Union Calendar No. 210
118th CONGRESS 1st Session |
[Report No. 118–260]
To amend the Employee Retirement Income Security Act of 1974 to ensure plan fiduciaries may access de-identified information relating to health claims, and for other purposes.
July 11, 2023
Mrs. Chavez-DeRemer (for herself, Mr. Takano, and Ms. Manning) introduced the following bill; which was referred to the Committee on Education and the Workforce
November 1, 2023
Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed
[Strike out all after the enacting clause and insert the part printed in italic]
[For text of introduced bill, see copy of bill as introduced on July 11, 2023]
To amend the Employee Retirement Income Security Act of 1974 to ensure plan fiduciaries may access de-identified information relating to health claims, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
This Act may be cited as the “Health Data Access, Transparency, and Affordability Act of 2023” or the “Health DATA Act of 2023”.
SEC. 2. Plan fiduciary access to information.
(a) In general.—Paragraph (2) of section 408(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1108(b)) is amended by adding at the end the following new subparagraph:
“(C) No contract or arrangement for services between a group health plan and any other entity, such as a health care provider, network or association of providers, third-party administrator, or pharmacy benefit manager, is reasonable within the meaning of this paragraph unless such contract or agreement—
“(i) allows the responsible plan fiduciary to audit all de-identified claims and encounter information or data described in section 724(a)(1)(B) to—
“(ii) does not—
“(II) limit the number of de-identified claims and encounter information or data that the responsible plan fiduciary may access during an audit;
(b) Civil enforcement.—
(1) IN GENERAL.—Subsection (c) of section 502 of such Act (29 U.S.C. 1132) is amended by adding at the end the following new paragraph:
“(13) In the case of an agreement between a group health plan and a health care provider, network or association of providers, third-party administrator, pharmacy benefit manager, or other service provider that violates the provisions of section 724, the Secretary may assess a civil penalty against such provider, network or association, third-party administrator, pharmacy benefit manager, or other service provider in the amount of $10,000 for each day during which such violation continues. Such penalty shall be in addition to other penalties as may be prescribed by law.”.
(c) Existing provisions void.—Section 410 of such Act is amended by adding at the end the following new subsection:
SEC. 3. Updated attestation for price and quality information.
Section 724(a)(3) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185m(a)(3)) is amended to read as follows:
“(3) ATTESTATION.—
“(A) IN GENERAL.—Subject to subparagraph (C), the fiduciary of a group health plan or 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 subsection. Such attestation shall also include a statement verifying that—
“(B) LIMITATION ON SUBMISSION.—Subject to clause (ii), 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 (A).
“(C) 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 (A), such plan or issuer may submit a written statement in lieu of such attestation that includes—
“(i) an explanation of why such plan or issuer was unsuccessful in obtaining such information or data, including whether such plan or issuer was limited or prevented from auditing, reviewing, or otherwise accessing such information or data;
Not later than 1 year after the date of enactment of this Act, the Secretary of Labor shall submit to the Committee on Education and the Workforce of the House of Representatives a report on the status of de-identified claims and encounter information or data described in section 724(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185m), including information on the following:
(1) Circumstances under current law where such information or data could be deemed a group health plan asset (as defined under section 3(42) of such Act).
(2) Whether restrictions on the ability of a plan fiduciary to access such information or data violates a requirement of current law.
Union Calendar No. 210 | |||||
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[Report No. 118–260] | |||||
A BILL | |||||
To amend the Employee Retirement Income Security Act of 1974 to ensure plan fiduciaries may access de-identified information relating to health claims, and for other purposes. | |||||
November 1, 2023 | |||||
Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed |