,,ii #aahth ,,congress #ast ,session ,s4 #cedh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #ad1 #bjbc,mr4 ,braun 7for himself1 ,mr4 ,sanders1 ,ms4 ,smith1 and ,mr4 ,hickenlooper7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,public ,health ,service ,act to provide for hospital and insurer price transparency4 #a4 ,short title ,this ,act may be cited as the ,health ,care ,prices ,revealed and ,information to ,consumers ,explained ,transparency ,act or the ,health ,care ,,price ,transparency ,act #b4j4 #b4 ,strengthening hospital price transparency requirements 7a7 ,in general ,section #bgah7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ah7;e77 is amended to read as follows3 7e7 ,standard hospital charges 7#a7 ,in general 7,a7 ,disclosure of standard charges ,for purposes of paragraph 7#a71 the price transparency requirement described in this paragraph is1 with respect to a hospital1 that such hospital1 in accordance with a method and format established by the ,secretary under subparagraph 7,c71 compile and make public 7without subscription and free of charge7 for each month-- 7i7 all of the hospital's standard charges 7including the information described in subparagraph 7,b77 for each item and service furnished by such hospital2 and 7ii7 information in a consumer-friendly format 7as specified by the ,secretary7-- 7,i7 on the hospital's prices 7including the information described in subparagraph 7,b77 for as many of the ,centers for ,medicare amp2 ,medicaid ,services-specified shoppable services that are furnished by the hospital1 and as many additional hospital-selected shoppable services 7or all such additional services1 if such hospital furnishes fewer than #cjj shoppable services7 as may be necessary for a combined total of at least #cjj shoppable services through ,december #ca1 #bjbd1 after which the hospital's prices shall include all shoppable services2 and 7,,ii7 that includes1 with respect to each ,centers for ,medicare ,medicaid ,services-specified shoppable service that is not furnished by the hospital1 an indication that such service is not so furnished4 7,b7 ,standard charges described ,for purposes of subparagraph 7,a71 the information described in this subparagraph is1 with respect to standard charges and prices1 as applicable1 made public by a hospital1 the following3 7i7 ,a plain language description of each item or service1 accompanied by any applicable billing codes1 including modifiers1 using commonly recognized billing code sets1 including the ,current ,procedural ,terminology code1 the ,healthcare ,common ,procedure ,coding ,system code1 the diagnosis-related group1 the ,national ,drug ,code1 and other nationally recognized identifier4 7ii7 ,the gross charge1 as applicable1 expressed as a dollar amount1 for each such item or service1 when provided in1 as applicable1 the inpatient setting and outpatient department setting4 7iii7 ,the discounted cash price1 as applicable1 expressed as a dollar amount1 for each such item or service when provided in1 as applicable1 the inpatient setting and outpatient department setting 7or1 in the case no discounted cash price is available for an item or service1 the minimum cash price accepted by the hospital from self-pay individuals for such item or service1 expressed as a dollar amount1 as well as1 with respect to prices made public pursuant to subparagraph 7,a77ii71 a link to a consumer-friendly document that clearly explains the hospital's charity care policy74 ,the hospital shall accept the discounted cash price as payment in full from any patient that chooses to pay in cash without regard to the patient's coverage4 7iv7 ,the payer-specific negotiated charges1 expressed as a dollar amount and clearly associated with the name of the applicable third party payer and name of each plan1 that apply to each such item or service when provided in1 as applicable1 the inpatient setting and outpatient department setting4 ,if the charges are based on an algorithm1 percentage of another amount1 or other formula or criteria1 the hospital also shall disclose such algorithm1 percentage1 formula1 or criteria as set forth in its contract and any other terms1 schedules1 exhibits1 data1 or other information referenced in any such contract as shall be required to determine and disclose the negotiated charge4 7v7 ,the de-identified maximum and minimum negotiated charges1 as applicable1 for each such item or service1 expressed as a non-zero dollar amount4 7vi7 ,any other additional information the ,secretary may require for the purpose of improving the accuracy of1 or enabling consumers to easily understand and compare1 standard charges and prices for an item or service1 except information that is duplicative of any other reporting requirement under this subsection4 ,in the case of standard charges and prices for an item or service included as part of a bundled1 per diem1 episodic1 or other similar arrangement1 the information described in this subparagraph shall be made available as determined appropriate by the ,secretary4 7,c7 ,uniform method and format ,not later than ,january #a1 #bjbe1 the ,secretary shall establish a standard1 uniform method and format for hospitals to use in compiling and making public standard charges pursuant to subparagraph 7,a77i7 and a standard1 uniform method and format for such hospitals to use in compiling and making public prices pursuant to subparagraph 7,a77ii74 ,such methods and formats-- 7i7 shall1 in the case of such method and format for making public standard charges pursuant to subparagraph 7,a77i71 ensure that such charges are made available in a machine-readable spreadsheet format2 7ii7 may be similar to any template made available by the ,centers for ,medicare ,medicaid ,services as of the date of the enactment of this subparagraph2 7iii7 shall meet such standards as determined appropriate by the ,secretary in order to ensure the accessibility and usability of such charges and prices2 and 7iv7 shall be updated as determined appropriate by the ,secretary1 in consultation with stakeholders4 7#b7 ,no deemed compliance ,the availability of a price estimator tool shall not be considered to deem compliance with or otherwise vitiate the requirements of paragraph 7#b77;,a77ii7 or any other requirements of this section4 ,furthermore1 the use of an estimator tool shall not be used for purposes of compliance with any provisions in this ,section4 7#c7 ,monitoring compliance ,the ,secretary shall1 in consultation with the ,inspector ,general of the ,department of ,health and ,human ,services1 establish a process to monitor compliance with this subsection4 ,such process shall ensure that each hospital's compliance with this subsection is reviewed not less frequently than once every year4 7#d7 ,attestation ,a senior official from each hospital 7the ,chief ,executive ,officer1 ,chief ,financial ,officer1 or an official of equivalent seniority7 shall attest to the accuracy and completeness of the disclosures made in accordance with the hospital price transparency requirements set forth in this regulation4 ,such attestation shall be deemed to be material to payment from the ,federal ,government to the hospital4 7#e7 ,enforcement 7,a7 ,in general ,in the case of a hospital that fails to comply with the requirements of this subsection1 not later than #cj days after the date on which the ,secretary determines such failure exists1 the ,secretary shall submit to such hospital a notification of such determination1 which shall include a request for a corrective action plan to comply with such requirements4 7,b7 ,civil monetary penalty 7i7 ,in general ,in addition to any other enforcement actions or penalties that may apply under another provision of law1 a hospital that has received