,i #aaf? ,,congress #b;d ,session ,h4 ,r4 #hjih ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,augu/ #be1 #bjbj ,mr4 ,banks introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committees on ,ways & ,means1 & ! ,judici>y1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to address hospital consolidation & promote hospital price transp>5cy1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,hospital ,competition ,act ( #bjbj4 #b4 ,hospital consolidation 7a7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ #afj1jjj1jjj to ! ,f$]al ,trade ,commission to hire /aff to inve/igate1 z consi/5t ) ! ,%]man ,antitru/ ,act & o!r relevant ,f$]al laws1 anti-competitive m]g]s & practices "u su* laws to ! ext5t su* m]g]s & practices relate to provid]s ( inpati5t & outpati5t heal? c>e s]vices1 z def9$ by ! ,secret>y ( ,heal? & ,human ,s]vices4 7b7 ,m$ic>e ,advantage rates appli$ to c]ta9 ,,hhi hospitals 7#a7 ,9 g5]al ,section #ahff7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77 is am5d$-- 7,a7 9 p>agraph 7#a7-- 7i7 9 subp>agraph 7,x71 by /rik+ & at ! end2 7ii7 9 subp>agraph 7,y71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7iii7 by ins]t+ aft] subp>agraph 7,y7 ! foll[+ new subp>agraph3 7,z7 subject to p>agraph 7#d71 9 ! case ( a hospital locat$ 9 a c\nty ^: population d5sity is above ! m$ian population d5sity = all c\nties 9 ! ,unit$ ,/ates ) respect to :i* !re is a ,h]f9dahl-,hirs*man ,index 7,,hhi7 ( great] ?an #d1jjj1 to apply ! av]age reimbursem5t rate ) respect to individuals 7reg>dless ( :e!r su* an individual is entitl$ to or eligible = b5efits "u ?is title1 b exclud+ individuals eligible = m$ical assi/ance "u a ,/ate plan "u title ,,xix7 furni%$ items & s]vices at su* hospital t w\ld be billable "u ?is title = su* items & s]vices if furni%$ by su* hospital to an individual enroll$ "u "p ,c4 2 & 7,b7 by add+ at ! end ! foll[+ new p>agraph3 7#d7 7,a7 ,! requirem5t "u p>agraph 7#a77,z7 %all n apply 9 ! case ( a hospital 9 a hospital ref]ral region if-- 7i7 ! ,,hrr m>ket %>e ( su* hospital 7z det]m9$ "u subp>agraph 7,b77 is less ?an #j4ae2 or 7ii7 ! hospital is locat$ 9 a rural area 7z def9$ 9 section #ahhf7;d77#b77;,d772 7,b7 ,= purposes ( subp>agraph 7,a71 ! ,,hrr m>ket %>e ( a hospital 9 a hospital ref]ral region is equal to-- 7i7 ! total rev5ue ( ! hospital1 divid$ by 7ii7 ! total rev5ue ( all hospital 9 ! hospital ref]ral region4 4 7#b7 ,effective date ,! am5dm5ts made by ?is subsection %all apply ) respect to items & s]vices furni%$ on or aft] ,janu>y #a1 #bjba4 7c7 ,grants = hospital infra/ructure improvem5t 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all c>ry out a grant program "u :i* ! ,secret>y %all provide grants to eligible ,/ates1 9 accordance ) ?is subsection4 7#b7 ,uses ,an eligible ,/ate receiv+ a grant "u ?is subsection may use su* grant to improve ! ,/ate hospital infra/ructure & to supplem5t any o!r funds provid$ = a purpose au?oriz$ "u a ,/ate or local hospital grant programs "u ,/ate law4 7#c7 ,eligibility 7,a7 ,9 g5]al ,an eligible ,/ate may receive n m ?an "o grant "u ?is subsection ) respect to ea* qualify+ crit]ion describ$ 9 subp>agraph 7,b7 t is met by ! ,/ate4 7,b7 ,eligible ,/ate ,= purposes ( ?is subsection1 ! t]m eligible ,/ate means a ,/ate t meets any "o or m ( ! foll[+ qualify+ crit]ia3 7i7 ,! ,/ate does n h 9 effect any ,/ate c]tificate ( ne$ law t requires a heal? c>e provid] to provide to a regulatory body a c]tification t ! community ne$s ! s]vices provid$ by ! heal? c>e provid]4 7ii7 ,! ,/ate has 9 effect ,/ate scope ( practice laws t-- 7,i7 all[ advanc$ practice provid]s 7su* z nurse practition]s1 advanc$ practice regi/]$ nurses1 cl9ical nurse speciali/s1 & physician assi/ants7 to evaluate pati5ts2 diagnose1 ord]1 & int]pret diagno/ic te/s2 & initiate & manage treatm5ts2 or 7,,ii7 provide t ! only ju/ification = limit+ ! scope ( practice ( a heal? c>e provid] is safety to ! public4 7iii7 ,! ,/ate does n h 9 effect any ,/ate laws t require manag$ c>e plans to accept into ! network ( su* plan any qualifi$ provid] :o is will+ to accept ! t]ms & conditions ( ! manag$ c>e plan4 7iv7 ,! ,/ate does n h 9 effect any ,c]tificate ( ,public ,advantage laws t cle>ly articulate ! ,/ate's int5t to displace competition 9 favor ( regulation or t violate ,/ate or ,f$]al antitru/ laws4 7v7 ,! ,/ate does n h 9 effect any network adequacy laws regulat+ a heal? plan's ability to deliv] b5efits by provid+ reasonable access to a suffici5t numb] ( 9-network prim>y c>e & specialty physicians1 z well z all heal? c>e s]vices includ$ "u ! t]ms ( an insuree's contract ) a heal? insur]4 7#d7 ,fund+ ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #a1jjj1jjj1jjj = ea* ( ! fiscal ye>s #bjba ?r\gh #bjcj4 ,funds appropriat$ "u ?is p>agraph %all rema9 available until exp5d$4 7d7 ,critical access hospital reimbursem5t rates 7#a7 ,"p ,a ,section #ahad7l77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7l77#a77 is am5d$ by ins]t+ 7or1 = #bjba1 #ajb1 plus #a p]c5tage po9t = ea* subsequ5t ye> ?r\gh #bjbi1 & #aaj = ea* subsequ5t ye> !reaft]7 aft] #aja4 7#b7 ,"p ,b ,section #ahcd7;g77#a7 ( su* ,act 7#db ,u4,s4,c4 #aciem7g77#a77 is am5d$ by ins]t+ 7or1 = #bjba1 #ajb1 plus #a p]c5tage po9t = ea* subsequ5t ye> ?r\gh #bjbi1 & #aaj = ea* subsequ5t ye> !reaft]7 aft] #aja4 #c4 ,price transp>5cy ,section #ahff ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc71 z am5d$ by section #dja1 is fur!r am5d$-- 7#a7 9 subsection 7a77#a7-- 7,a7 9 subp>agraph 7,y71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,z71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by ins]t+ aft] subp>agraph 7,z7 ! foll[+ new subp>agraph3 7,,aa7 9 ! case ( a hospital1 to comply ) ! requirem5t "u subsection 7l74 2 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7l7 ,requirem5t relat+ to publi%+ c]ta9 hospital prices 7#a7 ,9 g5]al ,= purposes ( subsection 7a77#a77;,,aa71 ! requirem5t describ$ 9 ?is subsection is1 ) respect to a hospital & ye> 7beg9n+ ) #bjba71 = ! hospital to publicly po/1 ?r\gh ! sy/em e/abli%$ "u p>agraph 7#c71 = ea* commonly %oppable s]vice includ$ 9 ! li/ publi%$ "u p>agraph 7#b7 = su* ye>1 ! volume-weight$ av]age price *>g$ by ! hospital to-- 7,a7 individuals enroll$ dur+ su* ye> 9 gr\p heal? plans or heal? insurance cov]age (f]$ 9 ! individual or gr\p m>ket 7z su* t]ms are def9$ 9 section #bgia ( ! ,public ,heal? ,s]vice ,act72 & 7,b7 individuals :o are n enroll$ 9 any heal? insurance cov]age or heal? b5efits plan & individuals :o are enroll$ 9 su* cov]age or plan b su* cov]age or plan does n provide b5efits = ! s]vice4 7#b7 ,commonly %oppable s]vices ,= purposes ( subsection 7a77#a77;,,aa7 & ?is subsection1 ! ,secret>y %all1 = #bjba & ea* subsequ5t ye>1 publi% a li/ ( ! #ajj commonly %oppable s]vices t are ! mo/ highly utiliz$ 9 a hospital-bas$ sett+4 7#c7 ,/&>diz$ digital report+ sy/em ,n lat] ?an ,janu>y #a1 #bjba1 ! ,secret>y %all e/abli% a /&>diz$ digital sy/em = purposes ( p>agraph 7#a74 4 #d4 ,repeal+ eligibility ( c]ta9 ,a,c,os 7a7 ,9 g5]al ,section #ahii7;b77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7b77#a77 is am5d$ by /rik+ subp>agraphs 7,c7 ?r\gh 7,e74 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all take effect on ,janu>y #a1 #bjba4 #e4 ,(f-campus