,,ii  #aai? ,,congress  #b;d ,session   
,s4 #djbg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,m>* #i1 #bjbf,mr4     
,hu/$ introduc$ ! foll[+ bill2 :i* 0    
read twice & ref]r$ to ! ,committee on  
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to ban anticompetitive t]ms 
9 facility & insurance contracts t limit
 access to high] quality1 l[] co/ c>e4  
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,heal?y ,competition = ,bett] ,c>e    
,act4  #b4 ,bann+ anticompetitive t]ms 9
 facility & insurance contracts t limit 
access to high] quality1 l[] co/ c>e    
7a7 ,9 g5]al  7#a7 ,,phsa  7,a7 ,9 g5]al
 ,section #bgii;,a-#i ( ! ,public ,heal?
 ,s]vice ,act 7#db ,u4,s4,c4            
#cjj;gg-#aai7 is am5d$-- 7i7 9 ! head+1 
by /rik+ by remov+ & all t foll[s ?r\gh 
in=mation & ins]t+ 2 prohibition on     
anticompetitive agreem5ts2  7ii7 9      
subsection 7a77#e71 9 ! fir/ s5t5ce1 by 
/rik+ section & ins]t+ subsection2 &    
7iii7 by add+ at ! end ! foll[+3  7b7   
,protect+ heal? plans network design    

flexibility  7#a7 ,9 g5]al ,a gr\p heal?
 plan or a heal? insurance issu] (f]+   
gr\p or individual heal? insurance      
cov]age may n ent] into an agreem5t ) a 
cov]$ entity if su* agreem5t1 directly  
or indirectly-- 7,a7 re/ricts 7includ+  
by op]ation ( any agreem5t 9 effect     
betwe5 su* cov]$ entity & ano!r cov]$   
entity7 ! gr\p heal? plan or heal?      
insurance issu] f-- 7i7 direct+ or /e]+ 
p>ticipants or b5efici>ies to o!r heal? 
c>e provid]s :o are n subject to su*    
agreem5t2 or  7ii7 (f]+ inc5tives to    
enc\rage p>ticipants or b5efici>ies to  
utilize specific heal? c>e provid]s2    
7,b7 requires ! gr\p heal? plan or heal?
 insurance issu] to ent] into any       
additional agreem5t ) an affiliate ( !  
cov]$ entity2  7,c7 requires ! gr\p     
heal? plan or heal? insurance issu] to  
agree to paym5t rates or o!r t]ms = any 
affiliate ( ! cov]$ entity n p>ty to !  
agreem5t2 or  7,d7 re/ricts o!r gr\p    
heal? plans or heal? insurance issu]s n 
p>ty to ! agreem5t f pay+ a l[] rate =  

items or s]vices ?an ! plan or issu]    
involv$ 9 ! agreem5t pays = su* items or
 s]vices4  7#b7 ,exceptions = c]ta9     
provid] gr\p & value-bas$ network       
designs ,p>agraph 7#a77;,a7 %all n apply
 to a gr\p heal? plan or heal? insurance
 issu] (f]+ gr\p or individual heal?    
insurance cov]age ) respect to-- 7,a7 a 
heal? ma9t5ance organization1 if su*    
heal? ma9t5ance organization op]ates    
prim>ily ?r\gh exclusive contracts )    
multi-specialty physician gr\ps1 nor to 
any arrangem5t betwe5 su* a heal?       
ma9t5ance organization & its affiliates2
 or  7,b7 a value-bas$ network          
arrangem5t1 su* z an exclusive provid]  
network1 acc\ntable c>e organization1   
c5t] ( excell5ce1 a provid] sponsor$    
heal? insurance issu] t op]ates prim>ily
 ?r\gh align$ multi-specialty physician 
gr\p practices or integrat$ heal?       
sy/ems1 or su* o!r simil> network       
arrangem5ts z det]m9$ by ! ,secret>y    
?r\gh guidance or rulemak+4  7#c7 ,cov]$
 entity def9$ ,= purposes ( ?is         