a request for a corrective action plan under subparagraph 7,a7 and fails to comply with the requirements of this subsection by the date that is #de days after such request is made shall be subject to a civil monetary penalty of an amount specified by the ,secretary for each day 7beginning with the day on which the ,secretary first determined that such hospital was not complying with such requirements7 during which such failure was ongoing4 ,such amount shall not exceed-- 7,i7 in the case of a hospital with #cj or fewer beds1 #cjj per day2 7,,ii7 in the case of a hospital with more than #cj beds but fewer than #aja beds1 #aj per bed per day 7or1 in the case of such a hospital that has been noncompliant with such requirements for a #a-year period or longer1 beginning with the first day following such #a-year period1 #ab4ej per bed per day72 7,,iii7 in the case of a hospital with more than #ajj beds but fewer than #cja beds1 #ae per bed per day 7or1 in the case of such a hospital that has been noncompliant with such requirements for a #a-year period or longer1 beginning with the first day following such #a-year period1 #ag4ej per bed per day72 7,,iv7 in the case of a hospital with more than #cjj beds but fewer than #eja beds1 #bj per bed per day 7or1 in the case of such a hospital that has been noncompliant with such requirements for a #a-year period or longer1 beginning with the first day following such #a-year period1 #be per bed per day72 and 7,v7 in the case of a hospital with more than #ejj beds1 #be per bed per day 7or1 in the case of such a hospital that has been noncompliant with such requirements for a #a-year period or longer1 beginning with the first day following such #a-year period1 #ce per bed per day74 7ii7 ,increase authority ,in applying this subparagraph with respect to violations occurring in #bjbg or a subsequent year1 the ,secretary may through notice and comment rulemaking increase-- 7,i7 the limitation on the per day amount of any penalty applicable to a hospital under clause 7i77,i72 7,,ii7 the limitations on the per bed per day amount of any penalty applicable under any of subclauses 7,,ii7 through 7,v7 of clause 7i72 and 7,,iii7 the limitation on the increase of any penalty applied under clause 7iii7 pursuant to the amounts specified in subclause 7,,ii7 of such clause4 7iii7 ,persistent noncompliance 7,i7 ,in general ,in the case of a hospital that the ,secretary has determined to be knowingly and willfully noncompliant with the provisions of this subsection two or more times during a #a-year period1 the ,secretary may increase any penalty otherwise applicable under this subparagraph by the amount specified in subclause 7,,ii7 with respect to such hospital and may require such hospital to complete such additional corrective actions plans as the ,secretary may specify4 7,,ii7 ,specified amount ,for purposes of subclause 7,i71 the amount specified in this subclause is1 with respect to a hospital-- 7aa7 with more than #cj beds but fewer than #aja beds1 an amount that is not less than #ejj1jjj and not more than #a1jjj1jjj2 7bb7 with more than #ajj beds but fewer than #cja beds1 an amount that is greater than #a1jjj1jjj and not more than #b1jjj1jjj2 7cc7 with more than #cjj beds but fewer than #eja beds1 an amount that is greater than #b1jjj1jjj and not more than #d1jjj1jjj2 and 7dd7 with more than #ejj beds1 and amount that is not less than #e1jjj1jjj and not more than #aj1jjj1jjj4 7iv7 ,provision of technical assistance ,the ,secretary may1 to the extent practicable1 provide technical assistance relating to compliance with the provisions of this section to hospitals requesting such assistance4 7v7 ,application of certain provisions ,the provisions of section #aabh;,a 7other than subsections 7a7 and 7b7 of such section7 shall apply to a civil monetary penalty imposed under this subparagraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection 7a7 of such section4 7,c7 ,no waiver ,the ,secretary shall not grant or extend any waiver1 delay1 tolling1 or other mitigation of a civil monetary penalty for violation of this subsection4 7#f7 ,definitions ,for purposes of this subsection3 7,a7 ,discounted cash price ,the term discounted cash price means the minimum charge that the hospital accepts from an individual who pays cash1 or cash equivalent1 for a hospital-furnished item or service4 7,b7 ,gross charge ,the term gross charge means the charge for an individual item or service that is reflected on a hospital's chargemaster1 absent any discounts4 7,c7 ,hospital ,the term hospital means a hospital 7as defined in section #ahfa7;e7 of the ,social ,security ,act71 a critical access hospital 7as defined in section #ahfa7mmm77#a7 of the ,social ,security ,act71 or a rural emergency hospital 7as defined in section #ahfa7kkk7 of the ,social ,security ,act71 together with any parent1 subsidiary1 or other affiliated provider or supplier of health care items and services without regard to whether such parent1 subsidiary1 or other affiliated provider or supplier operates under separate licensure1 certification1 or designation4 7,d7 ,payer-specific negotiated charge ,the term payer-specific negotiated charge means the charge that a hospital has negotiated with a third party payer for an item or service4 7,e7 ,shoppable service ,the term shoppable service means a service that can be scheduled by a health care consumer in advance and includes all ancillary items and services customarily furnished as part of such service4 7,f7 ,third party payer ,the term third party payer means an entity that is1 by statute1 contract1 or agreement1 legally responsible for payment of a claim for a health care item or service4 4 7b7 ,effective date 7#a7 ,in general ,the amendments made by subsection 7a7 shall apply beginning ,january #a1 #bjbe4 7#b7 ,continued applicability of rules for previous years ,nothing in the amendments made by this section may be construed as affecting the applicability of the regulations codified at part #ahj of title #de1 ,code of ,federal ,regulations1 before ,january #a1 #bjbe4 7c7 ,continued applicability of state law ,the provisions of this ,act shall not supersede any provision of ,state law that establishes1 implements1 or continues in effect any requirement or prohibition related to health care price transparency1 except to the extent that such requirement or prohibition prevents the application of a requirement or prohibition of this ,act4 #c4 ,increasing price transparency of clinical diagnostic laboratory tests under the medicare program ,section #bgah of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ah7 is amended by adding at the end the following3 7f7 ,clinical diagnostic laboratory price transparency 7#a7 ,in general ,beginning ,january #a1 #bjbe1 any applicable laboratory that receives payment from a group health plan or health insurance issuer for furnishing any specified clinical diagnostic laboratory test shall-- 7,a7 make publicly available on an internet website the information described in paragraph 7#b7 with respect to each such specified clinical diagnostic laboratory test that such laboratory so furnishes2 and 7,b7 ensure that such information is updated not less frequently than annually4 7#b7 ,information described ,for purposes of paragraph 7#a71 the information described in this paragraph is1 with respect to an applicable laboratory and a specified clinical diagnostic laboratory test1 the following3 7,a7 ,a plain language description of each item or service1 accompanied by any applicable billing codes1 including modifiers1 using commonly recognized billing code sets1 including the ,current ,procedural ,terminology code1 the ,healthcare ,common ,procedure ,coding ,system code1 the diagnosis-related group1 the ,national ,drug ,code1 and other nationally recognized identifier4 7,b7 ,the gross charge1 as applicable1 expressed as a dollar amount1 for each such item or service4 7,c7 ,the discounted cash price1 as applicable1 expressed as a dollar amount1 for each such item or service 7or1 in the case no discounted cash price is available for an item or service1 the minimum cash price accepted by the laboratory from self-pay individuals for such item or service when provided in such settings for the previous three years1 expressed as a dollar amount1 as well as1 with respect to prices made public pursuant to subparagraph 7,a77ii71 a link to a consumer-friendly document that clearly explains the laboratory's charity care policy74 ,the laboratory shall accept the discounted cash price as payment in full from any patient that chooses to pay in cash without regard to the patient's coverage4 7,d7 ,the payer-specific negotiated charges1 expressed as a dollar amount and clearly associated with the name of the applicable third party payer and name of each plan1 that apply to each such item or service when provided in1 as applicable1 the inpatient setting and outpatient department setting4 ,if the charges are based on an algorithm1 percentage of another amount1 or other formula or criteria1 the clinical diagnostic laboratory also shall disclose such algorithm1 percentage1 formula1 or criteria as set forth in its contract and any other terms1 schedules1 exhibits1 data1 or other information referenced in any such contract as shall be required to determine and disclose the negotiated charge4 7,e7 ,the de-identified maximum and minimum negotiated charges1 as applicable1 for each such item or service1 expressed as a non-zero dollar amount4 7,f7 ,any other additional information the ,secretary may require for the purpose of improving the accuracy of1 or enabling consumers to easily understand and compare1 standard charges and prices for an item or service1 except information that is duplicative of any other reporting requirement under this subsection4 ,in the case of standard charges and prices for an item or service included as part of a bundled1 per diem1 episodic1 or other similar arrangement1 the information described in this subparagraph shall be made available as determined appropriate by the ,secretary4 7#c7 ,uniform method and format ,not later than ,january #a1 #bjbe1 the ,secretary shall establish a standard1 uniform method and format for applicable laboratories to use in compiling and making public information pursuant to paragraph 7#a74 ,such method and format-- 7,a7 shall include a machine-readable spreadsheet format containing the information described in paragraph 7#b7 for all items and services furnished by each laboratory2 7,b7 may be similar to any template made available by the ,centers for ,medicare ,medicaid ,services 7as described in subsection 7e772 7,c7 shall meet such standards as determined appropriate by the ,secretary in order to ensure the accessibility and usability of such information2 and 7,d7 shall be updated as determined appropriate by the ,secretary1 in consultation with stakeholders4 7#d7 ,inclusion of ancillary services ,any price or rate for a specified clinical diagnostic laboratory test available to be furnished by an applicable laboratory made publicly available in accordance with paragraph 7#a7 shall include the price or rate 7as applicable7 for any ancillary item or service 7such as specimen collection services7 that would normally be furnished by such laboratory as part of such test1 as specified by the ,secretary4 7#e7 ,enforcement 7,a7 ,in general ,in the case that the ,secretary determines that an applicable laboratory is not in compliance with paragraph 7#a7-- 7i7 not later than #cj days after such determination1 the ,secretary shall notify such laboratory of such determination2 and 7ii7 if such laboratory continues to fail to comply with such paragraph after the date that is #ij days after such notification is sent1 the ,secretary may impose a civil monetary penalty in an amount not to exceed #cjj for each 7beginning with the day on which the ,secretary first determined that such laboratory was failing to comply with such paragraph7 during which such failure is ongoing4 7,b7 ,increase authority ,in applying this paragraph with respect to violations occurring in #bjbe or a subsequent year1 the ,secretary may through notice and comment rulemaking increase the per day limitation on civil monetary penalties under subparagraph 7,a77ii74 7,c7 ,application of certain provisions ,the provisions of section #aabh;,a of the ,social ,security ,act 7other than subsections 7a7 and 7b7 of such section7 shall apply to a civil monetary penalty imposed under this paragraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection 7a7 of such section4 7#f7 ,provision of technical assistance ,the ,secretary shall1 to the extent practicable1 provide technical assistance relating to compliance with the provisions of this subsection to applicable laboratories requesting such assistance4 7#g7 ,definitions ,in this subsection3 7,a7 ,applicable laboratory ,the term applicable laboratory has the meaning given such term in section #dad4ejb1 of title #db1 ,code of ,federal ,regulations 7or a successor regulation71 except that such term does not include a laboratory with respect to which standard charges and prices for specified clinical diagnostic laboratory tests furnished by such laboratory are made available by a hospital pursuant to subsection 7e74 7,b7 ,discounted cash price ,the term discounted cash price means the charge that applies to an individual who pays cash1 or cash equivalent1 for an item or service4 7,c7 ,gross charge ,the term gross charge means the charge for an individual item or service that is reflected on an applicable laboratory's chargemaster1 absent any discounts4 7,d7 ,payer-specific negotiated charge ,the term payer-specific negotiated charge means the charge that an applicable laboratory has negotiated with a third party payer for an item or service4 7,e7 ,specified clinical diagnostic laboratory test ,the term specified clinical diagnostic laboratory test means a clinical diagnostic laboratory test that is included on the list of shoppable services specified by the ,centers for ,medicare ,medicaid ,services 7as described in subsection 7e771 other than such a test that is only available to be furnished by a single provider of services or supplier4 7,f7 ,third party payer ,the term third party payer means an entity that is1 by statute1 contract1 or agreement1 legally responsible for payment of a claim for a health care item or service4 4 #d4 ,imaging transparency ,section #bgah of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ah71 as amended by section #c1 is further amended by adding at the end the following3 7g7 ,imaging services price transparency 7#a7 ,in general ,beginning ,january #a1 #bjbe1 each provider of services and supplier that receives payment from a group health plan or health insurance issuer for furnishing a specified imaging service1 other than such a provider or supplier with respect to which standard charges and prices for such services furnished by such provider or supplier are made available by a hospital pursuant to subsection 7e71 shall-- 7,a7 make publicly available 7in accordance with paragraph 7#c77 on an internet website the information described in paragraph 7#b7 with respect to each such service that such provider of services or supplier furnishes2 and 7,b7 ensure that such information is updated not less frequently than annually4 7#b7 ,information described ,for purposes of paragraph 7#a71 the information described in this paragraph is1 with respect to a provider of services or supplier and a specified