provid]-bas$ dep>tm5t m$ic>e site neutral paym5t 7a7 ,9 g5]al ,section #ahcd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7x7 ,(f-,campus provid]-,bas$ dep>tm5t site neutral paym5t 7#a7 ,9 g5]al ,) respect to items & s]vices furni%$ 9 an (f-campus provid]-bas$ dep>tm5t1 paym5t "u ?is section = su* items & s]vices %all be ! am\nt det]m9$ "u ! fee s*$ule "u section #ahdh = su* items & s]vices furni%$ if furni%$ 9 a physician (fice sett+4 7#b7 ,(f-campus provid]-bas$ dep>tm5t ,= purposes ( ?is subsection1 ! t]m (f-campus provid]-bas$ dep>tm5t has su* mean+ z specifi$ by ! ,secret>y4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply ) respect to items & s]vices furni%$ on or aft] ,janu>y #a1 #bjba4 #f4 ,repeal ( heal? c>e re=m provisions limit+ ,m$ic>e exception to ! prohibition on c]ta9 physician ref]rals = hospitals ,sections #fjja & #ajfja ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh2 #abd ,/at4 #fhd1 #ajje7 & section #aajf ( ! ,heal? ,c>e & ,education ,reconciliation ,act ( #bjaj 7,public ,law #aaa-aeb2 #abd ,/at4 #ajdi7 are repeal$ & ! provisions ( law am5d$ by su* sections are re/or$ z if su* sections _h nev] be5 enact$4 #g4 ,advisory gr\p on r$uc+ burd5 ( hospital adm9i/rative requirem5ts 7a7 ,9 g5]al ,n lat] ?an ,janu>y #a1 #bjba1 ! ,secret>y ( ,heal? & ,human ,s]vices %all conv5e an advisory gr\p to provide1 9 accordance ) ?is section1 recomm5dations on ways ! ,f$]al ,gov]nm5t c\ld r$uce ! burd5 ( adm9i/rative requirem5ts on hospitals4 7b7 ,recomm5dations ,n lat] ?an ,janu>y #a1 #bjbb1 ! advisory bo>d conv5$ "u ?is section %all-- 7#a7 submit to ! ,secret>y ( ,heal? & ,human ,s]vices recomm5dations describ$ "u subsection 7a7 = executive action & any recomm5dations = ,/ate actions = pot5tial consid]ation 9 mak+ grants "u section #b7;c7 to ,/ates2 & 7#b7 submit to ,congress recomm5dations describ$ "u subsection 7a7 = legislative proposals4 7c7 ,memb]%ip ,! advisory bo>d "u ?is section %all consi/ ( ! foll[+ memb]s3 7#a7 ,?ree repres5tatives ( companies t h-- 7,a7 geographically di/ribut$ work=ces2 7,b7 at lea/ #aj1jjj employees2 & 7,c7 no m ?an #aj p]c5t ( su* employees 9 any s+le ,/ate4 7#b7 ,?ree repres5tatives ( heal? insurance issu]s & heal? plans1 consi/+ (-- 7,a7 "o repres5tative ( =-pr(it heal? insurance issu]s & heal? plans ) at lea/ #bj1jjj1jjj enrollees 9 ! employ]-sponsor$ m>ket2 7,b7 "o repres5tative ( non-pr(it heal? insurance issu]s & heal? plans op]at+ 9 at lea/ #e ,/ates2 & 7,c7 "o repres5tative ( non-pr(it heal? insurance issu]s & heal? plans op]at+ 9 a rural ,/ate 7z def9$ by ! ,c5sus ,bureau74 7#c7 ,sev5 public policy exp]ts 9 ! field ( hospital consolidation4 #h4 ,au?ority ( ,f$]al ,trade ,commission ov] c]ta9 tax-exempt organizations ,section #d ( ! ,f$]al ,trade ,commission ,act 7#ae ,u4,s4,c4 #dd7 is am5d$1 9 ! undesignat$ p>agraph relat+ to ! def9ition ( ! t]m ,corporation-- 7#a7 by /rik+ 1 & any & ins]t+ 1 any2 & 7#b7 by ins]t+ be=e ! p]iod at ! end ! foll[+3 1 & any organization describ$ 9 section #eja7;c77#c7 ( ! ,int]nal ,rev5ue ,code ( #aihf t is exempt f taxation "u section #eja7;a7 ( su* ,code4 #i4 ,level+ ! play+ field betwe5 provid]s & pay]s 7a7 ,exemption ,x %all n be a violation ( ! antitru/ laws = "o or m private heal? insur] issu]s or _! designat$ ag5ts to jo9tly negotiate prices ( p>ticul> hospital s]vices ) a hospital provid] ) reg>ds to ! reimbursem5t policies ( ! insur]s = ^? s]vices4 7b7 ,def9itions ,= purposes ( ?is section3 7#a7 ,antitru/ laws ,! t]m antitru/ laws has ! mean+ giv5 x 9 subsection 7a7 ( ! #a/ section ( ! ,clayton ,act 7#ae ,u4,s4,c4 #ab7;a771 except t su* t]m includes section #e ( ! ,f$]al ,trade ,commission ,act 7#ae ,u4,s4,c4 #de7 to ! ext5t su* section #e applies to unfair me?ods ( competition4 7#b7 ,heal? insurance issu] ,! t]m heal? insurance issu] means an insurance company1 insurance s]vice1 or insurance organization 7includ+ a heal? ma9t5ance organization1 z def9$ 9 subp>agraph 7,c77 :i* is lic5s$ to engage 9 ! bus9ess ( insurance 9 a ,/ate & :i* is subject to ,/ate law :i* regulates insurance 7)9 ! mean+ ( section #ead7;b77#b7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aadd7;b77#b774 ,su* t]m does n include a gr\p heal? plan4 7#c7 ,heal? ma9t5ance organization ,! t]m heal? ma9t5ance organization means-- 7,a7 a f$]ally qualifi$ heal? ma9t5ance organization 7z def9$ 9 section #cjj;e7a7 ( title #db ( ! ,code ( ,f$]al ,regulations71 7,b7 an organization recogniz$ "u ,/ate law z a heal? ma9t5ance organization1 or 7,c7 a simil> organization regulat$ "u ,/ate law = solv5cy 9 ! same mann] & to ! same ext5t z su* a heal? ma9t5ance organization4 7c7 ,effective date ,?is section %all take effect on ! date ( ! enactm5t ( ?is ,act b %all n apply ) respect to conduct t occurs be=e su* date4 #aj4 ,increas+ transp>5cy by remov+ gag clauses on price & quality in=mation ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq471 z am5d$ by section #ajc1 is am5d$ by add+ at ! end ! foll[+3 #bgbi;,b4 ,increas+ transp>5cy by remov+ gag clauses on price & quality in=mation 7a7 ,increas+ price & quality transp>5cy = plan sponsors & gr\p & individual m>ket & consum]s 7#a7 ,gr\p heal? plans ,a gr\p heal? plan or heal? insurance issu] (f]+ gr\p heal? insurance cov]age may n ent] into an agreem5t ) a heal? c>e provid]1 network or association ( provid]s1 ?ird-p>ty adm9i/rator1 or o!r s]vice provid] (f]+ access to a network ( provid]s t w\ld directly or indirectly re/rict a gr\p heal? plan or heal? insurance issu] f-- 7,a7 provid+ provid]-specific co/ or quality ( c>e in=mation1 ?r\gh a consum] engagem5t tool or any o!r means1 to ref]r+ provid]s1 ! plan sponsor1 enrollees1 or eligible enrollees ( ! plan or cov]age2 7,b7 electronically access+ de-id5tifi$ claims & enc\nt] data = ea* enrollee 9 ! plan or cov]age1 ^u reque/ & consi/5t ) ! privacy regulations promulgat$ pursuant to section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act1 ! am5dm5ts to ?is ,act made by ! ,g5etic ,in=mation ,nondiscrim9ation ,act ( #bjjh1 & ! ,am]icans ) ,disabilities ,act ( #aiij1 ) respect to ! applicable heal? plan or heal? insurance cov]age1 includ+1 on a p] claim basis-- 7i7 f9ancial in=mation1 su* z ! all[$ am\nt1 or any o!r claim-relat$ f9ancial obligations includ$ 9 ! provid] contract2 7ii7 provid] in=mation1 includ+ "n & cl9ical designation2 7iii7 s]vice codes2 or 7iv7 any o!r data elem5t normally includ$ 9 claim or enc\nt] transactions :5 receiv$ by a plan or issu]2 or 7,c7 %>+ data describ$ 9 subp>agraph 7,a7 or 7,b7 ) a bus9ess associate z def9$ 9 section #afj4ajc ( title #de1 ,code ( ,f$]al ,regulations 7or successor regulations71 consi/5t ) ! privacy regulations promulgat$ pursuant to section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act1 ! am5dm5ts to ?is ,act made by ! ,g5etic ,in=mation ,nondiscrim9ation ,act ( #bjjh1 & ! ,am]icans ) ,disabilities ,act ( #aiij4 7#b7 ,individual heal? insurance cov]age ,a heal? insurance issu] (f]+ individual heal? insurance cov]age may n ent] into an agreem5t ) a heal? c>e provid]1 network or association ( provid]s1 or o!r s]vice provid] (f]+ access to a network ( provid]s t w\ld directly or indirectly re/rict ! heal? insurance issu] f-- 7,a7 provid+ provid]-specific price or quality ( c>e in=mation1 ?r\gh a consum] engagem5t tool or any o!r means1 to ref]r+ provid]s1 enrollees1 or eligible enrollees ( ! plan or cov]age2 or 7,b7 %>+1 = plan design1 plan adm9i/ration1 & plan1 f9ancial1 legal1 & quality improvem5t activities1 data describ$ 9 subp>agraph 7,a7 ) a bus9ess associate z def9$ 9 section #afj4ajc ( title #de1 ,code ( ,f$]al ,regulations 7or successor regulations71 consi/5t ) ! privacy regulations promulgat$ pursuant to section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act1 ! am5dm5ts to ?is ,act made by ! ,g5etic ,in=mation ,nondiscrim9ation ,act ( #bjjh1 & ! ,am]icans ) ,disabilities ,act ( #aiij4 7#c7 ,cl>ification reg>d+ public disclosure ( in=mation ,no?