H. R. 133—1687 
‘‘(C) does not otherwise have a conflict of interest with 
such a party (as determined by the Secretary); and 
‘‘(2) the provision of a notification of such selection to 
the individual and the provider or facility (as applicable) party 
to such determination. 
An entity selected pursuant to the previous sentence to make a 
determination described in such sentence shall be referred to in 
this subsection as the ‘selected dispute resolution entity’ with 
respect to such determination. 
‘‘(c) ADMINISTRATIVE FEE.—The Secretary shall establish a fee 
to participate in the patient-provider dispute resolution process 
in such a manner as to not create a barrier to an uninsured 
individual’s access to such process. 
‘‘(d) CERTIFICATION.—The Secretary shall establish or recognize 
a process to certify entities under this subparagraph. Such process 
shall ensure that an entity so certified satisfies at least the criteria 
specified in section 2799A–1(c).’’. 
SEC. 113. ENSURING CONTINUITY OF CARE. 
(a) PUBLIC HEALTH SERVICE ACT.—Title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg et seq.) is amended, in the 
part D, as added and amended by section 102(a) and further 
amended by the previous provisions of this title, by inserting after 
section 2799A–2 the following new section: 
‘‘SEC. 2799A-3. CONTINUITY OF CARE. 
‘‘(a) ENSURING CONTINUITY OF CARE WITH RESPECT TO TERMI-
NATIONS OF CERTAIN CONTRACTUAL RELATIONSHIPS RESULTING IN 
CHANGES IN PROVIDER NETWORK STATUS.— 
‘‘(1) IN GENERAL.—In the case of an individual with benefits 
under a group health plan or group or individual health insur-
ance coverage offered by a health insurance issuer and with 
respect to a health care provider or facility that has a contrac-
tual relationship with such plan or such issuer (as applicable) 
for furnishing items and services under such plan or such 
coverage, if, while such individual is a continuing care patient 
(as defined in subsection (b)) with respect to such provider 
or facility— 
‘‘(A) such contractual relationship is terminated (as 
defined in subsection (b)); 
‘‘(B) benefits provided under such plan or such health 
insurance coverage with respect to such provider or facility 
are terminated because of a change in the terms of the 
participation of such provider or facility in such plan or 
coverage; or 
‘‘(C) a contract between such group health plan and 
a health insurance issuer offering health insurance cov-
erage in connection with such plan is terminated, resulting 
in a loss of benefits provided under such plan with respect 
to such provider or facility; 
the plan or issuer, respectively, shall meet the requirements 
of paragraph (2) with respect to such individual. 
‘‘(2) REQUIREMENTS.—The requirements of this paragraph 
are that the plan or issuer— 
‘‘(A) notify each individual enrolled under such plan 
or coverage who is a continuing care patient with respect 
to a provider or facility at the time of a termination 
described in paragraph (1) affecting such provider or facility
H. R. 133—1688 
on a timely basis of such termination and such individual’s 
right to elect continued transitional care from such provider 
or facility under this section; 
‘‘(B) provide such individual with an opportunity to 
notify the plan or issuer of the individual’s need for transi-
tional care; and 
‘‘(C) permit the patient to elect to continue to have 
benefits provided under such plan or such coverage, under 
the same terms and conditions as would have applied and 
with respect to such items and services as would have 
been covered under such plan or coverage had such termi-
nation not occurred, with respect to the course of treatment 
furnished by such provider or facility relating to such 
individual’s status as a continuing care patient during the 
period beginning on the date on which the notice under 
subparagraph (A) is provided and ending on the earlier 
of— 
‘‘(i) the 90-day period beginning on such date; or 
‘‘(ii) the date on which such individual is no longer 
a continuing care patient with respect to such provider 
or facility. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) CONTINUING CARE PATIENT.—The term ‘continuing care 
patient’ means an individual who, with respect to a provider 
or facility— 
‘‘(A) is undergoing a course of treatment for a serious 
and complex condition from the provider or facility; 
‘‘(B) is undergoing a course of institutional or inpatient 
care from the provider or facility; 
‘‘(C) is scheduled to undergo nonelective surgery from 
the provider, including receipt of postoperative care from 
such provider or facility with respect to such a surgery; 
‘‘(D) is pregnant and undergoing a course of treatment 
for the pregnancy from the provider or facility; or 
‘‘(E) is or was determined to be terminally ill (as deter-
mined under section 1861(dd)(3)(A) of the Social Security 
Act) and is receiving treatment for such illness from such 
provider or facility. 
‘‘(2) SERIOUS AND COMPLEX CONDITION.—The term ‘serious 
and complex condition’ means, with respect to a participant, 
beneficiary, or enrollee under a group health plan or group 
or individual health insurance coverage— 
‘‘(A) in the case of an acute illness, a condition that 
is serious enough to require specialized medical treatment 
to avoid the reasonable possibility of death or permanent 
harm; or 
‘‘(B) in the case of a chronic illness or condition, a 
condition that is— 
‘‘(i) is life-threatening, degenerative, potentially 
disabling, or congenital; and 
‘‘(ii) requires specialized medical care over a pro-
longed period of time. 
‘‘(3) TERMINATED.—The term ‘terminated’ includes, with 
respect to a contract, the expiration or nonrenewal of the con-
tract, but does not include a termination of the contract for 
failure to meet applicable quality standards or for fraud.’’. 
(b) INTERNAL REVENUE CODE.—
H. R. 133—1689 
(1) IN
GENERAL.—Subchapter B of chapter 100 of the 
Internal Revenue Code of 1986, as amended by sections 102(c) 
and 105(a)(3), is further amended by inserting after section 
9817 the following new section: 
‘‘SEC. 9818. CONTINUITY OF CARE. 
‘‘(a) ENSURING CONTINUITY OF CARE WITH RESPECT TO TERMI-
NATIONS OF CERTAIN CONTRACTUAL RELATIONSHIPS RESULTING IN 
CHANGES IN PROVIDER NETWORK STATUS.— 
‘‘(1) IN GENERAL.—In the case of an individual with benefits 
under a group health plan and with respect to a health care 
provider or facility that has a contractual relationship with 
such plan for furnishing items and services under such plan, 
if, while such individual is a continuing care patient (as defined 
in subsection (b)) with respect to such provider or facility— 
‘‘(A) such contractual relationship is terminated (as 
defined in paragraph (b)); 
‘‘(B) benefits provided under such plan with respect 
to such provider or facility are terminated because of a 
change in the terms of the participation of such provider 
or facility in such plan; or 
‘‘(C) a contract between such group health plan and 
a health insurance issuer offering health insurance cov-
erage in connection with such plan is terminated, resulting 
in a loss of benefits provided under such plan with respect 
to such provider or facility; 
the plan shall meet the requirements of paragraph (2) with 
respect to such individual. 
