsection (e). 25 VerDate Sep 11 2014 20:11 Feb 12, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5807.IH H5807 lotter on DSKBCFDHB2PROD with BILLS 7 •HR 5807 IH ‘‘(b) VERIFICATION PROCESS.—The verification 1 process described in this subsection is, with respect to a 2 group health plan, a process— 3 ‘‘(1) under which such plan verifies and updates 4 the provider directory information included on the 5 database described in subsection (d) of such plan 6 of— 7 ‘‘(A) not less frequently than once every 90 8 days, a random sample of at least 10 percent 9 of health care providers and health care facili- 10 ties included in such database; and 11 ‘‘(B) any such provider or such facility in- 12 cluded in such database that has not submitted 13 any claim to such plan during a 12-month pe- 14 riod; 15 ‘‘(2) that establishes a procedure for the re- 16 moval from such database of such a provider or fa- 17 cility with respect to which such plan has been un- 18 able to verify such information during a period spec- 19 ified by the plan; and 20 ‘‘(3) that provides for the update of such data- 21 base within 2 business days of such plan receiving 22 from such a provider or facility information pursu- 23 ant to section 1150C of the Social Security Act. 24 VerDate Sep 11 2014 20:11 Feb 12, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5807.IH H5807 lotter on DSKBCFDHB2PROD with BILLS 8 •HR 5807 IH ‘‘(c) RESPONSE PROTOCOL.—The response protocol 1 described in this subsection is, in the case of an individual 2 enrolled under a group health plan who requests informa- 3 tion through a telephone call or email on whether a health 4 care provider or health care facility has a contractual rela- 5 tionship to furnish items and services under such plan, 6 a protocol under which such plan— 7 ‘‘(1) responds to such individual as soon as 8 practicable, and in no case later than 1 business day 9 after such call or email is received, through a writ- 10 ten electronic communication; and 11 ‘‘(2) retains such communication in such indi- 12 vidual’s file for at least 2 years following such re- 13 sponse. 14 ‘‘(d) DATABASE.—The database described in this 15 subsection is, with respect to a group health plan, a data- 16 base on the public website of such plan that contains— 17 ‘‘(1) a list of each health care provider and 18 health care facility with which such plan has a con- 19 tractual relationship for furnishing items and serv- 20 ices under such plan; and 21 ‘‘(2) provider directory information with respect 22 to each such provider and facility. 23 ‘‘(e) INFORMATION.—The information described in 24 this subsection is, with respect to a directory containing 25 VerDate Sep 11 2014 20:11 Feb 12, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5807.IH H5807 lotter on DSKBCFDHB2PROD with BILLS 9 •HR 5807 IH provider directory information with respect to a group 1 health plan, a notification that such information contained 2 in such directory was accurate as of the date of publication 3 of such directory and that an individual enrolled under 4 such plan should consult the database described in sub- 5 section (d) with respect to such plan or contact such plan 6 to obtain the most current provider directory information 7 with respect to such plan. 8 ‘‘(f) DEFINITION.—For purposes of this section, the 9 term ‘provider directory information’ includes, with re- 10 spect to a group health plan, the name, address, specialty, 11 and telephone number of each health care provider or 12 health care facility with which such plan has a contractual 13 relationship for furnishing items and services under such 14 plan or such coverage.’’. 15 (B) CONFORMING AMENDMENT.—Section 16 9815(a) of the Internal Revenue Code of 1986 17 is amended— 18 (i) in paragraph (1), by striking ‘‘(as 19 amended by the Patient Protection and Af- 20 fordable Care Act)’’ and inserting ‘‘(other 21 than the provisions of section 2730 of such 22 Act)’’; and 23 (ii) in paragraph (2), by inserting 24 ‘‘(other than the provisions of section 2730 25 VerDate Sep 11 2014 20:11 Feb 12, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5807.IH H5807 lotter on DSKBCFDHB2PROD with BILLS 10 •HR 5807 IH of such Act)’’ after the first occurrence of 1 ‘‘such part A’’. 2 (C) CLERICAL AMENDMENT.—The table of 3 sections for such subchapter is amended by 4 adding at the end the following new items: 5 ‘‘Sec. 9815. Additional market reforms. ‘‘Sec. 9816. Provider directory requirements.’’. (3) EMPLOYEE RETIREMENT INCOME SECURITY 6 ACT OF 1974.— 7 (A) IN GENERAL.—Subpart B of part 7 of 8 subtitle B of title I of the Employee Retirement 9 Income Security Act of 1974 (29 U.S.C. 1185 10 et seq.) is amended by adding at the end the 11 following new section: 12 ‘‘SEC. 716. PROVIDER DIRECTORY REQUIREMENTS. 13 ‘‘(a) IN GENERAL.—Beginning not later than Janu- 14 ary 1, 2022, each group health plan and health insurance 15 issuer offering group health insurance coverage shall— 16 ‘‘(1) establish the verification process described 17 in subsection (b); 18 ‘‘(2) establish the response protocol described in 19 subsection (c); 20 ‘‘(3) establish the database described in sub- 21 section (d); and 22 ‘‘(4) include in any directory (other than the 23 database described in paragraph (3)) containing pro- 24 VerDate Sep 11 2014 20:11 Feb 12, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5807.IH H5807 lotter on DSKBCFDHB2PROD with BILLS 11 •HR 5807 IH vider directory information with respect to such plan 1 or such coverage the information described in sub- 2 section (e). 3 ‘‘(b) VERIFICATION PROCESS.—The verification 4 process described in this subsection is, with respect to a 5 group health plan or a health insurance issuer offering 6 group health insurance coverage, a process— 7 ‘‘(1) under which such plan or such issuer (as 8 applicable) verifies and updates the provider direc- 9 tory information included on the database described 10 in subsection (d) of such plan or issuer of— 11 ‘‘(A) not less frequently than once every 90 12 days, a random sample of at least 10 percent 13 of health care providers and health care facili- 14 ties included in such database; and 15 ‘‘(B) any such provider or such facility in- 16 cluded in such database that has not submitted 17 any claim to such plan or such issuer (as appli- 18 cable) during a 12-month period; 19 ‘‘(2) that establishes a procedure for the re- 20 moval from such database of such a provider or fa- 21 cility with respect to which such plan or issuer has [Text truncated for display. 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