subsection1 ! t]m cov]$ entity means a  
heal? c>e provid]1 network or           
association ( provid]s1 ?ird-p>ty       
adm9i/rator1 or o!r s]vice provid] (f]+ 
access to a network ( provid]s4  7#d7   
,/ate gr&fa!r+ option ,an applicable    
,/ate au?ority may make a det]m9ation t 
! prohibitions "u p>agraph 7#a77;,a7    
7relat+ to conditions t w\ld direct or  
/e] enrollees to1 or (f] inc5tives to   
enc\rage enrollees to use1 o!r heal? c>e
 provid]s7 w n apply 9 ! ,/ate ) respect
 to any specifi$ agreem5t execut$ on    
,june #ai1 #bjai1 & any agreem5ts relat$
 to su* specifi$ agreem5t execut$ on or 
be=e ,decemb] #ca1 #bjbj1 = a maximum   
l5g? ( nonapplicability ( up to #aj ye>s
 f ! date ( execution ( ! contract if ! 
applicable ,/ate au?ority det]m9es t !  
contract is unlikely to significantly   
less5 competition4 ,) respect to a      
specifi$ agreem5t = :i* an applicable   
,/ate au?ority has made a det]m9ation "u
 ! prec$+ s5t5ce1 an applicable ,/ate   
au?ority may det]m9e :e!r r5ewal ( !    

contract1 )9 ! applicable #aj-ye> p]iod1
 is all[$4  7#e7 ,rule ( con/ruction    
,except z provid$ 9 p>agraph 7#a71 no?+ 
9 ?is subsection %all be con/ru$ to     
limit network design or co/ or quality  
initiatives by a gr\p heal? plan or     
heal? insurance issu]1 includ+          
acc\ntable c>e organizations1 exclusive 
provid] organizations1 networks t ti]   
provid]s by co/ or quality or /e]       
enrollees to c5t]s ( excell5ce1 or o!r  
pay-=-p]=mance programs4  4  7,b7       
,regulations ,n lat] ?an #a ye> aft] !  
date ( ! enactm5t ( ?is ,act1 !         
,secret>y ( ,heal? & ,human ,s]vices1 9 
consultation ) ! ,secret>y ( ,labor & ! 
,secret>y ( ! ,treasury1 %all promulgate
 regulations to c>ry out ! am5dm5ts made
 by ?is p>agraph4  7#b7 ,employee       
,retirem5t ,income ,security ,act (     
#aigd  7,a7 ,9 g5]al ,section #gbd ( !  
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4 #aahem7 is  
am5d$-- 7i7 9 ! head+1 by /rik+ by      
remov+ & all t foll[s ?r\gh in=mation & 

ins]t+ 2 prohibition on anticompetitive 
agreem5ts2  7ii7 9 subsection 7a77#d71 9
 ! fir/ s5t5ce1 by /rik+ section &      
ins]t+ subsection2 &  7iii7 by add+ at !
 end ! foll[+3  7b7 ,protect+ heal?     
plans network design flexibility  7#a7  
,9 g5]al ,a gr\p heal? plan or a heal?  
insurance issu] (f]+ gr\p heal?         
insurance cov]age may n ent] into an    
agreem5t ) a cov]$ entity if su*        
agreem5t1 directly or indirectly-- 7,a7 
re/ricts 7includ+ by op]ation ( any     
agreem5t 9 effect betwe5 su* cov]$      
entity & ano!r cov]$ entity7 ! gr\p     
heal? plan or heal? insurance issu] f-- 
7i7 direct+ or /e]+ p>ticipants or      
b5efici>ies to o!r heal? c>e provid]s :o
 are n subject to su* agreem5t2 or  7ii7
 (f]+ inc5tives to enc\rage p>ticipants 
or b5efici>ies to utilize specific heal?
 c>e provid]s2  7,b7 requires ! gr\p    
heal? plan or heal? insurance issu] to  
ent] into any additional agreem5t ) an  
affiliate ( ! cov]$ entity2  7,c7       
requires ! gr\p heal? plan or heal?     

insurance issu] to agree to paym5t rates
 or o!r t]ms = any affiliate ( ! cov]$  
entity n p>ty to ! agreem5t2 or  7,d7   
re/ricts o!r gr\p heal? plans or heal?  
insurance issu]s n p>ty to ! agreem5t f 
pay+ a l[] rate = items or s]vices ?an !
 plan or issu] involv$ 9 ! agreem5t pays
 = su* items or s]vices4  7#b7          
,exceptions = c]ta9 provid] gr\p &      
value-bas$ network designs ,p>agraph    
7#a77;,a7 %all n apply to a gr\p heal?  
plan or heal? insurance issu] (f]+ gr\p 
heal? insurance cov]age ) respect to--  
7,a7 a heal? ma9t5ance organization1 if 
su* heal? ma9t5ance organization op]ates
 prim>ily ?r\gh exclusive contracts )   
multi-specialty physician gr\ps1 nor to 
any arrangem5t betwe5 su* a heal?       
ma9t5ance organization & its affiliates2
 or  7,b7 a value-bas$ network          
arrangem5t1 su* z an exclusive provid]  
network1 acc\ntable c>e organization1   
c5t] ( excell5ce1 a provid] sponsor$    
heal? insurance issu] t op]ates prim>ily
 ?r\gh align$ multi-specialty physician 

