I 
118TH CONGRESS 
1ST SESSION H. R. 4527 
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. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 11, 2023 
Mrs. CHAVEZ-DEREMER (for herself, Mr. TAKANO, and Ms. MANNING) intro-
duced the following bill; which was referred to the Committee on Edu-
cation and the Workforce 
A BILL 
To amend the Employee Retirement Income Security Act 
of 1974 to ensure plan fiduciaries may access de-identi-
fied information relating to health claims, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Data Access, 
Transparency, and Affordability Act’’ or the ‘‘Health 
DATA Act’’. 
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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 associa-
tion of providers, third-party administrator, or phar-
macy 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 in-
formation 
or 
data 
described 
in 
section 
724(a)(1)(B) to— 
‘‘(I) ensure that such entity complies 
with the terms of the plan and any appli-
cable law; and 
‘‘(II) determine the reasonableness of 
compensation paid by the plan; and 
‘‘(ii) does not— 
‘‘(I) unreasonably limit the number of 
audits permitted during a given period of 
time; 
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‘‘(II) limit the number of de-identified 
claims and encounter information or data 
that the responsible plan fiduciary may ac-
cess during an audit; 
‘‘(III) limit the disclosure of pricing 
terms for value based payment arrange-
ments, including— 
‘‘(aa) payment calculations and 
formulas; 
‘‘(bb) quality measures; 
‘‘(cc) contract terms; 
‘‘(dd) payment amounts; 
‘‘(ee) measurement periods for all 
incentives; and 
‘‘(ff) other payment methodolo-
gies furnished by a health care pro-
vider, network or association of pro-
viders, third-party administrator, or 
pharmacy benefit manager; 
‘‘(IV) limit the disclosure of overpay-
ments and overpayment recovery terms; 
‘‘(V) limit the right of the responsible 
plan fiduciary to select an auditor; 
‘‘(VI) otherwise limit or unduly delay 
by greater than 60 days the responsible 
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plan fiduciary from auditing such informa-
tion or data; or 
‘‘(VII) charge a fee beyond the rea-
sonable direct costs to administer the oper-
ation of conducting such audits.’’. 
(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 associa-
tion 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.’’. 
(2) CONFORMING AMENDMENT.—Paragraph (6) 
of section 502(a) of such Act is amended by striking 
‘‘or (9)’’ and inserting ‘‘(9), or (13)’’. 
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(c) EXISTING PROVISIONS VOID.—Section 410 of 
such Act is amended by adding at the end the following 
new subsection: 
‘‘(c) Any provision in an agreement or instrument 
shall be void as against public policy if such provision— 
‘‘(1) unduly delays or limits a plan fiduciary 
from accessing the de-identified claims and encoun-
ter information or data described in section 
724(a)(1)(B); or 
‘‘(2) violates the requirements of section 
408(b)(2)(C).’’. 
(d) TECHNICAL AMENDMENT.—Clause (i) of section 
408(b)(2)(B) of such Act is amended by striking ‘‘this 
clause’’ and inserting ‘‘this paragraph’’. 
SEC. 3. UPDATED ATTESTATION FOR PRICE AND QUALITY 
INFORMATION. 
Section 724(a)(3) of the Employee Retirement In-
come Security Act (29 U.S.C. 1185m(a)(3)) is amended 
to read as follows: 
‘‘(3) ATTESTATION.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (C), the fiduciary of a group health plan 
or issuer offering group health insurance cov-
erage shall annually submit to the Secretary an 
attestation that such plan or issuer of such cov-
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erage is in compliance with the requirements of 
this subsection. Such attestation shall also in-
clude a statement verifying that— 
‘‘(i) the information or data described 
under subparagraphs (A) and (B) of para-
graph (1) is available upon request and 
provided to the plan fiduciary, the plan ad-
ministrator, or the issuer in a timely man-
ner; and 
‘‘(ii) there are no terms in the agree-
ment under such paragraph (1) that di-
rectly or indirectly restrict or unduly delay 
a plan fiduciary, the plan administrator, or 
the issuer from auditing, reviewing, or oth-
erwise accessing such information. 
‘‘(B) LIMITATION ON SUBMISSION.—Sub-
ject 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 sub-
mit the attestation required under subpara-
graph (A). 
‘‘(C) EXCEPTION.—In the case of a group 
health plan or issuer offering group health in-
surance coverage that is unable to obtain the 
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information or data needed to submit the attes-
tation 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 wheth-
er such plan or issuer was limited or pre-
vented from auditing, reviewing, or other-
wise accessing such information or data; 
‘‘(ii) a description of the efforts made 
by the plan fiduciary to remove any gag 
clause provisions from the agreement 
under paragraph (1); and 
‘‘(iii) a description of any response by 
the third-party administrator or other serv-
ice provider with respect to efforts to com-
ply with the attestation requirement under 
subparagraph (A).’’. 
SEC. 4. STUDY ON PLAN ASSETS. 
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 sec-
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tion 724(a)(1)(B) of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1185m), including informa-
tion 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. 
(3) The existing regulatory authority of the 
Secretary to clarify whether such information or 
data belongs to a group health plan, rather than a 
service provider. 
(4) Legislative actions that may be taken to es-
tablish that such information or data related to a 
plan belongs to a group health plan and is handled 
in the best interests of plan participants and bene-
ficiaries. 
Æ 
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