,i  #aaith ,,congress  #b;d ,session    
,h4 ,r4 #idhf  ,,in ,,the ,,house ,,of  
,,representatives  ,june #be1 #bjbf,mr4 
,takano introduced the following bill2  
which was referred to the ,committee on 
,education and ,workforce  ,a ,,bill    
,to amend the ,employee ,retirement     
,income ,security ,act of #aigd to      
increase transparency of group health   
plan data1 prevent discrimination1 and  
for other purposes4  #a4 ,short title   
,this ,act may be cited as the ,health  
,data ,access1 ,transparency1 and       
,affordability ,act of #bjbf or ,health 
,,data ,act of #bjbf4  #b4 ,increasing  
transparency of group health plan data  
7a7 ,group health plan audit rights     
7#a7 ,in general ,section #djh7;b77#b7  
of the ,employee ,retirement ,income    
,security ,act of #aigd 7#bi ,u4,s4,c4  
#aajh7;b77#b77 is amended by inserting  
after subparagraph 7,c7 the following3  
7,d7 ,no contract or arrangement for    
services1 and no extension or renewal of
 such a contract or arrangement1 between

 a group health plan 7as defined in     
section #gcc7;a77 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 entity providing      
pharmacy benefit management services1 is
 reasonable within the meaning of this  
paragraph unless such contract or       
arrangement-- 7i7 allows the group      
health plan to audit all de-identified  
claims and encounter information or data
 described in section #gbd7;a77#a77;,b71
 provided that such information or data 
has been deidentified in accordance with
 section #afd4ead of title #de1 ,code of
 ,federal ,regulations 7or successor    
regulations71 to--  7,i7 ensure that    
such entity complies with the terms of  
the plan1 the terms of the contract or  
arrangement for services1 and the       
requirements of this title2 and  7,,ii7 
determine the reasonableness of         

compensation received by such entity2   
and  7ii7 does not-- 7,i7 unreasonably  
limit the number of audits permitted    
during a given period of time2  7,,ii7  
limit the number of de-identified 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 entity providing      
pharmacy benefit management services2   
7,,iv7 limit the disclosure of          
overpayments and overpayment recovery   

terms2  7,v7 limit the right of the     
group health plan to select an auditor2 
7,,vi7 otherwise limit or unduly delay  
by greater than #fj calendar days after 
the date of request the group health    
plan from auditing any such             
de-identified claims and encounter      
information or data2 or  7,,vii7 permit 
the entity to charge a fee beyond the   
reasonable direct costs to provide the  
required information and otherwise      
comply and assist with an audit request4
  4  7#b7 ,privacy requirements  7,a7   
,in general ,section #djh7;b77#b7 of the
 ,employee ,retirement ,income ,security
 ,act of #aigd 7#bi ,u4,s4,c4           
#aajh7;b77#b771 as amended by paragraph 
7#a71 is further amended by adding at   
the end the following3  7,e7 ,privacy   
requirements  7i7 ,in general ,an entity
 shall--  7,i7 provide data or          
information under subparagraph 7,d7 in a
 manner consistent with-- 7aa7 the      
privacy regulations promulgated under   
section #acdjb7;a7 of the ,health       

,information ,technology for ,clinical  
,health ,act 7#db ,u4,s4,c4 #agicb7;a772
 and  7bb7 the privacy regulations      
promulgated under the ,health ,insurance
 ,portability and ,accountability ,act  
of #aiif in part #afj and subparts ,a   
and ,e of part #afd of title #de1 ,code 
of ,federal ,regulations 7or successor  
regulations72 and  7,,ii7 to the extent 
such data or information constitutes    
protected health information1 restrict  
the use and disclosure of such          
information for purposes of such privacy
 regulations4  7ii7 ,restriction ,a     
group health plan shall comply with     
section #afd4ejd7;f7 of title #de1 ,code
 of ,federal ,regulations 7or a         
successor regulation71 and a plan       
sponsor shall act in accordance with the
 terms of the agreement described in    
such section4  4  7b7 ,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 following3  7#ad7 ,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  
entity providing pharmacy benefit       
management services1 or other service   
provider that violates the provisions of
 section #gbd1 the ,secretary may assess
 a civil penalty against such provider1 
network or association of providers1    
service provider offering access to a   
network of providers1 third-party       
administrator1 entity providing pharmacy
 benefit management services1 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  4  7#b7      
,penalty collection ,paragraph 7#f7 of  
section #ejb7;a7 of such ,act1 is       
amended to read as follows3  7#f7 by the
 ,secretary to collect any civil penalty

