,i #aafth ,,congress #b;d ,session ,h4 ,r4 #ehjg ,,in ,,the ,,house ,,of ,,representatives ,february #g1 #bjbj,mr4 ,larson of ,connecticut 7for himself and ,mr4 ,wenstrup7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 and ,education and ,labor1 for a period to be subsequently determined by the ,speaker1 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 ,act1 the ,internal ,revenue ,code of #aihf1 the ,employee ,retirement ,income ,security ,act of #aigd1 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 coverage4 #a4 ,short title ,this ,act may be cited as the ,know ,your ,provider ,act of #bjbj4 #b4 ,improving 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 7a7 ,group health plan and health insurance issuer requirements 7#a7 ,public ,health ,service ,act ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq47 is amended by adding at the end the following new section3 #bgcj4 ,provider directory requirements 7a7 ,in general ,beginning not later than ,january #a1 #bjbb1 each group health plan and health insurance issuer offering group or individual health insurance coverage shall-- 7#a7 establish the verification process described in subsection 7b72 7#b7 establish the response protocol described in subsection 7c72 7#c7 establish the database described in subsection 7d72 and 7#d7 include in any directory 7other than the database described in paragraph 7#c77 containing provider directory information with respect to such plan or such coverage the information described in subsection 7e74 7b7 ,verification process ,the verification process described in this subsection is1 with respect to a group health plan or a health insurance issuer offering group or individual health insurance coverage1 a process-- 7#a7 under which such plan or such issuer 7as applicable7 verifies and updates the provider directory information included on the database described in subsection 7d7 of such plan or issuer of-- 7,a7 not less frequently than once every #ij days1 a random sample of at least #aj percent of health care providers and health care facilities included in such database2 and 7,b7 any such provider or such facility included in such database that has not submitted any claim to such plan or such issuer 7as applicable7 during a #ab-month period2 7#b7 that establishes a procedure for the removal from such database of such a provider or facility with respect to which such plan or issuer has been unable to verify such information during a period specified by the plan or issuer2 and 7#c7 that provides for the update of such database within #b business days of such plan or such issuer 7as applicable7 receiving from such a provider or facility information pursuant to section #aaej;,c of the ,social ,security ,act4 7c7 ,response protocol ,the response protocol described in this subsection is1 in the case of an individual enrolled under a group health plan or group or individual health insurance coverage offered by a health insurance issuer who requests information through a telephone call or email on whether a health care provider or health care facility has a contractual relationship to furnish items and services under such plan or such coverage1 a protocol under which such plan or such issuer 7as applicable7-- 7#a7 responds to such individual as soon as practicable1 and in no case later than #a business day after such call or email is received1 through a written electronic communication2 and 7#b7 retains such communication in such individual's file for at least #b years following such response4 7d7 ,database ,the database described in this subsection is1 with respect to a group health plan or health insurance issuer offering group or individual health insurance coverage1 a database on the public website of such plan or issuer that contains-- 7#a7 a list of each health care provider and health care facility with which such plan or such issuer has a contractual relationship for furnishing items and services under such plan or such coverage2 and 7#b7 provider directory information with respect to each such provider and facility4 7e7 ,information ,the information described in this subsection is1 with respect to a directory containing provider directory information with respect to a group health plan or individual or group health insurance coverage offered by a health insurance issuer1 a notification that such information contained in such directory was accurate as of the date of publication of such directory and that an individual enrolled under such plan or such coverage should consult the database described in subsection 7d7 with respect to such plan or such coverage or contact such plan or the issuer of such coverage to obtain the most current provider directory information with respect to such plan or such coverage4 7f7 ,definition ,for purposes of this section1 the term provider directory information includes1 with respect to a group health plan and a health insurance issuer offering group or individual health insurance coverage1 the name1 address1 specialty1 and telephone number of each health care provider or health care facility with which such plan or such issuer has a contractual relationship for furnishing items and services under such plan or such coverage4 4 7#b7 ,internal ,revenue ,code of #aihf 7,a7 ,in general ,subchapter ,b of chapter #ajj of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new section3 #ihaf4 ,provider directory requirements 7a7 ,in general ,beginning not later than ,january #a1 #bjbb1 each group health plan shall-- 7#a7 establish the verification process described in subsection 7b72 7#b7 establish the response protocol described in subsection 7c72 7#c7 establish the database described in subsection 7d72 and 7#d7 include in any directory 7other than the