,,ib ,union ,calendar ,no4 #gbd #aaith ,,congress #b;d ,session ,h4 ,r4 #ibbh ,report ,no4 #aai-hbf ,,in ,,the ,,house ,,of ,,representatives ,june #i1 #bjbf,mr4 ,onder introduced the following bill2 which was referred to the ,committee on ,education and ,workforce ,september #ae1 #bjbf;,additional sponsors3 ,mrs4 ,spartz and ,mrs4 ,harshbarger ,september #ae1 #bjbf,reported with an amendment1 committed to the ,committee of the ,whole ,house on the ,state of the ,union1 and ordered to be printed,strike out all after the enacting clause and insert the part printed in italic,for text of introduced bill1 see copy of bill as introduced on ,june #i1 #bjbf ,a ,,bill ,to amend the ,employee ,retirement ,income ,security ,act of #aigd to ensure plan fiduciaries have access to de-identified information relating to health claims1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,health ,data ,access1 ,transparency1 and ,affordability ,act of #bjbf or the ,health ,,data ,act of #bjbf4 #b4 ,increasing group health plan access to health data 7a7 ,group health plan access to information 7#a7 ,definition ,section #c of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajjb7 is amended by adding at the end the following3 7#df7 ,network service provider 7,a7 ,in general ,the term network service provider means-- 7i7 any person or entity that has an arrangement or contract1 direct or indirect1 to provide services to a group health plan 7as defined in section #gcc7;a771 including a health care provider1 health care facility1 network or association of providers1 service provider offering access to a network of providers1 third party administrator1 health insurance issuer 7as defined in section #gcc7;b771 entity providing pharmacy benefit management services1 or any other service provider2 and 7ii7 any person or entity acting as an intermediary between the group health plan and a person or entity described in subparagraph 7,a74 7,b7 ,health care provider ,notwithstanding subparagraph 7,a71 no health care provider shall be considered a network service provider solely in its capacity as a provider of health care services4 4 7#b7 ,in general ,section #djh7;b77#b7 of such ,act 7#bi ,u4,s4,c4 #aajh7;b77#b77 is amended by adding at the end the following3 7,d7 ,no contract or arrangement for services1 whether direct or indirect1 and no extension or renewal of such contract or arrangement1 between a group health plan 7as defined in section #gcc7;a77 and any other person or entity1 including a network service provider1 is reasonable within the meaning of this paragraph unless such contract or arrangement-- 7i7 allows the responsible plan fiduciary 7as that term is defined in subparagraph 7,b77ii77,i77 and the designated agent 7which may include the plan sponsor1 the plan administrator1 or a business associate 7other than such other party or entity 7or its subsidiaries or affiliates77 of such fiduciary access to all claims and encounter information described in section #gbd7;a77#a77;,b71 and any documentation1 including medical records and policy documents1 supporting claim payments2 and 7ii7 does not-- 7,i7 limit or delay access by the responsible plan fiduciary or designated agent to claims and encounter information or data for longer than #ae days or a period determined appropriate by the ,secretary1 whichever is shorter2 7,,ii7 limit the amount of claims and encounter information or data that the responsible plan fiduciary or designated agent may access pursuant to any request for such information or data2 7,,iii7 limit access by the responsible plan fiduciary or designated agent to pricing terms for alternative payment arrangements or capitated payment arrangements1 including-- 7aa7 payment calculations and formulas2 7bb7 quality measurements or indicators2 7cc7 contract terms2 7dd7 payment amounts2 7ee7 measurement periods for all incentives2 and 7ff7 other payment methodologies2 7,,iv7 limit access by the responsible plan fiduciary or designated agent to information regarding overpayments1 including terms for recovery of overpayments2 7,v7 limit the ability of the group health plan1 the plan sponsor1 or the plan administrator of such plan to select an auditor and define the scope and frequency of audits2 7,,vi7 otherwise limit or delay the responsible plan fiduciary or designated agent from accessing such claims and encounter information or data in a daily batch or on a daily basis2 7,,vii7 limit the disclosure to the responsible plan fiduciary or designated agent 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 ability of the responsible plan fiduciary or designated agent to request action on any claims or claim payments that such fiduciary or agent identifies as potentially erroneous or fraudulent2 7,,ix7 limit public disclosure of de-identified or aggregated information2 or 7,x7 limit access by the responsible plan fiduciary or designated agent to any extra-contractual terms containing claims payment calculations and formulas1 pricing methodologies1 and other information used to determine the dollar value of provider reimbursement4 7,e7 7i7 ,a person or entity shall provide information or data under this paragraph in a manner consistent with the privacy and security regulations promulgated under the ,health ,insurance ,portability and ,accountability ,act 7referred to in this paragraph as ,,hipaa74 7ii7 ,a group health plan that receives a disclosure pursuant to subparagraph 7,b7 or 7,c7 shall comply with the privacy and security regulations promulgated under ,,hipaa4 7iii7 ,nothing in this subparagraph shall be construed to