,i #aafth ,,congress #b;d ,session ,h4 ,r4 #hjih ,,in ,,the ,,house ,,of ,,representatives ,august #be1 #bjbj ,mr4 ,banks 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 the ,judiciary1 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 address hospital consolidation and promote hospital price transparency1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,hospital ,competition ,act of #bjbj4 #b4 ,hospital consolidation 7a7 ,authorization of appropriations ,there is authorized to be appropriated #afj1jjj1jjj to the ,federal ,trade ,commission to hire staff to investigate1 as consistent with the ,sherman ,antitrust ,act and other relevant ,federal laws1 anti-competitive mergers and practices under such laws to the extent such mergers and practices relate to providers of inpatient and outpatient health care services1 as defined by the ,secretary of ,health and ,human ,services4 7b7 ,medicare ,advantage rates applied to certain ,,hhi hospitals 7#a7 ,in general ,section #ahff7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77 is amended-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,x71 by striking and at the end2 7ii7 in subparagraph 7,y71 by striking the period at the end and inserting 2 and2 and 7iii7 by inserting after subparagraph 7,y7 the following new subparagraph3 7,z7 subject to paragraph 7#d71 in the case of a hospital located in a county whose population density is above the median population density for all counties in the ,united ,states with respect to which there is a ,herfindahl-,hirschman ,index 7,,hhi7 of greater than #d1jjj1 to apply the average reimbursement rate with respect to individuals 7regardless of whether such an individual is entitled to or eligible for benefits under this title1 but excluding individuals eligible for medical assistance under a ,state plan under title ,,xix7 furnished items and services at such hospital that would be billable under this title for such items and services if furnished by such hospital to an individual enrolled under part ,c4 2 and 7,b7 by adding at the end the following new paragraph3 7#d7 7,a7 ,the requirement under paragraph 7#a77,z7 shall not apply in the case of a hospital in a hospital referral region if-- 7i7 the ,,hrr market share of such hospital 7as determined under subparagraph 7,b77 is less than #j4ae2 or 7ii7 the hospital is located in a rural area 7as defined in section #ahhf7;d77#b77;,d772 7,b7 ,for purposes of subparagraph 7,a71 the ,,hrr market share of a hospital in a hospital referral region is equal to-- 7i7 the total revenue of the hospital1 divided by 7ii7 the total revenue of all hospital in the hospital referral region4 4 7#b7 ,effective date ,the amendments made by this subsection shall apply with respect to items and services furnished on or after ,january #a1 #bjba4 7c7 ,grants for hospital infrastructure improvement 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall carry out a grant program under which the ,secretary shall provide grants to eligible ,states1 in accordance with this subsection4 7#b7 ,uses ,an eligible ,state receiving a grant under this subsection may use such grant to improve the ,state hospital infrastructure and to supplement any other funds provided for a purpose authorized under a ,state or local hospital grant programs under ,state law4 7#c7 ,eligibility 7,a7 ,in general ,an eligible ,state may receive not more than one grant under this subsection with respect to each qualifying criterion described in subparagraph 7,b7 that is met by the ,state4 7,b7 ,eligible ,state ,for purposes of this subsection1 the term eligible ,state means a ,state that meets any one or more of the following qualifying criteria3 7i7 ,the ,state does not have in effect any ,state certificate of need law that requires a health care provider to provide to a regulatory body a certification that the community needs the services provided by the health care provider4 7ii7 ,the ,state has in effect ,state scope of practice laws that-- 7,i7 allow advanced practice providers 7such as nurse practitioners1 advanced practice registered nurses1 clinical nurse specialists1 and physician assistants7 to evaluate patients2 diagnose1 order1 and interpret diagnostic tests2 and initiate and manage treatments2 or 7,,ii7 provide that the only justification for limiting the scope of practice of a health care provider is safety to the public4 7iii7 ,the ,state does not have in effect any ,state laws that require managed care plans to accept into the network of such plan any qualified provider who is willing to accept the terms and conditions of the managed care plan4 7iv7 ,the ,state does not have in effect any ,certificate of ,public ,advantage laws that clearly articulate the ,state's intent to displace competition in favor of regulation or that violate ,state or ,federal antitrust laws4 7v7 ,the ,state does not have in effect any network adequacy laws regulating a health plan's ability to deliver benefits by providing reasonable access to a sufficient number of in-network primary care and specialty physicians1 as well as all health care services included under the terms of an insuree's contract with a health insurer4 7#d7 ,funding ,there is authorized to be appropriated to carry out this subsection #a1jjj1jjj1jjj for each of the fiscal years #bjba through #bjcj4 ,funds appropriated under this paragraph shall remain available until expended4 7d7 ,critical access hospital reimbursement rates 7#a7 ,part ,a ,section #ahad7l77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7l77#a77 is amended by inserting 7or1 for #bjba1 #ajb1 plus #a percentage point for each subsequent year through #bjbi1 and #aaj for each subsequent year thereafter7 after #aja4 7#b7 ,part ,b ,section #ahcd7;g77#a7 of such ,act 7#db ,u4,s4,c4 #aciem7g77#a77 is amended by inserting 7or1 for #bjba1 #ajb1 plus #a percentage point for each subsequent year through #bjbi1 and #aaj for each subsequent year thereafter7 after #aja4 #c4 ,price transparency ,section #ahff of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc71 as amended by section #dja1 is further amended-- 7#a7 in subsection 7a77#a7-- 7,a7 in subparagraph 7,y71 by striking and at the end2 7,b7 in subparagraph 7,z71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after subparagraph 7,z7 the following new subparagraph3 7,,aa7 in the case of a hospital1 to comply with the requirement under subsection 7l74 2 and 7#b7 by adding at the end the following new subsection3 7l7 ,requirement relating to publishing certain hospital prices 7#a7 ,in general ,for purposes of subsection 7a77#a77;,,aa71 the requirement described in this subsection is1 with respect to a hospital and year 7beginning with #bjba71 for the hospital to publicly post1 through the system established under paragraph 7#c71 for each commonly shoppable service included in the list published under paragraph 7#b7 for such year1 the volume-weighted average price charged by the hospital to-- 7,a7 individuals enrolled during such year in group health plans or health insurance coverage offered in the individual or group market 7as such terms are defined in section #bgia of the ,public ,health ,service ,act72 and 7,b7 individuals who are not enrolled in any health insurance coverage or health benefits plan and individuals who are enrolled in such coverage or plan but such coverage or plan does not provide benefits for the service4 7#b7 ,commonly shoppable services ,for purposes of subsection 7a77#a77;,,aa7 and this subsection1 the ,secretary shall1 for #bjba and each subsequent year1 publish a list of the #ajj commonly shoppable services that are the most highly utilized in a hospital-based setting4 7#c7 ,standardized digital reporting system ,not later than ,january #a1 #bjba1 the ,secretary shall establish a standardized digital system for purposes of paragraph 7#a74 4 #d4 ,repealing eligibility of certain ,a,c,os 7a7 ,in general ,section #ahii7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7b77#a77 is amended by striking subparagraphs 7,c7 through 7,e74 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on ,january #a1 #bjba4 #e4 ,off-campus provider-based department medicare site neutral payment 7a7 ,in general ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7x7 ,off-,campus provider-,based department site neutral payment 7#a7 ,in general ,with respect to items and services furnished in an off-campus provider-based department1 payment under this section for such items and services shall be the amount determined under the fee schedule under section #ahdh for such items and services furnished if furnished in a physician office setting4 7#b7 ,off-campus provider-based department ,for purposes of this subsection1 the term off-campus provider-based department has such meaning as specified by the ,secretary4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply with respect to items and services furnished on or after ,january #a1 #bjba4 #f4 ,repeal of health care reform provisions limiting ,medicare exception to the prohibition on certain physician referrals for hospitals ,sections #fjja and #ajfja of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh2 #abd ,stat4 #fhd1 #ajje7 and section #aajf of the ,health ,care and ,education ,reconciliation ,act of #bjaj 7,public ,law #aaa-aeb2 #abd ,stat4 #ajdi7 are repealed and the provisions of law amended by such sections are restored as if such sections had never been enacted4 #g4 ,advisory group on reducing burden of hospital administrative requirements 7a7 ,in general ,not later than ,january #a1 #bjba1 the ,secretary of ,health and ,human ,services shall convene an advisory group to provide1 in accordance with this section1 recommendations on ways the ,federal ,government could reduce the burden of administrative requirements on hospitals4 7b7 ,recommendations ,not later than ,january #a1 #bjbb1 the advisory board convened under this section shall-- 7#a7 submit to the ,secretary of ,health and ,human ,services recommendations described under subsection 7a7 for executive action and any recommendations for ,state actions for potential consideration in making grants under section #b7;c7 to ,states2 and 7#b7 submit to ,congress recommendations described under subsection 7a7 for legislative proposals4 7c7 ,membership ,the advisory board under this section shall consist of the following members3 7#a7 ,three representatives of companies that have-- 7,a7 geographically distributed workforces2 7,b7 at least #aj1jjj employees2 and 7,c7 no more than #aj percent of such employees in any single ,state4 7#b7 ,three representatives of health insurance issuers and health plans1 consisting of-- 7,a7 one representative of for-profit health insurance issuers and health plans with at least #bj1jjj1jjj enrollees in the employer-sponsored market2 7,b7 one representative of non-profit health insurance issuers and health plans operating in at least #e ,states2 and 7,c7 one representative of non-profit health insurance issuers and health plans operating in a rural ,state 7as defined by the ,census ,bureau74 7#c7 ,seven public policy experts in the field of hospital consolidation4 #h4 ,authority of ,federal ,trade ,commission over certain tax-exempt organizations ,section #d of the ,federal ,trade ,commission ,act 7#ae ,u4,s4,c4 #dd7 is amended1 in the undesignated paragraph relating to the definition of the term ,corporation-- 7#a7 by striking 1 and any and inserting 1 any2 and 7#b7 by inserting before the period at the end the following3 1 and any organization described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf that is exempt from taxation under section #eja7;a7 of such ,code4 #i4 ,leveling the playing field between providers and payers 7a7 ,exemption ,it shall not be a violation of the antitrust laws for one or more private health insurer issuers or their designated agents to jointly negotiate prices of particular hospital services with a hospital provider with regards to the reimbursement policies of the insurers for those services4 7b7 ,definitions ,for purposes of this section3 7#a7 ,antitrust laws ,the term antitrust laws has the meaning given it in subsection 7a7 of the #ast section of the ,clayton ,act 7#ae ,u4,s4,c4 #ab7;a771 except that such term includes section #e of the ,federal ,trade ,commission ,act 7#ae ,u4,s4,c4 #de7 to the extent such section #e applies to unfair methods of competition4 7#b7 ,health insurance issuer ,the term health insurance issuer means an insurance company1 insurance service1 or insurance organization 7including a health maintenance organization1 as defined in subparagraph 7,c77 which is licensed to engage in the business of insurance in a ,state and which is subject to ,state law which regulates insurance 7within the meaning of section #ead7;b77#b7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aadd7;b77#b774 ,such term does not include a group health plan4 7#c7 ,health maintenance organization ,the term health maintenance organization means-- 7,a7 a federally qualified health maintenance organization 7as defined in section #cjj;e7a7 of title #db of the ,code of ,federal ,regulations71 7,b7 an organization recognized under ,state law as a health maintenance organization1 or 7,c7 a similar organization regulated under ,state law for solvency in the same manner and to the same extent as such a health maintenance organization4 7c7 ,effective date ,this section shall take effect on the date of the enactment of this ,act but shall not apply with respect to conduct that occurs before such date4 #aj4 ,increasing transparency by removing gag clauses on price and quality information ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq471 as amended by section #ajc1 is amended by adding at the end the following3 #bgbi;,b4 ,increasing transparency by removing gag clauses on price and quality information 7a7 ,increasing price and quality transparency for plan sponsors and group and individual market and consumers 7#a7 ,group health plans ,a group health plan or health insurance issuer offering group health insurance coverage may not enter into an agreement with a health care provider1 network or association of providers1 third-party administrator1 or other service provider offering access to a network of providers that would directly or indirectly restrict a group health plan or health insurance issuer from-- 7,a7 providing provider-specific cost or quality of care information1 through a consumer engagement tool or any other means1 to referring providers1 the plan sponsor1 enrollees1 or eligible enrollees of the plan or coverage2 7,b7 electronically accessing de-identified claims and encounter data for each enrollee in the plan or coverage1 upon request and consistent with the privacy regulations promulgated pursuant to section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act1 the amendments to this ,act made by the ,genetic ,information ,nondiscrimination ,act of #bjjh1 and the ,americans with ,disabilities ,act of #aiij1 with respect to the applicable health plan or health insurance coverage1 including1 on a per claim basis-- 7i7 financial information1 such as the allowed amount1 or any other claim-related financial obligations included in the provider contract2 7ii7 provider information1 including name and clinical designation2 7iii7 service codes2 or 7iv7 any other data element normally included in claim or encounter transactions when received by a plan or issuer2 or 7,c7 sharing data described in subparagraph 7,a7 or 7,b7 with a business associate as defined in section #afj4ajc of title #de1 ,code of ,federal ,regulations 7or successor regulations71 consistent with the privacy regulations promulgated pursuant to section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act1 the amendments to this ,act made by the ,genetic ,information ,nondiscrimination ,act of #bjjh1 and the ,americans with ,disabilities ,act of #aiij4 7#b7 ,individual health insurance coverage ,a health insurance issuer offering individual health insurance coverage may not enter into an agreement with a health care provider1 network or association of providers1 or other service provider offering access to a network of providers that would directly or indirectly restrict the health insurance issuer from-- 7,a7 providing provider-specific price or quality of care information1 through a consumer engagement tool or any other means1 to referring