database described in paragraph 7#c77 containing provider directory information with respect to such plan the information described in subsection 7e74 7b7 ,verification process ,the verification process described in this subsection is1 with respect to a group health plan1 a process-- 7#a7 under which such plan verifies and updates the provider directory information included on the database described in subsection 7d7 of such plan of-- 7,a7 not less frequently than once every #ij days1 a random sample of at least #aj percent of health care providers and health care facilities included in such database2 and 7,b7 any such provider or such facility included in such database that has not submitted any claim to such plan during a #ab-month period2 7#b7 that establishes a procedure for the removal from such database of such a provider or facility with respect to which such plan has been unable to verify such information during a period specified by the plan2 and 7#c7 that provides for the update of such database within #b business days of such plan receiving from such a provider or facility information pursuant to section #aaej;,c of the ,social ,security ,act4 7c7 ,response protocol ,the response protocol described in this subsection is1 in the case of an individual enrolled under a group health plan who requests information through a telephone call or email on whether a health care provider or health care facility has a contractual relationship to furnish items and services under such plan1 a protocol under which such plan-- 7#a7 responds to such individual as soon as practicable1 and in no case later than #a business day after such call or email is received1 through a written electronic communication2 and 7#b7 retains such communication in such individual's file for at least #b years following such response4 7d7 ,database ,the database described in this subsection is1 with respect to a group health plan1 a database on the public website of such plan that contains-- 7#a7 a list of each health care provider and health care facility with which such plan has a contractual relationship for furnishing items and services under such plan2 and 7#b7 provider directory information with respect to each such provider and facility4 7e7 ,information ,the information described in this subsection is1 with respect to a directory containing provider directory information with respect to a group health plan1 a notification that such information contained in such directory was accurate as of the date of publication of such directory and that an individual enrolled under such plan should consult the database described in subsection 7d7 with respect to such plan or contact such plan to obtain the most current provider directory information with respect to such plan4 7f7 ,definition ,for purposes of this section1 the term provider directory information includes1 with respect to a group health plan1 the name1 address1 specialty1 and telephone number of each health care provider or health care facility with which such plan has a contractual relationship for furnishing items and services under such plan or such coverage4 4 7,b7 ,conforming amendment ,section #ihae7;a7 of the ,internal ,revenue ,code of #aihf is amended-- 7i7 in paragraph 7#a71 by striking 7as amended by the ,patient ,protection and ,affordable ,care ,act7 and inserting 7other than the provisions of section #bgcj of such ,act72 and 7ii7 in paragraph 7#b71 by inserting 7other than the provisions of section #bgcj of such ,act7 after the first occurrence of such part ,a4 7,c7 ,clerical amendment ,the table of sections for such subchapter is amended by adding at the end the following new items3 ,sec4 #ihae4 ,additional market reforms4 ,sec4 #ihaf4 ,provider directory requirements4 4 7#c7 ,employee ,retirement ,income ,security ,act of #aigd 7,a7 ,in general ,subpart ,b of part #g of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe et seq47 is amended by adding at the end the following new section3 #gaf4 ,provider directory requirements 7a7 ,in general ,beginning not later than ,january #a1 #bjbb1 each group health plan and health insurance issuer offering group health insurance coverage shall-- 7#a7 establish the verification process described in subsection 7b72 7#b7 establish the response protocol described in subsection 7c72 7#c7 establish the database described in subsection 7d72 and 7#d7 include in any directory 7other than the database described in paragraph 7#c77 containing provider directory information with respect to such plan or such coverage the information described in subsection 7e74 7b7 ,verification process ,the verification process described in this subsection is1 with respect to a group health plan or a health insurance issuer offering group health insurance coverage1 a process-- 7#a7 under which such plan or such issuer 7as applicable7 verifies and updates the provider directory information included on the database described in subsection 7d7 of such plan or issuer of-- 7,a7 not less frequently than once every #ij days1 a random sample of at least #aj percent of health care providers and health care facilities included in such database2 and 7,b7 any such provider or such facility included in such database that has not submitted any claim to such plan or such issuer 7as applicable7 during a #ab-month period2 7#b7 that establishes a procedure for the removal from such database of such a provider or facility with respect to which such plan or issuer has been unable to verify such information during a period specified by the plan or issuer2 and 7#c7 that provides for the update of such database within #b business days of such plan or such issuer 7as applicable7 receiving from such a provider or facility information pursuant to section #aaej;,c of the ,social ,security ,act4 7c7 ,response protocol ,the response protocol described in this subsection is1 in the case of an individual enrolled under a group health plan or group health insurance coverage offered by a health insurance issuer who requests information through a telephone call or email on whether a health care provider or health care facility has a contractual relationship to furnish items and services under such plan or such coverage1 a protocol under which such plan or such issuer 7as applicable7-- 7#a7 responds to such individual as soon as practicable1 and in no case later than #a business day after such call or email is received1 through a written electronic communication2 and 7#b7 retains such communication in such individual's file for at least #b years following such response4 7d7 ,database ,the database described in this subsection is1 with respect to a group health plan or health insurance issuer offering group health insurance coverage1 a database on the public website of such plan or issuer that contains-- 7#a7 a list of each health care provider and health care facility with which such plan or such issuer has a contractual relationship for furnishing items and services under such plan or such coverage2 and 7#b7 provider directory information with respect to each such provider and facility4 7e7 ,information ,the information described in this subsection is1 with respect to a directory containing provider directory information with respect to a group health plan or group health insurance coverage offered by a health insurance issuer1 a notification that such information contained in such directory was accurate as of the date of publication of such directory and that an individual enrolled under such plan or such coverage should consult the database described in subsection 7d7 with respect to such plan or such coverage or contact such plan or the issuer of such coverage to obtain the most current provider directory information with respect to such plan or such coverage4 7f7 ,definition ,for purposes of this section1 the term provider directory information includes1 with respect to a group health plan and a health insurance issuer offering group health insurance coverage1 the name1 address1 specialty1 and telephone number of each health care provider or health care facility with which such plan or such issuer has a contractual relationship for furnishing items and services under such plan or such coverage4 4 7,b7 ,conforming amendment ,section #gae7;a7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;d7a77 is amended-- 7i7 in paragraph 7#a71 by striking 7as amended by the ,patient ,protection and ,affordable ,care ,act7 and inserting 7other than the provisions of section #bgcj of such ,act72 and 7ii7 in paragraph 7#b71 by inserting 7other than the provisions of section #bgcj of such ,act7 after the first occurrence of such part ,a4 7,c7 ,clerical amendment ,the table of contents in section #a of the ,employee ,retirement ,income ,security ,act of #aigd is amended by inserting after the item relating to section #gad the following new items3 ,sec4 #gae4 ,additional market reforms4 ,sec4 #gaf4 ,provider directory requirements4 4 7b7 ,health care providers ,part ,a of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acjaj et seq47 is amended by adding at the end the following new section3 #aaej;,c4 ,submission of information to health plans of certain provider information 7a7 ,in general ,beginning not later than #a year after the date of the enactment of this section1 each health care provider and health care facility shall establish a process under which such provider or facility transmits1 to each health insurance issuer offering group or individual health insurance coverage and group health plan with which such provider or supplier has in effect a contractual relationship for furnishing items and services under such coverage or such plan1 provider directory information 7as defined in section #bgcj7;e7 of the ,public ,health ,service ,act1 section #gaf7;e7 of the ,employee ,retirement ,income ,security ,act of #aigd1 or section #ihaf7;e7 of the ,internal ,revenue ,code of #aihf1 as applicable7 with respect to such provider or facility1 as applicable4 ,such provider or facility shall so transmit such information to such issuer offering such coverage or such group health plan-- 7#a7 when there are any material changes 7including a change in address1 telephone number1 or other contact information7 to such provider directory information of the provider or facility with respect to such coverage offered by such issuer or with respect to such plan2 and 7#b7 at any other time 7including upon the request of such issuer or plan7 determined appropriate by the provider1 facility1 or the ,secretary4 7b7 ,penalty 7#a7 ,in general ,each health care provider or health care facility that fails to transmit information as required under subsection 7a7 shall be subject to a civil monetary penalty of #a1jjj for each day such provider or facility 7as applicable7 fails to so transmit such information4 7#b7 ,application of provisions ,the provisions of section #aabh;,a 7other than subsection 7a71 subsection 7b71 the first sentence of subsection 7c77#a71 subsection 7d71 and subsection 7o77 shall apply with respect to a civil monetary penalty imposed under this subsection in the same manner as such provisions apply with respect to a penalty or proceeding under subsection 7a7 of such section4 7c7 ,definitions ,in this section1 the terms health insurance issuer1 group health plan1 group health insurance coverage1 and individual health insurance coverage have the meaning given such terms1 respectively1 in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia et seq474 4