,,ib ,union ,cal5d> ,no4 #baj #aah?     
,,congress  #a/ ,session  ,h4 ,r4 #debg 
,report ,no4 #aah-bfj ,,9 ,,! ,,h\se ,,(
 ,,repres5tatives  ,july #aa1 #bjbc,mrs4
 ,*avez-,de,remer 7= h]self1 ,mr4       
,takano1 & ,ms4 ,mann+7 introduc$ !     
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,education & ! ,work=ce   
,novemb] #a1 #bjbc,report$ ) an am5dm5t1
 committ$ to ! ,committee ( ! ,:ole     
,h\se on ! ,/ate ( ! ,union1 & ord]$ to 
be printed,strike out all aft] ! enact+ 
clause & ins]t ! "p pr9t$ 9 italic,for  
text ( introduc$ bill1 see copy ( bill z
 introduc$ on ,july #aa1 #bjbc  ,a      
,,bill  ,to am5d ! ,employee ,retirem5t 
,income ,security ,act ( #aigd to ensure
 plan fiduci>ies may access de-id5tifi$ 
in=mation relat+ to heal? claims1 & =   
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,heal? ,data ,access1  
,transp>5cy1 & ,af=dability ,act ( #bjbc
 or ! ,heal? ,,data ,act ( #bjbc4  #b4  
,plan fiduci>y access to in=mation  7a7 
,9 g5]al ,p>agraph 7#b7 ( section       

#djh7;b7 ( ! ,employee ,retirem5t       
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aajh7;b77 is am5d$ by add+ at
 ! end ! foll[+ new subp>agraph3  7,c7  
,no contract or arrangem5t = s]vices    
betwe5 a gr\p heal? plan & any o!r      
entity1 su* z a heal? c>e provid]1      
network or association ( provid]s1      
?ird-p>ty adm9i/rator1 or ph>macy b5efit
 manag]1 is reasonable )9 ! mean+ ( ?is 
p>agraph unless su* contract or         
agreem5t-- 7i7 all[s ! responsible plan 
fiduci>y to audit all de-id5tifi$ claims
 & enc\nt] in=mation or data describ$ 9 
section #gbd7;a77#a77;,b7 to-- 7,i7     
ensure t su* entity complies ) ! t]ms ( 
! plan & any applicable law2 &  7,,ii7  
det]m9e ! reasonabl5ess ( comp5sation   
paid by ! plan2 &  7ii7 does n-- 7,i7   
unreasonably limit ! numb] ( audits     
p]mitt$ dur+ a giv5 p]iod ( "t2  7,,ii7 
limit ! numb] ( de-id5tifi$ claims &    
enc\nt] in=mation or data t !           
responsible plan fiduci>y may access    
dur+ an audit2  7,,iii7 limit !         

disclosure ( pric+ t]ms = value bas$    
paym5t arrangem5ts1 includ+-- 7aa7      
paym5t calculations & =mulas2  7bb7     
quality measures2  7cc7 contract t]ms2  
7dd7 paym5t am\nts2  7ee7 measurem5t    
p]iods = all inc5tives2 &  7ff7 o!r     
paym5t me?odologies furni%$ by a heal?  
c>e provid]1 network or association (   
provid]s1 ?ird-p>ty adm9i/rator1 or     
ph>macy b5efit manag]2  7,,iv7 limit !  
disclosure ( ov]paym5ts & ov]paym5t     
recov]y t]ms2  7,v7 limit ! "r ( !      
responsible plan fiduci>y to select an  
auditor2  7,,vi7 o!rwise limit or unduly
 delay by great] ?an #fj days !         
responsible plan fiduci>y f audit+ su*  
in=mation or data2 or  7,,vii7 *>ge a   
fee beyond ! reasonable direct co/s to  
adm9i/] ! op]ation ( conduct+ su*       
audits4  4  7b7 ,civil en=cem5t  7#a7 ,9
 g5]al ,subsection 7c7 ( section #ejb ( 
su* ,act 7#bi ,u4,s4,c4 #aacb7 is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 
7#ac7 ,9 ! case ( an agreem5t betwe5 a  
gr\p heal? plan & a heal? c>e provid]1  

network or association ( provid]s1      
?ird-p>ty adm9i/rator1 ph>macy b5efit   
manag]1 or o!r s]vice provid] t violates
 ! provisions ( section #gbd1 !         
,secret>y may assess a civil p5alty     
aga9/ su* provid]1 network or           
association1 ?ird-p>ty adm9i/rator1     
ph>macy b5efit manag]1 or o!r s]vice    
provid] 9 ! am\nt ( #aj1jjj = ea* day   
dur+ :i* su* violation cont9ues4 ,su*   
p5alty %all be 9 addition to o!r        
p5alties z may be prescrib$ by law4  4  
7#b7 ,con=m+ am5dm5t ,p>agraph 7#f7 (   
section #ejb7;a7 ( su* ,act is am5d$ by 
/rik+ or 7#i7 & ins]t+ 7#i71 or 7#ac72 &
  7c7 ,exi/+ provisions void ,section   
#daj ( su* ,act is am5d$ by add+ at !   
end ! foll[+ new subsection3  7c7 ,any  
provision 9 an agreem5t or in/rum5t %all
 be void z aga9/ public policy if su*   
provision-- 7#a7 unduly delays or limits
 a plan fiduci>y f access+ ! de-id5tifi$
 claims & enc\nt] in=mation or data     
describ$ 9 section #gbd7;a77#a77;,b72 or
  7#b7 violates ! requirem5ts ( section 

