vidual) that meets such requirements as the 
Secretary may specify.’’; and 
(3) by adding at the end the following new 
clauses: 
‘‘(ii) SPECIFIED
INFORMATION.—For 
purposes of clause (i), the information 
specified in this clause is, with respect to 
an item or service for which benefits are 
available under a health plan furnished by 
a health care provider, the following: 
‘‘(I) If such provider is a partici-
pating provider with respect to such 
item or service, the in-network rate 
(as defined in subparagraph (F)) for 
such item or service. 
‘‘(II) If such provider is not de-
scribed in subclause (I), the maximum 
allowed amount for such item or serv-
ice. 
‘‘(III) The amount of cost shar-
ing 
(including 
deductibles, 
copay-
ments, and coinsurance) that the indi-
vidual will incur for such item or serv-
ice (which, in the case such item or 
service is to be furnished by a pro-
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pbinns on DSKJLVW7X2PROD with $$_JOB
vider described in subclause (II), shall 
be calculated using the maximum 
amount described in such subclause). 
‘‘(IV) The amount the individual 
has already accumulated with respect 
to any deductible or out of pocket 
maximum under the plan (broken 
down, in the case separate deductibles 
or maximums apply to separate indi-
viduals enrolled in the plan, by such 
separate deductibles or maximums, in 
addition to any cumulative deductible 
or maximum). 
‘‘(V) In the case such plan im-
poses any frequency or volume limita-
tions with respect to such item or 
service (excluding medical necessity 
determinations), the amount that such 
individual has accrued towards such 
limitation with respect to such item or 
service. 
‘‘(VI) Any prior authorization, 
concurrent review, step therapy, fail 
first, or similar requirements applica-
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pbinns on DSKJLVW7X2PROD with $$_JOB
ble to coverage of such item or service 
under such plan. 
‘‘(iii) SELF-SERVICE TOOL.—For pur-
poses of clause (i), a self-service tool estab-
lished by a health plan meets the require-
ments of this clause if such tool— 
‘‘(I) is based on an Internet 
website; 
‘‘(II) provides for real-time re-
sponses to requests described in such 
clause; 
‘‘(III) is updated in a manner 
such 
that 
information 
provided 
through such tool is timely and accu-
rate; 
‘‘(IV) allows such a request to be 
made with respect to an item or serv-
ice furnished by— 
‘‘(aa) a specific provider 
that is a participating provider 
with respect to such item or serv-
ice; 
‘‘(bb) all providers that are 
participating providers with re-
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pbinns on DSKJLVW7X2PROD with $$_JOB
spect to such plan and such item 
or service; or 
‘‘(cc) a provider that is not 
described in item (bb); and 
‘‘(V) provides that such a request 
may be made with respect to an item 
or service through use of the billing 
code for such item or service or 
through use of a descriptive term for 
such item or service. 
The Secretary may require such tool, as a 
condition of complying with subclause (V), 
to link multiple billing codes to a single de-
scriptive term if the Secretary determines 
that the billing codes to be so linked cor-
respond to items and services.’’. 
(b) DISCLOSURE OF ADDITIONAL INFORMATION.— 
Section 1311(e)(3) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18031(e)(3)) is amended by add-
ing at the end the following new subparagraphs: 
‘‘(E) RATE
AND
PAYMENT
INFORMA-
TION.— 
‘‘(i) IN
GENERAL.—Not later than 
January 1, 2025, and every 3 months 
thereafter, each health plan shall submit to 
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pbinns on DSKJLVW7X2PROD with $$_JOB
the Exchange, the Secretary, the State in-
surance commissioner, and make available 
to the public, the rate and payment infor-
mation described in clause (ii) in accord-
ance with clause (iii). 
‘‘(ii) RATE AND PAYMENT INFORMA-
TION DESCRIBED.—For purposes of clause 
(i), the rate and payment information de-
scribed in this clause is, with respect to a 
health plan, the following: 
‘‘(I) With respect to each item or 
service for which benefits are available 
under such plan, the in-network rate 
in effect as of the date of the submis-
sion of such information with each 
provider (identified by national pro-
vider identifier) that is a participating 
provider with respect to such item or 
service, other than such a rate in ef-
fect with a provider that, during the 
1-year period ending on such date, 
submitted fewer than 10 claims for 
such item or service to such plan. 
‘‘(II) With respect to each drug 
(identified by national drug code) for 
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pbinns on DSKJLVW7X2PROD with $$_JOB
which benefits are available under 
such plan, the average amount paid 
by such plan (net of rebates, dis-
counts, and price concessions) for 
such drug dispensed or administered 
during the 90-day period beginning 
180 days before such date of submis-
sion to each provider that was a par-
ticipating provider with respect to 
such drug, broken down by each such 
provider (identified by national pro-
vider identifier), other than such an 
amount paid to a provider that, dur-
ing such period, submitted fewer than 
20 claims for such drug to such plan. 
‘‘(III) With respect to each item 
or service for which benefits are avail-
able under such plan, the amount 
billed, and the amount allowed by the 
plan, for each such item or service 
furnished during the 90-day period 
specified in subclause (II) by a pro-
vider that was not a participating pro-
vider with respect to such item or 
service, broken down by each such 
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