providers1 enrollees1 or eligible enrollees of the plan or coverage2 or 7,b7 sharing1 for plan design1 plan administration1 and plan1 financial1 legal1 and quality improvement activities1 data described in subparagraph 7,a7 with a business associate as defined in section #afj4ajc of title #de1 ,code of ,federal ,regulations 7or successor regulations71 consistent with the privacy regulations promulgated pursuant to section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act1 the amendments to this ,act made by the ,genetic ,information ,nondiscrimination ,act of #bjjh1 and the ,americans with ,disabilities ,act of #aiij4 7#c7 ,clarification regarding public disclosure of information ,nothing in paragraph 7#a77;,a7 or 7#b77;,a7 prevents a health care provider1 network or association of providers1 or other service provider from placing reasonable restrictions on the public disclosure of the information described in such paragraphs 7#a7 and 7#b74 7#d7 ,attestation ,a group health plan or a health insurance issuer offering group or individual health insurance coverage shall annually submit to1 as applicable1 the applicable authority described in section #bgbc or the ,secretary of ,labor1 an attestation that such plan or issuer is in compliance with the requirements of this subsection4 7#e7 ,rule of construction ,nothing in this section shall be construed to otherwise limit group health plan1 plan sponsor1 or health insurance issuer access to data currently permitted under the privacy regulations promulgated pursuant to section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act1 the amendments to this ,act made by the ,genetic ,information ,nondiscrimination ,act of #bjjh1 and the ,americans with ,disabilities ,act of #aiij4 4 #aa4 ,banning anticompetitive terms in facility and insurance contracts that limit access to higher quality1 lower cost care 7a7 ,in general ,section #bgbi;,b of the ,public ,health ,service ,act1 as added by section #cja1 is amended by adding at the end the following3 7b7 ,protecting ,health ,plans ,network ,design ,flexibility 7#a7 ,in general ,a group health plan or a health insurance issuer offering group or individual health insurance coverage shall not enter into an agreement with a provider1 network or association of providers1 or other service provider offering access to a network of service providers if such agreement1 directly or indirectly-- 7,a7 restricts the group health plan or health insurance issuer from-- 7i7 directing or steering enrollees to other health care providers2 or 7ii7 offering incentives to encourage enrollees to utilize specific health care providers2 or 7,b7 requires the group health plan or health insurance issuer to enter into any additional contract with an affiliate of the provider1 such as an affiliate of the provider1 as a condition of entering into a contract with such provider2 7,c7 requires the group health plan or health insurance issuer to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved2 or 7,d7 restricts other group health plans or health insurance issuers not party to the contract from paying a lower rate for items or services than the contracting plan or issuer pays for such items or services4 7#b7 ,additional requirement for self-insured plans ,a self-insured group health plan shall not enter into an agreement with a provider1 network or association of providers1 third-party administrator1 or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify1 attest1 or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to1 without a disclosure that such terms exist4 7#c7 ,exception for certain group model issuers ,paragraph 7#a77;,a7 shall not apply to a group health plan or health insurance issuer offering group or individual health insurance coverage with respect to-- 7,a7 a health maintenance organization 7as defined in section #bgia7;b77#c771 if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups1 nor to any arrangement between such a health maintenance organization and its affiliates2 or 7,b7 a value-based network arrangement1 such as an exclusive provider network1 accountable care organization1 center of excellence1 a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems1 or such other similar network arrangements as determined by the ,secretary through rulemaking4 7#d7 ,attestation ,a group health plan or health insurance issuer offering group or individual health insurance coverage shall annually submit to1 as applicable1 the applicable authority described in section #bgbc or the ,secretary of ,labor1 an attestation that such plan or issuer is in compliance with the requirements of this subsection4 7c7 ,maintenance of existing ,,hipaa1 ,,gina1 and ,,ada protections ,nothing in this section shall modify1 reduce1 or eliminate the existing privacy protections and standards provided by reason of ,state and ,federal law1 including the requirements of parts #afj and #afd of title #de1 ,code of ,federal ,regulations 7or any successor regulations74 7d7 ,regulations ,the ,secretary1 not later than #a year after the date of enactment of the ,hospital ,competition ,act of #bjbj1 shall promulgate regulations to carry out this section4 7e7 ,rule of construction ,nothing in this section shall be construed to limit network design or cost or quality initiatives by a group health plan or health insurance issuer1 including accountable care organizations1 exclusive provider organizations1 networks that tier providers by cost or quality or steer enrollees to centers of excellence1 or other pay-for-performance programs4 7f7 ,clarification with respect to antitrust laws ,compliance with this section does not constitute compliance with the antitrust laws1 as defined in subsection 7a7 of the first section of the ,clayton ,act 7#ae ,u4,s4,c4 #ab7;a774 4 7b7 ,effective date ,section #bgbi;,b of the ,public ,health ,service ,act 7as added by section #cja and amended by subsection 7a77 shall apply with respect to any contract entered into on or after the date that is #ah months after the date of enactment of this ,act4 ,with respect to an applicable contract that is in effect on the date of enactment of this ,act1 such section #bgbi;,b shall apply on the earlier of the date of renewal of such contract or #c years after such date of enactment4 #ab4 ,designation of a nongovernmental1 nonprofit transparency organization to lower ,americans' health care costs 7a7 ,in general ,subpart ,c of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia et seq471 as amended by section #ajb1 is further amended by adding at the end the following3 #bgif4 ,designation of a nongovernmental1 nonprofit transparency organization to lower ,americans' health care costs 7a7 ,in general ,the ,secretary1 in consultation with the ,secretary of ,labor1 not later than #a year after the date of enactment of the ,hospital ,competition ,act of #bjbj1 shall enter into contracts with at least #b nonprofit entities to support the establishment and maintenance of a database that receives and utilizes health care claims information and related information and issues reports that are available to the public and authorized users1 and are submitted to the ,department of ,health and ,human ,services4 7b7 ,requirements 7#a7 ,in general ,the database established under subsection 7a7 shall-- 7,a7 improve transparency by using de-identified health care data to-- 7i7 inform patients about the cost1 quality1 and value of their care2 7ii7 assist providers and hospitals1 as they work with patients1 to make informed choices about care2 7iii7 enable providers1 hospitals1 and communities to improve services and outcomes for patients by benchmarking their performance against that of other providers1 hospitals1 and communities2 7iv7 enable purchasers1 including employers1 employee organizations1 and health plans1 to develop value-based purchasing models1 improve quality1 and reduce the cost of health care and insurance coverage for enrollees2 7v7 enable employers and employee organizations to evaluate network design and construction1 and the cost of care for enrollees2 7vi7 facilitate ,state-led initiatives to lower health care costs and improve quality2 and 7vii7 promote competition based on