‘‘(2) REQUIREMENTS.—The requirements of this paragraph 
are that the plan— 
‘‘(A) notify each individual enrolled under such plan 
who is a continuing care patient with respect to a provider 
or facility at the time of a termination described in para-
graph (1) affecting such provider on a timely basis of such 
termination and such individual’s right to elect continued 
transitional care from such provider or facility under this 
section; 
‘‘(B) provide such individual with an opportunity to 
notify the plan of the individual’s need for transitional 
care; and 
‘‘(C) permit the patient to elect to continue to have 
benefits provided under such plan, under the same terms 
and conditions as would have applied and with respect 
to such items and services as would have been covered 
under such plan had such termination not occurred, with 
respect to the course of treatment furnished by such pro-
vider or facility relating to such individual’s status as a 
continuing care patient during the period beginning on 
the date on which the notice under subparagraph (A) is 
provided and ending on the earlier of— 
‘‘(i) the 90-day period beginning on such date; or 
‘‘(ii) the date on which such individual is no longer 
a continuing care patient with respect to such provider 
or facility. 
‘‘(b) DEFINITIONS.—In this section:
H. R. 133—1690 
‘‘(1) CONTINUING CARE PATIENT.—The term ‘continuing care 
patient’ means an individual who, with respect to a provider 
or facility— 
‘‘(A) is undergoing a course of treatment for a serious 
and complex condition from the provider or facility; 
‘‘(B) is undergoing a course of institutional or inpatient 
care from the provider or facility; 
‘‘(C) is scheduled to undergo nonelective surgery from 
the provider or facility, including receipt of postoperative 
care from such provider or facility with respect to such 
a surgery; 
‘‘(D) is pregnant and undergoing a course of treatment 
for the pregnancy from the provider or facility; or 
‘‘(E) is or was determined to be terminally ill (as deter-
mined under section 1861(dd)(3)(A) of the Social Security 
Act) and is receiving treatment for such illness from such 
provider or facility. 
‘‘(2) SERIOUS AND COMPLEX CONDITION.—The term ‘serious 
and complex condition’ means, with respect to a participant 
or beneficiary under a group health plan— 
‘‘(A) in the case of an acute illness, a condition that 
is serious enough to require specialized medical treatment 
to avoid the reasonable possibility of death or permanent 
harm; or 
‘‘(B) in the case of a chronic illness or condition, a 
condition that— 
‘‘(i) is life-threatening, degenerative, potentially 
disabling, or congenital; and 
‘‘(ii) requires specialized medical care over a pro-
longed period of time. 
‘‘(3) TERMINATED.—The term ‘terminated’ includes, with 
respect to a contract, the expiration or nonrenewal of the con-
tract, but does not include a termination of the contract for 
failure to meet applicable quality standards or for fraud.’’. 
(2) CLERICAL AMENDMENT.—The table of sections for such 
subchapter, as amended by the previous sections, is further 
amended by inserting after the item relating to section 9817 
the following new item: 
‘‘Sec. 9818. Continuity of care.’’. 
(c) EMPLOYEE RETIREMENT INCOME SECURITY ACT.— 
(1) IN
GENERAL.—Subpart B of part 7 of subtitle B of 
title I of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1185 et seq.), as amended by section 102(c) 
and further amended by the previous provisions of this title, 
is further amended by inserting after section 717 the following 
new section: 
‘‘SEC. 718. CONTINUITY OF CARE. 
‘‘(a) ENSURING CONTINUITY OF CARE WITH RESPECT TO TERMI-
NATIONS OF CERTAIN CONTRACTUAL RELATIONSHIPS RESULTING IN 
CHANGES IN PROVIDER NETWORK STATUS.— 
‘‘(1) IN GENERAL.—In the case of an individual with benefits 
under a group health plan or group health insurance coverage 
offered by a health insurance issuer and with respect to a 
health care provider or facility that has a contractual relation-
ship with such plan or such issuer (as applicable) for furnishing
H. R. 133—1691 
items and services under such plan or such coverage, if, while 
such individual is a continuing care patient (as defined in 
subsection (b)) with respect to such provider or facility— 
‘‘(A) such contractual relationship is terminated (as 
defined in paragraph (b)); 
‘‘(B) benefits provided under such plan or such health 
insurance coverage with respect to such provider or facility 
are terminated because of a change in the terms of the 
participation of the provider or facility in such plan or 
coverage; or 
‘‘(C) a contract between such group health plan and 
a health insurance issuer offering health insurance cov-
erage in connection with such plan is terminated, resulting 
in a loss of benefits provided under such plan with respect 
to such provider or facility; 
the plan or issuer, respectively, shall meet the requirements 
of paragraph (2) with respect to such individual. 
‘‘(2) REQUIREMENTS.—The requirements of this paragraph 
are that the plan or issuer— 
‘‘(A) notify each individual enrolled under such plan 
or coverage who is a continuing care patient with respect 
to a provider or facility at the time of a termination 
described in paragraph (1) affecting such provider or facility 
on a timely basis of such termination and such individual’s 
right to elect continued transitional care from such provider 
or facility under this section; 
‘‘(B) provide such individual with an opportunity to 
notify the plan or issuer of the individual’s need for transi-
tional care; and 
‘‘(C) permit the patient to elect to continue to have 
benefits provided under such plan or such coverage, under 
the same terms and conditions as would have applied and 
with respect to such items and services as would have 
been covered under such plan or coverage had such termi-
nation not occurred, with respect to the course of treatment 
furnished by such provider or facility relating to such 
individual’s status as a continuing care patient during the 
period beginning on the date on which the notice under 
subparagraph (A) is provided and ending on the earlier 
of— 
‘‘(i) the 90-day period beginning on such date; or 
‘‘(ii) the date on which such individual is no longer 
a continuing care patient with respect to such provider 
or facility. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) CONTINUING CARE PATIENT.—The term ‘continuing care 
patient’ means an individual who, with respect to a provider 
or facility— 
‘‘(A) is undergoing a course of treatment for a serious 
and complex condition from the provider or facility; 
‘‘(B) is undergoing a course of institutional or inpatient 
care from the provider or facility; 
‘‘(C) is scheduled to undergo nonelective surgery from 
the provide or facility, including receipt of postoperative 
care from such provider or facility with respect to such 
a surgery;
H. R. 133—1692 
‘‘(D) is pregnant and undergoing a course of treatment 
for the pregnancy from the provider or facility; or 
‘‘(E) is or was determined to be terminally ill (as deter-
mined under section 1861(dd)(3)(A) of the Social Security 
Act) and is receiving treatment for such illness from such 
provider or facility. 
