,,ii #aaith ,,congress #b;d ,session ,s4 #djbg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #i1 #bjbf,mr4 ,husted introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to ban anticompetitive terms in facility and insurance contracts that limit access to higher quality1 lower cost care4 #a4 ,short title ,this ,act may be cited as the ,healthy ,competition for ,better ,care ,act4 #b4 ,banning anticompetitive terms in facility and insurance contracts that limit access to higher quality1 lower cost care 7a7 ,in general 7#a7 ,,phsa 7,a7 ,in general ,section #bgii;,a-#i of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aai7 is amended-- 7i7 in the heading1 by striking by removing and all that follows through information and inserting 2 prohibition on anticompetitive agreements2 7ii7 in subsection 7a77#e71 in the first sentence1 by striking section and inserting subsection2 and 7iii7 by adding at the end the following3 7b7 ,protecting health plans network design flexibility 7#a7 ,in general ,a group health plan or a health insurance issuer offering group or individual health insurance coverage may not enter into an agreement with a covered entity if such agreement1 directly or indirectly-- 7,a7 restricts 7including by operation of any agreement in effect between such covered entity and another covered entity7 the group health plan or health insurance issuer from-- 7i7 directing or steering participants or beneficiaries to other health care providers who are not subject to such agreement2 or 7ii7 offering incentives to encourage participants or beneficiaries to utilize specific health care providers2 7,b7 requires the group health plan or health insurance issuer to enter into any additional agreement with an affiliate of the covered entity2 7,c7 requires the group health plan or health insurance issuer to agree to payment rates or other terms for any affiliate of the covered entity not party to the agreement2 or 7,d7 restricts other group health plans or health insurance issuers not party to the agreement from paying a lower rate for items or services than the plan or issuer involved in the agreement pays for such items or services4 7#b7 ,exceptions for certain provider group and value-based network designs ,paragraph 7#a77;,a7 shall not apply to a group health plan or health insurance issuer offering group or individual health insurance coverage with respect to-- 7,a7 a health maintenance organization1 if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups1 nor to any arrangement between such a health maintenance organization and its affiliates2 or 7,b7 a value-based network arrangement1 such as an exclusive provider network1 accountable care organization1 center of excellence1 a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems1 or such other similar network arrangements as determined by the ,secretary through guidance or rulemaking4 7#c7 ,covered entity defined ,for purposes of this subsection1 the term covered entity means a health care provider1 network or association of providers1 third-party administrator1 or other service provider offering access to a network of providers4 7#d7 ,state grandfathering option ,an applicable ,state authority may make a determination that the prohibitions under paragraph 7#a77;,a7 7relating to conditions that would direct or steer enrollees to1 or offer incentives to encourage enrollees to use1 other health care providers7 will not apply in the ,state with respect to any specified agreement executed on ,june #ai1 #bjai1 and any agreements related to such specified agreement executed on or before ,december #ca1 #bjbj1 for a maximum length of nonapplicability of up to #aj years from the date of execution of the contract if the applicable ,state authority determines that the contract is unlikely to significantly lessen competition4 ,with respect to a specified agreement for which an applicable ,state authority has made a determination under the preceding sentence1 an applicable ,state authority may determine whether renewal of the contract1 within the applicable #aj-year period1 is allowed4 7#e7 ,rule of construction ,except as provided in paragraph 7#a71 nothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan or health insurance issuer1 including accountable care organizations1 exclusive provider organizations1 networks that tier providers by cost or quality or steer enrollees to centers of excellence1 or other pay-for-performance programs4 4 7,b7 ,regulations ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in consultation with the ,secretary of ,labor and the ,secretary of the ,treasury1 shall promulgate regulations to carry out the amendments made by this paragraph4 7#b7 ,employee ,retirement ,income ,security ,act of #aigd 7,a7 ,in general ,section #gbd of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahem7 is amended-- 7i7 in the heading1 by striking by removing and all that follows through information and inserting 2 prohibition on anticompetitive agreements2 7ii7 in subsection 7a77#d71 in the first sentence1 by striking section and inserting subsection2 and 7iii7 by adding at the end the following3 7b7 ,protecting health plans network design flexibility 7#a7 ,in general ,a group health plan or a health insurance issuer offering group health insurance coverage may not enter into an agreement with a covered entity if such agreement1 directly or indirectly-- 7,a7 restricts 7including by operation of any agreement in effect between such covered entity and another covered entity7 the group health plan or health insurance issuer from-- 7i7 directing or steering participants or beneficiaries to other health care providers who are not subject to such agreement2 or 7ii7 offering incentives to encourage participants or beneficiaries to utilize specific health care providers2 7,b7 requires the group health plan or health insurance issuer to enter into any additional agreement with an affiliate of the covered entity2 7,c7 requires the group health plan or health insurance issuer to agree to payment rates or other terms for any affiliate of the covered entity not party to the agreement2 or 7,d7 restricts other group health plans or health insurance issuers not party to the agreement from paying a lower rate for items or services than the plan or issuer involved in the agreement pays for such items or services4 7#b7 ,exceptions for certain provider group and value-based network designs ,paragraph 7#a77;,a7 shall not apply to a group health plan or health insurance issuer offering group health insurance coverage with respect to-- 7,a7 a health maintenance organization1 if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups1 nor to any arrangement between such a health maintenance