gr\p practices or integrat$ heal?       
sy/ems1 or su* o!r simil> network       
arrangem5ts z det]m9$ by ! ,secret>y    
?r\gh guidance or rulemak+4  7#c7 ,cov]$
 entity def9$ ,= purposes ( ?is         
subsection1 ! t]m cov]$ entity means a  
heal? c>e provid]1 network or           
association ( provid]s1 ?ird-p>ty       
adm9i/rator1 or o!r s]vice provid] (f]+ 
access to a network ( provid]s4  7#d7   
,/ate gr&fa!r+ option ,an applicable    
,/ate au?ority may make a det]m9ation t 
! prohibitions "u p>agraph 7#a77;,a7    
7relat+ to conditions t w\ld direct or  
/e] enrollees to1 or (f] inc5tives to   
enc\rage enrollees to use1 o!r heal? c>e
 provid]s7 w n apply 9 ! ,/ate ) respect
 to any specifi$ agreem5t execut$ on    
,june #ai1 #bjai1 & any agreem5ts relat$
 to su* specifi$ agreem5t execut$ on or 
be=e ,decemb] #ca1 #bjbj1 = a maximum   
l5g? ( nonapplicability ( up to #aj ye>s
 f ! date ( execution ( ! contract if ! 
applicable ,/ate au?ority det]m9es t !  
contract is unlikely to significantly   

less5 competition4 ,) respect to a      
specifi$ agreem5t = :i* an applicable   
,/ate au?ority has made a det]m9ation "u
 ! prec$+ s5t5ce1 an applicable ,/ate   
au?ority may det]m9e :e!r r5ewal ( !    
contract1 )9 ! applicable #aj-ye> p]iod1
 is all[$4  7#e7 ,rule ( con/ruction    
,except z provid$ 9 p>agraph 7#a71 no?+ 
9 ?is subsection %all be con/ru$ to     
limit network design or co/ or quality  
initiatives by a gr\p heal? plan or     
heal? insurance issu]1 includ+          
acc\ntable c>e organizations1 exclusive 
provid] organizations1 networks t ti]   
provid]s by co/ or quality or /e]       
enrollees to c5t]s ( excell5ce1 or o!r  
pay-=-p]=mance programs4  4  7,b7       
,cl]ical am5dm5t ,! table ( cont5ts 9   
section #a ( su* ,act is am5d$1 9 !     
entry relat+ to section #gbd1 by am5d+  
su* entry to read z foll[s3  ,sec4 #gbd4
 ,increas+ transp>5cy2 prohibition on   
anticompetitive agreem5ts4  4  7,c7     
,regulations ,n lat] ?an #a ye> aft] !  
date ( ! enactm5t ( ?is ,act1 !         

,secret>y ( ,labor1 9 consultation ) !  
,secret>y ( ,heal? & ,human ,s]vices & !
 ,secret>y ( ! ,treasury1 %all          
promulgate regulations to c>ry out !    
am5dm5ts made by ?is p>agraph4  7#c7    
,,irc  7,a7 ,9 g5]al ,section #ihbd ( ! 
,int]nal ,rev5ue ,code ( #aihf is       
am5d$-- 7i7 9 ! head]1 by /rik+ by      
remov+ & all t foll[s ?r\gh in=mation & 
ins]t+ 2 prohibition on anticompetitive 
agreem5ts2  7ii7 9 subsection 7a77#d71 9
 ! fir/ s5t5ce1 by /rik+ section &      
ins]t+ subsection2 &  7iii7 by add+ at !
 end ! foll[+3  7b7 ,protect+ heal?     
plans network design flexibility  7#a7  
,9 g5]al ,a gr\p heal? plan may n ent]  
into an agreem5t ) a cov]$ entity if su*
 agreem5t1 directly or indirectly-- 7,a7
 re/ricts 7includ+ by op]ation ( any    
agreem5t 9 effect betwe5 su* cov]$      
entity & ano!r cov]$ entity7 ! gr\p     
heal? plan f-- 7i7 direct+ or /e]+      
p>ticipants or b5efici>ies to o!r heal? 
c>e provid]s :o are n subject to su*    
agreem5t2 or  7ii7 (f]+ inc5tives to    