quality and cost2 7,b7 collect medical claims1 prescription drug claims1 and remittance data consistent with the protections and requirements of subsection 7d72 7,c7 be established in such a manner that allows the data collected pursuant to subparagraph 7,b7 to be shared with any ,state all-payer claims database or regional database operated with authorization from ,states1 at cost1 using a standardized format1 if such ,state or regional database also submits claims data to the database established under this section2 and 7,d7 be available to-- 7i7 the ,director of the ,congressional ,budget ,office1 the ,comptroller ,general of the ,united ,states1 the ,executive ,director of the ,medicare ,payment ,advisory ,commission1 and the ,executive ,director of the ,medicaid and ,,chip ,payment ,advisory ,commission1 upon request1 subject to the privacy and security requirements of authorized users under subsection 7e77#b72 and 7ii7 authorized users1 including employers1 employee organizations1 providers1 group health plans1 health insurance issuers1 researchers1 and policymakers1 subject to subsection 7e74 7#b7 ,privacy and security2 breach notifications 7,a7 ,regulations 7i7 ,in general ,the ,secretary shall issue regulations prescribing the extent to which1 and the manner in which1 the following rules 7and any successors of such rules7 shall apply to the activities under this section of an entity receiving a contract under subsection 7a73 7,i7 ,the ,privacy ,rule under part #afj and subparts ,a and ,e of part #afd of title #de1 ,code of ,federal ,regulations 7or any successor regulations74 7,,ii7 ,the ,security ,rule under part #afj and subparts ,a and ,c of part #afd of such title #de 7or any successor regulations74 7,,iii7 ,the ,breach ,notification ,rule under part #afj and subparts ,a and ,d of part #afd of such title #de 7or any successor regulations74 7ii7 ,supplemental regulations ,in order to ensure data privacy and security and the notification of breaches1 the ,secretary may issue such supplemental regulations on the subjects of the rules listed under clause 7i7 as the ,secretary determines appropriate to address differences between the activities described by this section and the activities covered by such rules4 7,b7 ,enforcement ,section #aagf of ,social ,security ,act shall apply with respect to a violation of this paragraph in the same manner such section #aagf applies to a violation of part ,c of title ,,xi of the ,social ,security ,act1 and the ,secretary may include in the regulations promulgated under this section provisions to apply such section to this paragraph4 7,c7 ,procedure 7i7 ,timing ,the ,secretary shall issue the initial set of regulations under this paragraph not later than #a year after the date of enactment of the ,hospital ,competition ,act of #bjbj4 7ii7 ,authority to use interim final procedures ,the ,secretary may make such initial set of regulations effective and final immediately upon issuance1 on an interim basis1 and provide for a period of public comment on such initial set of regulations after the date of publication4 7,d7 ,requirements of entity ,an entity receiving the contract under this section shall-- 7i7 not disclose to the public any individually identifiable health information2 7ii7 strictly limit staff access to the data to staff with appropriate training1 clearance1 and background checks and require regular privacy and security training2 7iii7 maintain effective security standards for transferring data or making data available to authorized users2 7iv7 develop a process for providing access to data to authorized users1 in a secure manner that maintains privacy and confidentiality of data2 and 7v7 adhere to current best security practices with respect to the management and use of such data for health services research1 in accordance with applicable ,federal privacy law4 7#c7 ,consultation 7,a7 ,advisory committee ,not later than #ahj days after the date of enactment of the ,hospital ,competition ,act of #bjbj1 the ,secretary shall convene an ,advisory ,committee 7referred to in this section as the ,committee71 consisting of #ac members1 to advise the ,secretary1 a contracting entity1 and ,congress on the establishment1 operations1 and use of the database established under this section4 7,b7 ,membership 7i7 ,appointment ,in accordance with clause 7ii71 the ,secretary1 in consultation with the ,secretary of ,labor and the ,comptroller ,general of the ,united ,states shall1 not later than #ahj days after the date of enactment of the ,hospital ,competition ,act of #bjbj1 appoint members to the ,committee who have distinguished themselves in the fields of health services research1 health economics1 health informatics1 or the governance of ,state all-payer claims databases1 or who represent organizations likely to submit data to or use the database1 including patients1 employers1 or employee organizations that sponsor group health plans1 health care providers1 health insurance issuers1 or third-party administrators of group health plans4 ,such members shall serve #c-year terms on a staggered basis4 ,vacancies on the ,committee shall be filled by appointment consistent with this subsection not later than #c months after the vacancy arises4 7ii7 ,composition ,in accordance with clause 7i7-- 7,i7 the ,secretary1 in consultation with the ,secretary of ,labor1 shall appoint to the ,committee-- 7aa7 #a member selected by the ,secretary1 in coordination with the ,secretary of ,labor1 to serve as the chair of the ,committee2 7bb7 the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services1 or a designee of such ,assistant ,secretary2 7cc7 #a representative of the ,centers for ,medicare ,medicaid ,services2 7dd7 #a representative of the ,agency for ,health ,research and ,quality2 7ee7 #a representative of the ,office for ,civil ,rights of the ,department of ,health and ,human ,services with expertise in data privacy and security2 7ff7 #a representative of the ,national ,center for ,health ,statistics2 and 7gg7 #a representative of the ,employee ,benefits and ,security ,administration of the ,department of ,labor2 and 7,,ii7 the ,comptroller ,general of the ,united ,states shall appoint to the ,committee-- 7aa7 #a representative of an employer that sponsors a group health plan2 7bb7 #a representative of an employee organization that sponsors a group health plan2 7cc7 #a academic researcher with expertise in health economics or health services research2 7dd7 #a consumer advocate2 and 7ee7 #b additional members4 7,c7 ,duties ,the ,committee shall-- 7i7 advise the ,secretary on the management of the contract under subsection 7a72 7ii7 assist and advise the entities receiving the contract under subsection 7a7 in establishing-- 7,i7 the scope and format of the data to be submitted under subsection 7d72 7,,ii7 best practices with respect to de-identification of data1 as appropriate2 7,,iii7 the appropriate uses of data by authorized users1 including developing standards for the approval of requests by organizations to access and use the data2 and 7,,iv7 the appropriate formats and methods for making reports and analyses based on the database to the public2 7iii7 conduct an annual review of whether data was used according to the appropriate uses as described in clause 7ii77,,ii71 and advise the designated entities on using the data for authorized purposes2 7iv7 report1 as appropriate1 to the ,secretary and ,congress on the operation of the database and opportunities to better achieve the objectives of this section2 7v7 establish additional restrictions on researchers who receive compensation from entities described in subsection 7e77#b77;,b77ii71 in order to protect individually identifiable health information2 and 7vi7 establish objectives for research and public reporting4 7#d7 ,state requirements ,a ,state may require health insurance issuers and other payers to submit claims data to the database established under this section1 provided that such data is submitted to the entities awarded contracts under this section in a form and manner established by the ,secretary1 and pursuant to subsection 7d77#d77;,b74 7#e7 ,sanctions ,the ,secretary shall take appropriate