organization and its affiliates2 or 7,b7 a value-based network arrangement1 such as an exclusive provider network1 accountable care organization1 center of excellence1 a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems1 or such other similar network arrangements as determined by the ,secretary through guidance or rulemaking4 7#c7 ,covered entity defined ,for purposes of this subsection1 the term covered entity means a health care provider1 network or association of providers1 third-party administrator1 or other service provider offering access to a network of providers4 7#d7 ,state grandfathering option ,an applicable ,state authority may make a determination that the prohibitions under paragraph 7#a77;,a7 7relating to conditions that would direct or steer enrollees to1 or offer incentives to encourage enrollees to use1 other health care providers7 will not apply in the ,state with respect to any specified agreement executed on ,june #ai1 #bjai1 and any agreements related to such specified agreement executed on or before ,december #ca1 #bjbj1 for a maximum length of nonapplicability of up to #aj years from the date of execution of the contract if the applicable ,state authority determines that the contract is unlikely to significantly lessen competition4 ,with respect to a specified agreement for which an applicable ,state authority has made a determination under the preceding sentence1 an applicable ,state authority may determine whether renewal of the contract1 within the applicable #aj-year period1 is allowed4 7#e7 ,rule of construction ,except as provided in paragraph 7#a71 nothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan or health insurance issuer1 including accountable care organizations1 exclusive provider organizations1 networks that tier providers by cost or quality or steer enrollees to centers of excellence1 or other pay-for-performance programs4 4 7,b7 ,clerical amendment ,the table of contents in section #a of such ,act is amended1 in the entry relating to section #gbd1 by amending such entry to read as follows3 ,sec4 #gbd4 ,increasing transparency2 prohibition on anticompetitive agreements4 4 7,c7 ,regulations ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,labor1 in consultation with the ,secretary of ,health and ,human ,services and the ,secretary of the ,treasury1 shall promulgate regulations to carry out the amendments made by this paragraph4 7#c7 ,,irc 7,a7 ,in general ,section #ihbd of the ,internal ,revenue ,code of #aihf is amended-- 7i7 in the header1 by striking by removing and all that follows through information and inserting 2 prohibition on anticompetitive agreements2 7ii7 in subsection 7a77#d71 in the first sentence1 by striking section and inserting subsection2 and 7iii7 by adding at the end the following3 7b7 ,protecting health plans network design flexibility 7#a7 ,in general ,a group health plan may not enter into an agreement with a covered entity if such agreement1 directly or indirectly-- 7,a7 restricts 7including by operation of any agreement in effect between such covered entity and another covered entity7 the group health plan from-- 7i7 directing or steering participants or beneficiaries to other health care providers who are not subject to such agreement2 or 7ii7 offering incentives to encourage participants or beneficiaries to utilize specific health care providers2 7,b7 requires the group health plan to enter into any additional agreement with an affiliate of the covered entity2 7,c7 requires the group health plan to agree to payment rates or other terms for any affiliate of the covered entity not party to the agreement2 or 7,d7 restricts other group health plans not party to the agreement from paying a lower rate for items or services than the plan involved in the agreement pays for such items or services4 7#b7 ,exceptions for certain provider group and value-based network designs ,paragraph 7#a77;,a7 shall not apply to a group health plan with respect to-- 7,a7 a health maintenance organization1 if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups1 nor to any arrangement between such a health maintenance organization and its affiliates2 or 7,b7 a value-based network arrangement1 such as an exclusive provider network1 accountable care organization1 center of excellence1 a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems1 or such other similar network arrangements as determined by the ,secretary through guidance or rulemaking4 7#c7 ,covered entity defined ,for purposes of this subsection1 the term covered entity means a health care provider1 network or association of providers1 third-party administrator1 or other service provider offering access to a network of providers4 7#d7 ,state grandfathering option ,an applicable ,state authority may make a determination that the prohibitions under paragraph 7#a77;,a7 7relating to conditions that would direct or steer enrollees to1 or offer incentives to encourage enrollees to use1 other health care providers7 will not apply in the ,state with respect to any specified agreement executed on ,june #ai1 #bjai1 and any agreements related to such specified agreement executed on or before ,december #ca1 #bjbj1 for a maximum length of nonapplicability of up to #aj years from the date of execution of the contract if the applicable ,state authority determines that the contract is unlikely to significantly lessen competition4 ,with respect to a specified agreement for which an applicable ,state authority has made a determination under the preceding sentence1 an applicable ,state authority may determine whether renewal of the contract1 within the applicable #aj-year period1 is allowed4 7#e7 ,rule of construction ,except as provided in paragraph 7#a71 nothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan1 including accountable care organizations1 exclusive provider organizations1 networks that tier providers by cost or quality or steer enrollees to centers of excellence1 or other pay-for-performance programs4 4 7,b7 ,clerical amendment ,the table of contents in section #a of such ,act is amended1 in the entry relating to section #ihbd1 by amending such entry to read as follows3 ,sec4 #ihbd4 ,increasing transparency2 prohibition on anticompetitive agreements4 4 7,c7 ,regulations ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of the ,treasury1 in consultation with the ,secretary of ,health and ,human ,services and the ,secretary of ,labor1 shall promulgate regulations to carry out the amendments made by this paragraph4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply with respect to any contract entered into1 amended1 or renewed on or after the date that is #ah months after the date of enactment of this ,act4