enc\rage p>ticipants or b5efici>ies to  
utilize specific heal? c>e provid]s2    
7,b7 requires ! gr\p heal? plan to ent] 
into any additional agreem5t ) an       
affiliate ( ! cov]$ entity2  7,c7       
requires ! gr\p heal? plan to agree to  
paym5t rates or o!r t]ms = any affiliate
 ( ! cov]$ entity n p>ty to ! agreem5t2 
or  7,d7 re/ricts o!r gr\p heal? plans n
 p>ty to ! agreem5t f pay+ a l[] rate = 
items or s]vices ?an ! plan involv$ 9 ! 
agreem5t pays = su* items or s]vices4   
7#b7 ,exceptions = c]ta9 provid] gr\p & 
value-bas$ network designs ,p>agraph    
7#a77;,a7 %all n apply to a gr\p heal?  
plan ) respect to-- 7,a7 a heal?        
ma9t5ance organization1 if su* heal?    
ma9t5ance organization op]ates prim>ily 
?r\gh exclusive contracts )             
multi-specialty physician gr\ps1 nor to 
any arrangem5t betwe5 su* a heal?       
ma9t5ance organization & its affiliates2
 or  7,b7 a value-bas$ network          
arrangem5t1 su* z an exclusive provid]  
network1 acc\ntable c>e organization1   

c5t] ( excell5ce1 a provid] sponsor$    
heal? insurance issu] t op]ates prim>ily
 ?r\gh align$ multi-specialty physician 
gr\p practices or integrat$ heal?       
sy/ems1 or su* o!r simil> network       
arrangem5ts z det]m9$ by ! ,secret>y    
?r\gh guidance or rulemak+4  7#c7 ,cov]$
 entity def9$ ,= purposes ( ?is         
subsection1 ! t]m cov]$ entity means a  
heal? c>e provid]1 network or           
association ( provid]s1 ?ird-p>ty       
adm9i/rator1 or o!r s]vice provid] (f]+ 
access to a network ( provid]s4  7#d7   
,/ate gr&fa!r+ option ,an applicable    
,/ate au?ority may make a det]m9ation t 
! prohibitions "u p>agraph 7#a77;,a7    
7relat+ to conditions t w\ld direct or  
/e] enrollees to1 or (f] inc5tives to   
enc\rage enrollees to use1 o!r heal? c>e
 provid]s7 w n apply 9 ! ,/ate ) respect
 to any specifi$ agreem5t execut$ on    
,june #ai1 #bjai1 & any agreem5ts relat$
 to su* specifi$ agreem5t execut$ on or 
be=e ,decemb] #ca1 #bjbj1 = a maximum   
l5g? ( nonapplicability ( up to #aj ye>s

 f ! date ( execution ( ! contract if ! 
applicable ,/ate au?ority det]m9es t !  
contract is unlikely to significantly   
less5 competition4 ,) respect to a      
specifi$ agreem5t = :i* an applicable   
,/ate au?ority has made a det]m9ation "u
 ! prec$+ s5t5ce1 an applicable ,/ate   
au?ority may det]m9e :e!r r5ewal ( !    
contract1 )9 ! applicable #aj-ye> p]iod1
 is all[$4  7#e7 ,rule ( con/ruction    
,except z provid$ 9 p>agraph 7#a71 no?+ 
9 ?is subsection %all be con/ru$ to     
limit network design or co/ or quality  
initiatives by a gr\p heal? plan1       
includ+ acc\ntable c>e organizations1   
exclusive provid] organizations1        
networks t ti] provid]s by co/ or       
quality or /e] enrollees to c5t]s (     
excell5ce1 or o!r pay-=-p]=mance        
programs4  4  7,b7 ,cl]ical am5dm5t ,!  
table ( cont5ts 9 section #a ( su* ,act 
is am5d$1 9 ! entry relat+ to section   
#ihbd1 by am5d+ su* entry to read z     
foll[s3  ,sec4 #ihbd4 ,increas+         
transp>5cy2 prohibition on              

anticompetitive agreem5ts4  4  7,c7     
,regulations ,n lat] ?an #a ye> aft] !  
date ( ! enactm5t ( ?is ,act1 !         
,secret>y ( ! ,treasury1 9 consultation 
) ! ,secret>y ( ,heal? & ,human ,s]vices
 & ! ,secret>y ( ,labor1 %all promulgate
 regulations to c>ry out ! am5dm5ts made
 by ?is p>agraph4  7b7 ,effective date  
,! am5dm5ts made by subsection 7a7 %all 
apply ) respect to any contract ent]$   
into1 am5d$1 or r5ew$ on or aft] ! date 
t is #ah mon?s aft] ! date ( enactm5t ( 
?is ,act4