‘‘(2) SERIOUS AND COMPLEX CONDITION.—The term ‘serious 
and complex condition’ means, with respect to a participant 
or beneficiary under a group health plan or group health insur-
ance coverage— 
‘‘(A) in the case of an acute illness, a condition that 
is serious enough to require specialized medical treatment 
to avoid the reasonable possibility of death or permanent 
harm; or 
‘‘(B) in the case of a chronic illness or condition, a 
condition that— 
‘‘(i) is life-threatening, degenerative, potentially 
disabling, or congenital; and 
‘‘(ii) requires specialized medical care over a pro-
longed period of time. 
‘‘(3) TERMINATED.—The term ‘terminated’ includes, with 
respect to a contract, the expiration or nonrenewal of the con-
tract, but does not include a termination of the contract for 
failure to meet applicable quality standards or for fraud.’’. 
(2) CLERICAL AMENDMENT.—The table of contents in section 
1 of the Employee Retirement Income Security Act of 1974 
is amended by inserting after the item relating to section 716 
the following new item: 
‘‘Sec. 718. Continuity of care.’’. 
(d) PROVIDER REQUIREMENT.—Part E of title XXVII of the 
Public Health Service Act (42 U.S.C. 300gg et seq.), as added 
by section 104 and further amended by the previous provisions 
of this title, is further amended by adding at the end the following 
new section: 
‘‘SEC. 2799B–8. CONTINUITY OF CARE. 
‘‘A health care provider or health care facility shall, in the 
case of an individual furnished items and services by such provider 
or facility for which coverage is provided under a group health 
plan or group or individual health insurance coverage pursuant 
to section 2799A–3, section 9818 of the Internal Revenue Code 
of 1986, or section 718 of the Employee Retirement Income Security 
Act of 1974— 
‘‘(1) accept payment from such plan or such issuer (as 
applicable) (and cost-sharing from such individual, if applicable, 
in accordance with subsection (a)(2)(C) of such section 2799A– 
3, 9818, or 718) for such items and services as payment in 
full for such items and services; and 
‘‘(2) continue to adhere to all policies, procedures, and 
quality standards imposed by such plan or issuer with respect 
to such individual and such items and services in the same 
manner as if such termination had not occurred.’’. 
(e) EFFECTIVE DATE.—The amendments made by subsections 
(a), (b), and (c) shall apply with respect to plan years beginning 
on or after January 1, 2022.
H. R. 133—1693 
SEC. 114. MAINTENANCE OF PRICE COMPARISON TOOL. 
(a) PUBLIC HEALTH SERVICE ACT.—Title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg et seq.) is amended, in part 
D, as added and amended by section 102 and further amended 
by the previous provisions of this title, by inserting after section 
2799A–3 the following new section: 
‘‘SEC. 2799A–4. MAINTENANCE OF PRICE COMPARISON TOOL. 
‘‘A group health plan or a health insurance issuer offering 
group or individual health insurance coverage shall offer price 
comparison guidance by telephone and make available on the Inter-
net website of the plan or issuer a price comparison tool that 
(to the extent practicable) allows an individual enrolled under such 
plan or coverage, with respect to such plan year, such geographic 
region, and participating providers with respect to such plan or 
coverage, to compare the amount of cost-sharing that the individual 
would be responsible for paying under such plan or coverage with 
respect to the furnishing of a specific item or service by any such 
provider.’’. 
(b) INTERNAL REVENUE CODE.— 
(1) IN
GENERAL.—Subchapter B of chapter 100 of the 
Internal Revenue Code of 1986, as amended by sections 102, 
105, and 113, is further amended by inserting after section 
9818 the following new section: 
‘‘SEC. 9819. MAINTENANCE OF PRICE COMPARISON TOOL. 
‘‘A group health plan shall offer price comparison guidance 
by telephone and make available on the Internet website of the 
plan or issuer a price comparison tool that (to the extent practicable) 
allows an individual enrolled under such plan, with respect to 
such plan year, such geographic region, and participating providers 
with respect to such plan or coverage, to compare the amount 
of cost-sharing that the individual would be responsible for paying 
under such plan with respect to the furnishing of a specific item 
or service by any such provider.’’. 
(2) CLERICAL AMENDMENT.—The table of sections for such 
subchapter, as amended by the previous sections, is further 
amended by inserting after the item relating to section 9818 
the following new item: 
‘‘Sec. 9819. Maintenance of price comparison tool.’’. 
(c) EMPLOYEE RETIREMENT INCOME SECURITY ACT.— 
(1) IN
GENERAL.—Subpart B of part 7 of subtitle B of 
title I of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1185 et seq.), as amended by sections 102, 
105, and 113, is further amended by inserting after section 
718 the following new section: 
‘‘SEC. 719. MAINTENANCE OF PRICE COMPARISON TOOL. 
‘‘A group health plan or a health insurance issuer offering 
group health insurance coverage shall offer price comparison guid-
ance by telephone and make available on the Internet website 
of the plan or issuer a price comparison tool that (to the extent 
practicable) allows an individual enrolled under such plan or cov-
erage, with respect to such plan year, such geographic region, 
and participating providers with respect to such plan or coverage, 
to compare the amount of cost-sharing that the individual would
H. R. 133—1694 
be responsible for paying under such plan or coverage with respect 
to the furnishing of a specific item or service by any such provider.’’. 
(2) CLERICAL AMENDMENT.—The table of contents in section 
1 of the Employee Retirement Income Security Act of 1974, 
as amended by the previous provisions of this title, is further 
amended by inserting after the item relating to section 716 
the following new item: 
‘‘Sec. 719. Maintenance of price comparison tool.’’. 
(d) EFFECTIVE DATE.—The amendments made by this section 
shall apply with respect to plan years beginning on or after January 
1, 2022. 
SEC. 115. STATE ALL PAYER CLAIMS DATABASES. 
(a) GRANTS TO STATES.—Part B of title III of the Public Health 
Service Act (42 U.S.C. 243 et seq.) is amended by adding at the 
end the following: 
‘‘SEC. 320B. STATE ALL PAYER CLAIMS DATABASES. 
‘‘(a) IN GENERAL.—The Secretary shall make one-time grants 
to eligible States for the purposes described in subsection (b). 
‘‘(b) USES.—A State may use a grant received under subsection 
(a) for one of the following purposes: 
‘‘(1) To establish a State All Payer Claims Database. 