imaging service1 the following3 7,a7 ,a plain language description of each item or service1 accompanied by any applicable billing codes1 including modifiers1 using commonly recognized billing code sets1 including the ,current ,procedural ,terminology code1 the ,healthcare ,common ,procedure ,coding ,system code1 the diagnosis-related group1 the ,national ,drug ,code1 and other nationally recognized identifier4 7,b7 ,the gross charge1 as applicable1 expressed as a dollar amount1 for each such item or service4 7,c7 ,the discounted cash price1 as applicable1 expressed as a dollar amount1 for each such item or service 7or1 in the case no discounted cash price is available for an item or service1 the minimum cash price accepted by the provider of services or supplier from self-pay individuals for such item or service when provided in such settings for the previous three years1 expressed as a dollar amount1 as well as1 with respect to prices made public pursuant to subparagraph 7,a77ii71 a link to a consumer-friendly document that clearly explains the provider of services or supplier's charity care policy74 ,the provider of services or supplier shall accept the discounted cash price as payment in full from any patient that chooses to pay in cash without regard to the patient's coverage4 7,d7 ,the payer-specific negotiated charges1 expressed as a dollar amount and clearly associated with the name of the applicable third party payer and name of each plan1 that apply to each such item or service when provided in1 as applicable1 the inpatient setting and outpatient department setting4 ,if the charges are based on an algorithm1 percentage of another amount1 or other formula or criteria1 the provider or supplier also shall disclose such algorithm1 percentage1 formula1 or criteria as set forth in its contract and any other terms1 schedules1 exhibits1 data1 or other information referenced in any such contract as shall be required to determine and disclose the negotiated charge4 7,e7 ,the de-identified maximum and minimum negotiated charges1 as applicable1 for each such item or service1 expressed as a non-zero dollar amount4 7,f7 ,any other additional information the ,secretary may require for the purpose of improving the accuracy of1 or enabling consumers to easily understand and compare1 standard charges and prices for an item or service1 except information that is duplicative of any other reporting requirement under this subsection4 ,in the case of standard charges and prices for an item or service included as part of a bundled1 per diem1 episodic1 or other similar arrangement1 the information described in this subparagraph shall be made available as determined appropriate by the ,secretary4 7#c7 ,uniform method and format ,not later than ,january #a1 #bjbe1 the ,secretary shall establish a standard1 uniform method and format for providers of services and suppliers to use in making public information described in paragraph 7#b74 ,any such method and format-- 7,a7 shall include a machine-readable spreadsheet format containing the information described in paragraph 7#b7 for all items and services furnished by each provider of services and supplier described in paragraph 7#a72 7,b7 may be similar to any template made available by the ,centers for ,medicare ,medicaid ,services 7as described in subsection 7e772 7,c7 shall meet such standards as determined appropriate by the ,secretary in order to ensure the accessibility and usability of such information2 and 7,d7 shall be updated as determined appropriate by the ,secretary1 in consultation with stakeholders4 7#d7 ,monitoring compliance ,the ,secretary shall1 through notice and comment rulemaking and in consultation with the ,inspector ,general of the ,department of ,health and ,human ,services1 establish a process to monitor compliance with this subsection4 7#e7 ,enforcement 7,a7 ,in general ,in the case that the ,secretary determines that a provider of services or supplier is not in compliance with paragraph 7#a7-- 7i7 not later than #cj days after such determination1 the ,secretary shall notify such provider or supplier of such determination2 7ii7 upon request of the ,secretary1 such provider or supplier shall submit to the ,secretary1 not later than #de days after the date of such request1 a corrective action plan to comply with such paragraph2 and 7iii7 if such provider or supplier continues to fail to comply with such paragraph after the date that is #ij days after such notification is sent 7or1 in the case of such a provider or supplier that has submitted a corrective action plan described in clause 7ii7 in response to a request so described1 after the date that is #ij days after such submission71 the ,secretary may impose a civil monetary penalty in an amount not to exceed #cjj for each day 7beginning with the day on which the ,secretary first determined that such provider or supplier was failing to comply with such paragraph7 during which such failure to comply or failure to submit is ongoing4 7,b7 ,increase authority ,in applying this paragraph with respect to violations occurring in #bjbg or a subsequent year1 the ,secretary may through notice and comment rulemaking increase the amount of the civil monetary penalty under subparagraph 7,a77iii74 7,c7 ,application of certain provisions ,the provisions of section #aabh;,a of the ,social ,security ,act 7other than subsections 7a7 and 7b7 of such section7 shall apply to a civil monetary penalty imposed under this paragraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection 7a7 of such section4 7,d7 ,no authority to waive or reduce penalty ,the ,secretary shall not grant or extend any waiver1 delay1 tolling1 or other mitigation of a civil monetary penalty for violation of this subsection4 7,e7 ,provision of technical assistance ,the ,secretary shall1 to the extent practicable1 provide technical assistance relating to compliance with the provisions of this subsection to providers of services and suppliers requesting such assistance4 7,f7 ,clarification of nonapplicability of other enforcement provisions ,notwithstanding any other provision of this title1 this paragraph shall be the sole means of enforcing the provisions of this subsection4 7#f7 ,specified imaging service defined the term specified imaging service means an imaging service that is a ,centers for ,medicare ,medicaid ,services-specified shoppable service 7as described in subsection 7e774 4 #e4 ,ambulatory surgical center price transparency requirements ,section #bgah of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ah71 as amended by section #d1 is further amended by adding at the end the following3 7h7 ,ambulatory surgery center transparency 7#a7 ,in general ,beginning ,january #a1 #bjbe1 each specified ambulatory surgical center that receives payment from a group health plan or health insurance issuer for furnishing items and services shall comply with the price transparency requirement described in paragraph 7#b74 7#b7 ,requirement described 7,a7 ,in general ,for purposes of paragraph 7#a71 the price transparency requirement described in this subsection is1 with respect to a specified ambulatory surgical center1 that such surgical center in accordance with a method and format established by the ,secretary under subparagraph 7,c771 compile and make public 7without subscription and free of charge71 for each year-- 7i7 one or more lists1 in a machine-readable format specified by the ,secretary1 of the ambulatory surgical center's standard charges 7including the information described in subparagraph 7,b77 for each item and service furnished by such surgical center2 7ii7 information in a consumer-friendly format 7as specified by the ,secretary7 on the ambulatory surgical center's prices 7including