,,ii  #aag? ,,congress  #a/ ,session    
,s4 #caci  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,novemb] #b1 #bjba,mr4 
,braun 7= himself & ,ms4 ,baldw97       
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to ban anticompetitive t]ms 
9 facility & insurance contracts t limit
 access to high] quality1 l[] co/ c>e4  
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,heal?y ,competition = ,bett] ,c>e    
,act4  #b4 ,bann+ anticompetitive t]ms 9
 facility & insurance contracts t limit 
access to high] quality1 l[] co/ c>e    
7a7 ,9 g5]al  7#a7 ,,phsa ,section      
#bgii;,a-#i ( ! ,public ,heal? ,s]vice  
,act 7#db ,u4,s4,c4 #cjj;gg-#aai7 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  7,b7 requires ! gr\p heal?   
plan or heal? insurance issu] to ent]   
into any additional contract ) an       
affiliate ( ! provid] 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$2 or  
7,d7 re/ricts o!r gr\p heal? plans or   
heal? insurance issu]s n p>ty to !      
contract1 f pay+ a l[] rate = items or  
s]vices ?an ! contract+ plan or issu]   
pays = su* items or s]vices4  7#b7      
,additional requirem5t = self-insur$    
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 organization or 
o!r alt]native paym5t model1 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 9 consultation ) ! ,secret>y 
( ,labor & ! ,secret>y ( ! ,treasury1 n 
lat] ?an #a ye> aft] ! date ( enactm5t (
 ?is section1 %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  7#b7 ,,erisa    
,section #gbd ( ! ,employee ,retirem5t  
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aahem7 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 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    
7,b7 requires ! gr\p heal? plan or heal?
 insurance issu] to ent] into any       
additional contract ) an affiliate ( !  
provid] 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 ! contract1 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 heal?   
insurance cov]age ) respect to-- 7,a7 a 
heal? ma9t5ance organization 7z def9$ 9 
section #gcc7;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 organization or 
o!r alt]native paym5t model1 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 heal?   
insurance cov]age %all annually submit  
to ! ,secret>y ( ,labor 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 9            
consultation ) ! ,secret>y ( ,heal? &   
,human ,s]vices & ! ,secret>y ( !       
,treasury1 n lat] ?an #a ye> aft] ! date
 ( enactm5t ( ?is section1 %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  7#c7 ,,irc ,section #ihbd
 ( ! ,int]nal ,rev5ue ,code ( #aihf 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 %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 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  7,b7 requires !    
gr\p heal? plan to ent] into any        
additional contract ) an affiliate ( !  
provid] z a condition ( ent]+ into a    
contract ) su* provid]2  7,c7 requires !
 gr\p heal? plan to agree to paym5t     
rates or o!r t]ms = any affiliate n p>ty
 to ! contract ( ! provid] involv$2 or  
7,d7 re/ricts o!r gr\p heal? plans n    
p>ty to ! contract1 f pay+ a l[] rate = 
items or s]vices ?an ! contract+ plan   
pays = su* items or s]vices4  7#b7      
,additional requirem5t = self-insur$    
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 ) respect to-- 7,a7 a   
heal? ma9t5ance organization 7z def9$ 9 
section #ihcb7;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 organization or 

o!r alt]native paym5t model1 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 %all
 annually submit to ! ,secret>y ( ,labor
 an atte/ation t su* plan 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 9 consultation ) ! ,secret>y 
( ,heal? & ,human ,s]vices & ! ,secret>y
 ( ,labor1 n lat] ?an #a ye> aft] ! date
 ( enactm5t ( ?is section1 %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? plan1       
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 ,! am5dm5ts made by subsection 7a7 
%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* am5dm5ts %all apply on ! e>li]
 ( ! date ( r5ewal ( su* contract or #c 
ye>s aft] su* date ( enactm5t4