‘‘(2) To improve an existing State All Payer Claims Data-
bases. 
‘‘(c) ELIGIBILITY.—To be eligible to receive a grant under sub-
section (a), a State shall submit to the Secretary an application 
at such time, in such manner, and containing such information 
as the Secretary specifies, including, with respect to a State All 
Payer Claims Database, at least specifics on how the State will 
ensure uniform data collection and the privacy and security of 
such data. 
‘‘(d) GRANT PERIOD AND AMOUNT.—Grants awarded under this 
section shall be for a period of 3-years, and in an amount of 
$2,500,000, of which $1,000,000 shall be made available to the 
State for each of the first 2 years of the grant period, and $500,000 
shall be made available to the State for the third year of the 
grant period. 
‘‘(e) AUTHORIZED USERS.— 
‘‘(1) APPLICATION.—An entity desiring authorization for 
access to a State All Payer Claims Database that has received 
a grant under this section shall submit to the State All Payer 
Claims Database an application for such access, which shall 
include— 
‘‘(A) in the case of an entity requesting access for 
research purposes— 
‘‘(i) a description of the uses and methodologies 
for evaluating health system performance using such 
data; and 
‘‘(ii) documentation of approval of the research by 
an institutional review board, if applicable for a par-
ticular plan of research; or 
‘‘(B) in the case of an entity such as an employer, 
health insurance issuer, third-party administrator, or 
health care provider, requesting access for the purpose
H. R. 133—1695 
of quality improvement or cost-containment, a description 
of the intended uses for such data. 
‘‘(2) REQUIREMENTS.— 
‘‘(A) ACCESS FOR RESEARCH PURPOSES.—Upon approval 
of an application for research purposes under paragraph 
(1)(A), the authorized user shall enter into a data use 
and confidentiality agreement with the State All Payer 
Claims Database that has received a grant under this 
subsection, which shall include a prohibition on attempts 
to reidentify and disclose individually identifiable health 
information and proprietary financial information. 
‘‘(B) CUSTOMIZED REPORTS.—Employers and employer 
organizations may request customized reports from a State 
All Payer Claims Database that has received a grant under 
this section, at cost, subject to the requirements of this 
section with respect to privacy, security, and proprietary 
financial information. 
‘‘(C) NON-CUSTOMIZED
REPORTS.—A State All Payer 
Claims Database that has received a grant under this 
section shall make available to all authorized users aggre-
gate data sets available through the State All Payer Claims 
Database, free of charge. 
‘‘(3) WAIVERS.—The Secretary may waive the requirements 
of this subsection of a State All Payer Claims Database to 
provide access of entities to such database if such State All 
Payer Claims Database is substantially in compliance with 
this subsection. 
‘‘(f) EXPANDED ACCESS.— 
‘‘(1) 
MULTI-STATE
APPLICATIONS.—The 
Secretary 
may 
prioritize applications submitted by a State whose application 
demonstrates that the State will work with other State All 
Payer Claims Databases to establish a single application for 
access to data by authorized users across multiple States. 
‘‘(2) EXPANSION
OF
DATA
SETS.—The Secretary may 
prioritize applications submitted by a State whose application 
demonstrates that the State will implement the reporting for-
mat for self-insured group health plans described in section 
735 of the Employee Retirement Income Security Act of 1974. 
‘‘(g) DEFINITIONS.—In this section— 
‘‘(1) the term ‘individually identifiable health information’ 
has the meaning given such term in section 1171(6) of the 
Social Security Act; 
‘‘(2) the term ‘proprietary financial information’ means data 
that would disclose the terms of a specific contract between 
an individual health care provider or facility and a specific 
group health plan, managed care entity (as defined in section 
1932(a)(1)(B) of the Social Security Act) or other managed care 
organization, or health insurance issuer offering group or indi-
vidual health insurance coverage; and 
‘‘(3) the term ‘State All Payer Claims Database’ means, 
with respect to a State, a database that may include medical 
claims, pharmacy claims, dental claims, and eligibility and 
provider files, which are collected from private and public 
payers. 
‘‘(h) AUTHORIZATION
OF APPROPRIATIONS.—To carry out this 
section, there is authorized to be appropriated $50,000,000 for each
H. R. 133—1696 
of fiscal years 2022 and 2023, and $25,000,000 for fiscal year 
2024, to remain available until expended.’’. 
(b) STANDARDIZED REPORTING FORMAT.— 
Subpart C of part 7 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1191 et 
seq.) is amended by adding at the end the following: 
‘‘SEC. 735. STANDARDIZED REPORTING FORMAT. 
‘‘(a) IN GENERAL.—Not later than 1 year after the date of 
enactment of this section, the Secretary shall establish (and periodi-
cally update) a standardized reporting format for the voluntary 
reporting, by group health plans to State All Payer Claims Data-
bases, of medical claims, pharmacy claims, dental claims, and eligi-
bility and provider files that are collected from private and public 
payers, and shall provide guidance to States on the process by 
which States may collect such data from such plans in the standard-
ized reporting format. 
‘‘(b) CONSULTATION.— 
‘‘(1) ADVISORY COMMITTEE.—Not later than 90 days after 
the date of enactment of this section, the Secretary shall con-
vene an Advisory Committee (referred to in this section as 
the ‘Committee’), consisting of 15 members to advise the Sec-
retary regarding the format and guidance described in para-
graph (1). 
‘‘(2) MEMBERSHIP.— 
‘‘(A) APPOINTMENT.—In accordance with subparagraph 
(B), not later than 90 days after the date of enactment 
this section, the Secretary, in coordination with the Sec-
retary of Health and Human Services, shall appoint under 
subparagraph (B)(iii), and the Comptroller General of the 
United States shall appoint under subparagraph (B)(iv), 
members who have distinguished themselves in the fields 
of health services research, health economics, health 
informatics, data privacy and security, or the governance 
of State All Payer Claims Databases, or who represent 
organizations likely to submit data to or use the database, 
including patients, employers, or employee organizations 
that sponsor group health plans, health care providers, 
health insurance issuers, or third-party administrators of 
group health plans. Such members shall serve 3-year terms 
on a staggered basis. Vacancies on the Committee shall 
be filled by appointment consistent with this paragraph 
not later than 3 months after the vacancy arises. 