action to sanction users who attempt to re-identify data accessed pursuant to paragraph 7#a77;,d74 7c7 ,contract requirements 7#a7 ,competitive procedures ,the ,secretary shall enter into the contract under subsection 7a7 using full and open competition procedures pursuant to chapter #cc of title #da1 ,united ,states ,code4 7#b7 ,eligible entities ,to be eligible to enter into a contract described in subsection 7a71 an entity shall-- 7,a7 be a private nonprofit entity governed by a board that includes representatives of the academic research community and individuals with expertise in employer-sponsored insurance1 research using health care claims data and actuarial analysis2 7,b7 conduct its business in an open and transparent manner that provides the opportunity for public comment on its activities2 and 7,c7 agree to comply with any requirements imposed under the rulemaking described in subsection 7d77#d77;,a74 7#c7 ,considerations ,in awarding a contract under subsection 7a71 the ,secretary shall consider an entity's experience in-- 7,a7 health care claims data collection1 aggregation1 quality assurance1 analysis1 and security2 7,b7 supporting academic research on health costs1 spending1 and utilization for and by privately insured patients2 7,c7 working with large health insurance issuers and third-party administrators to assemble a national claims database2 7,d7 effectively collaborating with and engaging stakeholders to develop reports2 7,e7 meeting budgets and timelines1 including in connection with report generation2 and 7,f7 facilitating the creation of1 or supporting1 ,state all-payer claims databases4 7#d7 ,contract term ,a contract awarded under this section shall be for a period of #e years1 and may be renewed after a subsequent competitive bidding process under this section4 7#e7 ,transition of contract ,if the ,secretary1 following a competitive process at the end of the contract period1 selects a new entity to maintain the database1 all data shall be transferred to the new entity according to a schedule and process to be determined by the ,secretary4 ,upon termination of a contract1 no entity may keep data held by the database or disclose such data to any entity other than the entity so designated by the ,secretary4 ,the ,secretary shall include enforcement terms in any contract with an organization chosen under this section1 to ensure the timely transfer of all data1 and any associated code or algorithms1 to a new entity in the event of contract termination4 7d7 ,receiving health information 7#a7 ,requirements 7,a7 ,in general ,the ,secretary of ,labor shall ensure that the applicable self-insured group health plan1 through its third-party administrator1 pharmacy benefit manager1 or other entity designated by the group health plan1 as applicable1 electronically submits all claims data with respect to the plan1 pursuant to subparagraph 7,b74 7,b7 ,scope of information and format of submission ,an entity awarded the contract under subsection 7a71 in consultation with the ,committee described in subsection 7b77#c71 and pursuant to the privacy and security requirements of subsection 7b77#b71 shall-- 7i7 specify the data elements required to be submitted under subparagraph 7,a71 which shall include all data related to transactions described in subparagraphs 7,a7 and 7,e7 of section #aagc7;a77#b7 of the ,social ,security ,act1 including all data elements normally present in such transactions when adjudicated1 and enrollment information2 7ii7 specify the form and manner for such submissions1 and the historical period to be included in the initial submission2 and 7iii7 offer an automated submission option to minimize administrative burdens for entities required to submit data4 7,c7 ,de-identification of data ,an entity awarded the contract under subsection 7a7 shall-- 7i7 establish a process under which data is de-identified consistent with the de-identification requirements under section #afd4ead of title #de1 ,code of ,federal ,regulations 7or any successor regulations71 while retaining the ability to link data longitudinally for the purposes of research on cost and quality1 and the ability to complete risk adjustment and geographic analysis2 7ii7 ensure that any third-party subcontractors who perform the de-identification process described in clause 7i7 retain only the minimum necessary information to perform such a process1 and adhere to effective security and encryption practices in data storage and transmission2 7iii7 store claims and other data collected under this subsection only in de-identified form1 in accordance with section #afd4ead of title #de1 ,code of ,federal ,regulations 7or any successor regulations72 and 7iv7 ensure that individually identifiable data is encrypted1 in accordance with guidance issued by the ,secretary under section #acdjb7;h77#b7 of the ,,hitech ,act4 7#b7 ,applicable self-insured group health plan ,for purposes of paragraph 7#a71 a self-insured group health plan is an applicable self-insured group health plan if such plan is self-administered1 or is administered by a third-party plan administrator that meets #a or both of the following criteria3 7,a7 ,administers health1 medical1 or pharmacy benefits for more than #ej1jjj enrollees4 7,b7 ,is one of the #e largest administrators or issuers of self-insured group health plans in a ,state in which such administrator operates1 as measured by the aggregate number of enrollees in plans administered by such administrator in such ,state1 as determined by the ,secretary4 7#c7 ,third-party administrators ,in the case of a third-party administrator that is required under this subsection to submit claims data with respect to an applicable self-insured group health plan1 such administrator shall submit claims data with respect to all self-insured group health plans that the administrator administers1 including such plans that are not applicable self-insured group health plans1 as described in paragraph 7#b74 7#d7 ,receiving other information 7,a7 ,medicare data ,the ,secretary1 through rulemaking1 shall ensure that the data made available to such entity is available to qualified entities under section #ahgd7;e7 of the ,social ,security ,act is made available to each entity awarded a contract under subsection 7a74 7,b7 ,state data ,an entity awarded a contract under subsection 7a7 shall collect data from ,state all payer claims databases that seek access to the database established under this section4 7#e7 ,availability of data ,an entity required to submit data under this subsection may not place any restrictions on the use of such data by authorized users4 7e7 ,uses of information 7#a7 ,in general ,an entity awarded a contract under subsection 7a7 shall make the database available to users who are authorized under this subsection1 without charge1 and reports and analyses based on the data available to the public with no charge4 7#b7 ,authorization of users 7,a7 ,in general ,an entity may request authorization by an entity awarded a contract under subsection 7a7 for access to the database in accordance with this paragraph4 7,b7 ,application ,an entity desiring authorization under this paragraph shall submit to an entity awarded a contract an application for such access1 which shall include-- 7i7 in the case of an entity requesting access for research purposes-- 7,i7 a description of the uses and methodologies for evaluating health system performance using such data2 and 7,,ii7 documentation of approval of the research by an institutional review board1 if applicable for a particular plan of research2 or 7ii7 in the case of an entity such as an employer1 health insurance issuer1 third-party administrator1 or health care provider1 requesting access for the purpose of quality improvement or cost-containment1 a description of the intended uses for such data4 7,c7 ,requirements 7i7 ,research ,upon approval of an application for research purposes under subparagraph 7,b77i71 the authorized user shall enter into a data use and confidentiality agreement with an entity awarded a contract under subsection 7a71 which shall include a prohibition on attempts to reidentify and disclose individually identifiable health information4 