+ 9 p>agraph 7#a77;,a7 or 7#b77;,a7 prev5ts a heal? c>e provid]1 network or association ( provid]s1 or o!r s]vice provid] f plac+ reasonable re/rictions on ! public disclosure ( ! in=mation describ$ 9 su* p>agraphs 7#a7 & 7#b74 7#d7 ,atte/ation ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all annually submit to1 z applicable1 ! applicable au?ority describ$ 9 section #bgbc or ! ,secret>y ( ,labor1 an atte/ation t su* plan or issu] is 9 compliance ) ! requirem5ts ( ?is subsection4 7#e7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ to o!rwise limit gr\p heal? plan1 plan sponsor1 or heal? insurance issu] access to data curr5tly p]mitt$ "u ! privacy regulations promulgat$ pursuant to section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act1 ! am5dm5ts to ?is ,act made by ! ,g5etic ,in=mation ,nondiscrim9ation ,act ( #bjjh1 & ! ,am]icans ) ,disabilities ,act ( #aiij4 4 #aa4 ,bann+ anticompetitive t]ms 9 facility & insurance contracts t limit access to high] quality1 l[] co/ c>e 7a7 ,9 g5]al ,section #bgbi;,b ( ! ,public ,heal? ,s]vice ,act1 z add$ by section #cja1 is am5d$ by add+ at ! end ! foll[+3 7b7 ,protect+ ,heal? ,plans ,network ,design ,flexibility 7#a7 ,9 g5]al ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all n ent] into an agreem5t ) a provid]1 network or association ( provid]s1 or o!r s]vice provid] (f]+ access to a network ( s]vice provid]s if su* agreem5t1 directly or indirectly-- 7,a7 re/ricts ! gr\p heal? plan or heal? insurance issu] f-- 7i7 direct+ or /e]+ enrollees to o!r heal? c>e provid]s2 or 7ii7 (f]+ inc5tives to enc\rage enrollees to utilize specific heal? c>e provid]s2 or 7,b7 requires ! gr\p heal? plan or heal? insurance issu] to ent] into any additional contract ) an affiliate ( ! provid]1 su* z an affiliate ( ! provid]1 z a condition ( ent]+ into a contract ) su* provid]2 7,c7 requires ! gr\p heal? plan or heal? insurance issu] to agree to paym5t rates or o!r t]ms = any affiliate n p>ty to ! contract ( ! provid] involv$2 or 7,d7 re/ricts o!r gr\p heal? plans or heal? insurance issu]s n p>ty to ! contract f pay+ a l[] rate = items or s]vices ?an ! contract+ plan or issu] pays = su* items or s]vices4 7#b7 ,additional requirem5t = self-insur$ plans ,a self-insur$ gr\p heal? plan %all n ent] into an agreem5t ) a provid]1 network or association ( provid]s1 ?ird-p>ty adm9i/rator1 or o!r s]vice provid] (f]+ access to a network ( provid]s if su* agreem5t directly or indirectly requires ! gr\p heal? plan to c]tify1 atte/1 or o!rwise confirm 9 writ+ t ! gr\p heal? plan is b\nd by re/rictive contract+ t]ms betwe5 ! s]vice provid] & a ?ird-p>ty adm9i/rator t ! gr\p heal? plan is n p>ty to1 )\t a disclosure t su* t]ms exi/4 7#c7 ,exception = c]ta9 gr\p model issu]s ,p>agraph 7#a77;,a7 %all n apply to a gr\p heal? plan or heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age ) respect to-- 7,a7 a heal? ma9t5ance organization 7z def9$ 9 section #bgia7;b77#c771 if su* heal? ma9t5ance organization op]ates prim>ily ?r\gh exclusive contracts ) multi-specialty physician gr\ps1 nor to any arrangem5t betwe5 su* a heal? ma9t5ance organization & its affiliates2 or 7,b7 a value-bas$ network arrangem5t1 su* z an exclusive provid] network1 acc\ntable c>e organization1 c5t] ( excell5ce1 a provid] sponsor$ heal? insurance issu] t op]ates prim>ily ?r\gh align$ multi-specialty physician gr\p practices or integrat$ heal? sy/ems1 or su* o!r simil> network arrangem5ts z det]m9$ by ! ,secret>y ?r\gh rulemak+4 7#d7 ,atte/ation ,a gr\p heal? plan or heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all annually submit to1 z applicable1 ! applicable au?ority describ$ 9 section #bgbc or ! ,secret>y ( ,labor1 an atte/ation t su* plan or issu] is 9 compliance ) ! requirem5ts ( ?is subsection4 7c7 ,ma9t5ance ( exi/+ ,,hipaa1 ,,g9a1 & ,,ada protections ,no?+ 9 ?is section %all modify1 r$uce1 or elim9ate ! exi/+ privacy protections & /&>ds provid$ by reason ( ,/ate & ,f$]al law1 includ+ ! requirem5ts ( p>ts #afj & #afd ( title #de1 ,code ( ,f$]al ,regulations 7or any successor regulations74 7d7 ,regulations ,! ,secret>y1 n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,hospital ,competition ,act ( #bjbj1 %all promulgate regulations to c>ry out ?is section4 7e7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ to limit network design or co/ or quality initiatives by a gr\p heal? plan or heal? insurance issu]1 includ+ acc\ntable c>e organizations1 exclusive provid] organizations1 networks t ti] provid]s by co/ or quality or /e] enrollees to c5t]s ( excell5ce1 or o!r pay-=-p]=mance programs4 7f7 ,cl>ification ) respect to antitru/ laws ,compliance ) ?is section does n con/itute compliance ) ! antitru/ laws1 z def9$ 9 subsection 7a7 ( ! fir/ section ( ! ,clayton ,act 7#ae ,u4,s4,c4 #ab7;a774 4 7b7 ,effective date ,section #bgbi;,b ( ! ,public ,heal? ,s]vice ,act 7z add$ by section #cja & am5d$ by subsection 7a77 %all apply ) respect to any contract ent]$ into on or aft] ! date t is #ah mon?s aft] ! date ( enactm5t ( ?is ,act4 ,) respect to an applicable contract t is 9 effect on ! date ( enactm5t ( ?is ,act1 su* section #bgbi;,b %all apply on ! e>li] ( ! date ( r5ewal ( su* contract or #c ye>s aft] su* date ( enactm5t4 #ab4 ,designation ( a nongov]nm5tal1 nonpr(it transp>5cy organization to l[] ,am]icans' heal? c>e co/s 7a7 ,9 g5]al ,subp>t ,c ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia et seq471 z am5d$ by section #ajb1 is fur!r am5d$ by add+ at ! end ! foll[+3 #bgif4 ,designation ( a nongov]nm5tal1 nonpr(it transp>5cy organization to l[] ,am]icans' heal? c>e co/s 7a7 ,9 g5]al ,! ,secret>y1 9 consultation ) ! ,secret>y ( ,labor1 n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,hospital ,competition ,act ( #bjbj1 %all ent] into contracts ) at lea/ #b nonpr(it entities to support ! e/abli%m5t & ma9t5ance ( a database t receives & utilizes heal? c>e claims in=mation & relat$ in=mation & issues reports t are available to ! public & au?oriz$ us]s1 & are submitt$ to ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7b7 ,requirem5ts 7#a7 ,9 g5]al ,! database e/abli%$ "u subsection 7a7 %all-- 7,a7 improve transp>5cy by us+ de-id5tifi$ heal? c>e data to-- 7i7 in=m pati5ts ab\t ! co/1 quality1 & value ( _! c>e2 7ii7 assi/ provid]s & hospitals1 z !y "w ) pati5ts1 to make in=m$ *oices ab\t c>e2 7iii7 enable provid]s1 hospitals1 & communities to improve s]vices & outcomes = pati5ts by b5*m>k+ _! p]=mance aga9/ t ( o!r provid]s1 hospitals1 & communities2 7iv7 enable pur*as]s1 includ+ employ]s1 employee organizations1 & heal? plans1 to