the information described in subparagraph 7,b77 for as many of the ,centers for ,medicare ,medicaid ,services-specified shoppable services included on the list described in subsection 7e7 that are furnished by such surgical center1 and as many additional ambulatory surgical center-selected shoppable services 7or all such additional services1 if such surgical center furnishes fewer than #cjj shoppable services7 as may be necessary for a combined total of at least #cjj shoppable services2 and 7iii7 with respect to each ,centers for ,medicare ,medicaid ,services-specified shoppable service 7as described in clause 7ii77 that is not furnished by the ambulatory surgical center1 an indication that such service is not so furnished4 7,b7 ,information described ,for purposes of subparagraph 7,a71 the information described in this subparagraph is1 with respect to standard charges and prices1 as applicable1 made public by a specified ambulatory surgical center1 the following3 7i7 ,a description of each item or service1 accompanied by1 as applicable1 the ,healthcare ,common ,procedure ,coding ,system code1 the national drug code1 or other identifier used or approved by the ,centers for ,medicare amp2 ,medicaid ,services4 7ii7 ,the gross charge1 expressed as a dollar amount1 for each such item or service4 7iii7 ,the discounted cash price1 expressed as a dollar amount1 for each such item or service 7or1 in the case no discounted cash price is available for an item or service1 the minimum cash price accepted by the specified ambulatory surgical center from self-pay individuals for such item or service when provided in such settings for the previous three years1 expressed as a dollar amount1 as well as1 with respect to prices made public pursuant to subparagraph 7,a77ii71 a link to a consumer-friendly document that clearly explains the provider of services or supplier's charity care policy74 ,the specified ambulatory surgical center shall accept the discounted cash price as payment in full from any patient that chooses to pay in cash without regard to the patient's coverage4 7iv7 ,the payer-specific negotiated charges1 expressed as a dollar amount and clearly associated with the name of the applicable third party payer and name of each plan1 that apply to each such item or service when provided in1 as applicable1 the inpatient setting and outpatient department setting4 ,if the charges are based on an algorithm1 percentage of another amount1 or other formula or criteria1 the ambulatory surgical center also shall disclose such algorithm1 percentage1 formula1 or criteria as set forth in its contract and any other terms1 schedules1 exhibits1 data1 or other information referenced in any such contract as shall be required to determine and disclose the negotiated charge4 7v7 ,the de-identified maximum and minimum negotiated charges1 as applicable1 for each such item or service1 expressed as a non-zero dollar amount4 7vi7 ,any other additional information the ,secretary may require for the purpose of improving the accuracy of1 or enabling consumers to easily understand and compare1 standard charges and prices for an item or service1 except information that is duplicative of any other reporting requirement under this subsection4 7,c7 ,uniform method and format ,not later than ,january #a1 #bjbe1 the ,secretary shall establish a standard1 uniform method and format for specified ambulatory surgical centers to use in making public standard charges pursuant to subparagraph 7,a77i7 and a standard1 uniform method and format for such centers to use in making public prices pursuant to subparagraph 7,a77ii74 ,any such method and format-- 7i7 shall1 in the case of such charges made public by an ambulatory surgical center1 ensure that such charges are made available in a machine-readable format2 7ii7 may be similar to any template made available by the ,centers for ,medicare ,medicaid ,services 7as described in subsection 7e772 7iii7 shall meet such standards as determined appropriate by the ,secretary in order to ensure the accessibility and usability of such charges and prices2 and 7iv7 shall be updated as determined appropriate by the ,secretary1 in consultation with stakeholders4 7#c7 ,no deemed compliance ,the availability of a price estimator tool shall not be considered to deem compliance with or otherwise vitiate the requirements of this subsection 7aa74 ,furthermore1 the use of an estimator tool shall not be used for purposes of compliance with any provisions in this subsection4 7#d7 ,monitoring compliance ,the ,secretary shall1 in consultation with the ,inspector ,general of the ,department of ,health and ,human ,services1 establish a process to monitor compliance with this subsection4 ,such process shall ensure that each specified ambulatory surgical center's compliance with this subsection is reviewed not less frequently than once every year4 7#e7 ,enforcement 7,a7 ,in general ,in the case of a specified ambulatory surgical center that fails to comply with the requirements of this subsection-- 7i7 the ,secretary shall notify such ambulatory surgical center of such failure not later than #cj days after the date on which the ,secretary determines such failure exists2 and 7ii7 upon request of the ,secretary1 the ambulatory surgical center shall submit to the ,secretary1 not later than #de days after the date of such request1 a corrective action plan to comply with such requirements4 7,b7 ,civil monetary penalty 7i7 ,in general ,a specified ambulatory surgical center that has received a notification under subparagraph 7,a77i7 and fails to comply with the requirements of this subsection by the date that is #ij days after such notification 7or1 in the case of an ambulatory surgical center that has submitted a corrective action plan described in subparagraph 7,a77ii7 in response to a request so described1 by the date that is #ij days after such submission7 shall be subject to a civil monetary penalty of an amount specified by the ,secretary for each day 7beginning with the day on which the ,secretary first determined that such hospital was not complying with such requirements7 during which such failure is ongoing 7not to exceed #cjj per day74 7ii7 ,increase authority ,in applying this subparagraph with respect to violations occurring in #bjbg or a subsequent year1 the ,secretary may through notice and comment rulemaking increase the limitation on the per day amount of any penalty applicable to a specified ambulatory surgical center under clause 7i74 7iii7 ,application of certain provisions ,the provisions of section #aabh;,a of the ,social ,security ,act 7other than subsections 7a7 and 7b7 of such section7 shall apply to a civil monetary penalty imposed under this subparagraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection 7a7 of such section4 7iv7 ,no authority to waive or reduce penalty ,the ,secretary shall not grant or extend any waiver1 delay1 tolling1 or other mitigation of a civil monetary penalty for violation of this subsection4 7#f7 ,provision of technical assistance ,the ,secretary shall1 to the extent practicable1 provide technical assistance relating to compliance with the provisions of this subsection to specified ambulatory surgical centers requesting such assistance4 7#g7 ,definitions ,for purposes of this section3 7,a7 ,discounted cash price ,the term discounted cash price means the charge that applies to an individual who pays cash1 or cash equivalent1 for a item or service furnished by an ambulatory surgical center4 7,b7 ,gross charge ,the term gross charge means the charge for an individual item or service that is reflected on a specified surgical center's chargemaster1 absent any discounts4 7,c7 ,group health plan2 group health insurance coverage2 individual health insurance coverage ,the terms group health plan1 group health insurance coverage1 and individual health insurance coverage have the meaning given such terms in section #bgia of the ,public ,health ,service ,act4 7,d7 ,payer-specific negotiated charge ,the term payer-specific negotiated charge means the charge that a specified surgical center has negotiated with a third party payer for an item or service4 7,e7 ,shoppable service ,the term shoppable service means a service that can be scheduled by a health care consumer in advance and includes all ancillary items and services customarily furnished as part of such service4 7,f7 ,specified ambulatory surgical center ,the term specified ambulatory surgical center means an ambulatory surgical center with respect to which a hospital 7or any person with an ownership or control interest 7as defined in section #aabd7;a77#c7 of the ,social ,security ,act7 in a hospital7 is a person with an ownership or control interest 7as so defined74 7,g7 ,third party payer ,the term third party payer means an entity that is1 by statute1 contract1 or agreement1 legally responsible for payment of a claim for a health care item or service4 4 #f4 ,strengthening health coverage transparency requirements 7a7 ,transparency in coverage ,section #acaa7;e77#c77;,c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;e77#c77;,c77 is amended-- 7#a7 by striking ,the ,exchange and inserting the following3 7i7 ,in general ,the ,exchange 2 7#b7 in clause 7i71 as inserted by paragraph 7#a7-- 7,a7 by striking participating provider and inserting provider2 7,b7 by inserting shall include the information specified in clause 7ii7 and after such information2 7,c7 by striking an ,internet website and inserting a self-service tool that meets the requirements of clause 7iii72 and 7,d7 by striking and such other and all that follows through the period and inserting or1 at the option such individual1 through a paper or phone disclosure 7as selected by such individual and provided at no cost to such individual7 that meets such requirements as the ,secretary may specify42 and 7#c7 by adding at the end the following new clauses3 7ii7 ,specified information ,for purposes of clause 7i71 the information specified in this clause is1 with respect to benefits available under a health plan for an item or service furnished by a health care provider1 the following3 7,i7 ,if such provider is a participating provider with respect to such item or service1 the in-network rate 7as defined in subparagraph 7,f77 for such item or service4 7,,ii7 ,if such provider is not described in subclause 7,i71 the maximum allowed amount for such item or service4 7,,iii7 ,the amount of cost sharing 7including deductibles1 copayments1 and coinsurance7 that the individual will incur for such item or service 7which1 in the case such item or service is to be furnished by a provider described in subclause 7,,ii71 shall be calculated using the maximum amount described in such subclause74 7,,iv7 ,the amount the individual has already accumulated with respect to any deductible or out of pocket maximum under the plan 7broken down1 in the case separate deductibles or maximums apply to separate individuals enrolled in the plan1 by such separate deductibles or maximums1 in addition to any cumulative deductible or maximum74 7,v7 ,in the case such plan imposes any frequency or volume limitations with respect to such item or service 7excluding medical necessity determinations71 the amount that such individual has accrued towards such limitation with respect to such item or service4 7,,vi7 ,any prior authorization1 concurrent review1 step therapy1 fail first1 or similar requirements applicable to coverage of such item or service under such plan4 7iii7 ,self-service tool ,for purposes of clause 7i71 a self-service tool established by a health plan meets the requirements of this clause if such tool-- 7,i7 is based on an internet website2 7,,ii7 provides for real-time responses to requests described in such clause2 7,,iii7 is updated in a manner such that information provided through such tool is timely and accurate2 7,,iv7 allows such a request to be made with respect to an item or service furnished by-- 7aa7 a specific provider that is a participating provider with respect to such item or service2 7bb7 all providers that are participating providers with respect to such plan and such item or service2 or 7cc7 a provider that is not described in item 7bb72 7,v7 provides that such a request may be made with respect to an item or service through use of the billing code for such item or service or through use of a descriptive term for such item or service2 and 7,,vi7 holds a member harmless for the amount of any difference in excess of the amount of the individual's responsibility generated by the self-service tool and the amount ultimately billed or charged to the individual4 4 7b7 ,disclosure of additional information ,section #acaa7;e77#c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;e77#c77 is amended by adding at the end the following new subparagraphs3 7,e7 ,rate and payment information 7i7 ,in general ,not later than ,january #a1 #bjbe1 and every month thereafter1 each health plan shall submit to the ,exchange1 the ,secretary1 the ,state insurance commissioner1 and make available to the public1 the rate and payment information described in clause 7ii7 in accordance with clause 7iii74 7ii7 ,rate and payment information described ,for purposes of clause 7i71 the rate and payment information described in this clause is1 with respect to a health plan1 the following3 7,i7 ,with respect to each item or service for which benefits are available under such plan 7expressed as a dollar amount71 including prescription drugs1 identified by ,,cpt1 ,,hcpcs1 ,,drg1 ,,ndc1 or other applicable nationally recognized identifier1 including any applicable code modifiers1 and accompanied by a brief description of the item or service1 the in-network rate in effect as of the date of the submission of such information with each provider 7identified by national provider identifier7 that is a participating provider with respect to such item or service1 other than such a rate in effect with a provider that has submitted no claims for such item or service to such plan4 7,,ii7 ,with respect to each drug 7identified by ,national ,drug ,code1 ,j-code1 or other commonly recognized billing code used for drugs7 for which benefits are available under such plan3 7aa7 ,the in-network rate 7expressed as a dollar amount71 including the individual and total amounts for any bundled rates1 in effect as of the first day of the month in which such information is made public with each provider that is a participating provider with respect to such drug4 7bb7 ,the historical net price paid by such plan 7net of rebates1 discounts1 and price concessions7 7expressed as a dollar amount7 for such drug dispensed or administered during the #ij-;day period beginning #ahj days before such date of submission to each provider that was a participating provider with respect to such drug1 broken down by each such provider 7identified by national provider identifier71 other than such an amount paid to a provider that has submitted no claims for such drug to such plan4 7,,iii7 ,with respect to each item or service for which benefits are available under such plan 7expressed as a dollar amount71 identified by ,,cpt1 ,,drg1 ,,hcpcs1 ,,ndc1 or other applicable nationally recognized identifier1 including any applicable code modifiers1 and accompanied by a brief description of the item or service1 the amount billed or charged by the provider1 and the amount allowed by the plan1 for each such item or service furnished during the #ij-;day period beginning #ahj days before such date of submission by each provider that was not a participating provider with respect to such item or service1 broken down by each such provider 7identified by national provider identifier71 other than items and services with respect to which no claims for such item or service were submitted to such plan during such period4 7iii7 ,manner of submission ,rate and payment information required to be submitted and made available under this subparagraph shall be so submitted and so made available as follows3 7,i7 ,information shall be contained in #c separate machine-readable files corresponding to the information described in each of subclauses 7,i7 through 7,,iii7 of clause 7ii7 that meet such requirements as specified by the ,secretary through rulemaking1 in consultation with the ,secretaries of ,labor and the ,treasury to apply comparable requirements to group health plans and to entities providing benefit management or other third-party administration services on a contractual basis with a group health plan4 7,,ii7 ,requirements specified by the ,secretary through rulemaking shall ensure that3 7aa7 ,such files are limited to an appropriate size1 are made available in a widely available format that allows for information contained in such files to be compared across health plans1 and are accessible to individuals at no cost and without the need to establish a user account or provider other credentials4 7bb7 ,the rates1 amounts1 and prices to be disclosed include contractual terms containing calculation formulae1 pricing methodologies1 and other information necessary to determine the dollar value of reimbursement4 7cc7 ,each such file includes each of the following data elements3 7,,aa7 ,a numerical identifier for the group health plan and_/or health insurance issuer 7such as a ,health ,insurance ,oversight ,system identifier74 7,,bb7 ,a plain-language description of the item or service 7including1 for drugs1 the proprietary and nonproprietary name assigned74 7,,cc7 ,the billing code1 including any applicable modifiers1 associated with such item or service1 including the ,healthcare ,common ,procedure ,coding ,system code1 diagnosis-related group1 national drug code1 or other commonly recognized code set4 7,,dd7 ,the place of service code4 7,,ee7 ,the ,national ,provider ,identifier or provider ,tax ,identification ,number4 7,,iii7 ,the rate and payment information disclosed under subclauses 7,i7 through 7,,iii7 of clause 7ii7 shall be separately delineated for each item or service1 regardless of whether such item or service is reimbursed as a part of a bundle1 episode1 or other grouping of items and services4 7,,iv7 ,an officer or executive of competent authority shall attest to the accuracy and completeness of information submitted and made available under this subparagraph4 ,such attestation shall be deemed material to payments from the ,federal ,government received by the group health plan or health insurance issuer4 7,v7 ,regulations promulgated pursuant to this section shall provide that3 7aa7 ,the ,secretary shall audit the three machine-readable files required by subparagraph 7,e77ii7 posted by no fewer than #bj group health plans or health insurance issuers4 7bb7 ,the ,secretary of ,labor shall audit the three machine-readable files required by subparagraph 7,e77ii7 posted by no fewer than #bjj group health plans or service providers furnishing third-party administrator services to a group health plan4 7cc7 ,findings1 conclusions1 and enforcement actions taken based on audits of the machine-readable files shall be reported annually to ,congress no later than ,july #a of the calendar year during which the files were audited4 ,such report to ,congress shall be accessible to the public4 7iv7 ,user guide ,each health plan shall make available to the public instructions written in plain language explaining how individuals may search for information described in clause 7ii7 in files submitted in accordance with clause 7iii74 7,f7 ,definitions ,in this paragraph3 7i7 ,participating provider ,the term participating provider has the meaning given such term in section #bgii;,a-#a of the ,public ,health ,service ,act4 7ii7 ,in-network rate ,the term in-network rate means1 with respect to a health plan and an item or service furnished by a provider that is a participating provider with respect to such plan and item or service1 the contracted rate in effect between such plan and such provider for such item or service4 ,if the rate is based on an algorithm1 percentage of another amount1 or other formula or criteria1 the health plan also shall disclose such algorithm1 percentage1 formula1 or criteria as set forth in its contract and any other terms1 schedules1 exhibits1 data1 or other information referenced in any such contract as shall be required to determine and disclose the negotiated rate4 7,g7 ,applicability to accountable care organizations ,an applicable ,,aco participating in the ,medicare ,shared ,savings ,program1 as defined in ,section #ahii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj71 shall be subject to the requirements of this paragraph as if such applicable ,,aco is a group health plan or health insurance issuer4 7,h7 ,enforcement ,each year1 the ,secretary shall audit the three machine-readable files required by subparagraph 7,e77ii7 posted by no fewer than #bj group health plans or health insurance issuers4 4 7c7 ,effective date 7#a7 ,in general ,the amendments made by subsection 7a7 shall apply beginning ,january #a1 #bjbe4 7#b7 ,continued applicability of rules for previous years ,nothing in the amendments made by this section may be construed as affecting the applicability of the rule entitled ,transparency in ,coverage published by the ,department of the ,treasury1 the ,department of ,labor1 and the ,department of ,health and ,human ,services on ,november #ab1 #bjbj 7#he ,fed4 ,reg4 #gbaeh7 before ,january #a1 #bjbe4 #g4 ,increasing group health plan access to health data 7a7 ,group health plan access to information 7#a7 ,in general ,paragraph 7#b7 of section #djh7;b7 of the ,employee ,retirement ,income ,security ,act of #aigd 7 #bi ,u4,s4,c4 #aajh7;b77 is amended by adding at the end the following new subparagraphs3 7,c7 ,no contract or arrangement for services between a group health plan and any other entity1 including a health care provider 7including a health care facility71 network or association of providers1 service provider offering access to a network of providers1 third-party administrator1 or pharmacy benefit manager 7collectively1 ,covered ,service ,providers71 is reasonable within the meaning of this paragraph unless such contract or arrangement-- 7i7 allows the responsible group health plan access to all claims and encounter information1 and any documentation supporting claim payments1 including1 but not limited to1 medical records and policy documents1 or data described in section #gbd7;a77#a77;,b7 to-- 7,i7 enable such entity to comply with the terms of the plan and any applicable law2 and 7,,ii7 determine the accuracy or reasonableness of payment2 and 7ii7 does not-- 7,i7 unreasonably limit or delay access to such information or data2 7,,ii7 limit the volume of claims and encounter information or data that the group health plan may access during an audit2 7,,iii7 limit the disclosure of pricing terms for value-based payment arrangements or capitated payment arrangements1 including-- 7aa7 payment calculations and formulas2 7bb7 quality measures2 7cc7 contract terms2 7dd7 payment amounts2 7ee7 measurement periods for all incentives2 and 7ff7 other payment methodologies used by an entity1 including a health care provider 7including a health care facility71 network or association of providers1 service provider