7ii7 ,quality improvement and cost-containment ,in consultation with the ,committee described in subsection 7b77#c71 the ,secretary shall1 through rulemaking1 establish the form and manner in which authorized users described in subparagraph 7,b77ii7 may access data4 ,data provided to such authorized users shall be provided in a form and manner such that users may not obtain individually identifiable price information with respect to direct competitors4 ,upon approval1 such authorized user shall enter into a data use and confidentiality agreement with the entity4 7iii7 ,customized reports ,employers and employer organizations may request customized reports from an entity awarded a contract under subsection 7a71 at cost1 subject to the requirements of this section with respect to privacy and security4 7iv7 ,non-customized reports ,an entity awarded a contract under subsection 7a71 in consultation with the ,committee1 shall make available to all authorized users aggregate data sets1 free of charge4 7f7 ,funding 7#a7 ,initial funding ,there are authorized to be appropriated1 and there are appropriated1 out of monies in the ,treasury not otherwise appropriated1 #bj1jjj1jjj for fiscal year #bjbj1 for the implementation of the initial contract and establishment of the database under this section4 7#b7 ,ongoing funding ,there are authorized to be appropriated #ae1jjj1jjj for each of fiscal years #bjba through #bjbe1 for purposes of carrying out this section 7other than the grant program under subsection 7h774 7g7 ,annual report 7#a7 ,submission ,on each of the dates described in paragraph 7#b71 an entity receiving a contract under subsection 7a7 shall submit to ,congress1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,labor and publish online for access by the general public1 a report containing a description of-- 7,a7 trends in the price1 utilization1 and total spending on health care services1 including a geographic analysis of differences in such trends2 7,b7 limitations in the data set2 7,c7 progress towards the objectives of this section2 and 7,d7 the performance by the entity of the duties required under such contract4 7#b7 ,dates described ,the reports described in paragraph 7#a7 shall be submitted-- 7,a7 not later than #c years after the date of enactment of the ,hospital ,competition ,act of #bjbj2 7,b7 the later of #a year after the date that is #c years after such date of enactment or ,march #a of the year after the date that is #c years after such date of enactment2 and 7,c7 ,march #a of each year thereafter4 7#c7 ,public reports and research ,an entity receiving a contract under subsection 7a7 shall1 in coordination with authorized users1 make analyses and research available to the public on an ongoing basis to promote the objectives of this section4 7h7 ,grants to ,states 7#a7 ,in general ,the ,secretary1 in consultation with the ,secretary of ,labor1 may award grants to ,states for the purpose of establishing and maintaining ,state all-payer claims databases that improve transparency of data in order to meet the goals of subsection 7a77#a74 7#b7 ,requirement ,to be eligible to receive the funding under paragraph 7#a71 a ,state shall submit data to the database as described in subsection 7b77#a77;,c71 using the format described in subsection 7d77#a74 7#c7 ,funding ,there is authorized to be appropriated #ajj1jjj1jjj for the period of fiscal years #bjbj through #bjbi for the purpose of awarding grants to ,states under this subsection4 7i7 ,exemption from public disclosure 7#a7 ,in general ,claims data provided to the database1 and the database itself shall not be considered public records and shall be exempt from public disclosure requirements4 7#b7 ,restrictions on uses for certain proceedings ,data disclosed to authorized users shall not be subject to discovery or admission as public information1 or evidence in judicial or administrative proceedings without consent of the affected parties4 7j7 ,individually identifiable health information defined ,the term individually identifiable health information has the meaning given such term in section #aaga7f7 of the ,social ,security ,act4 7k7 ,rule of construction ,nothing in this section shall be construed to affect or modify enforcement of the privacy1 security1 or breach notification rules promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7or successor regulations74 4 7b7 ,,gao report 7#a7 ,in general ,the ,comptroller ,general of the ,united ,states shall conduct a study on-- 7,a7 the performance of the entity awarded a contract under section #bgie7;a7 of the ,public ,health ,service ,act1 as added by subsection 7a71 under such contract2 7,b7 the privacy and security of the information reported to the entity2 and 7,c7 the costs incurred by such entity in performing such duties4 7#b7 ,reports ,not later than #b years after the effective date of the first contract entered into under section #bgie7;a7 of the ,public ,health ,service ,act1 as added by subsection 7a71 and again not later than #d years after such effective date1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #ac4 ,protecting patients and improving the accuracy of provider directory information 7a7 ,in general ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq471 as amended by sections #cja and #cjb1 is further amended by adding at the end the following3 #bgbi;,c4 ,protecting patients and improving the accuracy of provider directory information 7a7 ,network status of providers 7#a7 ,in general ,beginning on the date that is one year after the date of enactment of this section1 a group health plan or a health insurance issuer offering group or individual health insurance coverage shall-- 7,a7 establish business processes to ensure that all enrollees in such plan or coverage receive proof of a health care provider's network status1 based on what a plan or issuer knows or could reasonably know-- 7i7 through a written electronic communication from the plan or issuer to the enrollee1 as soon as practicable and not later than #a business day after a telephone inquiry is made by such enrollee for such information2 7ii7 through an oral confirmation1 documented by such issuer or coverage1 and kept in the enrollee's file for a minimum of #b years2 and 7iii7 in real-time through an online health care provider directory search tool maintained by the plan or issuer2 and 7,b7 include in any print directory a disclosure that the information included in the directory is accurate as of the date of the last data update and that enrollees or prospective enrollees should consult the group health plan or issuer's electronic provider directory on its website or call a specified customer service telephone number to obtain the most current provider directory information4 7#b7 ,group health plan and health insurance issuer business processes ,beginning on the date that is one year after the date of enactment of the ,hospital ,competition ,act of #bjbj1 a group health plan or a health insurance issuer offering group or individual health insurance coverage shall establish business processes to-- 7,a7 verify and update1 at least once every #ij days1 the provider directory information for all providers included in the online health care provider directory search tool described in paragraph 7#a77;,a77iii72 and 7,b7 remove any provider from such online directory search tool if such provider has not verified the directory information within the previous #f months or the plan or issuer has been unable to verify the provider's network participation4 7b7 ,cost-,sharing limitations 7#a7 ,in general ,a group health plan or a health insurance issuer offering group or individual health insurance coverage shall not apply1 and shall ensure that no provider applies cost-sharing to an enrollee for treatment or services provided by a health care provider in excess of the normal cost-sharing applied for in-network care 7including any balance bill issued by the health care provider involved71 if such enrollee1 or health care provider referring such enrollee1 demonstrates 7based on the electronic1 written information described in subsection 7a77#a77;,a77i71 the oral confirmation described in