modify the requirements for the creation1 receipt1 maintenance1 or transmission of protected health information under the ,,hipaa privacy regulation 7as defined in section #aahj7;b77#c7 of the ,social ,security ,act7 as they apply directly or indirectly to a person or an entity pursuant to this paragraph4 7iv7 ,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 network service providers or plan sponsors4 7,f7 ,a group health plan receiving information or data under this paragraph may disclose such information only in a manner that is consistent with ,,hipaa and the privacy and security regulations promulgated thereunder1 regardless of their direct or indirect applicability to the plan or any persons or entities that could be or are business associates4 7,g7 ,information made available under this subparagraph shall conform to the following standards3 7i7 ,all claims from a healthcare provider shall be provided to the group health plan in accordance with transaction standards adopted by regulation under ,,hipaa1 as follows3 7,i7 ,institutional1 professional1 and dental claims shall be in ,,asc ,x#ab,n #hcg format or any subsequent standard approved by the ,secretary4 7,,ii7 ,pharmacy claims shall be in the ,national ,council for ,prescription ,drug ,programs format or any subsequent standard approved by the ,secretary4 7,,iii7 ,the files shall contain unmodified data taken directly from the files sent from the provider4 ,in the event that paper claims are sent by the provider1 they shall be converted to the appropriate standard electronic format4 ,the files shall be accessible to the plan at no cost to the group health plan4 7ii7 ,all claim payment 7or electronic funds transfer 7,,eft77 and electronic remittance advice 7,,era7 notices sent by a network service provider shall be made available to the group health plan as ,,asc ,x#ab,n #hce files1 or any subsequent standard approved by the ,secretary1 in accordance with standards adopted by regulation under ,,hipaa4 ,the files shall be unmodified copies of the files sent by the network service provider to the healthcare provider4 ,files shall be accessible at no cost to the group health plan4 7iii7 ,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 ,application ,programming ,interface and through a downloadable ,comma ,separated ,value file1 or any subsequent standards approved by the ,secretary4 7,h7 ,the ,secretary shall have authority to implement subparagraphs 7,c7 through 7,f7 through notice and comment rulemaking in accordance with section #eec of title #e1 ,united ,states ,code4 4 7#c7 ,civil enforcement ,section #ejb7;c7 of such ,act 7#bi ,u4,s4,c4 #aacb7;c77 is amended by adding at the end the following3 7#ad7 ,in the case of an agreement between a group health plan 7as defined in section #gcc7;a771 or the responsible plan fiduciary1 the plan sponsor1 or the plan administrator of such plan1 and any other person or entity1 including a network service provider that violates section #gbd1 the ,secretary of ,labor may assess a civil penalty against such other person or entity in the amount of up to #aj1jjj for each day during which such violation continues4 ,such penalty shall be in addition to other penalties as may be prescribed by law4 4 7#d7 ,existing provisions void ,section #daj of such ,act 7#bi ,u4,s4,c4 #aaaj7 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 delays or limits a group health plan 7as defined in section #gcc7;a771 or the responsible plan fiduciary1 the plan sponsor1 or the plan administrator of such plan1 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#b74 4 7#e7 ,prohibition on indemnification of service providers for civil penalties ,section #daj7;a7 of such ,act 7#bi ,u4,s4,c4 #aaaj7;a77 is amended-- 7,a7 by striking ,except and inserting 7#a7 ,except2 and 7,b7 by adding at the end the following3 7#b7 ,except as provided in subsection #daj7;b77#b71 no person or entity subject to a civil enforcement penalty under section #ejb7;c77#ac7 or #ejb7;c77#ad7 may be indemnified1 directly or indirectly1 or otherwise relieved from liability for any penalty1 responsibility1 obligation1 or duty of such person or entity under this title4 7#c7 ,any provision of a contract or agreement in violation of paragraph 7#b7 shall be void as against public policy4 4 7b7 ,updated attestation for price and quality information ,section #gbd7;a77#c7 of such ,act 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 a 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 sponsor1 the plan administrator1 or the business associate 7other than the contracting party or entity or its subsidiaries or affiliates7 of such plan1 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 sponsor1 the plan administrator1 a business associate 7other than the contracting party or entity or its subsidiaries or affiliates7 of such plan1 or the issuer from auditing1 reviewing1 or otherwise accessing such information4 7,b7 ,limitation on submission ,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 plan1 the plan sponsor1 or the plan administrator 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 plan1 the plan sponsor1 or the plan administrator 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,a71 including the name of the third-party administrator or other service provider4 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 ,act regardless of the date of execution of any contact with a network service provider4 ,september #ae1 #bjbf,reported with an amendment1 committed to the ,committee of the ,whole ,house on the ,state of the ,union1 and ordered to be printed