I 

116TH CONGRESS 

2D SESSION H. R. 7267 

To amend title XXVII of the Public Health Service Act, the Employee 

Retirement Income Security Act of 1974, and the Internal Revenue 

Code of 1986 to prohibit a group health plan and a health insurance 

issuer offering group or individual health insurance coverage from reducing contracted rates, or terminating contracts, with health care providers 

during a public health emergency. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 18, 2020 

Ms. PORTER (for herself and Ms. DELAURO) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committees on Ways and Means, and Education and 

Labor, 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 title XXVII of the Public Health Service Act, 

the Employee Retirement Income Security Act of 1974, 

and the Internal Revenue Code of 1986 to prohibit a 

group health plan and a health insurance issuer offering 

group or individual health insurance coverage from reducing contracted rates, or terminating contracts, with 

health care providers during a public health emergency. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Patients Before Profits 

3 Act of 2020’’. 

4 SEC. 2. PROHIBITING A GROUP HEALTH PLAN AND A 

5 HEALTH INSURANCE ISSUER OFFERING 

6 GROUP OR INDIVIDUAL HEALTH INSURANCE 

7 COVERAGE FROM REDUCING CONTRACTED 

8 RATES, OR TERMINATING CONTRACTS, WITH 

9 HEALTH CARE PROVIDERS DURING A PUBLIC 

10 HEALTH EMERGENCY. 

11 (a) PHSA.—Subpart II of part A of title XXVII of 

12 the Public Health Service Act (42 U.S.C. 300gg–11 et 

13 seq.) is amended by adding at the end the following new 

14 section: 

15 ‘‘SEC. 2730. PROHIBITION ON REDUCTION OF RATES AND 

16 TERMINATION OF CONTRACTS DURING PUB17 LIC HEALTH EMERGENCIES. 

18 ‘‘(a) IN GENERAL.—A group health plan and a health 

19 insurance issuer offering group or individual health insur20 ance coverage may not, with respect to a health care pro21 vider located in an emergency area during an emergency 

22 period that, as of the day before the date of the beginning 

23 of such period, had in effect a contractual relationship for 

24 furnishing items and services under such plan or cov25 erage— 


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1 ‘‘(1) provide for an amount of reimbursement 

2 for any such item or service furnished by such pro3 vider during such period that is less than the 

4 amount of such reimbursement that would have been 

5 payable under such plan or coverage had such item 

6 or service been furnished by such provider on such 

7 day; or 

8 ‘‘(2) terminate such relationship during such 

9 period; 

10 unless such lesser reimbursement or such termination is 

11 based on fraud, abuse, or other quality concerns with re12 spect to such provider or such provider being placed on 

13 the exclusion list maintained by the Inspector General of 

14 the Department of Health and Human Services. 

15 ‘‘(b) DEFINITIONS.—For purposes of this section, an 

16 ‘emergency area’ is a geographical area in which, and an 

17 ‘emergency period’ is the period during which, there exists 

18 a public health emergency declared by the Secretary pur19 suant to section 319.’’. 

20 (b) ERISA.— 

21 (1) IN GENERAL.—Subpart B of part 7 of sub22 title B of title I of the Employee Retirement Income 

23 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 

24 amended by adding at the end the following new sec25 tion: 


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1 ‘‘SEC. 716. PROHIBITION ON REDUCTION OF RATES AND 

2 TERMINATION OF CONTRACTS DURING PUB3 LIC HEALTH EMERGENCIES. 

4 ‘‘(a) IN GENERAL.—A group health plan and a health 

5 insurance issuer offering group health insurance coverage 

6 may not, with respect to a health care provider located 

7 in an emergency area during an emergency period that, 

8 as of the day before the date of the beginning of such 

9 period, had in effect a contractual relationship for fur10 nishing items and services under such plan or coverage— 

11 ‘‘(1) provide for an amount of reimbursement 

12 for any such item or service furnished by such pro13 vider during such period that is less than the 

14 amount of such reimbursement that would have been 

15 payable under such plan or coverage had such item 

16 or service been furnished by such provider on such 

17 day; or 

18 ‘‘(2) terminate such relationship during such 

19 period; 

20 unless such lesser reimbursement or such termination is 

21 based on fraud, abuse, or other quality concerns with re22 spect to such provider or such provider being placed on 

23 the exclusion list maintained by the Inspector General of 

24 the Department of Health and Human Services. 

25 ‘‘(b) DEFINITIONS.—For purposes of this section, an 

26 ‘emergency area’ is a geographical area in which, and an 


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1 ‘emergency period’ is the period during which, there exists 

2 a public health emergency declared by the Secretary pur3 suant to section 319.’’. 

4 (2) CLERICAL AMENDMENT.—The table of con5 tents in section 1 of the Employee Retirement In6 come Security Act of 1974 is amended by inserting 

7 after the item relating to section 714 the following 

8 new items: 

‘‘Sec. 715. Additional market reforms. 

‘‘Sec. 716. Prohibition on reduction of rates and termination of contracts during public health emergencies.’’. 

9 (c) IRC.— 

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

11 100 of the Internal Revenue Code of 1986 is amend12 ed by adding at the end the following new section: 

13 ‘‘SEC. 9816. PROHIBITION ON REDUCTION OF RATES AND 

14 TERMINATION OF CONTRACTS DURING PUB15 LIC HEALTH EMERGENCIES. 

16 ‘‘(a) IN GENERAL.—A group health plan may not, 

17 with respect to a health care provider located in an emer18 gency area during an emergency period that, as of the day 

19 before the date of the beginning of such period, had in 

20 effect a contractual relationship for furnishing items and 

21 services under such plan— 

22 ‘‘(1) provide for an amount of reimbursement 

23 for any such item or service furnished by such pro24 vider during such period that is less than the 


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1 amount of such reimbursement that would have been 

2 payable under such plan had such item or service 

3 been furnished by such provider on such day; or 

4 ‘‘(2) terminate such relationship during such 

5 period; 

6 unless such lesser reimbursement or such termination is 

7 based on fraud, abuse, or other quality concerns with re8 spect to such provider or such provider being placed on 

9 the exclusion list maintained by the Inspector General of 

10 the Department of Health and Human Services. 

11 ‘‘(b) DEFINITIONS.—For purposes of this section, an 

12 ‘emergency area’ is a geographical area in which, and an 

13 ‘emergency period’ is the period during which, there exists 

14 a public health emergency declared by the Secretary pur15 suant to section 319.’’. 

16 (2) CLERICAL AMENDMENT.—The table of sec17 tions for such subchapter is amended by adding at 

18 the end the following new items: 

‘‘Sec. 9815. Additional market reforms. 

‘‘Sec. 9816. Prohibition on reduction of rates and termination of contracts during public health emergencies.’’. 

19 (d) EFFECTIVE DATE.—The amendment made by 

20 this section shall apply with respect to public health emer21 gencies declared by the Secretary of Health and Human 

22 Services on or after January 31, 2020, and items and 


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1 services furnished, and terminations occurring, on or after 

2 the date of the enactment of this Act. 

Æ 


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