subsection 7a77#a77;,a77ii71 or a copy of the online provider directory described in subsection 7a77#a77;,a77iii7 on the date the enrollee attempted to obtain the provider's network status7 that the enrollee relied on the information described in subsection 7a77#a71 if the provider's network status or directory information on such directory was incorrect at the time the treatment or services involved was provided4 7#b7 ,refunds to enrollees ,if a health care provider submits a bill to an enrollee in violation of paragraph 7#a71 and the enrollee pays such bill1 the provider shall reimburse the enrollee for the full amount paid by the enrollee in excess of the in-network cost-sharing amount for the treatment or services involved1 plus interest1 at an interest rate determined by the ,secretary4 7c7 ,provider business processes ,a health care provider shall have in place business processes to ensure the timely provision of provider directory information to a group health plan or a health insurance issuer offering group or individual health insurance coverage to support compliance by such plans or issuers with subsection 7a77#a74 ,such providers shall submit provider directory information to a plan or issuers1 at a minimum-- 7#a7 when the provider begins a network agreement with a plan or with an issuer with respect to certain coverage2 7#b7 when the provider terminates a network agreement with a plan or with an issuer with respect to certain coverage2 7#c7 when there are material changes to the content of provider directory information described in subsection 7a77#a72 and 7#d7 every #ij days throughout the duration of the network agreement with a plan or issuer4 7d7 ,enforcement 7#a7 ,in general ,subject to paragraph 7#b71 a health care provider that violates a requirement under subsection 7c7 or takes actions that prevent a group health plan or health insurance issuer from complying with subsection 7a77#a7 or 7b7 shall be subject to a civil monetary penalty of not more than #aj1jjj for each act constituting such violation4 7#b7 ,safe harbor ,the ,secretary may waive the penalty described under paragraph 7#a7 with respect to a health care provider that unknowingly violates subsection 7b77#a7 with respect to an enrollee if such provider rescinds the bill involved and1 if applicable1 reimburses the enrollee within #cj days of the date on which the provider billed the enrollee in violation of such subsection4 7#c7 ,procedure ,the provisions of section #aabh;,a of the ,social ,security ,act1 other than subsections 7a7 and 7b7 and the first sentence of subsection 7c77#a7 of such section1 shall apply to civil money penalties under this subsection in the same manner as such provisions apply to a penalty or proceeding under section #aabh;,a of the ,social ,security ,act4 7e7 ,savings clause ,nothing in this section shall prohibit a provider from requiring in the terms of a contract1 or contract termination1 with a group health plan or health insurance issuer-- 7#a7 that the plan or issuer remove1 at the time of termination of such contract1 the provider from a directory of the plan or issuer described in subsection 7a77#a72 or 7#b7 that the plan or issuer bear financial responsibility1 including under subsection 7b71 for providing inaccurate network status information to an enrollee4 7f7 ,definition ,for purposes of this section1 the term provider directory information includes the names1 addresses1 specialty1 and telephone numbers of individual health care providers1 and the names1 addresses1 and telephone numbers of each medical group1 clinic1 or facility contracted to participate in any of the networks of the group health plan or health insurance coverage involved4 7g7 ,rule of construction ,nothing in this section shall be construed to preempt any provision of ,state law relating to health care provider directories or network adequacy4 4 7b7 ,effective date ,section #bgbi;,c of the ,public ,health ,service ,act1 as added by subsection 7a71 shall take effect with respect to plan years beginning on or after the date that is #ah months after the date of enactment of this ,act4 #ad4 ,timely bills for patients 7a7 ,in general 7#a7 ,amendment ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is amended by adding at the end the following3 #cii,v-#g4 ,timely bills for patients 7a7 ,in general ,the ,secretary shall require-- 7#a7 health care facilities1 or in the case of practitioners providing services outside of such a facility1 practitioners1 to provide to patients a list of services rendered during the visit to such facility or practitioner1 and1 in the case of a facility1 the name of the provider for each such service1 upon discharge or end of the visit or by postal or electronic communication as soon as practicable and not later than #e calendar days after discharge or date of visit2 and 7#b7 health care facilities and practitioners to furnish all adjudicated bills to the patient as soon as practicable1 but not later than #de calendar days after discharge or date of visit4 7b7 ,payment after billing ,no patient may be required to pay a bill for health care services any earlier than #ce days after the postmark date of a bill for such services4 7c7 ,effect of violation 7#a7 ,notification and refund requirements 7,a7 ,provider lists ,if a facility or practitioner fails to provide a patient a list as required under subsection 7a77#a71 such facility or practitioner shall report such failure to the ,secretary4 7,b7 ,billing ,if a facility or practitioner bills a patient after the #de-;calendar-day period described in subsection 7a77#b71 such facility or practitioner shall-- 7i7 report such bill to the ,secretary2 and 7ii7 refund the patient for the full amount paid in response to such bill with interest1 at a rate determined by the ,secretary4 7#b7 ,civil monetary penalties 7,a7 ,in general ,the ,secretary may impose civil monetary penalties of up to #aj1jjj a day on any facility or practitioner that-- 7i7 fails to provide a list required under subsection 7a77#a7 more than #aj times1 beginning on the date of such tenth failure2 7ii7 submits more than #aj bills outside of the period described in subsection 7a77#b71 beginning on the date on which such facility or practitioner sends the tenth such bill2 7iii7 fails to report to the ,secretary any failure to provide lists as required under paragraph 7#a77;,a71 beginning on the date that is #de calendar days after discharge or visit2 or 7iv7 fails to send any bill as required under subsection 7a77#b71 beginning on the date that is #de calendar days after the date of discharge or visit1 as applicable4 7,b7 ,procedure ,the provisions of section #aabh;,a of the ,social ,security ,act1 other than subsections 7a7 and 7b7 and the first sentence of subsection 7c77#a7 of such section1 shall apply to civil money penalties under this subsection in the same manner as such provisions apply to a penalty or proceeding under section #aabh;,a of the ,social ,security ,act4 7#c7 ,safe harbor ,the ,secretary may exempt a practitioner or facility from the penalties under paragraph 7#b77;,a7 or extend the period of time specified under subsection 7a77#b7 for compliance with such subsection if a practitioner or facility-- 7,a7 makes a good-faith attempt to send a bill within #cj days but is unable to do so because of an incorrect address2 or 7,b7 experiences extenuating circumstances 7as defined by the ,secretary71 such as a hurricane or cyberattack1 that may reasonably delay delivery of a timely bill4 4 7#b7 ,rulemaking ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall promulgate final regulations to define the term extenuating circumstance for purposes of section #cii,v-#g7;c77#c77;,b7 of the ,public ,health ,service ,act1 as added by paragraph 7#a74 7b7 ,group health plan and health insurance issuer requirements ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa71 as amended by section #cjd1 is further amended by adding at the end the following3 #bgbi;,d4 ,timely bills for patients 7a7 ,in general ,a group health plan or health insurance issuer offering group or individual health insurance coverage shall have in place business practices with respect to in-network facilities