,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #bjda  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #aa1 #bjbe,mr4   
,c\rtney 7= himself & ,mrs4 ,h\*97      
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,education & ,work=ce  
,a ,,bill  ,to am5d ! ,employee         
,retirem5t ,income ,security ,act (     
#aigd to cl>ify & /r5g!n ! application (
 c]ta9 employ]-sponsor$ heal? plan      
disclosure requirem5ts4  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,hidd5 ,fee  
,disclosure ,act ( #bjbe4  #b4          
,cl>ification ( ! application ( fee     
disclosure requirem5ts to cov]$ s]vice  
provid]s  7a7 ,s]vices ,clause          
7ii77,i77bb7 ( section #djh7;b77#b77;,b7
 ( ! ,employee ,retirem5t ,income       
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#aajh7;b77#b77;,b77 is am5d$-- 7#a7 9   
subitem 7,,aa7 by /rik+ ,brok]age       
s]vices1 & ins]t+ ,s]vices 7includ+     
brok]age s]vices712 &  7#b7 9 subitem   
7,,bb7-- 7,a7 by /rik+ ,consult+1 &     
ins]t+ ,o!r s]vices12 &  7,b7 by /rik+  

relat$ to ! developm5t or implem5tation 
( plan design & all t foll[s ?r\gh !    
p]iod at ! end & ins]t+ any ( ! foll[+3 
plan design1 claim repric+1 insurance or
 insurance product selection 7includ+   
vision & d5tal71 recordkeep+1 m$ical    
managem5t1 b5efits adm9i/ration         
selection 7includ+ vision & d5tal71     
/op-loss insurance1 ph>macy b5efit      
managem5t s]vices1 wellness design &    
managem5t s]vices1 transp>5cy tools1    
gr\p pur*as+ organization agreem5ts &   
s]vices1 p>ticipation 9 & s]vices f     
pref]r$ v5dor panels1 disease managem5t1
 compliance s]vices1 employee assi/ance 
programs1 or ?ird p>ty adm9i/ration     
s]vices1 or consult+ s]vices relat$ to  
any su* s]vices44  7b7 ,disclosures     
,clause 7iii77,,iii7 ( section          
#djh7;b77#b77;,b7 ( ! ,employee         
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aajh7;b77#b77;,b77
 is am5d$ by /rik+ 1 ei!r 9 ! aggregate 
or by s]vice1 & ins]t+ by s]vice4  #c4  
,/r5g!n+ disclosure requirem5ts )       

respect to entities provid+ ph>macy     
b5efit managem5t s]vices & ?ird p>ty    
adm9i/rators = gr\p heal? plans  7a7    
,c]ta9 arrangem5ts = ph>macy b5efit     
managem5t s]vices consid]$ z indirect   
7#a7 ,9 g5]al ,clause 7i7 ( section     
#djh7;b77#b77;,b7 ( ! ,employee         
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aajh7;b77#b77;,b77
 is am5d$-- 7,a7 by /rik+ requirem5ts ( 
?is clause & ins]t+ requirem5ts ( ?is   
subp>agraph2 &  7,b7 by add+ at ! end ! 
foll[+3 ,= purposes ( apply+ section    
#djf7;a77#a77;,c7 ) respect to a        
transaction describ$ "u ?is subp>agraph1
 a contract or arrangem5t = s]vices     
betwe5 a cov]$ plan & an entity or      
subsidi>y provid+ s]vices to ! plan1    
includ+ a heal? insurance issu] provid+ 
heal? insurance cov]age 9 connection ) !
 cov]$ plan 9 :i* ! entity or subsidi>y 
contracts1 9 connection ) su* plan1 ) a 
s]vice provid] = ph>macy b5efit         
managem5t s]vices %all be consid]$ an   
indirect furni%+ ( goods1 s]vices1 or   