‘‘(B) COMPOSITION.—The Committee shall be comprised 
of— 
‘‘(i) the Assistant Secretary of Employee Benefits 
and Security Administration of the Department of 
Labor, or a designee of such Assistant Secretary; 
‘‘(ii) the Assistant Secretary for Planning and 
Evaluation of the Department of Health and Human 
Services, or a designee of such Assistant Secretary; 
‘‘(iii) members appointed by the Secretary, in 
coordination with the Secretary of Health and Human 
Services, including— 
‘‘(I) 1 member to serve as the chair of the 
Committee;
H. R. 133—1697 
‘‘(II) 1 representative of the Centers for Medi-
care & Medicaid Services; 
‘‘(III) 1 representative of the Agency for 
Healthcare Research and Quality; 
‘‘(IV) 1 representative of the Office for Civil 
Rights of the Department of Health and Human 
Services with expertise in data privacy and secu-
rity; 
‘‘(V) 1 representative of the National Center 
for Health Statistics; 
‘‘(VI) 1 representative of the Office of the 
National Coordinator for Health Information Tech-
nology; and 
‘‘(VII) 1 representative of a State All-Payer 
Claims Database; 
‘‘(iv) members appointed by the Comptroller Gen-
eral of the United States, including— 
‘‘(I) 1 representative of an employer that spon-
sors a group health plan; 
‘‘(II) 1 representative of an employee organiza-
tion that sponsors a group health plan; 
‘‘(III) 1 academic researcher with expertise in 
health economics or health services research; 
‘‘(IV) 1 consumer advocate; and 
‘‘(V) 2 additional members. 
‘‘(3) REPORT.—Not later than 180 days after the date of 
enactment of this section, the Committee shall report to the 
Secretary, the Committee on Health, Education, Labor, and 
Pensions of the Senate, and the Committee on Energy and 
Commerce and the Committee on Education and Labor of the 
House of Representatives. Such report shall include rec-
ommendations on the establishment of the format and guidance 
described in subsection (a). 
‘‘(c) STATE ALL PAYER CLAIMS DATABASE.—In this section, the 
term ‘State All Payer Claims Database’ means, with respect to 
a State, a database that may include medical claims, pharmacy 
claims, dental claims, and eligibility and provider files, which are 
collected from private and public payers. 
‘‘(d) AUTHORIZATION
OF APPROPRIATIONS.—To carry out this 
section, there are authorized to be appropriated $5,000,000 for 
fiscal year 2021, to remain available until expended or, if sooner, 
until the date described in subsection (e). 
‘‘(e) SUNSET.—Beginning on the date on which the report is 
submitted under subsection (b)(3), subsection (b) shall have no 
force or effect.’’. 
SEC. 116. PROTECTING PATIENTS AND IMPROVING THE ACCURACY 
OF PROVIDER DIRECTORY INFORMATION. 
(a) PHSA.—Part D of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg et seq.), as added and amended by section 
102 and further amended by the previous provisions of this title, 
is further amended by inserting after section 2799A–4 the following: 
‘‘SEC. 
2799A–5. 
PROTECTING 
PATIENTS 
AND 
IMPROVING 
THE 
ACCURACY OF PROVIDER DIRECTORY INFORMATION. 
‘‘(a) PROVIDER DIRECTORY INFORMATION REQUIREMENTS.— 
‘‘(1) IN GENERAL.—For plan years beginning on or after 
January 1, 2022, each group health plan and health insurance
H. R. 133—1698 
issuer offering group or individual health insurance coverage 
shall— 
‘‘(A) establish the verification process described in para-
graph (2); 
‘‘(B) establish the response protocol described in para-
graph (3); 
‘‘(C) establish the database described in paragraph (4); 
and 
‘‘(D) include in any directory (other than the database 
described in subparagraph (C)) containing provider direc-
tory information with respect to such plan or such coverage 
the information described in paragraph (5). 
‘‘(2) VERIFICATION
PROCESS.—The verification process 
described in this paragraph is, with respect to a group health 
plan or a health insurance issuer offering group or individual 
health insurance coverage, a process— 
‘‘(A) under which, not less frequently than once every 
90 days, such plan or such issuer (as applicable) verifies 
and updates the provider directory information included 
on the database described in paragraph (4) of such plan 
or issuer of each health care provider and health care 
facility included in such database; 
‘‘(B) that establishes a procedure for the removal of 
such a provider or facility with respect to which such 
plan or issuer has been unable to verify such information 
during a period specified by the plan or issuer; and 
‘‘(C) that provides for the update of such database 
within 2 business days of such plan or issuer receiving 
from such a provider or facility information pursuant to 
section 2799B–9. 
‘‘(3) RESPONSE PROTOCOL.—The response protocol described 
in this paragraph is, in the case of an individual enrolled 
under a group health plan or group or individual health insur-
ance coverage offered by a health insurance issuer who requests 
information through a telephone call or electronic, web-based, 
or Internet-based means on whether a health care provider 
or health care facility has a contractual relationship to furnish 
items and services under such plan or such coverage, a protocol 
under which such plan or such issuer (as applicable), in the 
case such request is made through a telephone call— 
‘‘(A) responds to such individual as soon as practicable 
and in no case later than 1 business day after such call 
is received, through a written electronic or print (as 
requested by such individual) communication; and 
‘‘(B) retains such communication in such individual’s 
file for at least 2 years following such response. 
‘‘(4) DATABASE.—The database described in this paragraph 
is, with respect to a group health plan or health insurance 
issuer offering group or individual health insurance coverage, 
a database on the public website of such plan or issuer that 
contains— 
‘‘(A) a list of each health care provider and health 
care facility with which such plan or such issuer has a 
direct or indirect contractual relationship for furnishing 
items and services under such plan or such coverage; and 
‘‘(B) provider directory information with respect to each 
such provider and facility.
H. R. 133—1699 
‘‘(5) INFORMATION.—The information described in this para-
graph is, with respect to a print directory containing provider 
directory information with respect to a group health plan or 
individual or group health insurance coverage offered by a 
health insurance issuer, a notification that such information 
contained in such directory was accurate as of the date of 
publication of such directory and that an individual enrolled 
under such plan or such coverage should consult the database 
described in paragraph (4) with respect to such plan or such 
coverage or contact such plan or the issuer of such coverage 
to obtain the most current provider directory information with 
respect to such plan or such coverage. 
‘‘(6) DEFINITION.—For purposes of this subsection, the term 
‘provider directory information’ includes, with respect to a group 
health plan and a health insurance issuer offering group or 
individual health insurance coverage, the name, address, spe-
cialty, telephone number, and digital contact information of 
each health care provider or health care facility with which 
such plan or such issuer has a contractual relationship for 
furnishing items and services under such plan or such coverage. 
‘‘(7) RULE OF CONSTRUCTION.—Nothing in this section shall 
be construed to preempt any provision of State law relating 
to health care provider directories. 