#djh7;b77#b77;,c74  4  7d7 ,te*nical    
am5dm5t ,clause 7i7 ( section           
#djh7;b77#b77;,b7 ( su* ,act is am5d$ by
 /rik+ ?is clause & ins]t+ ?is p>agraph4
  #c4 ,updat$ atte/ation = price &      
quality in=mation ,section #gbd7;a77#c7 
( ! ,employee ,retirem5t ,income        
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#aahem7a77#c77 is am5d$ to read z       
foll[s3  7#c7 ,atte/ation  7,a7 ,9 g5]al
 ,subject to subp>agraph 7,c71 !        
fiduci>y ( a gr\p heal? plan or issu]   
(f]+ gr\p heal? insurance cov]age %all  
annually submit to ! ,secret>y an       
atte/ation t su* plan or issu] ( su*    
cov]age is 9 compliance ) ! requirem5ts 
( ?is subsection4 ,su* atte/ation %all  
also include a /atem5t v]ify+ t-- 7i7 ! 
in=mation or data describ$ "u           
subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#a7
 is available ^u reque/ & provid$ to !  
plan fiduci>y1 ! plan adm9i/rator1 or ! 
issu] 9 a timely mann]2 &  7ii7 !re are 
no t]ms 9 ! agreem5t "u su* p>agraph    
7#a7 t directly or indirectly re/rict or

 unduly delay a plan fiduci>y1 ! plan   
adm9i/rator1 or ! issu] f audit+1       
review+1 or o!rwise access+ su*         
in=mation4  7,b7 ,limitation on         
submission ,subject to clause 7ii71 a   
gr\p heal? plan or issu] (f]+ gr\p heal?
 insurance cov]age may n ent] into an   
agreem5t ) a ?ird-p>ty adm9i/rator or   
o!r s]vice provid] to submit !          
atte/ation requir$ "u subp>agraph 7,a74 
7,c7 ,exception ,9 ! case ( a gr\p heal?
 plan or issu] (f]+ gr\p heal? insurance
 cov]age t is unable to obta9 !         
in=mation or data ne$$ to submit !      
atte/ation requir$ "u subp>agraph 7,a71 
su* plan or issu] may submit a writt5   
/atem5t 9 lieu ( su* atte/ation t       
includes-- 7i7 an explanation ( :y su*  
plan or issu] 0 unsuccessful 9 obta9+   
su* in=mation or data1 includ+ :e!r su* 
plan or issu] 0 limit$ or prev5t$ f     
audit+1 review+1 or o!rwise access+ su* 
in=mation or data2  7ii7 a description (
 ! ef=ts made by ! plan fiduci>y to     
remove any gag clause provisions f !    

agreem5t "u p>agraph 7#a72 &  7iii7 a   
description ( any response by !         
?ird-p>ty adm9i/rator or o!r s]vice     
provid] ) respect to ef=ts to comply ) !
 atte/ation requirem5t "u subp>agraph   
7,a74  4  #d4 ,/udy on plan assets ,n   
lat] ?an #a ye> aft] ! date ( enactm5t (
 ?is ,act1 ! ,secret>y ( ,labor %all    
submit to ! ,committee on ,education & !
 ,work=ce ( ! ,h\se ( ,repres5tatives a 
report on ! /atus ( de-id5tifi$ claims &
 enc\nt] in=mation or data describ$ 9   
section #gbd7;a77#a77;,b7 ( ! ,employee 
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aahem71 includ+   
in=mation on ! foll[+3 7#a7             
,circum/ances "u curr5t law :]e su*     
in=mation or data c\ld be deem$ a gr\p  
heal? plan asset 7z def9$ "u section    
#c7db7 ( su* ,act74  7#b7 ,:e!r         
re/rictions on ! ability ( a plan       
fiduci>y to access su* in=mation or data
 violates a requirem5t ( curr5t law4    
7#c7 ,! exi/+ regulatory au?ority ( !   
,secret>y to cl>ify :e!r su* in=mation  

or data belongs to a gr\p heal? plan1 r 
?an a s]vice provid]4  7#d7 ,legislative
 actions t may be tak5 to e/abli% t su* 
in=mation or data relat$ to a plan      
belongs to a gr\p heal? plan & is h&l$ 9
 ! be/ int]e/s ( plan p>ticipants &     
b5efici>ies4  ,novemb] #a1 #bjbc,report$
 ) an am5dm5t1 committ$ to ! ,committee 
( ! ,:ole ,h\se on ! ,/ate ( ! ,union1 &
 ord]$ to be pr9t$