facilities betwe5 ! cov]$ plan & !      
s]vice provid] = ph>macy b5efit         
managem5t s]vices act+ z ! p>ty 9       
int]e/44  7#b7 ,heal? insurance issu] & 
heal? insurance cov]age def9$ ,clause   
7ii77,i77aa7 ( section #djh7;b77#b77;,b7
 ( ! ,employee ,retirem5t ,income       
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#aajh7;b77#b77;,b77 is am5d$ by ins]t+  
be=e ! p]iod at ! end & ! t]ms heal?    
insurance cov]age & heal? insurance     
issu] h ! mean+s giv5 su* t]ms 9 section
 #gcc7;b74  7#c7 ,te*nical am5dm5t      
,section #djh7;b77#b77;,b77ii77,i77aa7 (
 ! ,employee ,retirem5t ,income         
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#aajh7;b77#b77;,b77ii77,i77aa77 is fur!r
 am5d$ by ins]t+ 9 aft] def9$4  7b7     
,specific disclosure requirem5ts )      
respect to entities provid+ ph>macy     
b5efit managem5t s]vices  7#a7 ,9 g5]al 
,clause 7iii7 ( section                 
#djh7;b77#b77;,b7 ( su* ,act 7#bi       
,u4,s4,c4 #aajh7;b77#b77;,b77 is am5d$  
by add+ at ! end ! foll[+3  7,,vii7 ,9 !

 case ( a cov]$ s]vice provid] 9 a      
contract or arrangem5t ) a cov]$ plan to
 provide ph>macy b5efit managem5t       
s]vices1 z "p ( ! description requir$ "u
 subclauses 7,,iii7 & 7,,iv7-- 7aa7 all 
comp5sation describ$ 9 clause           
7ii77,i77dd77,,aa71 includ+ fees1       
rebates1 alt]native disc\nts1 price     
concessions1 co-paym5t (fsets1 & o!r    
remun]ation reasonably expect$ to be    
receiv$ by ! cov]$ s]vice provid]1 an   
affiliate1 or a subcontractor f a drug  
manufactur]1 di/ributor1 rebate         
aggregator1 accumulator1 maximiz]1 gr\p 
pur*as+ organization1 or any o!r ?ird   
p>ty2  7bb7 ! am\nt & =m ( any fees1    
rebates1 alt]native disc\nts1 price     
concessions1 co-paym5t (fsets1 & o!r    
remun]ation1 includ+ ! am\nt expect$ to 
be pass$ ?r\gh to ! plan sponsor or !   
p>ticipants & b5efici>ies "u ! cov]$    
plan2  7cc7 all comp5sation reasonably  
expect$ to be receiv$ by ! cov]$ s]vice 
provid]1 an affiliate1 or a             
subcontractor z a result ( pay+ a l[]   

am\nt = ! drug ?an ! am\nt *>g$ z a     
copaym5t1 co9surance am\nt1 or          
d$uctible2  7dd7 all comp5sation expect$
 to be receiv$ by ! cov]$ s]vice        
provid]1 an affiliate1 or a             
subcontractor z a result ( pay+         
ph>macies less ?an ! am\nt *>g$ to !    
heal? plan1 plan sponsor1 or p>ticipants
 & b5efici>ies 7commonly ref]r$ to z    
spread pric+72  7ee7 all comp5sation    
expect$ to be receiv$ by ! cov]$ s]vice 
provid]1 an affiliate1 or a             
subcontractor f drug manufactur]s or any
 o!r ?ird p>ty 9 ex*ange =-- 7,,aa7     
adm9i/]+1 invoic+1 allocat+1 or collect+
 rebates relat$ to ! cov]$ plan2 7,,bb7 
provid+ access to drug utilization data2
 7,,cc7 reta9+ a p]c5tage ( ! li/ price 
( a drug2 or 7,,dd7 any o!r s]vice      
relat$ to ! role ( ! cov]$ s]vice       
provid] z a conduit betwe5 ! drug       
manufactur]s or any o!r ?ird p>ty & !   
cov]$ plan4  4  7#b7 ,annual disclosure 
,clause 7v7 ( section #djh7;b77#b77;,b7 
( su* ,act 7#bi ,u4,s4,c4               