develop value-bas$ pur*as+ models1 improve quality1 & r$uce ! co/ ( heal? c>e & insurance cov]age = enrollees2 7v7 enable employ]s & employee organizations to evaluate network design & con/ruction1 & ! co/ ( c>e = enrollees2 7vi7 facilitate ,/ate-l$ initiatives to l[] heal? c>e co/s & improve quality2 & 7vii7 promote competition bas$ on quality & co/2 7,b7 collect m$ical claims1 prescription drug claims1 & remittance data consi/5t ) ! protections & requirem5ts ( subsection 7d72 7,c7 be e/abli%$ 9 su* a mann] t all[s ! data collect$ pursuant to subp>agraph 7,b7 to be %>$ ) any ,/ate all-pay] claims database or regional database op]at$ ) au?orization f ,/ates1 at co/1 us+ a /&>diz$ =mat1 if su* ,/ate or regional database also submits claims data to ! database e/abli%$ "u ?is section2 & 7,d7 be available to-- 7i7 ! ,director ( ! ,congressional ,budget ,(fice1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates1 ! ,executive ,director ( ! ,m$ic>e ,paym5t ,advisory ,commission1 & ! ,executive ,director ( ! ,m$icaid & ,,*ip ,paym5t ,advisory ,commission1 ^u reque/1 subject to ! privacy & security requirem5ts ( au?oriz$ us]s "u subsection 7e77#b72 & 7ii7 au?oriz$ us]s1 includ+ employ]s1 employee organizations1 provid]s1 gr\p heal? plans1 heal? insurance issu]s1 rese>*]s1 & policymak]s1 subject to subsection 7e74 7#b7 ,privacy & security2 brea* notifications 7,a7 ,regulations 7i7 ,9 g5]al ,! ,secret>y %all issue regulations prescrib+ ! ext5t to :i*1 & ! mann] 9 :i*1 ! foll[+ rules 7& any successors ( su* rules7 %all apply to ! activities "u ?is section ( an entity receiv+ a contract "u subsection 7a73 7,i7 ,! ,privacy ,rule "u "p #afj & subp>ts ,a & ,e ( "p #afd ( title #de1 ,code ( ,f$]al ,regulations 7or any successor regulations74 7,,ii7 ,! ,security ,rule "u "p #afj & subp>ts ,a & ,c ( "p #afd ( su* title #de 7or any successor regulations74 7,,iii7 ,! ,brea* ,notification ,rule "u "p #afj & subp>ts ,a & ,d ( "p #afd ( su* title #de 7or any successor regulations74 7ii7 ,supplem5tal regulations ,9 ord] to ensure data privacy & security & ! notification ( brea*es1 ! ,secret>y may issue su* supplem5tal regulations on ! subjects ( ! rules li/$ "u clause 7i7 z ! ,secret>y det]m9es appropriate to address diff]5ces betwe5 ! activities describ$ by ?is section & ! activities cov]$ by su* rules4 7,b7 ,en=cem5t ,section #aagf ( ,social ,security ,act %all apply ) respect to a violation ( ?is p>agraph 9 ! same mann] su* section #aagf applies to a violation ( "p ,c ( title ,,xi ( ! ,social ,security ,act1 & ! ,secret>y may include 9 ! regulations promulgat$ "u ?is section provisions to apply su* section to ?is p>agraph4 7,c7 ,proc$ure 7i7 ,tim+ ,! ,secret>y %all issue ! initial set ( regulations "u ?is p>agraph n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,hospital ,competition ,act ( #bjbj4 7ii7 ,au?ority to use int]im f9al proc$ures ,! ,secret>y may make su* initial set ( regulations effective & f9al imm$iately ^u issuance1 on an int]im basis1 & provide = a p]iod ( public comm5t on su* initial set ( regulations aft] ! date ( publication4 7,d7 ,requirem5ts ( entity ,an entity receiv+ ! contract "u ?is section %all-- 7i7 n disclose to ! public any individually id5tifiable heal? in=mation2 7ii7 /rictly limit /aff access to ! data to /aff ) appropriate tra9+1 cle>ance1 & backgr\nd *ecks & require regul> privacy & security tra9+2 7iii7 ma9ta9 effective security /&>ds = transf]r+ data or mak+ data available to au?oriz$ us]s2 7iv7 develop a process = provid+ access to data to au?oriz$ us]s1 9 a secure mann] t ma9ta9s privacy & confid5tiality ( data2 & 7v7 adh]e to curr5t be/ security practices ) respect to ! managem5t & use ( su* data = heal? s]vices rese>*1 9 accordance ) applicable ,f$]al privacy law4 7#c7 ,consultation 7,a7 ,advisory committee ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ! ,hospital ,competition ,act ( #bjbj1 ! ,secret>y %all conv5e an ,advisory ,committee 7ref]r$ to 9 ?is section z ! ,committee71 consi/+ ( #ac memb]s1 to advise ! ,secret>y1 a contract+ entity1 & ,congress on ! e/abli%m5t1 op]ations1 & use ( ! database e/abli%$ "u ?is section4 7,b7 ,memb]%ip 7i7 ,appo9tm5t ,9 accordance ) clause 7ii71 ! ,secret>y1 9 consultation ) ! ,secret>y ( ,labor & ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all1 n lat] ?an #ahj days aft] ! date ( enactm5t ( ! ,hospital ,competition ,act ( #bjbj1 appo9t memb]s to ! ,committee :o h di/+ui%$ !mselves 9 ! fields ( heal? s]vices rese>*1 heal? economics1 heal? in=matics1 or ! gov]nance ( ,/ate all-pay] claims databases1 or :o repres5t organizations likely to submit data to or use ! database1 includ+ pati5ts1 employ]s1 or employee organizations t sponsor gr\p heal? plans1 heal? c>e provid]s1 heal? insurance issu]s1 or ?ird-p>ty adm9i/rators ( gr\p heal? plans4 ,su* memb]s %all s]ve #c-ye> t]ms on a /agg]$ basis4 ,vacancies on ! ,committee %all be fill$ by appo9tm5t consi/5t ) ?is subsection n lat] ?an #c mon?s aft] ! vacancy arises4 7ii7 ,composition ,9 accordance ) clause 7i7-- 7,i7 ! ,secret>y1 9 consultation ) ! ,secret>y ( ,labor1 %all appo9t to ! ,committee-- 7aa7 #a memb] select$ by ! ,secret>y1 9 coord9ation ) ! ,secret>y ( ,labor1 to s]ve z ! *air ( ! ,committee2 7bb7 ! ,assi/ant ,secret>y = ,plann+ & ,evaluation ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 or a designee ( su* ,assi/ant ,secret>y2 7cc7 #a repres5tative ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices2 7dd7 #a repres5tative ( ! ,ag5cy = ,heal? ,rese>* & ,quality2 7ee7 #a repres5tative ( ! ,(fice = ,civil ,rights ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices ) exp]tise 9 data privacy & security2 7ff7 #a repres5tative ( ! ,national ,c5t] = ,heal? ,/ati/ics2 & 7gg7 #a repres5tative ( ! ,employee ,b5efits & ,security ,adm9i/ration ( ! ,dep>tm5t ( ,labor2 & 7,,ii7 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all appo9t to ! ,committee-- 7aa7 #a repres5tative ( an employ] t sponsors a gr\p heal? plan2 7bb7 #a repres5tative ( an employee organization t sponsors a gr\p heal? plan2 7cc7 #a academic rese>*] ) exp]tise 9 heal? economics or heal? s]vices rese>*2 7dd7 #a consum] advocate2 & 7ee7 #b additional memb]s4 7,c7 ,duties ,! ,committee %all-- 7i7 advise ! ,secret>y on ! managem5t ( ! contract "u subsection 7a72 7ii7 assi/ & advise ! entities receiv+ ! contract "u subsection 7a7 9 e/abli%+-- 7,i7 ! scope & =mat ( ! data to be submitt$ "u subsection 7d72 7,,ii7 be/ practices ) respect to de-id5tification ( data1 z appropriate2 7,,iii7 ! appropriate uses ( data by au?oriz$ us]s1 includ+ develop+ /&>ds = ! approval ( reque/s by organizations to access & use ! data2 & 7,,iv7 ! appropriate =mats & me?ods = mak+ reports & analyses bas$ on ! database to ! public2 7iii7 conduct an annual review ( :e!r data 0 us$ accord+ to ! appropriate uses z describ$ 9 clause 7ii77,,ii71 & advise ! designat$ entities on us+ ! data = au?oriz$ purposes2 7iv7 report1 z appropriate1 to ! ,secret>y & ,congress on ! op]ation ( ! database & opportunities to bett] a*ieve ! objectives ( ?is section2 7v7 e/abli% additional re/rictions on rese>*]s :o receive comp5sation f entities describ$ 9 subsection 7e77#b77;,b77ii71 9 ord] to protect individually id5tifiable heal? in=mation2 & 7vi7 e/abli% objectives = rese>* & public report+4 7#d7 ,/ate requirem5ts ,a ,/ate may require heal? insurance issu]s & o!r pay]s to submit claims data to ! database e/abli%$ "u ?is section1 provid$ t su* data is submitt$ to ! entities aw>d$ contracts "u ?is section 9 a =m & mann] e/abli%$ by ! ,secret>y1 & pursuant to subsection 7d77#d77;,b74 7#e7 ,sanctions ,! ,secret>y %all take appropriate action to sanction us]s :o attempt to re-id5tify data access$ pursuant to p>agraph 7#a77;,d74 7c7 ,contract requirem5ts 7#a7 ,competitive proc$ures ,! ,secret>y %all ent] into ! contract "u subsection 7a7 us+ full & op5 competition proc$ures pursuant to *apt] #cc ( title #da1 ,unit$ ,/ates ,code4 7#b7 ,eligible entities ,to be eligible to ent] into a contract describ$ 9 subsection 7a71 an entity %all-- 7,a7 be a private nonpr(it entity gov]n$ by a bo>d t includes repres5tatives ( ! academic rese>* community & individuals ) exp]tise 9 employ]-sponsor$ insurance1 rese>* us+ heal? c>e claims data & actu>ial analysis2 7,b7 conduct its bus9ess 9 an op5 & transp>5t mann] t provides ! opportunity = public comm5t on its activities2 & 7,c7 agree to comply ) any requirem5ts impos$ "u ! rulemak+ describ$ 9 subsection 7d77#d77;,a74 7#c7 ,consid]ations ,9 aw>d+ a contract "u subsection 7a71 ! ,secret>y %all consid] an entity's exp]i5ce 9-- 7,a7 heal? c>e claims data collection1 aggregation1 quality assurance1 analysis1 & security2 7,b7 support+ academic rese>* on heal? co/s1 sp5d+1 & utilization = & by privately insur$ pati5ts2 7,c7 work+ ) l>ge heal? insurance issu]s & ?ird-p>ty adm9i/rators to assemble a national claims database2 7,d7 effectively collaborat+ ) & engag+ /akehold]s to develop reports2 7,e7 meet+ budgets & timel9es1 includ+ 9 connection ) report g5]ation2 & 7,f7 facilitat+ ! creation (1 or support+1 ,/ate all-pay] claims databases4 7#d7 ,contract t]m ,a contract aw>d$ "u ?is section %all be = a p]iod ( #e ye>s1 & may be r5ew$ aft] a subsequ5t competitive bidd+ process "u ?is section4 7#e7 ,transition ( contract ,if ! ,secret>y1 foll[+ a competitive process at ! end ( ! contract p]iod1 selects a new entity to ma9ta9 ! database1 all data %all be transf]r$ to ! new entity accord+ to a s*$ule & process to be det]m9$ by ! ,secret>y4 ,^u t]m9ation ( a contract1 no entity may keep data held by ! database or disclose su* data to any entity o!r ?an ! entity s designat$ by ! ,secret>y4 ,! ,secret>y %all include en=cem5t t]ms 9 any contract ) an organization *os5 "u ?is section1 to ensure ! timely transf] ( all data1 & any associat$ code or algori?ms1 to a new entity 9 ! ev5t ( contract t]m9ation4 7d7 ,receiv+ heal? in=mation 7#a7 ,requirem5ts 7,a7 ,9 g5]al ,! ,secret>y ( ,labor %all ensure t ! applicable self-insur$ gr\p heal? plan1 ?r\gh its ?ird-p>ty adm9i/rator1 ph>macy b5efit manag]1 or o!r entity designat$ by ! gr\p heal? plan1 z applicable1 electronically submits all claims data ) respect to ! plan1 pursuant to subp>agraph 7,b74 7,b7 ,scope ( in=mation & =mat ( submission ,an entity aw>d$ ! contract "u subsection 7a71 9 consultation ) ! ,committee describ$ 9 subsection 7b77#c71 & pursuant to ! privacy & security requirem5ts ( subsection 7b77#b71 %all-- 7i7 specify ! data elem5ts requir$ to be submitt$ "u subp>agraph 7,a71 :i* %all include all data relat$ to transactions describ$ 9 subp>agraphs 7,a7 & 7,e7 ( section #aagc7;a77#b7 ( ! ,social ,security ,act1 includ+ all data elem5ts normally pres5t 9 su* transactions :5 adjudicat$1 & enrollm5t in=mation2 7ii7 specify ! =m & mann] = su* submissions1 & ! hi/orical p]iod to be includ$ 9 ! initial submission2 & 7iii7 (f] an automat$ submission option to m9imize adm9i/rative burd5s = entities requir$ to submit data4 7,c7 ,de-id5tification ( data ,an entity aw>d$ ! contract "u subsection 7a7 %all-- 7i7 e/abli% a process "u :i* data is de-id5tifi$ consi/5t ) ! de-id5tification requirem5ts "u section #afd4ead ( title #de1 ,code ( ,f$]al ,regulations 7or any successor regulations71 :ile reta9+ ! ability to l9k data longitud9ally = ! purposes ( rese>* on co/ & quality1 & ! ability to complete risk adju/m5t & geographic analysis2 7ii7 ensure t any ?ird-p>ty subcontractors :o p]=m ! de-id5tification process describ$ 9 clause 7i7 reta9 only ! m9imum necess>y in=mation to p]=m su* a process1 & adh]e to effective security & encryption practices 9 data /orage & transmission2 7iii7 /ore claims & o!r data collect$ "u ?is subsection only 9 de-id5tifi$ =m1 9 accordance ) section #afd4ead ( title #de1 ,code ( ,f$]al ,regulations 7or any successor regulations72 & 7iv7 ensure t individually id5tifiable data is encrypt$1 9 accordance ) guidance issu$ by ! ,secret>y "u section #acdjb7;h77#b7 ( ! ,,hite* ,act4 7#b7 ,applicable self-insur$ gr\p heal? plan ,= purposes ( p>agraph 7#a71 a self-insur$ gr\p heal? plan is an applicable self-insur$ gr\p heal? plan if su* plan is self-adm9i/]$1 or is adm9i/]$ by a ?ird-p>ty plan adm9i/rator t meets #a or bo? ( ! foll[+ crit]ia3 7,a7 ,adm9i/]s heal?1 m$ical1 or ph>macy b5efits = m ?an #ej1jjj enrollees4 7,b7 ,is "o ( ! #e l>ge/ adm9i/rators or issu]s ( self-insur$ gr\p heal? plans 9 a ,/ate 9 :i* su* adm9i/rator op]ates1 z measur$ by ! aggregate numb] ( enrollees 9 plans adm9i/]$ by su* adm9i/rator 9 su* ,/ate1 z det]m9$ by ! ,secret>y4 7#c7 ,?ird-p>ty adm9i/rators ,9 ! case ( a ?ird-p>ty adm9i/rator t is requir$ "u ?is subsection to submit claims data ) respect to an applicable self-insur$ gr\p heal? plan1 su* adm9i/rator %all submit claims data ) respect to all self-insur$ gr\p heal? plans t ! adm9i/rator adm9i/]s1 includ+ su* plans t are n applicable self-insur$ gr\p heal? plans1 z describ$ 9 p>agraph 7#b74 7#d7 ,receiv+ o!r in=mation 7,a7 ,m$ic>e data ,! ,secret>y1 ?r\gh rulemak+1 %all ensure t ! data made available to su* entity is available to qualifi$ entities "u section #ahgd7;e7 ( ! ,social ,security ,act is made available to ea* entity aw>d$ a contract "u subsection 7a74 7,b7 ,/ate data ,an entity aw>d$ a contract "u subsection 7a7 %all collect data f ,/ate all pay] claims databases t seek access to ! database e/abli%$ "u ?is section4 7#e7 ,availability ( data ,an entity requir$ to submit data "u ?is subsection may n place any re/rictions on ! use ( su* data by au?oriz$ us]s4 7e7 ,uses ( in=mation 7#a7 ,9 g5]al ,an entity aw>d$ a contract "u subsection 7a7 %all make ! database available to us]s :o are au?oriz$ "u ?is subsection1 )\t *>ge1 & reports & analyses bas$ on ! data available to ! public ) no *>ge4 7#b7 ,au?orization ( us]s 7,a7 ,9 g5]al ,an entity may reque/ au?orization by an entity aw>d$ a contract "u subsection 7a7 = access to ! database 9 accordance ) ?is p>agraph4 7,b7 ,application ,an entity desir+ au?orization "u ?is p>agraph %all submit to an entity aw>d$ a contract an application = su* access1 :i* %all include-- 7i7 9 ! case ( an entity reque/+ access = rese>* purposes-- 7,i7 a description ( ! uses & me?odologies = evaluat+ heal? sy/em p]=mance us+ su* data2 & 7,,ii7 docum5tation ( approval ( ! rese>* by an in/itutional review bo>d1 if applicable = a p>ticul> plan ( rese>*2 or 7ii7 9 ! case ( an entity su* z an employ]1 heal? insurance issu]1 ?ird-p>ty adm9i/rator1 or heal? c>e provid]1 reque/+ access = ! purpose ( quality improvem5t or co/-conta9m5t1 a description ( ! int5d$ uses = su* data4 7,c7 ,requirem5ts 7i7 ,rese>* ,^u approval ( an application = rese>* purposes "u subp>agraph 7,b77i71 ! au?oriz$ us] %all ent] into a data use & confid5tiality agreem5t ) an entity aw>d$ a contract "u subsection 7a71 :i* %all include a prohibition on attempts to reid5tify & disclose individually id5tifiable heal? in=mation4 7ii7 ,quality improvem5t & co/-conta9m5t ,9 consultation ) ! ,committee describ$ 9 subsection 7b77#c71 ! ,secret>y %all1 ?r\gh rulemak+1 e/abli% ! =m & mann] 9 :i* au?oriz$ us]s describ$ 9 subp>agraph 7,b77ii7 may access data4 ,data provid$ to su* au?oriz$ us]s %all be provid$ 9 a =m & mann] su* t us]s may n obta9 individually id5tifiable price in=mation ) respect to direct competitors4 ,^u approval1 su* au?oriz$ us] %all ent] into a data use & confid5tiality agreem5t ) ! entity4 7iii7 ,cu/omiz$ reports ,employ]s & employ] organizations may reque/ cu/omiz$ reports f an entity aw>d$ a contract "u subsection 7a71 at co/1 subject to ! requirem5ts ( ?is section ) respect to privacy & security4 7iv7 ,non-cu/omiz$ reports ,an entity aw>d$ a contract "u subsection 7a71 9 consultation ) ! ,committee1 %all make available to all au?oriz$ us]s aggregate data sets1 free ( *>ge4 7f7 ,fund+ 7#a7 ,initial fund+ ,!re are au?oriz$ to be appropriat$1 & !re are appropriat$1 out ( monies 9 ! ,treasury n o!rwise appropriat$1 #bj1jjj1jjj = fiscal ye> #bjbj1 = ! implem5tation ( ! initial contract & e/abli%m5t ( ! database "u ?is section4 7#b7 ,ongo+ fund+ ,!re are au?oriz$ to be appropriat$ #ae1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe1 = purposes ( c>ry+ out ?is section 7o!r ?an ! grant program "u subsection 7h774 7g7 ,annual report 7#a7 ,submission ,on ea* ( ! dates describ$ 9 p>agraph 7#b71 an entity receiv+ a contract "u subsection 7a7 %all submit to ,congress1 ! ,secret>y ( ,heal? & ,human ,s]vices1 & ! ,secret>y ( ,labor & publi% onl9e = access by ! g5]al public1 a report conta9+ a description (-- 7,a7 tr5ds 9 ! price1 utilization1 & total sp5d+ on heal? c>e s]vices1 includ+ a geographic analysis ( diff]5ces 9 su* tr5ds2 7,b7 limitations 9 ! data set2 7,c7 progress t[>ds ! objectives ( ?is section2 & 7,d7 ! p]=mance by ! entity ( ! duties requir$ "u su* contract4 7#b7 ,dates describ$ ,! reports describ$ 9 p>agraph 7#a7 %all be submitt$-- 7,a7 n lat] ?an #c ye>s aft] ! date ( enactm5t ( ! ,hospital ,competition ,act ( #bjbj2 7,b7 ! lat] ( #a ye> aft] ! date t is #c ye>s aft] su* date ( enactm5t or ,m>* #a ( ! ye> aft] ! date t is #c ye>s aft] su* date ( enactm5t2 & 7,c7 ,m>* #a ( ea* ye> !reaft]4 7#c7 ,public reports & rese>* ,an entity receiv+ a contract "u subsection 7a7 %all1 9 coord9ation ) au?oriz$ us]s1 make analyses & rese>* available to ! public on an ongo+ basis to promote ! objectives ( ?is section4 7h7 ,grants to ,/ates 7#a7 ,9 g5]al ,! ,secret>y1 9 consultation ) ! ,secret>y ( ,labor1 may aw>d grants to ,/ates = ! purpose ( e/abli%+ & ma9ta9+ ,/ate all-pay] claims databases t improve transp>5cy ( data 9 ord] to meet ! goals ( subsection 7a77#a74 7#b7 ,requirem5t ,to be eligible to receive ! fund+ "u p>agraph 7#a71 a ,/ate %all submit data to ! database z describ$ 9 subsection 7b77#a77;,c71 us+ ! =mat describ$ 9 subsection 7d77#a74 7#c7 ,fund+ ,!re is au?oriz$ to be appropriat$ #ajj1jjj1jjj = ! p]iod ( fiscal ye>s #bjbj ?r\gh #bjbi = ! purpose ( aw>d+ grants to ,/ates "u ?is subsection4 7i7 ,exemption f public disclosure 7#a7 ,9 g5]al ,claims data provid$ to ! database1 & ! database itself %all n be consid]$ public records & %all be exempt f public disclosure requirem5ts4 7#b7 ,re/rictions on uses = c]ta9 proce$+s ,data disclos$ to au?oriz$ us]s %all n be subject to discov]y or admission z public in=mation1 or evid5ce 9 judicial or adm9i/rative proce$+s )\t cons5t ( ! affect$ p>ties4 7j7 ,individually id5tifiable heal? in=mation def9$ ,! t]m individually id5tifiable heal? in=mation has ! mean+ giv5 su* t]m 9 section #aaga7f7 ( ! ,social ,security ,act4 7k7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ to affect or modify en=cem5t ( ! privacy1 security1 or brea* notification rules promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif 7or successor regulations74 4 7b7 ,,gao report 7#a7 ,9 g5]al ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy on-- 7,a7 ! p]=mance ( ! entity aw>d$ a contract "u section #bgie7;a7 ( ! ,public ,heal? ,s]vice ,act1 z add$ by subsection 7a71 "u su* contract2 7,b7 ! privacy & security ( ! in=mation report$ to ! entity2 & 7,c7 ! co/s incurr$ by su* entity 9 p]=m+ su* duties4 7#b7 ,reports ,n lat] ?an #b ye>s aft] ! effective date ( ! fir/ contract ent]$ into "u section #bgie7;a7 ( ! ,public ,heal? ,s]vice ,act1 z add$ by subsection 7a71 & aga9 n lat] ?an #d ye>s aft] su* effective date1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report conta9+ ! results ( ! /udy conduct$ "u p>agraph 7#a71 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,comptroll] ,g5]al det]m9es appropriate4 #ac4 ,protect+ pati5ts & improv+ ! accuracy ( provid] directory in=mation 7a7 ,9 g5]al ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq471 z am5d$ by sections #cja & #cjb1 is fur!r am5d$ by add+ at ! end ! foll[+3 #bgbi;,c4 ,protect+ pati5ts & improv+ ! accuracy ( provid] directory in=mation 7a7 ,network /atus ( provid]s 7#a7 ,9 g5]al ,beg9n+ on ! date t is "o ye> aft] ! date ( enactm5t ( ?is section1 a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all-- 7,a7 e/abli% bus9ess processes to ensure t all enrollees 9 su* plan or cov]age receive pro( ( a heal? c>e provid]'s network /atus1 bas$ on :at a plan or issu] kn[s or c\ld reasonably "k-- 7i7 ?r\gh a writt5 electronic communication f ! plan or issu] to ! enrollee1 z soon z practicable & n lat] ?an #a bus9ess day aft] a telephone inquiry is made by su* enrollee = su* in=mation2 7ii7 ?r\gh an oral confirmation1 docum5t$ by su* issu] or cov]age1 & kept 9 ! enrollee's file = a m9imum ( #b ye>s2 & 7iii7 9 real-"t ?r\gh an onl9e heal? c>e provid] directory se>* tool ma9ta9$ by ! plan or issu]2 & 7,b7 include 9 any pr9t directory a disclosure t ! in=mation includ$ 9 ! directory is accurate z ( ! date ( ! la/ data update & t enrollees or prospective enrollees %\ld consult ! gr\p heal? plan or issu]'s electronic provid] directory on its website or call a specifi$ cu/om] s]vice telephone numb] to obta9 ! mo/ curr5t provid] directory in=mation4 7#b7 ,gr\p heal? plan & heal? insurance issu] bus9ess processes ,beg9n+ on ! date t is "o ye> aft] ! date ( enactm5t ( ! ,hospital ,competition ,act ( #bjbj1 a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all e/abli% bus9ess processes to-- 7,a7 v]ify & update1 at lea/ once e #ij days1 ! provid] directory in=mation = all provid]s includ$ 9 ! onl9e heal? c>e provid] directory se>* tool describ$ 9 p>agraph 7#a77;,a77iii72 & 7,b7 remove any provid] f su* onl9e directory se>* tool if su* provid] has n v]ifi$ ! directory in=mation )9 ! previ\s #f mon?s or ! plan or issu] has be5 unable to v]ify ! provid]'s network p>ticipation4 7b7 ,co/-,%>+ limitations 7#a7 ,9 g5]al ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all n apply1 & %all ensure t no provid] applies co/-%>+ to an enrollee = treatm5t or s]vices provid$ by a heal? c>e provid] 9 excess ( ! normal co/-%>+ appli$ = 9-network c>e 7includ+ any balance bill issu$ by ! heal? c>e provid] involv$71 if su* enrollee1 or heal? c>e provid] ref]r+ su* enrollee1 demon/rates 7bas$ on ! electronic1 writt5 in=mation describ$ 9 subsection 7a77#a77;,a77i71 ! oral confirmation describ$ 9 subsection 7a77#a77;,a77ii71 or a copy ( ! onl9e provid] directory describ$ 9 subsection 7a77#a77;,a77iii7 on ! date ! enrollee attempt$ to obta9 ! provid]'s network /atus7 t ! enrollee reli$ on ! in=mation describ$ 9 subsection 7a77#a71 if ! provid]'s network /atus or directory in=mation on su* directory 0 incorrect at ! "t ! treatm5t or s]vices involv$ 0 provid$4 7#b7 ,refunds to enrollees ,if a heal? c>e provid] submits a bill to an enrollee 9 violation ( p>agraph 7#a71 & ! enrollee pays su* bill1 ! provid] %all reimburse ! enrollee = ! full am\nt paid by ! enrollee 9 excess ( ! 