Patients Before Profits Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 7267 To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to prohibit a group health plan and a health insurance issuer offering group or individual health insurance coverage from reduc- ing contracted rates, or terminating contracts, with health care providers during a public health emergency. IN THE HOUSE OF REPRESENTATIVES JUNE 18, 2020 Ms. PORTER (for herself and Ms. DELAURO) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdic- tion of the committee concerned A BILL To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to prohibit a group health plan and a health insurance issuer offering group or individual health insurance coverage from re- ducing contracted rates, or terminating contracts, with health care providers during a public health emergency. 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 22:00 Jul 12, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H7267.IH H7267 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 7267 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Patients Before Profits 2 Act of 2020’’. 3 SEC. 2. PROHIBITING A GROUP HEALTH PLAN AND A 4 HEALTH INSURANCE ISSUER OFFERING 5 GROUP OR INDIVIDUAL HEALTH INSURANCE 6 COVERAGE FROM REDUCING CONTRACTED 7 RATES, OR TERMINATING CONTRACTS, WITH 8 HEALTH CARE PROVIDERS DURING A PUBLIC 9 HEALTH EMERGENCY. 10 (a) PHSA.—Subpart II of part A of title XXVII of 11 the Public Health Service Act (42 U.S.C. 300gg–11 et 12 seq.) is amended by adding at the end the following new 13 section: 14 ‘‘SEC. 2730. PROHIBITION ON REDUCTION OF RATES AND 15 TERMINATION OF CONTRACTS DURING PUB- 16 LIC HEALTH EMERGENCIES. 17 ‘‘(a) IN GENERAL.—A group health plan and a health 18 insurance issuer offering group or individual health insur- 19 ance coverage may not, with respect to a health care pro- 20 vider located in an emergency area during an emergency 21 period that, as of the day before the date of the beginning 22 of such period, had in effect a contractual relationship for 23 furnishing items and services under such plan or cov- 24 erage— 25 VerDate Sep 11 2014 22:00 Jul 12, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H7267.IH H7267 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 7267 IH ‘‘(1) provide for an amount of reimbursement 1 for any such item or service furnished by such pro- 2 vider during such period that is less than the 3 amount of such reimbursement that would have been 4 payable under such plan or coverage had such item 5 or service been furnished by such provider on such 6 day; or 7 ‘‘(2) terminate such relationship during such 8 period; 9 unless such lesser reimbursement or such termination is 10 based on fraud, abuse, or other quality concerns with re- 11 spect to such provider or such provider being placed on 12 the exclusion list maintained by the Inspector General of 13 the Department of Health and Human Services. 14 ‘‘(b) DEFINITIONS.—For purposes of this section, an 15 ‘emergency area’ is a geographical area in which, and an 16 ‘emergency period’ is the period during which, there exists 17 a public health emergency declared by the Secretary pur- 18 suant to section 319.’’. 19 (b) ERISA.— 20 (1) IN GENERAL.—Subpart B of part 7 of sub- 21 title B of title I of the Employee Retirement Income 22 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 23 amended by adding at the end the following new sec- 24 tion: 25 VerDate Sep 11 2014 22:00 Jul 12, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H7267.IH H7267 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 7267 IH ‘‘SEC. 716. PROHIBITION ON REDUCTION OF RATES AND 1 TERMINATION OF CONTRACTS DURING PUB- 2 LIC HEALTH EMERGENCIES. 3 ‘‘(a) IN GENERAL.—A group health plan and a health 4 insurance issuer offering group health insurance coverage 5 may not, with respect to a health care provider located 6 in an emergency area during an emergency period that, 7 as of the day before the date of the beginning of such 8 period, had in effect a contractual relationship for fur- 9 nishing items and services under such plan or coverage— 10 ‘‘(1) provide for an amount of reimbursement 11 for any such item or service furnished by such pro- 12 vider during such period that is less than the 13 amount of such reimbursement that would have been 14 payable under such plan or coverage had such item 15 or service been furnished by such provider on such 16 day; or 17 ‘‘(2) terminate such relationship during such 18 period; 19 unless such lesser reimbursement or such termination is 20 based on fraud, abuse, or other quality concerns with re- 21 spect to such provider or such provider being placed on 22 the exclusion list maintained by the Inspector General of 23 the Department of Health and Human Services. 24 ‘‘(b) DEFINITIONS.—For purposes of this section, an 25 ‘emergency area’ is a geographical area in which, and an 26 VerDate Sep 11 2014 22:00 Jul 12, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H7267.IH H7267 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 7267 IH ‘emergency period’ is the period during which, there exists 1 a public health emergency declared by the Secretary pur- 2 suant to section 319.’’. 3 (2) CLERICAL AMENDMENT.—The table of con- 4 tents in section 1 of the Employee Retirement In- 5 come Security Act of 1974 is amended by inserting 6 after the item relating to section 714 the following 7 new items: 8 ‘‘Sec. 715. Additional market reforms. ‘‘Sec. 716. Prohibition on reduction of rates and termination of contracts dur- ing public health emergencies.’’. (c) IRC.— 9 (1) IN GENERAL.—Subchapter B of chapter 10 100 of the Internal Revenue Code of 1986 is amend- 11 ed by adding at the end the following new section: 12 ‘‘SEC. 9816. PROHIBITION ON REDUCTION OF RATES AND 13 TERMINATION OF CONTRACTS DURING PUB- 14 LIC HEALTH EMERGENCIES. 15 ‘‘(a) IN GENERAL.—A group health plan may not, 16 with respect to a health care provider located in an emer- 17 gency area during an emergency period that, as of the day 18 before the date of the beginning of such period, had in 19 effect a contractual relationship for furnishing items and 20 services under such plan— 21 ‘‘(1) provide for an amount of reimbursement 22 for any such item or service furnished by such pro- 23 vider during such period that is less than the 24 VerDate Sep 11 2014 22:00 Jul 12, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H7267.IH H7267 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 7267 IH amount of such reimbursement that would have been 1 payable under such plan had such item or service 2 been furnished by such provider on such day; or 3 ‘‘(2) terminate such relationship during such 4 period; 5 unless such lesser reimbursement or such termination is 6 based on fraud, abuse, or other quality concerns with re- 7 spect to such provider or such provider being placed on 8 the exclusion list maintained by the Inspector General of 9 the Department of Health and Human Services. 10 ‘‘(b) DEFINITIONS.—For purposes of this section, an 11 ‘emergency area’ is a geographical area in which, and an 12 ‘emergency period’ is the period during which, there exists 13 a public health emergency declared by the Secretary pur- 14 suant to section 319.’’. 15 (2) CLERICAL AMENDMENT.—The table of sec- 16 tions for such subchapter is amended by adding at 17 the end the following new items: 18 ‘‘Sec. 9815. Additional market reforms. ‘‘Sec. 9816. Prohibition on reduction of rates and termination of contracts dur- ing public health emergencies.’’. (d) EFFECTIVE DATE.—The amendment made by 19 this section shall apply with respect to public health emer- 20 gencies declared by the Secretary of Health and Human 21 Services on or after January 31, 2020, and items and 22 VerDate Sep 11 2014 22:00 Jul 12, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H7267.IH H7267 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 7267 IH services furnished, and terminations occurring, on or after 1 the date of the enactment of this Act. 2 Æ VerDate Sep 11 2014 22:00 Jul 12, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H7267.IH H7267 pbinns on DSKJLVW7X2PROD with BILLS