,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ibbh  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,june #i1 #bjbf,mr4   
,ond] introduc$ ! foll[+ bill2 :i* 0    
ref]r$ to ! ,committee on ,education &  
,work=ce  ,a ,,bill  ,to am5d !         
,employee ,retirem5t ,income ,security  
,act ( #aigd to ensure plan fiduci>ies h
 access to 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 ( #bjbf4  #b4         
,increas+ gr\p heal? plan access to     
heal? data  7a7 ,gr\p heal? plan access 
to in=mation  7#a7 ,def9ition ,section  
#c ( ! ,employee ,retirem5t ,income     
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#ajjb7 is am5d$ by add+ at ! end !      
foll[+3  7#df7 ,network s]vice provid]  
7,a7 ,9 g5]al ,! t]m network s]vice     
provid] means-- 7i7 any p]son or entity 
t has an arrangem5t or contract1 direct 
or indirect1 to provide s]vices to a    
gr\p heal? plan 7z def9$ 9 section      

#gcc7;a771 includ+ a heal? c>e provid]1 
heal? c>e facility1 network or          
association ( provid]s1 s]vice provid]  
(f]+ access to a network ( provid]s1    
?ird p>ty adm9i/rator1 heal? insurance  
issu] 7z def9$ 9 section #gcc7;b771     
entity provid+ ph>macy b5efit managem5t 
s]vices1 or any o!r s]vice provid]2 &   
7ii7 any p]son or entity act+ z an      
int]m$i>y betwe5 ! gr\p heal? plan & a  
p]son or entity describ$ 9 subp>agraph  
7,a74  7,b7 ,heal? c>e provid] ,not)/&+ 
subp>agraph 7,a71 no heal? c>e provid]  
%all be consid]$ a network s]vice       
provid] solely 9 its capacity z a       
provid] ( heal? c>e s]vices4  4  7#b7 ,9
 g5]al ,section #djh7;b77#b7 ( su* ,act 
7#bi ,u4,s4,c4 #aajh7;b77#b77 is am5d$  
by add+ at ! end ! foll[+3  7,d7 ,no    
contract or arrangem5t = s]vices1 :e!r  
direct or indirect1 & no ext5sion or    
r5ewal ( su* contract or arrangem5t1    
betwe5 a gr\p heal? plan 7z def9$ 9     
section #gcc7;a77 & any o!r p]son or    
entity1 includ+ a network s]vice        

provid]1 is reasonable )9 ! mean+ ( ?is 
p>agraph unless su* contract or         
arrangem5t--  7i7 all[s ! responsible   
plan fiduci>y 7z t t]m is def9$ 9       
subp>agraph 7,b77ii77,i77 & ! designat$ 
ag5t 7:i* may include ! plan sponsor1 ! 
plan adm9i/rator1 or a bus9ess associate
 7o!r ?an su* o!r p>ty or entity 7or its
 subsidi>ies or affiliates777 ( su*     
fiduci>y access to all claims & enc\nt] 
in=mation describ$ 9 section            
#gbd7;a77#a77;,b71 & any docum5tation1  
includ+ m$ical records & policy         
docum5ts1 support+ claim paym5ts2 &     
7ii7 does n-- 7,i7 limit or delay access
 by ! responsible plan fiduci>y or      
designat$ ag5t to claims & enc\nt]      
in=mation or data = long] ?an #ae days  
or a p]iod det]m9$ appropriate by !     
,secret>y1 :i*ev] is %ort]2  7,,ii7     
limit ! am\nt ( claims & enc\nt]        
in=mation or data t ! responsible plan  
fiduci>y or designat$ ag5t may access   
pursuant to any reque/ = su* in=mation  
or data2  7,,iii7 limit access by !     

responsible plan fiduci>y or designat$  
ag5t to pric+ t]ms = alt]native paym5t  
arrangem5ts or capitat$ paym5t          
arrangem5ts1 includ+--  7aa7 paym5t     
calculations & =mulas2  7bb7 quality    
measurem5ts or indicators2  7cc7        
contract t]ms2  7dd7 paym5t am\nts2     
7ee7 measurem5t p]iods = all inc5tives2 
&  7ff7 o!r paym5t me?odologies2  7,,iv7
 limit access by ! responsible plan     
fiduci>y or designat$ ag5t to in=mation 
reg>d+ ov]paym5ts1 includ+ t]ms =       
recov]y ( ov]paym5ts2  7,v7 limit !     
ability ( ! gr\p heal? plan1 ! plan     
sponsor1 or ! plan adm9i/rator ( su*    
plan to select an auditor & def9e !     
scope & frequ5cy ( audits2  7,,vi7      
o!rwise limit or delay ! responsible    
plan fiduci>y or designat$ ag5t f       
access+ su* claims & enc\nt] in=mation  
or data 9 a daily bat* or on a daily    
basis2  7,,vii7 limit ! disclosure to ! 
responsible plan fiduci>y or designat$  
ag5t ( fees *>g$ to ! gr\p heal? plan   
relat$ to plan adm9i/ration & claims    