#aajh7;b77#b77;,b77 is am5d$ by add+ at 
! end ! foll[+3  7,,iii7 ,a cov]$ s]vice
 provid]1 ) respect to a contract or    
arrangem5t ) ! cov]$ plan 9 connection )
 provid+ ph>macy b5efit managem5t       
s]vices1 %all disclose1 on an annual    
basis n lat] ?an #fj days aft] ! beg9n+ 
( ea* plan ye>1 to a responsible plan   
fiduci>y1 9 writ+1 ! foll[+ ) respect to
 ! prec$+ plan ye>3 7aa7 ,all direct    
comp5sation describ$ 9 subclause 7,,iii7
 ( clause 7iii7 & indirect comp5sation  
describ$ 9 subclause 7,,iv7 ( clause    
7iii7 receiv$ by ! cov]$ s]vice provid] 
7includ+ su* comp5sation describ$ 9     
subclause 7,,vii7 ( clause 7iii774  7bb7
 ,! total gross sp5d+ by ! cov]$ plan on
 drugs 7exclud+ fees rebates1 alt]native
 disc\nts1 price concessions1 co-paym5t 
(fsets1 & o!r remun]ation74  7cc7 ,!    
total net sp5d+ by ! cov]$ plan on      
drugs4  7dd7 ,! total gross sp5d+ on    
drugs at all ph>macies :olly or p>tially
 own$ by ! cov]$ s]vice provid] or any  
entity affiliat$ ) ! cov]$ s]vice       

provid]1 includ+ mail-ord]1 specialty & 
retail ph>macies1 ) a breakd[n by       
individual ph>macy location4  7ee7 ,!   
aggregate am\nt ( co/-%>+ collect$ by ! 
cov]$ s]vice provid] f a ph>macy = a    
p>ticipant or b5efici>y 9 excess ( !    
contract$ rate f su* ph>macies1 includ+ 
mail-ord]1 specialty1 & retail          
ph>macies1 includ+-- 7,,aa7 categorical 
explanations 7gr\p$ by ! reason =       
collection ( su* am\nts1 su* z          
contractual true-up provisions1         
ov]paym5ts1 or non-cov]$ m$ication      
disp5s$1 & includ+ in=mation on ! am\nt 
9 ea* category t 0 pass$ ?r\gh to !     
cov]$ plan & to p>ticipants &           
b5efici>ies ( ! cov]$ plan72 or 7,,bb7  
individual explanations = su* am\nts4   
7ff7 ,total aggregate am\nts ( fees     
collect$ by ! cov]$ s]vice provid]1 an  
affiliate1 or a subcontractor 9         
connection ) ! provision ( ph>macy      
b5efit managem5t s]vices to ! cov]$     
plan1 brok5 d[n by ! s\rce ( su* fees   
7su* z ! cov]$ plan1 p>ticipants &      

b5efici>ies ( ! cov]$ plan1 any drug    
manufactur] or :olesal]1 or any ph>macy 
entity74  7gg7 ,any in=mation specifi$  
by ! ,secret>y ?r\gh regulations or     
guidance t may be necess>y = a          
responsible plan fiduci>y to det]m9e !  
reasonabl5ess ( ! contract or arrangem5t
 ) ! cov]$ s]vice provid]1 any          
comp5sation paid "u su* a contract or   
arrangem5t1 or any conflicts ( int]e/ t 
may exi/4  4  7#c7 ,ph>macy b5efit      
managem5t s]vices def9$ ,clause 7ii77,i7
 ( section #djh7;b77#b77;,b7 ( su* ,act 
7#bi ,u4,s4,c4 #aajh7;b77#b77;,b77 is   
am5d$ by add+ at ! end ! foll[+3  7gg7  
,! t]m ph>macy b5efit managem5t s]vices 
includes any s]vices provid$ by a cov]$ 
s]vice provid] to a cov]$ plan ) respect
 to ! adm9i/ration ( prescription drug  
b5efits "u ! cov]$ plan1 includ+--      
7,,aa7 ! process+ & paym5t ( claims2    
7,,bb7 design ( ph>macy networks2 7,,cc7
 negotiation1 aggregation1 & di/ribution
 ( rebates1 disc\nts1 & o!r price       
concessions2 7,,dd7 =mul>y design &     