‘‘(b) COST-SHARING FOR SERVICES PROVIDED BASED ON RELIANCE 
ON INCORRECT PROVIDER NETWORK INFORMATION.— 
‘‘(1) IN GENERAL.—For plan years beginning on or after 
January 1, 2022, in the case of an item or service furnished 
to a participant, beneficiary, or enrollee of a group health 
plan or group or individual health insurance coverage offered 
by a health insurance issuer by a nonparticipating provider 
or a nonparticipating facility, if such item or service would 
otherwise be covered under such plan or coverage if furnished 
by a participating provider or participating facility and if either 
of the criteria described in paragraph (2) applies with respect 
to such participant, beneficiary, or enrollee and item or service, 
the plan or coverage— 
‘‘(A) shall not impose on such participant, beneficiary, 
or enrollee a cost-sharing amount for such item or service 
so furnished that is greater than the cost-sharing amount 
that would apply under such plan or coverage had such 
item or service been furnished by a participating provider; 
and 
‘‘(B) shall apply the deductible or out-of-pocket max-
imum, if any, that would apply if such services were fur-
nished by a participating provider or a participating 
facility. 
‘‘(2) CRITERIA DESCRIBED.—For purposes of paragraph (1), 
the criteria described in this paragraph, with respect to an 
item or service furnished to a participant, beneficiary, or 
enrollee of a group health plan or group or individual health 
insurance coverage offered by a health insurance issuer by 
a nonparticipating provider or a nonparticipating facility, are 
the following: 
‘‘(A) The participant, beneficiary, or enrollee received 
through a database, provider directory, or response protocol 
described in subsection (a) information with respect to such 
item and service to be furnished and such information
H. R. 133—1700 
provided that the provider was a participating provider 
or facility was a participating facility, with respect to the 
plan for furnishing such item or service. 
‘‘(B) The information was not provided, in accordance 
with subsection (a), to the participant, beneficiary, or 
enrollee and the participant, beneficiary, or enrollee 
requested through the response protocol described in sub-
section (a)(3) of the plan or coverage information on 
whether the provider was a participating provider or 
facility was a participating facility with respect to the 
plan for furnishing such item or service and was informed 
through such protocol that the provider was such a partici-
pating provider or facility was such a participating facility. 
‘‘(c) DISCLOSURE ON PATIENT PROTECTIONS AGAINST BALANCE 
BILLING.—For plan years beginning on or after January 1, 2022, 
each group health plan and health insurance issuer offering group 
or individual health insurance coverage shall make publicly avail-
able, post on a public website of such plan or issuer, and include 
on each explanation of benefits for an item or service with respect 
to which the requirements under section 2799A–1 applies— 
‘‘(1) information in plain language on— 
‘‘(A) the requirements and prohibitions applied under 
sections 2799B–1 and 2799B–2 (relating to prohibitions 
on balance billing in certain circumstances); 
‘‘(B) if provided for under applicable State law, any 
other requirements on providers and facilities regarding 
the amounts such providers and facilities may, with respect 
to an item or service, charge a participant, beneficiary, 
or enrollee of such plan or coverage with respect to which 
such a provider or facility does not have a contractual 
relationship for furnishing such item or service under the 
plan or coverage after receiving payment from the plan 
or coverage for such item or service and any applicable 
cost sharing payment from such participant, beneficiary, 
or enrollee; and 
‘‘(C) the requirements applied under section 2799A- 
1; and 
‘‘(2) information on contacting appropriate State and Fed-
eral agencies in the case that an individual believes that such 
a provider or facility has violated any requirement described 
in paragraph (1) with respect to such individual.’’. 
(b) ERISA.—Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 
1185 et seq.), as amended by sections 102, 105, 113, and 114, 
is further amended by inserting after section 719 the following: 
‘‘SEC. 720. PROTECTING PATIENTS AND IMPROVING THE ACCURACY 
OF PROVIDER DIRECTORY INFORMATION. 
‘‘(a) PROVIDER DIRECTORY INFORMATION REQUIREMENTS.— 
‘‘(1) IN GENERAL.—For plan years beginning on or after 
January 1, 2022, each group health plan and health insurance 
issuer offering group health insurance coverage shall— 
‘‘(A) establish the verification process described in para-
graph (2); 
‘‘(B) establish the response protocol described in para-
graph (3);
H. R. 133—1701 
‘‘(C) establish the database described in paragraph (4); 
and 
‘‘(D) include in any directory (other than the database 
described in subparagraph (C)) containing provider direc-
tory information with respect to such plan or such coverage 
the information described in paragraph (5). 
‘‘(2) VERIFICATION
PROCESS.—The verification process 
described in this paragraph is, with respect to a group health 
plan or a health insurance issuer offering group health insur-
ance coverage, a process— 
‘‘(A) under which, not less frequently than once every 
90 days, such plan or such issuer (as applicable) verifies 
and updates the provider directory information included 
on the database described in paragraph (4) of such plan 
or issuer of each health care provider and health care 
facility included in such database; 
‘‘(B) that establishes a procedure for the removal of 
such a provider or facility with respect to which such 
plan or issuer has been unable to verify such information 
during a period specified by the plan or issuer; and 
‘‘(C) that provides for the update of such database 
within 2 business days of such plan or issuer receiving 
from such a provider or facility information pursuant to 
section 2799B–9 of the Public Health Service Act. 
‘‘(3) RESPONSE PROTOCOL.—The response protocol described 
in this paragraph is, in the case of an individual enrolled 
under a group health plan or group health insurance coverage 
offered by a health insurance issuer who requests information 
through a telephone call or electronic, web-based, or Internet- 
based means on whether a health care provider or health 
care facility has a contractual relationship to furnish items 
and services under such plan or such coverage, a protocol 
under which such plan or such issuer (as applicable), in the 
case such request is made through a telephone call— 
‘‘(A) responds to such individual as soon as practicable 
and in no case later than 1 business day after such call 
is received, through a written electronic or print (as 
requested by such individual) communication; and 
‘‘(B) retains such communication in such individual’s 
file for at least 2 years following such response. 
‘‘(4) DATABASE.—The database described in this paragraph 
is, with respect to a group health plan or health insurance 
issuer offering group health insurance coverage, a database 
on the public website of such plan or issuer that contains— 
‘‘(A) a list of each health care provider and health 
care facility with which such plan or such issuer has a 
direct or indirect contractual relationship for furnishing 
items and services under such plan or such coverage; and 
‘‘(B) provider directory information with respect to each 
such provider and facility. 