process+1 includ+ r5egotiation fees1    
access fees1 repric+ fees1 or enhanc$   
review fees2  7,,viii7 limit ! ability (
 ! responsible plan fiduci>y or         
designat$ ag5t to reque/ action on any  
claims or claim paym5ts t su* fiduci>y  
or ag5t id5tifies z pot5tially errone\s 
or fraudul5t2  7,,ix7 limit public      
disclosure ( de-id5tifi$ or aggregat$   
in=mation2 or  7,x7 limit access by !   
responsible plan fiduci>y or designat$  
ag5t to any extra-contractual t]ms      
conta9+ claims paym5t calculations &    
=mulas1 pric+ me?odologies1 & o!r       
in=mation us$ to det]m9e ! doll> value (
 provid] reimbursem5t4  7,e7 7i7 ,a     
p]son or entity %all provide in=mation  
or data "u ?is p>agraph 9 a mann]       
consi/5t ) ! privacy & security         
regulations promulgat$ "u ! ,heal?      
,insurance ,portability & ,acc\ntability
 ,act 7ref]r$ to 9 ?is p>agraph z       
,,hipaa74  7ii7 ,a gr\p heal? plan t    
receives a disclosure pursuant to       
subp>agraph 7,b7 or 7,c7 %all comply ) !

 privacy & security regulations         
promulgat$ "u ,,hipaa4  7iii7 ,no?+ 9   
?is subp>agraph %all be con/ru$ to      
modify ! requirem5ts = ! creation1      
receipt1 ma9t5ance1 or transmission (   
protect$ heal? in=mation "u ! ,,hipaa   
privacy regulation 7z def9$ 9 section   
#aahj7;b77#c7 ( ! ,social ,security     
,act7 z !y apply directly or indirectly 
to a p]son or an entity pursuant to ?is 
p>agraph4  7iv7 ,?is subp>agraph %all n 
be read to abridge or limit ! disclosure
 requirem5ts "u ?is p>agraph or to      
impose additional privacy or security   
requirem5ts on network s]vice provid]s  
or plan sponsors4  7,f7 ,a gr\p heal?   
plan receiv+ in=mation or data "u ?is   
p>agraph may disclose su* in=mation only
 9 a mann] t is consi/5t ) ,,hipaa & !  
privacy & security regulations          
promulgat$ !reund]1 reg>dless ( _!      
direct or indirect applicability to !   
plan or any p]sons or entities t c\ld be
 or are bus9ess associates4  7,g7       
,in=mation made available "u ?is        

subp>agraph %all con=m to ! foll[+      
/&>ds3 7i7 ,all claims f a heal?c>e     
provid] %all be provid$ to ! gr\p heal? 
plan 9 accordance ) transaction /&>ds   
adopt$ by regulation "u ,,hipaa1 z      
foll[s3  7,i7 ,in/itutional1            
pr(essional1 & d5tal claims %all be 9   
,,asc ,x#ab,n #hcg =mat or any subsequ5t
 /&>d approv$ by ! ,secret>y4  7,,ii7   
,ph>macy claims %all be 9 ! ,national   
,c\ncil = ,prescription ,drug ,programs 
=mat or any subsequ5t /&>d approv$ by ! 
,secret>y4  7,,iii7 ,! files %all conta9
 unmodifi$ data tak5 directly f ! files 
s5t f ! provid]4 ,9 ! ev5t t pap] claims
 are s5t by ! provid]1 !y %all be       
conv]t$ to ! appropriate /&>d electronic
 =mat4 ,! files %all be accessible to ! 
plan at no co/ to ! gr\p heal? plan4    
7ii7 ,all claim paym5t 7or electronic   
funds transf] 7,,eft77 & electronic     
remittance advice 7,,era7 notices s5t by
 a network s]vice provid] %all be made  
available to ! gr\p heal? plan z ,,asc  
,x#ab,n #hce files1 or any subsequ5t    

