Know the Price Act

I 116TH CONGRESS 2D SESSION H. R. 6005 To amend title XXVII of the Public Health Service Act to increase trans- parency of group health plans and health insurance issuers offering group or individual health insurance coverage by removing gag clauses on price and quality information, and for other purposes. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 27, 2020 Mr. MALINOWSKI (for himself and Mr. BUCSHON) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XXVII of the Public Health Service Act to increase transparency of group health plans and health insurance issuers offering group or individual health insurance coverage by removing gag clauses on price and quality information, 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 ‘‘Know the Price Act’’. 4 VerDate Sep 11 2014 04:36 Mar 03, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6005.IH H6005 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 6005 IH SEC. 2. INCREASING TRANSPARENCY BY REMOVING GAG 1 CLAUSES ON PRICE AND QUALITY INFORMA- 2 TION. 3 Subpart II of part A of title XXVII of the Public 4 Health Service Act (42 U.S.C. 300gg–11 et seq.) is 5 amended by adding at the end the following: 6 ‘‘SEC. 2729A. INCREASING TRANSPARENCY BY REMOVING 7 GAG CLAUSES ON PRICE AND QUALITY IN- 8 FORMATION. 9 ‘‘(a) INCREASING PRICE AND QUALITY TRANS- 10 PARENCY FOR PLAN SPONSORS AND CONSUMERS.— 11 ‘‘(1) GROUP HEALTH PLANS.—A group health 12 plan or a health insurance issuer offering group 13 health insurance coverage may not enter into an 14 agreement with a health care provider, network or 15 association of providers, third-party administrator, 16 or other service provider offering access to a network 17 of providers that would directly or indirectly restrict 18 a group health plan or health insurance issuer 19 from— 20 ‘‘(A) providing provider-specific cost or 21 quality of care information, through a consumer 22 engagement tool or any other means, to refer- 23 ring providers, the plan sponsor, enrollees, or 24 eligible enrollees of the plan or coverage; 25 VerDate Sep 11 2014 04:36 Mar 03, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6005.IH H6005 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 6005 IH ‘‘(B) electronically accessing de-identified 1 claims and encounter data for each enrollee in 2 the plan or coverage, upon request and con- 3 sistent with the privacy regulations promul- 4 gated pursuant to section 264(c) of the Health 5 Insurance Portability and Accountability Act, 6 the amendments to this Act made by the Ge- 7 netic Information Nondiscrimination Act of 8 2008, and the Americans with Disabilities Act 9 of 1990, with respect to the applicable health 10 plan or health insurance coverage, including, on 11 a per claim basis— 12 ‘‘(i) financial information, such as the 13 allowed amount, or any other claim-related 14 financial obligations included in the pro- 15 vider contract; 16 ‘‘(ii) provider information, including 17 name and clinical designation; 18 ‘‘(iii) service codes; or 19 ‘‘(iv) any other data element normally 20 included in claim or encounter transactions 21 when received by a plan or issuer; or 22 ‘‘(C) sharing data described in subpara- 23 graph (A) or (B) with a business associate as 24 defined in section 160.103 of title 45, Code of 25 VerDate Sep 11 2014 04:36 Mar 03, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6005.IH H6005 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 6005 IH Federal Regulations (or successor regulations), 1 consistent with the privacy regulations promul- 2 gated pursuant to section 264(c) of the Health 3 Insurance Portability and Accountability Act, 4 the amendments to this Act made by the Ge- 5 netic Information Nondiscrimination Act of 6 2008, and the Americans with Disabilities Act 7 of 1990. 8 ‘‘(2) INDIVIDUAL HEALTH INSURANCE COV- 9 ERAGE.—A health insurance issuer offering indi- 10 vidual health insurance coverage may not enter into 11 an agreement with a health care provider, network 12 or association of providers, or other service provider 13 offering access to a network of providers that would, 14 directly or indirectly restrict the health insurance 15 issuer from— 16 ‘‘(A) providing provider-specific price or 17 quality of care information, through a consumer 18 engagement tool or any other means, to refer- 19 ring providers or the plan sponsor, enrollees, or 20 eligible enrollees of the plan or coverage; or 21 ‘‘(B) sharing data described in subpara- 22 graph (A) with a business associate as defined 23 in section 160.103 of title 45, Code of Federal 24 Regulations (or successor regulations), con- 25 VerDate Sep 11 2014 04:36 Mar 03, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6005.IH H6005 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 6005 IH sistent with the privacy regulations promul- 1 gated pursuant to section 264(c) of the Health 2 Insurance Portability and Accountability Act, 3 the amendments to this Act made by the Ge- 4 netic Information Nondiscrimination Act of 5 2008, and the Americans with Disabilities Act 6 of 1990, for plan design, plan administration, 7 and plan, financial, legal, and quality improve- 8 ment activities. 9 ‘‘(3) CLARIFICATION REGARDING PUBLIC DIS- 10 CLOSURE OF INFORMATION.—Nothing in paragraph 11 (1)(A) or (2)(A) prevents a health care provider, 12 network or association of providers, or other service 13 provider from placing reasonable restrictions on the 14 public disclosure of the information described in 15 such paragraphs (1) and (2). 16 ‘‘(4) ATTESTATION.—A group health plan or a 17 health insurance issuer offering group or individual 18 health insurance coverage shall annually submit to, 19 as applicable, the applicable authority described in 20 section 2723 or the Secretary of Labor, an attesta- 21 tion that such plan or issuer is in compliance with 22 the requirements of this subsection. 23 ‘‘(5) RULE OF CONSTRUCTION.—Nothing in 24 this section shall be construed to otherwise limit 25 VerDate Sep 11 2014 04:36 Mar 03, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6005.IH H6005 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 6005 IH group health plan or plan sponsor access to data 1 currently permitted under the privacy regulations 2 promulgated pursuant to section 264(c) of the 3 Health Insurance Portability and Accountability Act, 4 the amendments to this Act made by the Genetic In- 5 formation Nondiscrimination Act of 2008, and the 6 Americans with Disabilities Act of 1990.’’. 7 Æ VerDate Sep 11 2014 04:36 Mar 03, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H6005.IH H6005 kjohnson on DSK79L0C42PROD with BILLS