I 

116TH CONGRESS 

1ST SESSION H. R. 5144 

To amend the Patient Protection and Affordable Care Act to require group 

health plans and health insurance coverage to have in place a process 

to self-audit information listed in publicly accessible provider directories 

of such plans and coverage. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 18, 2019 

Ms. DAVIDS of Kansas introduced the following bill; which was referred to the 

Committee on Energy and Commerce, and in addition to the Committees 

on Education and Labor, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Patient Protection and Affordable Care Act 

to require group health plans and health insurance coverage to have in place a process to self-audit information 

listed in publicly accessible provider directories of such 

plans and coverage. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Insurance Account5 ability and Transparency Act’’. 


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1 SEC. 2. REQUIREMENT FOR GROUP HEALTH PLANS AND 

2 HEALTH INSURANCE COVERAGE TO HAVE IN 

3 PLACE A PROCESS TO SELF-AUDIT INFORMA4 TION LISTED IN PUBLICLY ACCESSIBLE PRO5 VIDER DIRECTORIES OF SUCH PLANS AND 

6 COVERAGE. 

7 (a) PHSA.— 

8 (1) IN GENERAL.—Title XXVII of the Public 

9 Health Service Act (42 U.S.C. 300gg et seq.) is 

10 amended by adding at the end the following: 

11 ‘‘PART D—OTHER MARKET REFORMS 

12 ‘‘SEC. 2796. PROCESS TO SELF-AUDIT INFORMATION LISTED 

13 IN PUBLICLY ACCESSIBLE PROVIDER DIREC14 TORIES. 

15 ‘‘(a) IN GENERAL.—An entity specified in subsection 

16 (b), with respect to a group health plan or health insur17 ance coverage offered in the group or individual market, 

18 shall have in place a process under which, in order to self19 audit the information listed in any publicly accessible pro20 vider directory for such plan or coverage, such entity— 

21 ‘‘(1) contacts, not less than once every 6 

22 months during each plan year, each provider listed 

23 in such directory to verify— 

24 ‘‘(A) contact information listed in such di25 rectory with respect to such provider; and 


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1 ‘‘(B) the status of whether such provider is 

2 a provider within the network of such plan or 

3 coverage; and 

4 ‘‘(2) in the case that such entity determines 

5 that any of the information described in subpara6 graph (A) or (B) of paragraph (1) with respect to 

7 a provider listed in such directory of such plan or 

8 coverage is inaccurate, not later than 30 days after 

9 making such determination, corrects and updates 

10 such information in such directory. 

11 ‘‘(b) ENTITY DESCRIBED.—For purposes of sub12 section (a), an entity described in this subsection is— 

13 ‘‘(1) in the case of health insurance coverage or 

14 a group health plan this is not a self-insured plan, 

15 the health insurance issuer offering the health insur16 ance coverage or the group health plan, respectively; 

17 and 

18 ‘‘(2) in the case of a self-insured group health 

19 plan, the designated administrator of the plan (as 

20 such term is defined in section 3(16) of the Em21 ployee Retirement Income Security Act of 1974).’’. 

22 (2) CONFORMING AMENDMENTS.— 

23 (A) Section 2722 of the Public Health 

24 Service Act (42 U.S.C. 300gg–21) is amend25 ed— 


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1 (i) in subsection (a)(1), by inserting 

2 ‘‘and part D’’ after ‘‘subparts 1 and 2’’; 

3 (ii) in subsection (b), by inserting 

4 ‘‘and part D’’ after ‘‘subparts 1 and 2’’; 

5 (iii) in subsection (c)(1), by inserting 

6 ‘‘and part D’’ after ‘‘subparts 1 and 2’’; 

7 (iv) in subsection (c)(2), by inserting 

8 ‘‘and part D’’ after ‘‘subparts 1 and 2’’; 

9 (v) in subsection (c)(3), by inserting 

10 ‘‘and part D’’ after ‘‘this part’’; and 

11 (vi) in subsection (d), in the matter 

12 preceding paragraph (1), by inserting ‘‘and 

13 part D’’ after ‘‘this part’’. 

14 (B) Section 2723 of the Public Health 

15 Service Act (42 U.S.C. 300gg–22) is amend16 ed— 

17 (i) in subsection (a)(1), by inserting 

18 ‘‘and part D’’ after ‘‘this part’’; 

19 (ii) in subsection (a)(2), by inserting 

20 ‘‘or part D’’ after ‘‘this part’’; 

21 (iii) in subsection (b)(1), by inserting 

22 ‘‘or part D’’ after ‘‘this part’’; 

23 (iv) in subsection (b)(2)(A), by insert24 ing ‘‘or part D’’ after ‘‘this part’’; and 


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1 (v) in subsection (b)(2)(C)(ii), by in2 serting ‘‘and part D’’ after ‘‘this part’’. 