offering access to a network of providers1 third-party administrator1 or pharmacy benefit manager2 7,,iv7 limit the disclosure of overpayments and overpayment recovery terms2 7,v7 limit the right of the group health plan to select an auditor or define audit scope or frequency2 7,,vi7 otherwise limit or unduly delay the group health plan from accessing claims and encounter information or data in a daily batch4 7,,vii7 limit the disclosure of fees charged to the group health plan related to plan administration and claims processing1 including renegotiation fees1 access fees1 repricing fees1 or enhanced review fees2 7,,viii7 limit the right of the group health plan to request action on any suspect claim payments2 or 7,,ix7 limit public disclosure of de-identified or aggregate information4 7,d7 ,privacy requirements ,covered ,service ,providers shall provide information under this paragraph in a manner consistent with the privacy and security regulations promulgated under the ,health ,insurance ,portability and ,accountability ,act 7,,hipaa74 ,this subparagraph shall not be read to abridge or limit the disclosure requirements under this paragraph or to impose additional privacy or security requirements on ,covered ,service ,providers or plan sponsors4 7,e7 ,disclosure and redisclosure2 limitation to business associates ,a group health plan receiving information or data under this paragraph may disclose such information only to the entity from which the information or data was received1 the group health plan or plan sponsor to which the information or data pertains1 or to that entity's business associates as defined in section #afj4ajc of title #de1 ,code of ,federal ,regulations1 or as otherwise permitted by the ,,hipaa ,privacy ,rule 7#de ,,cfr parts #afj and #afd1 subparts ,a and ,e74 7,f7 ,data standards ,information made available under this section shall conform to the following standards3 7i7 ,institutional1 professional1 and dental claims received from a healthcare provider shall be made available to the group health plan as ,,asc ,x#ab,n #hcg files4 ,the files shall be unmodified copies of the files sent from the provider4 ,in the event that paper claims are sent by the provider1 they shall be converted to the ,,asc ,x#ab,n #hcg electronic format4 ,files shall be accessible to the plan at no cost to the group health plan4 7ii7 ,all claim payment 7or ,,eft1 electronic funds transfer7 and electronic remittance advice 7,,era7 notices sent by a ,covered ,service ,provider shall be made available to the group health plan as ,,asc ,x#ab,n #hce files4 ,the files shall be unmodified copies of the files sent by the ,covered ,service ,provider to the healthcare provider4 ,files shall be accessible at no cost to the group health plan4 7iii7 ,the contractual terms containing calculation formulae1 pricing methodologies1 and other information used to determine the dollar value of reimbursement4 7iv7 ,all non-claim costs shall be itemized and made available to the group health plan in real time through a web-based portal1 through an ,,api1 and through a downloadable ,,csv file4 4 7#b7 ,civil enforcement 7,a7 ,in general ,subsection 7c7 of section #ejb of such ,act 7#bi ,u4,s4,c4 #aacb7 is amended by adding at the end the following new paragraph3 #8#87#ac7 ,in the case of an agreement between a group health plan and a health care provider 7including a health care facility71 network or association of providers1 service provider offering access to a network of providers1 third-party administrator1 or pharmacy benefit manager1 that violates the provisions of section #gbd1 the ,secretary may assess a civil penalty against such provider1 network or association1 service provider offering access to a network of providers1 third-party administrator1 pharmacy benefit manager1 or other service provider in the amount of #aj1jjj for each day during which such violation continues4 ,such penalty shall be in addition to other penalties as may be prescribed by law4 7,b7 ,conforming amendment ,paragraph 7#f7 of section #ejb7;a7 of such ,act is amended by striking or 7#i7 and inserting 7#i71 or 7#ac7 4 7#c7 ,existing provisions void ,section #daj of such ,act is amended by adding at the end the following3 7c7 ,any provision in an agreement or instrument shall be void as against public policy if such provision-- 7#a7 unduly delays or limits a group health plan from accessing the claims and encounter information or data described in section #gbd7;a77#a77;,b72 or 7#b7 violates the requirements of section #djh7;b77#b77;,c74 4 7#d7 ,technical amendment ,clause 7i7 of section #djh7;b77#b77;,b7 of such ,act is amended by striking this clause and inserting this paragraph4 7b7 ,updated attestation for price and quality information ,section #gbd7;a77#c7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahem7a77#c77 is amended to read as follows3 7#c7 ,attestation 7,a7 ,in general ,subject to subparagraph 7,c71 the group health plan or health insurance issuer offering group health insurance coverage shall annually submit to the ,secretary an attestation that such plan or issuer of such coverage is in compliance with the requirements of this subsection4 ,such attestation shall also include a statement verifying that-- 7i7 the information or data described under subparagraphs 7,a7 and 7,b7 of paragraph 7#a7 is available upon request and provided to the group health plan1 the plan administrator1 or the issuer in a timely manner2 and 7ii7 there are no terms in the agreement under such paragraph 7#a7 that directly or indirectly restrict or unduly delay a group health plan1 the plan administrator1 or the issuer from auditing1 reviewing1 or otherwise accessing such information1 except as permitted under section #djh7;b77#b77;,c74 7,b7 ,limitation on submission ,subject to clause 7ii71 a group health plan or issuer offering group health insurance coverage may not enter into an agreement with a third-party administrator or other service provider to submit the attestation required under subparagraph 7,a74 7,c7 ,exception ,in the case of a group health plan or issuer offering group health insurance coverage that is unable to obtain the information or data needed to submit the attestation required under subparagraph 7,a71 such plan or issuer may submit a written statement in lieu of such attestation that includes-- 7i7 an explanation of why such plan or issuer was unsuccessful in obtaining such information or data1 including whether such plan or issuer was limited or prevented from auditing1 reviewing1 or otherwise accessing such information or data2 7ii7 a description of the efforts made by the group health plan to remove any gag clause provisions from the agreement under paragraph 7#a72 and 7iii7 a description of any response by the third-party administrator or other service provider with respect to efforts to comply with the attestation requirement under subparagraph 7,a74 4 7c7 ,effective date ,the amendments made by subsections 7a7 and 7b7 shall apply with respect to a plan beginning with the first plan year that begins on or after the date that is #a year after the date of enactment of this ,act4 #h4 ,preemption only in event of conflict ,the provisions of sections #b through #e of this ,act 7including the amendments made by such sections7 shall not supersede any provision of ,state law which establishes1 implements1 or continues in effect any requirement or prohibition related to health care price transparency1 except to the extent that such requirement or prohibition prevents the application of a requirement or prohibition of such sections 7or amendment74 ,nothing in this section shall be construed to affect health plans established under the ,employee ,retirement ,income ,security ,act of #aigd4