‘‘(5) INFORMATION.—The information described in this para-
graph is, with respect to a print directory containing provider 
directory information with respect to a group health plan or 
group health insurance coverage offered by a health insurance 
issuer, a notification that such information contained in such 
directory was accurate as of the date of publication of such 
directory and that an individual enrolled under such plan or
H. R. 133—1702 
such coverage should consult the database described in para-
graph (4) with respect to such plan or such coverage or contact 
such plan or the issuer of such coverage to obtain the most 
current provider directory information with respect to such 
plan or such coverage. 
‘‘(6) DEFINITION.—For purposes of this subsection, the term 
‘provider directory information’ includes, with respect to a group 
health plan and a health insurance issuer offering group health 
insurance coverage, the name, address, specialty, telephone 
number, and digital contact information of each health care 
provider or health care facility with which such plan or such 
issuer has a contractual relationship for furnishing items and 
services under such plan or such coverage. 
‘‘(7) RULE OF CONSTRUCTION.—Nothing in this section shall 
be construed to preempt any provision of State law relating 
to health care provider directories, to the extent such State 
law applies to such plan, coverage, or issuer, subject to section 
514. 
‘‘(b) COST-SHARING FOR SERVICES PROVIDED BASED ON RELIANCE 
ON INCORRECT PROVIDER NETWORK INFORMATION.— 
‘‘(1) IN GENERAL.—For plan years beginning on or after 
January 1, 2022, in the case of an item or service furnished 
to a participant or beneficiary of a group health plan or group 
health insurance coverage offered by a health insurance issuer 
by a nonparticipating provider or a nonparticipating facility, 
if such item or service would otherwise be covered under such 
plan or coverage if furnished by a participating provider or 
participating facility and if either of the criteria described in 
paragraph (2) applies with respect to such participant or bene-
ficiary and item or service, the plan or coverage— 
‘‘(A) shall not impose on such participant or beneficiary 
a cost-sharing amount for such item or service so furnished 
that is greater than the cost-sharing amount that would 
apply under such plan or coverage had such item or service 
been furnished by a participating provider; and 
‘‘(B) shall apply the deductible or out-of-pocket max-
imum, if any, that would apply if such services were fur-
nished by a participating provider or a participating 
facility. 
‘‘(2) CRITERIA DESCRIBED.—For purposes of paragraph (1), 
the criteria described in this paragraph, with respect to an 
item or service furnished to a participant or beneficiary of 
a group health plan or group health insurance coverage offered 
by a health insurance issuer by a nonparticipating provider 
or a nonparticipating facility, are the following: 
‘‘(A) The participant or beneficiary received through 
a database, provider directory, or response protocol 
described in subsection (a) information with respect to such 
item and service to be furnished and such information 
provided that the provider was a participating provider 
or facility was a participating facility, with respect to the 
plan for furnishing such item or service. 
‘‘(B) The information was not provided, in accordance 
with subsection (a), to the participant or beneficiary and 
the participant or beneficiary requested through the 
response protocol described in subsection (a)(3) of the plan 
or coverage information on whether the provider was a
H. R. 133—1703 
participating provider or facility was a participating facility 
with respect to the plan for furnishing such item or service 
and was informed through such protocol that the provider 
was such a participating provider or facility was such a 
participating facility. 
‘‘(c) DISCLOSURE ON PATIENT PROTECTIONS AGAINST BALANCE 
BILLING.—For plan years beginning on or after January 1, 2022, 
each group health plan and health insurance issuer offering group 
health insurance coverage shall make publicly available, post on 
a public website of such plan or issuer, and include on each expla-
nation of benefits for an item or service with respect to which 
the requirements under section 716 applies— 
‘‘(1) information in plain language on— 
‘‘(A) the requirements and prohibitions applied under 
sections 2799B–1 and 2799B–2 of the Public Health Service 
Act (relating to prohibitions on balance billing in certain 
circumstances); 
‘‘(B) if provided for under applicable State law, any 
other requirements on providers and facilities regarding 
the amounts such providers and facilities may, with respect 
to an item or service, charge a participant or beneficiary 
of such plan or coverage with respect to which such a 
provider or facility does not have a contractual relationship 
for furnishing such item or service under the plan or cov-
erage after receiving payment from the plan or coverage 
for such item or service and any applicable cost sharing 
payment from such participant or beneficiary; and 
‘‘(C) the requirements applied under section 716; and 
‘‘(2) information on contacting appropriate State and Fed-
eral agencies in the case that an individual believes that such 
a provider or facility has violated any requirement described 
in paragraph (1) with respect to such individual.’’. 
(c) IRC.—Subchapter B of chapter 100 of the Internal Revenue 
Code of 1986, as amended by sections 102, 105, 113, and 114, 
is further amended by inserting after section 9819 the following: 
‘‘SEC. 9820. PROTECTING PATIENTS AND IMPROVING THE ACCURACY 
OF PROVIDER DIRECTORY INFORMATION. 
‘‘(a) PROVIDER DIRECTORY INFORMATION REQUIREMENTS.— 
‘‘(1) IN GENERAL.—For plan years beginning on or after 
January 1, 2022, each group health plan shall— 
‘‘(A) establish the verification process described in para-
graph (2); 
‘‘(B) establish the response protocol described in para-
graph (3); 
‘‘(C) establish the database described in paragraph (4); 
and 
‘‘(D) include in any directory (other than the database 
described in subparagraph (C)) containing provider direc-
tory information with respect to such plan the information 
described in paragraph (5). 
‘‘(2) VERIFICATION
PROCESS.—The verification process 
described in this paragraph is, with respect to a group health 
plan, a process— 
‘‘(A) under which, not less frequently than once every 
90 days, such plan verifies and updates the provider direc-
tory information included on the database described in
H. R. 133—1704 
paragraph (4) of such plan or issuer of each health care 
provider and health care facility included in such database; 
‘‘(B) that establishes a procedure for the removal of 
such a provider or facility with respect to which such 
plan or issuer has been unable to verify such information 
during a period specified by the plan or issuer; and 
‘‘(C) that provides for the update of such database 
within 2 business days of such plan or issuer receiving 
from such a provider or facility information pursuant to 
section 2799B–9 of the Public Health Service Act. 
‘‘(3) RESPONSE PROTOCOL.—The response protocol described 
in this paragraph is, in the case of an individual enrolled 
under a group health plan who requests information through 
a telephone call or electronic, web-based, or Internet-based 
means on whether a health care provider or health care facility 
has a contractual relationship to furnish items and services 
under such plan, a protocol under which such plan or such 
issuer (as applicable), in the case such request is made through 
a telephone call— 
‘‘(A) responds to such individual as soon as practicable 
and in no case later than 1 business day after such call 
is received, through a written electronic or print (as 
requested by such individual) communication; and 
‘‘(B) retains such communication in such individual’s 
file for at least 2 years following such response. 