and practitioners to ensure that claims are adjudicated in order to facilitate facility and practitioner compliance with the requirements under section #cii,v-#g7;a74 7b7 ,clarification ,nothing in subsection 7a7 prohibits a provider and a group health plan or health insurance issuer from establishing in a contract the timeline for submission by either party to the other party of billing information1 adjudication1 sending of remittance information1 or any other coordination required between the provider and the plan or issuer necessary for meeting the deadline described in section #cii,v-#g7;a77#b74 4 7c7 ,effective date ,the amendments made by subsections 7a7 and 7b7 shall take effect #f months after the date of enactment of this ,act4 #ae4 ,government ,accountability ,office study on profit- and revenue-sharing in health care 7a7 ,study ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall conduct a study to-- 7#a7 describe what is known about profit- and revenue-sharing relationships in the commercial health care markets1 including those relationships that-- 7,a7 involve one or more-- 7i7 physician groups that practice within a hospital included in the profit- or revenue-sharing relationship1 or refer patients to such hospital2 7ii7 laboratory1 radiology1 or pharmacy services that are delivered to privately insured patients of such hospital2 7iii7 surgical services2 7iv7 hospitals or group purchasing organizations2 or 7v7 rehabilitation or physical therapy facilities or services2 and 7,b7 include revenue- or profit-sharing whether through a joint venture1 management or professional services agreement1 or other form of gain-sharing contract2 7#b7 describe ,federal oversight of such relationships1 including authorities of the ,department of ,health and ,human ,services and the ,federal ,trade ,commission to review such relationships and their potential to increase costs for patients1 and identify limitations in such oversight2 and 7#c7 as appropriate1 make recommendations to improve ,federal oversight of such relationships4 7b7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall prepare and submit a report on the study conducted under subsection 7a7 to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,education and ,labor and ,committee on ,energy and ,commerce of the ,house of ,representatives4 #af4 ,ensuring enrollee access to cost-sharing information 7a7 ,in general ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq471 as amended by section #cjf1 is further amended by adding at the end the following3 #bgbi;,f4 ,provision of cost-sharing information 7a7 ,provider disclosures ,a provider that is in-network with respect to a group health plan or a health insurance issuer offering group or individual health insurance coverage shall provide to an enrollee in the plan or coverage who submits a request for the information described in paragraph 7#a7 or 7#b71 together with accurate and complete information about the enrollee's coverage under the applicable plan or coverage-- 7#a7 as soon as practicable and not later than #b business days after the enrollee requests such information1 a good faith estimate of the expected enrollee cost-sharing for the provision of a particular health care service 7including any service that is reasonably expected to be provided in conjunction with such specific service72 and 7#b7 as soon as practicable and not later than #b business days after an enrollee requests such information1 the contact information for any ancillary providers for a scheduled health care service4 7b7 ,insurer disclosures ,a group health plan or a health insurance issuer offering group or individual health insurance coverage shall provide an enrollee in the plan or coverage with a good faith estimate of the enrollee's cost-sharing 7including deductibles1 copayments1 and coinsurance7 for which the enrollee would be responsible for paying with respect to a specific health care service 7including any service that is reasonably expected to be provided in conjunction with such specific service71 as soon as practicable and not later than #b business days after a request for such information by an enrollee4 7c7 ,enforcement 7#a7 ,in general ,subject to paragraph 7#b71 a health care provider that violates a requirement under subsection 7a7 shall be subject to a civil monetary penalty of not more than #aj1jjj for each act constituting such violation4 7#b7 ,procedure ,the provisions of section #aabh;,a of the ,social ,security ,act1 other than subsections 7a7 and 7b7 and the first sentence of subsection 7c77#a7 of such section1 shall apply to civil money penalties under this subsection in the same manner as such provisions apply to a penalty or proceeding under section #aabh;,a of the ,social ,security ,act4 4 7b7 ,effective date ,section #bgbi;,g of the ,public ,health ,service ,act1 as added by subsection 7a71 shall apply with respect to plan years beginning on or after the date that is #ah months after the date of enactment of this ,act4 #ag4 ,group health plan reporting requirements ,part ,c of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia et seq471 as amended by section #cjc1 is further amended by adding at the end the following3 #bgig4 ,group health plan reporting 7a7 ,in general ,a group health plan or health insurance issuer offering group or individual health insurance coverage shall submit to the ,secretary1 not later than ,march #a of each year1 the following information with respect to the health plan in the previous plan year3 7#a7 ,the beginning and end dates of the plan year4 7#b7 ,the number of enrollees4 7#c7 ,each ,state in which the plan is offered4 7#d7 ,the #ej brand prescription drugs most frequently dispensed by pharmacies for claims paid by the issuer1 and the total number of paid claims for each such drug4 7#e7 ,the #ej most costly prescription drugs with respect to the plan by total annual spending1 and the annual amount spent by the plan for each such drug4 7#f7 ,the #ej prescription drugs with the greatest increase in plan expenditures over the plan year preceding the plan year that is the subject of the report1 and1 for each such drug1 the change in amounts expended by the plan in each such plan year4 7#g7 ,total spending on health care services by such group health plan1 broken down by-- 7,a7 the type of costs1 including-- 7i7 hospital costs2 7ii7 health care provider and clinical service costs2 7iii7 costs for prescription drugs2 and 7iv7 other medical costs2 and 7,b7 spending on prescription drugs by-- 7i7 the health plan2 and 7ii7 the enrollees4 7#h7 ,the average monthly premium-- 7,a7 paid by employers on behalf of enrollees2 and 7,b7 paid by enrollees4 7#i7 ,any impact on premiums by rebates1 fees1 and any other remuneration paid by drug manufacturers to the plan or its administrators or service providers1 with respect to prescription drugs prescribed to enrollees in the plan1 including-- 7,a7 the amounts so paid for each therapeutic class of drugs2 and 7,b7 the amounts so paid for each of the #be drugs that yielded the highest amount of rebates and other remuneration under the plan from drug manufacturers during the plan year4 7#aj7 ,any reduction in premiums and out-of-pocket costs associated with rebates1 fees1 or other remuneration described in paragraph 7#i74 7b7 ,report ,not later than #ah months after the date on which the first report is required under subsection 7a7 and biannually thereafter1 the ,secretary1 acting through the ,assistant ,secretary of ,planning and ,evaluation and in coordination with the ,inspector ,general of the ,department of ,health and ,human ,services1 shall make available on the internet website of the ,department of ,health and ,human ,services a report on prescription drug reimbursements under group health plans1 prescription drug pricing trends1 and the role of prescription drug costs in contributing to premium increases or decreases under such plans1 aggregated in such a way as no drug or plan specific information will be made public4 7c7 ,privacy protections ,no confidential or trade secret information submitted to the ,secretary under subsection 7a7 shall be included in the report under subsection 7b74 4