 that the ,secretary has imposed or     
assessed pursuant to this title2  4  7c7
 ,improving collection of gag clause    
attestations  7#a7 ,in general ,section 
#ejf of such ,act 7#bi ,u4,s4,c4 #aacf7 
is amended by adding at the end the     
following3  7d7 ,attestations relating  
to group health plan data               
,notwithstanding subsection 7a7 of this 
section1 the ,secretary shall collect   
the attestations required to be         
submitted under section #gbd7;a77#c74   
,the ,secretary shall ensure that any   
service provider submitting such an     
attestation on behalf of a group health 
plan does not have any conflicts of     
interest with regard to such            
attestation4  4  7#b7 ,conforming       
amendment ,section #ejf7;a7 of such ,act
 7#bi ,u4,s4,c4 #aacf7;a77 is amended by
 striking ,in order and inserting       
,subject to subsection 7d71 in order4   
#c4 ,fiduciary duty with respect to plan
 data ,section #c7ba77;,a77iii7 of the  
,employee ,retirement ,income ,security 

,act 7#bi ,u4,s4,c4 #ajjb7ba77;,a77iii77
 is amended by striking such plan4 and  
inserting the following3 such plan1     
including any authority over the use1   
management1 disposition1 or safeguarding
 of data generated1 used1 or maintained 
by the plan or a service provider to the
 plan in connection with the            
administration of benefits or management
 of plan assets44  #d4 ,preventing      
discrimination based on plan data  7a7  
,in general ,part #e of subtitle ,b of  
title ,i of the ,employee ,retirement   
,income ,security ,act of #aigd 7#bi    
,u4,s4,c4 #aaca et seq47 is amended by  
adding at the end the following3  #ebd4 
,preventing discrimination based on plan
 data  7a7 ,in general ,it shall be     
unlawful for a person specified in      
subsection 7c7 to discharge1 fine1      
suspend1 expel1 discipline1 or          
discriminate against1 including by      
failing to meet the requirements of     
subsection 7a7 or 7b7 of section #gjb   
7related to discrimination in           

eligibility and premiums for            
participation in group health plans71 a 
participant or beneficiary on the basis 
of information or data described in     
section #gbd4  7b7 ,enforcement  7#a7   
,in general ,the provisions of section  
#ejb shall be applicable in the         
enforcement of this section1 except that
 in any action brought under subsection 
7a77#a77;,b7 of such section in relation
 to data or information described in    
section #gbd1 a participant or          
beneficiary may not be required to      
exhaust administrative remedies prior to
 bringing such action4  7#b7 ,equitable 
relief ,in applying section #ejb for the
 purposes of this section1 the term     
equitable relief shall include any      
relief necessary to restore a           
participant or beneficiary to the       
position they would have occupied but   
for a violation of subsection 7a74  7#c7
 ,civil monetary penalty  7,a7 ,in      
general ,in the case of a violation of  
subsection 7a7 by a person1 the         

,secretary may assess a civil monetary  
penalty against such person4  7,b7      
,amount ,the amount of the civil        
monetary penalty imposed by subparagraph
 7,a7 shall be #ajj for each day in the 
noncompliance period with respect to    
each participant or beneficiary to whom 
such violation of subsection 7a7        
relates4  7,c7 ,noncompliance period    
,for the purposes of this subparagraph1 
the term noncompliance period means1    
with respect to any violation of        
subsection 7a71 the period--  7i7       
beginning on the date such violation    
occurs2 and  7ii7 ending on the date    
such violation is corrected4  7c7       
,specified person ,a person specified in
 this subsection is any of the          
following3 7#a7 ,an employer4  7#b7 ,a  
plan sponsor4  7#c7 ,a plan             
administrator4  7#d7 ,a plan fiduciary4 
4  7b7 ,rule of construction ,nothing in
 this ,act1 or the amendments made by   
this ,act1 shall be construed to limit  
the application of any ,federal or      

,state privacy or civil rights law1     
including the ,,hipaa privacy           
regulations1 the ,genetic ,information  
,nondiscrimination ,act of #bjjh        
7,public ,law #aaj-bcc7 7including the  
amendments made by such ,act71 the      
,americans with ,disabilities ,act of   
#aiij 7#db ,u4,s4,c4 #abaja et seq471   
section #ejd of the ,rehabilitation ,act
 of #aigc 7#bi ,u4,s4,c4 #gid71 section 
#aeeg of the ,patient ,protection and   
,affordable ,care ,act 7#db ,u4,s4,c4   
#ahaaf71 title ,,vi of the ,civil       
,rights ,act of #aifd 7#db ,u4,s4,c4    
#bjjj;d71 and title ,,vii of the ,civil 
,rights ,act of #aifd 7#db ,u4,s4,c4    
#bjjj;e74  7c7 ,clerical amendment ,the 
table of contents in section #a of the  
,employee ,retirement ,income ,security 
,act of #aigd 7#bi ,u4,s4,c4 #ajja et   
seq47 is amended by inserting after the 
item relating to section #ebc the       
following3  ,sec4 #ebd4 ,preventing     
discrimination based on plan data4  4