3 (C) Section 2724 of the Public Health 

4 Service Act (42 U.S.C. 300gg–23) is amend5 ed— 

6 (i) in subsection (a)(1)— 

7 (I) by striking ‘‘this part and 

8 part C insofar as it relates to this 

9 part’’ and inserting ‘‘this part, part 

10 D, and part C insofar as it relates to 

11 this part or part D’’; and 

12 (II) by inserting ‘‘or part D’’ 

13 after ‘‘requirement of this part’’; 

14 (ii) in subsection (a)(2), by inserting 

15 ‘‘or part D’’ after ‘‘this part’’; and 

16 (iii) in subsection (c), by inserting ‘‘or 

17 part D’’ after ‘‘this part (other than sec18 tion 2704)’’. 

19 (b) ERISA.— 

20 (1) IN GENERAL.—Subpart B of part 7 of sub21 title B of title I of the Employee Retirement Income 

22 Security Act of 1974 (29 U.S.C. 1181 et seq.) is 

23 amended by adding at the end the following new sec24 tion: 


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1 ‘‘SEC. 716. PROCESS TO SELF-AUDIT INFORMATION LISTED 

2 IN PUBLICLY ACCESSIBLE PROVIDER DIREC3 TORIES. 

4 ‘‘(a) IN GENERAL.—An entity specified in subsection 

5 (b), with respect to a group health plan or health insur6 ance coverage offered in the group market, shall have in 

7 place a process under which, in order to self-audit the in8 formation listed in any publicly accessible provider direc9 tory for such plan or coverage, such entity— 

10 ‘‘(1) contacts, not less than once every 6 

11 months during each plan year, each provider listed 

12 in such directory to verify— 

13 ‘‘(A) contact information listed in such di14 rectory with respect to such provider; and 

15 ‘‘(B) the status of whether such provider is 

16 a provider within the network of such plan or 

17 coverage; and 

18 ‘‘(2) in the case that such entity determines 

19 that any of the information described in subpara20 graph (A) or (B) of paragraph (1) with respect to 

21 a provider listed in such directory of such plan or 

22 coverage is inaccurate, not later than 30 days after 

23 making such determination, corrects and updates 

24 such information in such directory. 

25 ‘‘(b) ENTITY DESCRIBED.—For purposes of sub26 section (a), an entity described in this subsection is— 


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1 ‘‘(1) in the case of health insurance coverage or 

2 a group health plan this is not a self-insured plan, 

3 the health insurance issuer offering the health insur4 ance coverage or the group health plan, respectively; 

5 and 

6 ‘‘(2) in the case of a self-insured group health 

7 plan, the designated administrator of the plan (as 

8 such term is defined in section 3(16)).’’. 

9 (2) CLERICAL AMENDMENT.—The table of sec10 tions for part 7 of subtitle B of title I of the Em11 ployee Retirement Income Security Act of 1974 is 

12 amended by adding at the end the following: 

‘‘Sec. 716. Process to self-audit information listed in publicly accessible provider directories.’’. 

13 (c) IRC.— 

14 (1) IN GENERAL.—Subchapter B of chapter 

15 100 of the Internal Revenue Code of 1986 is amend16 ed by adding at the end the following new section: 

17 ‘‘SEC. 9816. PROCESS TO SELF-AUDIT INFORMATION LISTED 

18 IN PUBLICLY ACCESSIBLE PROVIDER DIREC19 TORIES. 

20 ‘‘(a) IN GENERAL.—An entity specified in subsection 

21 (b), with respect to a group health plan, shall have in place 

22 a process under which, in order to self-audit the informa23 tion listed in any publicly accessible provider directory for 

24 such plan, such entity— 


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1 ‘‘(1) contacts, not less than once every 6 

2 months during each plan year, each provider listed 

3 in such directory to verify— 

4 ‘‘(A) contact information listed in such di5 rectory with respect to such provider; and 

6 ‘‘(B) the status of whether such provider is 

7 a provider within the network of such plan; and 

8 ‘‘(2) in the case that such entity determines 

9 that any of the information described in subpara10 graph (A) or (B) of paragraph (1) with respect to 

11 a provider listed in such directory of such plan is in12 accurate, not later than 30 days after making such 

13 determination, corrects and updates such informa14 tion in such directory. 

15 ‘‘(b) ENTITY DESCRIBED.—For purposes of sub16 section (a), an entity described in this subsection is— 

17 ‘‘(1) in the case of a group health plan this is 

18 not a self-insured plan, the health insurance issuer 

19 offering the group health plan; and 

20 ‘‘(2) in the case of a self-insured group health 

21 plan, the designated administrator of the plan (as 

22 such term is defined in section 3(16) of the Em23 ployee Retirement Income Security Act of 1974).’’. 

24 (2) CLERICAL AMENDMENT.—The table of sec25 tions for subchapter B of chapter 100 of such Code 


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1 is amended by adding at the end the following new 

2 item: 

‘‘Sec. 9816. Process to self-audit information listed in publicly accessible provider directories.’’. 

3 (d) EFFECTIVE DATE.—The amendments made by 

4 this section shall apply with respect to plan years begin5 ning on or after January 1, 2020. 

Æ 


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