ma9t5ance2 7,,ee7 op]ation ( ph>macies  
7:e!r retail1 mail ord]1 specialty drug1
 or o!rwise72 recordkeep+2 7,,ff7       
utilization review2 7,,gg7 adjudication 
( claims2 & 7,,hh7 any o!r s]vices      
specifi$ by ! ,secret>y ?r\gh guidance  
or rulemak+4  4  7c7 ,specific          
disclosure requirem5ts ) respect to ?ird
 p>ty adm9i/ration s]vices = gr\p heal? 
plans  7#a7 ,9 g5]al ,clause 7iii7 (    
section #djh7;b77#b77;,b7 ( su* ,act    
7#bi ,u4,s4,c4 #aajh7;b77#b77;,b771 z   
am5d$ by subsection 7b77#a71 is fur!r   
am5d$ by add+ at ! end ! foll[+3        
7,,viii7 ,) respect to a contract or    
arrangem5t ) ! cov]$ plan 9 connection )
 ! provision ( ?ird p>ty adm9i/ration   
s]vices = gr\p heal? plans1 z "p ( !    
description requir$ "u subclauses       
7,,iii7 & 7,,iv7-- 7aa7 ! am\nt & =m (  
any rebates1 disc\nts1 sav+s fees1      
refunds1 or am\nts receiv$ f provid]s & 
facilities1 includ+ ! am\nts t w be     
reta9$ by ! cov]$ s]vice provid]2  7bb7 
! am\nt & =m ( fees expect$ to be       

receiv$ f o!r s]vice provid]s 9 relation
 to ! cov]$ plan1 includ+ ! am\nts t w  
be reta9$ by ! cov]$ s]vice provid] z a 
fee1 to ! ext5t feasible2 &  7cc7 !     
am\nt & =m ( expect$ recov]ies by !     
cov]$ s]vice provid]1 includ+ ! am\nts t
 w be reta9$ by ! cov]$ s]vice provid]  
7disaggregat$ by category71 z a result  
(-- 7,,aa7 ov]paym5ts2 7,,bb7 errone\s  
paym5ts2 7,,cc7 unca%$ *ecks or         
incomplete paym5ts2 7,,dd7 bill+ errors2
 7,,ee7 subrogation2 7,,ff7 fraud2 or   
7,,gg7 any o!r reason on behalf ( !     
cov]$ plan4  4  7#b7 ,annual disclosure 
,clause 7v7 ( section #djh7;b77#b77;,b7 
( su* ,act 7#bi ,u4,s4,c4               
#aajh7;b77#b77;,b771 z am5d$ by         
subsection 7b77#b71 is am5d$ by add+ at 
! end ! foll[+3  7,,iv7 ,a cov]$ s]vice 
provid]1 ) respect to a contract or     
arrangem5t ) ! cov]$ plan 9 connection )
 provid+ ?ird p>ty adm9i/ration s]vices 
= gr\p heal? plans1 %all disclose1 on an
 annual basis n lat] ?an #fj days aft] !
 beg9n+ ( ea* plan ye>1 to a responsible

 plan fiduci>y1 9 writ+1 ! foll[+ )     
respect to ! prec$+ plan ye>3 7aa7 ,all 
direct comp5sation describ$ 9 subclause 
7,,iii7 ( clause 7iii74  7bb7 ,all      
indirect comp5sation describ$ 9         
subclause 7,,iv7 ( clause 7iii7 receiv$ 
by ! cov]$ s]vice provid]1 an affiliate1
 or a subcontractor 7includ+ su*        
comp5sation describ$ 9 subclause        
7,,viii7 ( clause 7iii774  7cc7 ,!      
aggregate am\nt = :i* ! cov]$ s]vice    
provid]1 an affiliate1 or a             
subcontractor receiv$ indirect          
comp5sation & ! e/imat$ am\nt ( co/-%>+ 
incurr$ by plan p>ticipants &           
b5efici>ies z a result4  7dd7 ,! total  
gross sp5d+ by ! cov]$ plan on all co/s 
& fees aris+ "u or paid "u !            
adm9i/rative s]vices agreem5t ) ! cov]$ 
s]vice provid] 7n includ+ any am\nts    
describ$ 9 items 7aa7 ?r\gh 7cc7 (      
clause 7iii77,,viii774  7ee7 ,! total   
net sp5d+ by ! cov]$ plan on all co/s & 
fees aris+ "u or paid "u ! adm9i/rative 
s]vices agreem5t ) ! cov]$ s]vice       

provid]4  7ff7 ,! aggregate fees        
collect$ by ! cov]$ s]vice provid]1 an  
affiliate1 or a subcontractor f any     
s\rce4  7gg7 ,any o!r in=mation specifi$
 by ! ,secret>y ?r\gh regulations or    
guidance t may be necess>y = a          
responsible plan fiduci>y to det]m9e !  
reasonabl5ess ( ! contract or arrangem5t
 ) ! cov]$ s]vice provid] any           
comp5sation paid "u su* a contractor or 
arrangem5t1 or any conflicts ( int]e/ t 
may exi/4  4  7#c7 ,?ird p>ty           
adm9i/ration s]vices = gr\p heal? plans 
def9$ ,clause 7ii77,i7 ( section        
#djh7;b77#b77;,b7 ( su* ,act 7#bi       
,u4,s4,c4 #aajh7;b77#b77;,b771 z am5d$  
by subsection 7b77#c71 is am5d$ by add+ 
at ! end ! foll[+3  7hh7 ,! t]m ?ird    
p>ty adm9i/ration s]vices = gr\p heal?  
plans includes any s]vices provid$ by a 
cov]$ s]vice provid] to a cov]$ plan )  
respect to ! adm9i/ration ( heal?       
b5efits "u ! cov]$ plan1 includ+--      
7,,aa7 ! process+1 repric+1 & paym5t (  
claims2 7,,bb7 design1 creation1 &      

ma9t5ance ( provid] networks2 7,,cc7    
negotiation ( disc\nts (f gross rates2  
7,,dd7 b5efit & plan design2 negotiation
 ( paym5t rates2 7,,ee7 recordkeep+2    
7,,ff7 utilization review2 7,,gg7       
adjudication ( claims2 7,,hh7 regulatory
 compliance2 & 7,,ii7 any o!r s]vices   
set =? 9 an adm9i/rative s]vices        
agreem5t or simil> agreem5t or specifi$ 
by ! ,secret>y ?r\gh guidance or        
rulemak+4  4  7d7 ,privacy requirem5ts  
,section #djh7;b77#b7 ( ! ,employee     
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aajh7;b77#b771 z  
am5d$ by subsection 7c71 is fur!r am5d$ 
by add+ at ! end ! foll[+3  7,c7        
,privacy requirem5ts ,cov]$ s]vice      
provid]s %all provide in=mation "u      
subp>agraph 7,b7 9 a mann] consi/5t ) ! 
privacy regulations promulgat$ "u       
section #acdjb7;a7 ( ! ,heal? ,in=mation
 ,te*nology = ,cl9ical ,heal? ,act 7#db 
,u4,s4,c4 #agicb7;a771 & consi/5t ) !   
privacy regulations promulgat$ "u !     
,heal? ,insurance ,portability &        

,acc\ntability ,act ( #aiif 9 "p #afj & 
subp>ts ,a & ,e ( "p #afd ( title #de1  
,code ( ,f$]al ,regulations 7or         
successor regulations7 & %all re/rict ! 
use & disclosure ( su* in=mation accord+
 to su* privacy1 security1 & brea*      
notification regulations & su* privacy  
regulations4  7,d7 ,disclosure &        
r$isclosure  7i7 ,limitation to bus9ess 
associates ,a responsible plan fiduci>y 
receiv+ in=mation disclos$ "u           
subp>agraph 7,b7 may disclose su*       
in=mation only to ! entity f :i* !      
in=mation 0 receiv$1 ! gr\p heal? plan  
to :i* ! in=mation p]ta9s1 or to t      
entity's bus9ess associates z def9$ 9   
section #afj4ajc ( title #de1 ,code (   
,f$]al ,regulations 7or successor       
regulations7 or z p]mitt$ by ! ,,hipaa  
,privacy ,rule 7p>ts #afj & #afd1       
subp>ts ,a & ,e ( title #de1 ,code (    
,f$]al ,regulations74  7ii7             
,cl>ification reg>d+ public disclosure (
 in=mation ,no?+ 9 ?is section %all     
prev5t a gr\p heal? plan or heal?       