9-network co/-%>+ am\nt = ! treatm5t or s]vices involv$1 plus int]e/1 at an int]e/ rate det]m9$ by ! ,secret>y4 7c7 ,provid] bus9ess processes ,a heal? c>e provid] %all h 9 place bus9ess processes to ensure ! timely provision ( provid] directory in=mation to a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age to support compliance by su* plans or issu]s ) subsection 7a77#a74 ,su* provid]s %all submit provid] directory in=mation to a plan or issu]s1 at a m9imum-- 7#a7 :5 ! provid] beg9s a network agreem5t ) a plan or ) an issu] ) respect to c]ta9 cov]age2 7#b7 :5 ! provid] t]m9ates a network agreem5t ) a plan or ) an issu] ) respect to c]ta9 cov]age2 7#c7 :5 !re are mat]ial *anges to ! cont5t ( provid] directory in=mation describ$ 9 subsection 7a77#a72 & 7#d7 e #ij days ?r\gh\t ! duration ( ! network agreem5t ) a plan or issu]4 7d7 ,en=cem5t 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 a heal? c>e provid] t violates a requirem5t "u subsection 7c7 or takes actions t prev5t a gr\p heal? plan or heal? insurance issu] f comply+ ) subsection 7a77#a7 or 7b7 %all be subject to a civil monet>y p5alty ( n m ?an #aj1jjj = ea* act con/itut+ su* violation4 7#b7 ,safe h>bor ,! ,secret>y may waive ! p5alty describ$ "u p>agraph 7#a7 ) respect to a heal? c>e provid] t unkn[+ly violates subsection 7b77#a7 ) respect to an enrollee if su* provid] resc9ds ! bill involv$ &1 if applicable1 reimburses ! enrollee )9 #cj days ( ! date on :i* ! provid] bill$ ! enrollee 9 violation ( su* subsection4 7#c7 ,proc$ure ,! provisions ( section #aabh;,a ( ! ,social ,security ,act1 o!r ?an subsections 7a7 & 7b7 & ! fir/ s5t5ce ( subsection 7c77#a7 ( su* section1 %all apply to civil money p5alties "u ?is subsection 9 ! same mann] z su* provisions apply to a p5alty or proce$+ "u section #aabh;,a ( ! ,social ,security ,act4 7e7 ,sav+s clause ,no?+ 9 ?is section %all prohibit a provid] f requir+ 9 ! t]ms ( a contract1 or contract t]m9ation1 ) a gr\p heal? plan or heal? insurance issu]-- 7#a7 t ! plan or issu] remove1 at ! "t ( t]m9ation ( su* contract1 ! provid] f a directory ( ! plan or issu] describ$ 9 subsection 7a77#a72 or 7#b7 t ! plan or issu] be> f9ancial responsibility1 includ+ "u subsection 7b71 = provid+ inaccurate network /atus in=mation to an enrollee4 7f7 ,def9ition ,= purposes ( ?is section1 ! t]m provid] directory in=mation includes ! names1 addresses1 specialty1 & telephone numb]s ( individual heal? c>e provid]s1 & ! names1 addresses1 & telephone numb]s ( ea* m$ical gr\p1 cl9ic1 or facility contract$ to p>ticipate 9 any ( ! networks ( ! gr\p heal? plan or heal? insurance cov]age involv$4 7g7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ to preempt any provision ( ,/ate law relat+ to heal? c>e provid] directories or network adequacy4 4 7b7 ,effective date ,section #bgbi;,c ( ! ,public ,heal? ,s]vice ,act1 z add$ by subsection 7a71 %all take effect ) respect to plan ye>s beg9n+ on or aft] ! date t is #ah mon?s aft] ! date ( enactm5t ( ?is ,act4 #ad4 ,timely bills = pati5ts 7a7 ,9 g5]al 7#a7 ,am5dm5t ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is am5d$ by add+ at ! end ! foll[+3 #cii,v-#g4 ,timely bills = pati5ts 7a7 ,9 g5]al ,! ,secret>y %all require-- 7#a7 heal? c>e facilities1 or 9 ! case ( practition]s provid+ s]vices outside ( su* a facility1 practition]s1 to provide to pati5ts a li/ ( s]vices r5d]$ dur+ ! visit to su* facility or practition]1 &1 9 ! case ( a facility1 ! "n ( ! provid] = ea* su* s]vice1 ^u dis*>ge or end ( ! visit or by po/al or electronic communication z soon z practicable & n lat] ?an #e cal5d> days aft] dis*>ge or date ( visit2 & 7#b7 heal? c>e facilities & practition]s to furni% all adjudicat$ bills to ! pati5t z soon z practicable1 b n lat] ?an #de cal5d> days aft] dis*>ge or date ( visit4 7b7 ,paym5t aft] bill+ ,no pati5t may be requir$ to pay a bill = heal? c>e s]vices any e>li] ?an #ce days aft] ! po/m>k date ( a bill = su* s]vices4 7c7 ,effect ( violation 7#a7 ,notification & refund requirem5ts 7,a7 ,provid] li/s ,if a facility or practition] fails to provide a pati5t a li/ z requir$ "u subsection 7a77#a71 su* facility or practition] %all report su* failure to ! ,secret>y4 7,b7 ,bill+ ,if a facility or practition] bills a pati5t aft] ! #de-;cal5d>-day p]iod describ$ 9 subsection 7a77#b71 su* facility or practition] %all-- 7i7 report su* bill to ! ,secret>y2 & 7ii7 refund ! pati5t = ! full am\nt paid 9 response to su* bill ) int]e/1 at a rate det]m9$ by ! ,secret>y4 7#b7 ,civil monet>y p5alties 7,a7 ,9 g5]al ,! ,secret>y may impose civil monet>y p5alties ( up to #aj1jjj a day on any facility or practition] t-- 7i7 fails to provide a li/ requir$ "u subsection 7a77#a7 m ?an #aj times1 beg9n+ on ! date ( su* t5? failure2 7ii7 submits m ?an #aj bills outside ( ! p]iod describ$ 9 subsection 7a77#b71 beg9n+ on ! date on :i* su* facility or practition] s5ds ! t5? su* bill2 7iii7 fails to report to ! ,secret>y any failure to provide li/s z requir$ "u p>agraph 7#a77;,a71 beg9n+ on ! date t is #de cal5d> days aft] dis*>ge or visit2 or 7iv7 fails to s5d any bill z requir$ "u subsection 7a77#b71 beg9n+ on ! date t is #de cal5d> days aft] ! date ( dis*>ge or visit1 z applicable4 7,b7 ,proc$ure ,! provisions ( section #aabh;,a ( ! ,social ,security ,act1 o!r ?an subsections 7a7 & 7b7 & ! fir/ s5t5ce ( subsection 7c77#a7 ( su* section1 %all apply to civil money p5alties "u ?is subsection 9 ! same mann] z su* provisions apply to a p5alty or proce$+ "u section #aabh;,a ( ! ,social ,security ,act4 7#c7 ,safe h>bor ,! ,secret>y may exempt a practition] or facility f ! p5alties "u p>agraph 7#b77;,a7 or ext5d ! p]iod ( "t specifi$ "u subsection 7a77#b7 = compliance ) su* subsection if a practition] or facility-- 7,a7 makes a good-fai? attempt to s5d a bill )9 #cj days b is unable to d s because ( an incorrect address2 or 7,b7 exp]i5ces ext5uat+ circum/ances 7z def9$ by ! ,secret>y71 su* z a hurricane or cyb]attack1 t may reasonably delay deliv]y ( a timely bill4 4 7#b7 ,rulemak+ ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all promulgate f9al regulations to def9e ! t]m ext5uat+ circum/ance = purposes ( section #cii,v-#g7;c77#c77;,b7 ( ! ,public ,heal? ,s]vice ,act1 z add$ by p>agraph 7#a74 7b7 ,gr\p heal? plan & heal? insurance issu] requirem5ts ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aa71 z am5d$ by section #cjd1 is fur!r am5d$ by add+ at ! end ! foll[+3 #bgbi;,d4 ,timely bills = pati5ts 7a7 ,9 g5]al ,a gr\p heal? plan or heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all h 9 place bus9ess practices ) respect to 9-network facilities & practition]s to ensure t claims are adjudicat$ 9 ord] to facilitate facility & practition] compliance ) ! requirem5ts "u section #cii,v-#g7;a74 7b7 ,cl>ification ,no?