/&>d approv$ by ! ,secret>y1 9          
accordance ) /&>ds adopt$ by regulation 
"u ,,hipaa4 ,! files %all be unmodifi$  
copies ( ! files s5t by ! network s]vice
 provid] to ! heal?c>e provid]4 ,files  
%all be accessible at no co/ to ! gr\p  
heal? plan4  7iii7 ,all non-claim co/s  
%all be itemiz$ & made available to !   
gr\p heal? plan 9 real "t ?r\gh a       
web-bas$ portal1 ?r\gh an ,application  
,programm+ ,int]face & ?r\gh a          
d[nloadable ,comma ,sep>at$ ,value file1
 or any subsequ5t /&>ds approv$ by !    
,secret>y4  7,h7 ,! ,secret>y %all h    
au?ority to implem5t subp>agraphs 7,c7  
?r\gh 7,f7 ?r\gh notice & comm5t        
rulemak+ 9 accordance ) section #eec (  
title #e1 ,unit$ ,/ates ,code4  4  7#c7 
,civil en=cem5t ,section #ejb7;c7 ( su* 
,act 7#bi ,u4,s4,c4 #aacb7;c77 is am5d$ 
by add+ at ! end ! foll[+3  7#ad7 ,9 !  
case ( an agreem5t betwe5 a gr\p heal?  
plan 7z def9$ 9 section #gcc7;a771 or ! 
responsible plan fiduci>y1 ! plan       
sponsor1 or ! plan adm9i/rator ( su*    

plan1 & any o!r p]son or entity1 includ+
 a network s]vice provid] t violates    
section #gbd1 ! ,secret>y ( ,labor may  
assess a civil p5alty aga9/ su* o!r     
p]son or entity 9 ! am\nt ( up to       
#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#d7 ,exi/+       
provisions void ,section #daj ( su* ,act
 7#bi ,u4,s4,c4 #aaaj7 is am5d$ by add+ 
at ! end ! foll[+3  7c7 ,any provision 9
 an agreem5t or in/rum5t %all be void z 
aga9/ public policy if su* provision--  
7#a7 delays or limits a gr\p heal? plan 
7z def9$ 9 section #gcc7;a771 or !      
responsible plan fiduci>y1 ! plan       
sponsor1 or ! plan adm9i/rator ( su*    
plan1 f access+ ! claims & enc\nt]      
in=mation or data describ$ 9 section    
#gbd7;a77#a77;,b72 or  7#b7 violates !  
requirem5ts ( section #djh7;b77#b74  4  
7#e7 ,prohibition on indemnification (  
s]vice provid]s = civil p5alties        
,section #daj7;a7 ( su* ,act 7#bi       

,u4,s4,c4 #aaaj7;a77 is am5d$-- 7,a7 by 
/rik+ ,except & ins]t+ 7#a7 ,except2 &  
7,b7 by add+ at ! end ! foll[+3  7#b7   
,except z provid$ 9 subsection          
#daj7;b77#b71 no p]son or entity subject
 to a civil en=cem5t p5alty "u section  
#ejb7;a77#ac71 #ejb7;a77#ad71           
#ejb7;a77#ae7 or section #gbg7;d7 may be
 indemnifi$1 directly or indirectly1 or 
o!rwise reliev$ f liability = any       
p5alty1 responsibility1 obligation1 or  
duty ( su* p]son or entity "u ?is title4
  7#c7 ,any provision ( a contract or   
agreem5t 9 violation ( p>agraph 7#b7    
%all be void z aga9/ public policy4  4  
7b7 ,updat$ atte/ation = price & quality
 in=mation ,section #gbd7;a77#c7 ( su*  
,act 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 a gr\p heal? plan or  
heal? insurance 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 ! gr\p heal? plan1 ! plan    
sponsor1 ! plan adm9i/rator1 or !       
bus9ess associate 7o!r ?an ! contract+  
p>ty or entity or its subsidi>ies or    
affiliates7 ( su* plan1 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 gr\p heal? plan1 ! plan        
sponsor1 ! plan adm9i/rator1 a bus9ess  
associate 7o!r ?an ! contract+ p>ty or  
entity or its subsidi>ies or affiliates7
 ( su* plan1 or ! issu] f audit+1       
review+1 or o!rwise access+ su*         
in=mation4  7,b7 ,limitation on         
submission ,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* plan1 ! plan     
sponsor1 or ! plan adm9i/rator 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 ! gr\p heal? plan1 ! plan sponsor1  
or ! plan adm9i/rator 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,a71 includ+ ! "n ( !      
?ird-p>ty adm9i/rator or o!r s]vice     
provid]4  4  7c7 ,effective date ,!     

am5dm5ts made by subsections 7a7 & 7b7  
%all apply ) respect to a plan beg9n+ ) 
! fir/ plan ye> t beg9s on or aft] !    
date t is #a ye> aft] ! date ( enactm5t 
( ?is ,act reg>dless ( ! date (         
execution ( any contact ) a network     
s]vice provid]4