insurance issu] (f]+ gr\p heal?         
insurance cov]age1 or a cov]$ s]vice    
provid]1 f plac+ reasonable re/rictions 
on ! public disclosure ( ! in=mation    
describ$ 9 ?is subp>agraph1 except t su*
 plan1 issu]1 or entity may n re/rict   
disclosure ( su* in=mation to !         
,dep>tm5t ( ,labor4  7,e7 ,additional   
privacy requirem5ts  7i7 ,9 g5]al ,cov]$
 s]vice provid]s %all ensure t in=mation
 provid$ "u subp>agraph 7,b7 conta9s    
only summ>y heal? in=mation1 z def9$ 9  
section #afd4ejd7;a7 ( title #de1 ,code 
( ,f$]al ,regulations 7or successor     
regulations74  7ii7 ,re/rictions ,a gr\p
 heal? plan %all comply ) section       
#afd4ejd7;f7 ( title #de1 ,code ( ,f$]al
 ,regulations 7or successor regulations7
 ) respect to any in=mation receiv$ by !
 plan or disclos$ to a plan sponsor or  
any o!r entity pursuant to ?is section1 
& a responsible plan adm9i/rator :o is a
 plan sponsor %all act 9 accordance ) ! 
t]ms ( ! agreem5t describ$ 9 su*        
section4  7,f7 ,rule ( con/ruction ,no?+

 9 ?is section %all be con/ru$ to modify
 ! requirem5ts = ! creation1 receipt1   
ma9t5ance1 or transmission ( protect$   
heal? in=mation "u ! privacy regulations
 promulgat$ "u ! ,heal? ,insurance      
,portability & ,acc\ntability ,act (    
#aiif 9 "p #afj & subp>ts ,a & ,e ( "p  
#afd ( title #de1 ,code ( ,f$]al        
,regulations 7or successor regulations74
  4  7e7 ,rule ( con/ruction ,no?+ 9 !  
am5dm5ts made by ?is section %all be    
con/ru$ to imply t a practice 9 relation
 to :i* a cov]$ s]vice provid] is       
requir$ to provide in=mation z a result 
( su* am5dm5ts is p]missible "u ,f$]al  
law4  7f7 ,effective date ,! am5dm5ts   
made by ?is subsection %all n apply to  
any contract or arrangem5t ent]$ into   
prior to ,janu>y #a1 #bjbf4 ,su*        
am5dm5ts %all apply to any contract or  
arrangem5t ent]$ into on or aft] to su* 
date1 includ+ any ext5sion or r5ewal ( a
 contract or arrangem5t1 reg>dless ( !  
date on :i* ! orig9al contract or       
agreem5t 7or any previ\s ext5sion or    

r5ewal7 0 ent]$ into4  #d4              
,implem5tation ,n lat] ?an #a ye> aft] !
 date ( enactm5t ( ?is ,act1 ! ,secret>y
 ( ,labor %all issue notice & comm5t    
rulemak+ z necess>y to implem5t !       
provisions ( ?is ,act4 ,! ,secret>y %all
 ensure t su* rulemak+-- 7#a7 acc\nts = 
! v>i$ comp5sation practices ( cov]$    
s]vice provid]s 7z def9$ "u section     
#djh7;b77#b77;,b72 &  7#b7 e/abli%es    
/&>ds = ! disclosure ( expect$          
comp5sation by su* cov]$ s]vice         
provid]s4