+ 9 subsection 7a7 prohibits a provid] & a gr\p heal? plan or heal? insurance issu] f e/abli%+ 9 a contract ! timel9e = submission by ei!r p>ty to ! o!r p>ty ( bill+ in=mation1 adjudication1 s5d+ ( remittance in=mation1 or any o!r coord9ation requir$ betwe5 ! provid] & ! plan or issu] necess>y = meet+ ! deadl9e describ$ 9 section #cii,v-#g7;a77#b74 4 7c7 ,effective date ,! am5dm5ts made by subsections 7a7 & 7b7 %all take effect #f mon?s aft] ! date ( enactm5t ( ?is ,act4 #ae4 ,gov]nm5t ,acc\ntability ,(fice /udy on pr(it- & rev5ue-%>+ 9 heal? c>e 7a7 ,/udy ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy to-- 7#a7 describe :at is kn[n ab\t pr(it- & rev5ue-%>+ relation%ips 9 ! comm]cial heal? c>e m>kets1 includ+ ^? relation%ips t-- 7,a7 involve "o or m-- 7i7 physician gr\ps t practice )9 a hospital includ$ 9 ! pr(it- or rev5ue-%>+ relation%ip1 or ref] pati5ts to su* hospital2 7ii7 laboratory1 radiology1 or ph>macy s]vices t are deliv]$ to privately insur$ pati5ts ( su* hospital2 7iii7 surgical s]vices2 7iv7 hospitals or gr\p pur*as+ organizations2 or 7v7 rehabilitation or physical !rapy facilities or s]vices2 & 7,b7 include rev5ue- or pr(it-%>+ :e!r ?r\gh a jo9t v5ture1 managem5t or pr(essional s]vices agreem5t1 or o!r =m ( ga9-%>+ contract2 7#b7 describe ,f$]al ov]sight ( su* relation%ips1 includ+ au?orities ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices & ! ,f$]al ,trade ,commission to review su* relation%ips & _! pot5tial to increase co/s = pati5ts1 & id5tify limitations 9 su* ov]sight2 & 7#c7 z appropriate1 make recomm5dations to improve ,f$]al ov]sight ( su* relation%ips4 7b7 ,report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all prep>e & submit a report on ! /udy conduct$ "u subsection 7a7 to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate & ! ,committee on ,education & ,labor & ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives4 #af4 ,ensur+ enrollee access to co/-%>+ in=mation 7a7 ,9 g5]al ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq471 z am5d$ by section #cjf1 is fur!r am5d$ by add+ at ! end ! foll[+3 #bgbi;,f4 ,provision ( co/-%>+ in=mation 7a7 ,provid] disclosures ,a provid] t is 9-network ) respect to a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all provide to an enrollee 9 ! plan or cov]age :o submits a reque/ = ! in=mation describ$ 9 p>agraph 7#a7 or 7#b71 toge!r ) accurate & complete in=mation ab\t ! enrollee's cov]age "u ! applicable plan or cov]age-- 7#a7 z soon z practicable & n lat] ?an #b bus9ess days aft] ! enrollee reque/s su* in=mation1 a good fai? e/imate ( ! expect$ enrollee co/-%>+ = ! provision ( a p>ticul> heal? c>e s]vice 7includ+ any s]vice t is reasonably expect$ to be provid$ 9 conjunction ) su* specific s]vice72 & 7#b7 z soon z practicable & n lat] ?an #b bus9ess days aft] an enrollee reque/s su* in=mation1 ! contact in=mation = any ancill>y provid]s = a s*$ul$ heal? c>e s]vice4 7b7 ,insur] disclosures ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all provide an enrollee 9 ! plan or cov]age ) a good fai? e/imate ( ! enrollee's co/-%>+ 7includ+ d$uctibles1 copaym5ts1 & co9surance7 = :i* ! enrollee w\ld be responsible = pay+ ) respect to a specific heal? c>e s]vice 7includ+ any s]vice t is reasonably expect$ to be provid$ 9 conjunction ) su* specific s]vice71 z soon z practicable & n lat] ?an #b bus9ess days aft] a reque/ = su* in=mation by an enrollee4 7c7 ,en=cem5t 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 a heal? c>e provid] t violates a requirem5t "u subsection 7a7 %all be subject to a civil monet>y p5alty ( n m ?an #aj1jjj = ea* act con/itut+ su* violation4 7#b7 ,proc$ure ,! provisions ( section #aabh;,a ( ! ,social ,security ,act1 o!r ?an subsections 7a7 & 7b7 & ! fir/ s5t5ce ( subsection 7c77#a7 ( su* section1 %all apply to civil money p5alties "u ?is subsection 9 ! same mann] z su* provisions apply to a p5alty or proce$+ "u section #aabh;,a ( ! ,social ,security ,act4 4 7b7 ,effective date ,section #bgbi;,g ( ! ,public ,heal? ,s]vice ,act1 z add$ by subsection 7a71 %all apply ) respect to plan ye>s beg9n+ on or aft] ! date t is #ah mon?s aft] ! date ( enactm5t ( ?is ,act4 #ag4 ,gr\p heal? plan report+ requirem5ts ,"p ,c ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia et seq471 z am5d$ by section #cjc1 is fur!r am5d$ by add+ at ! end ! foll[+3 #bgig4 ,gr\p heal? plan report+ 7a7 ,9 g5]al ,a gr\p heal? plan or heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all submit to ! ,secret>y1 n lat] ?an ,m>* #a ( ea* ye>1 ! foll[+ in=mation ) respect to ! heal? plan 9 ! previ\s plan ye>3 7#a7 ,! beg9n+ & end dates ( ! plan ye>4 7#b7 ,! numb] ( enrollees4 7#c7 ,ea* ,/ate 9 :i* ! plan is (f]$4 7#d7 ,! #ej br& prescription drugs mo/ frequ5tly disp5s$ by ph>macies = claims paid by ! issu]1 & ! total numb] ( paid claims = ea* su* drug4 7#e7 ,! #ej mo/ co/ly prescription drugs ) respect to ! plan by total annual sp5d+1 & ! annual am\nt sp5t by ! plan = ea* su* drug4 7#f7 ,! #ej prescription drugs ) ! greate/ increase 9 plan exp5ditures ov] ! plan ye> prec$+ ! plan ye> t is ! subject ( ! report1 &1 = ea* su* drug1 ! *ange 9 am\nts exp5d$ by ! plan 9 ea* su* plan ye>4 7#g7 ,total sp5d+ on heal? c>e s]vices by su* gr\p heal? plan1 brok5 d[n by-- 7,a7 ! type ( co/s1 includ+-- 7i7 hospital co/s2 7ii7 heal? c>e provid] & cl9ical s]vice co/s2 7iii7 co/s = prescription drugs2 & 7iv7 o!r m$ical co/s2 & 7,b7 sp5d+ on prescription drugs by-- 7i7 ! heal? plan2 & 7ii7 ! enrollees4 7#h7 ,! av]age mon?ly premium-- 7,a7 paid by employ]s on behalf ( enrollees2 & 7,b7 paid by enrollees4 7#i7 ,any impact on premiums by rebates1 fees1 & any o!r remun]ation paid by drug manufactur]s to ! plan or its adm9i/rators or s]vice provid]s1 ) respect to prescription drugs prescrib$ to enrollees 9 ! plan1 includ+-- 7,a7 ! am\nts s paid = ea* !rapeutic class ( drugs2 & 7,b7 ! am\nts s paid = ea* ( ! #be drugs t yield$ ! highe/ am\nt ( rebates & o!r remun]ation "u ! plan f drug manufactur]s dur+ ! plan ye>4 7#aj7 ,any r$uction 9 premiums & out-(-pocket co/s associat$ ) rebates1 fees1 or o!r remun]ation describ$ 9 p>agraph 7#i74 7b7 ,report ,n lat] ?an #ah mon?s aft] ! date on :i* ! fir/ report is requir$ "u subsection 7a7 & biannually !reaft]1 ! ,secret>y1 act+ ?r\gh ! ,assi/ant ,secret>y ( ,plann+ & ,evaluation & 9 coord9ation ) ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 %all make available on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices a report on prescription drug reimbursem5ts "u gr\p heal? plans1 prescription drug pric+ tr5ds1 & ! role ( prescription drug co/s 9 contribut+ to premium increases or decreases "u su* plans1 aggregat$ 9 su* a way z no drug or plan specific in=mation w be made public4 7c7 ,privacy protections ,no confid5tial or trade secret in=mation submitt$ to ! ,secret>y "u subsection 7a7 %all be includ$ 9 ! report "u subsection 7b74 4