‘‘(4) DATABASE.—The database described in this paragraph 
is, with respect to a group health plan, a database on the 
public website of such plan or issuer that contains— 
‘‘(A) a list of each health care provider and health 
care facility with which such plan or such issuer has a 
direct or indirect contractual relationship for furnishing 
items and services under such plan; and 
‘‘(B) provider directory information with respect to each 
such provider and facility. 
‘‘(5) INFORMATION.—The information described in this para-
graph is, with respect to a print directory containing provider 
directory information with respect to a group health plan, a 
notification that such information contained in such directory 
was accurate as of the date of publication of such directory 
and that an individual enrolled under such plan should consult 
the database described in paragraph (4) with respect to such 
plan or contact such plan to obtain the most current provider 
directory information with respect to such plan. 
‘‘(6) DEFINITION.—For purposes of this subsection, the term 
‘provider directory information’ includes, with respect to a group 
health plan, the name, address, specialty, telephone number, 
and digital contact information of each health care provider 
or health care facility with which such plan has a contractual 
relationship for furnishing items and services under such plan. 
‘‘(7) RULE OF CONSTRUCTION.—Nothing in this section shall 
be construed to preempt any provision of State law relating 
to health care provider directories. 
‘‘(b) COST-SHARING FOR SERVICES PROVIDED BASED ON RELIANCE 
ON INCORRECT PROVIDER NETWORK INFORMATION.— 
‘‘(1) IN GENERAL.—For plan years beginning on or after 
January 1, 2022, in the case of an item or service furnished 
to a participant or beneficiary of a group health plan by a
H. R. 133—1705 
nonparticipating provider or a nonparticipating facility, if such 
item or service would otherwise be covered under such plan 
if furnished by a participating provider or participating facility 
and if either of the criteria described in paragraph (2) applies 
with respect to such participant or beneficiary and item or 
service, the plan— 
‘‘(A) shall not impose on such participant or beneficiary 
a cost-sharing amount for such item or service so furnished 
that is greater than the cost-sharing amount that would 
apply under such plan had such item or service been fur-
nished by a participating provider; and 
‘‘(B) shall apply the deductible or out-of-pocket max-
imum, if any, that would apply if such services were fur-
nished by a participating provider or a participating 
facility. 
‘‘(2) CRITERIA DESCRIBED.—For purposes of paragraph (1), 
the criteria described in this paragraph, with respect to an 
item or service furnished to a participant or beneficiary of 
a group health plan by a nonparticipating provider or a non-
participating facility, are the following: 
‘‘(A) The participant or beneficiary received through 
a database, provider directory, or response protocol 
described in subsection (a) information with respect to such 
item and service to be furnished and such information 
provided that the provider was a participating provider 
or facility was a participating facility, with respect to the 
plan for furnishing such item or service. 
‘‘(B) The information was not provided, in accordance 
with subsection (a), to the participant or beneficiary and 
the participant or beneficiary requested through the 
response protocol described in subsection (a)(3) of the plan 
information on whether the provider was a participating 
provider or facility was a participating facility with respect 
to the plan for furnishing such item or service and was 
informed through such protocol that the provider was such 
a participating provider or facility was such a participating 
facility. 
‘‘(c) DISCLOSURE ON PATIENT PROTECTIONS AGAINST BALANCE 
BILLING.—For plan years beginning on or after January 1, 2022, 
each group health plan shall make publicly available, post on a 
public website of such plan or issuer, and include on each expla-
nation of benefits for an item or service with respect to which 
the requirements under section 9816 applies— 
‘‘(1) information in plain language on— 
‘‘(A) the requirements and prohibitions applied under 
sections 2799B–1 and 2799B–2 of the Public Health Service 
Act(relating to prohibitions on balance billing in certain 
circumstances); 
‘‘(B) if provided for under applicable State law, any 
other requirements on providers and facilities regarding 
the amounts such providers and facilities may, with respect 
to an item or service, charge a participant or beneficiary 
of such plan with respect to which such a provider or 
facility does not have a contractual relationship for fur-
nishing such item or service under the plan after receiving 
payment from the plan for such item or service and any
H. R. 133—1706 
applicable cost sharing payment from such participant or 
beneficiary; and 
‘‘(C) the requirements applied under section 9816; and 
‘‘(2) information on contacting appropriate State and Fed-
eral agencies in the case that an individual believes that such 
a provider or facility has violated any requirement described 
in paragraph (1) with respect to such individual.’’. 
(d) CLERICAL AMENDMENTS.— 
(1) ERISA.—The table of contents in section 1 of the 
Employee Retirement Income Security Act of 1974 (29 U.S.C. 
1001 et seq.), as amended by the previous provisions of this 
title, is further amended by inserting after the item relating 
to section 719 the following new item: 
‘‘720. Protecting patients and improving the accuracy of provider directory informa-
tion.’’. 
(2) IRC.—The table of sections for subchapter B of chapter 
100 of the Internal Revenue Code of 1986, as amended by 
the previous provisions of this title, is further amended by 
inserting after the item relating to section 9819 the following 
new item: 
‘‘9820. Protecting patients and improving the accuracy of provider directory informa-
tion.’’. 
(e) PROVIDER REQUIREMENTS.—Part E of title XXVII of the 
Public Health Service Act (42 U.S.C. 300gg et seq.), as added 
by section 104 and as further amended by the previous provisions 
of this title, is further amended by adding at the end the following: 
‘‘SEC. 2799B–9. PROVIDER REQUIREMENTS TO PROTECT PATIENTS AND 
IMPROVE THE ACCURACY OF PROVIDER DIRECTORY 
INFORMATION. 
‘‘(a) PROVIDER BUSINESS PROCESSES.—Beginning not later than 
January 1, 2022, each health care provider and each health care 
facility shall have in place business processes to ensure the timely 
provision of provider directory information to a group health plan 
or a health insurance issuer offering group or individual health 
insurance coverage to support compliance by such plans or issuers 
with section 2799A–5(a)(1), section 720(a)(1) of the Employee Retire-
ment Income Security Act of 1974, or section 9820(a)(1) of the 
Internal Revenue Code of 1986, as applicable. Such providers shall 
submit provider directory information to a plan or issuers, at a 
minimum— 
‘‘(1) when the provider or facility begins a network agree-
ment with a plan or with an issuer with respect to certain 
coverage; 
‘‘(2) when the provider or facility terminates a network 
agreement with a plan or with an issuer with respect to certain 
coverage; 
‘‘(3) when there are material changes to the content of 
provider directory information of the provider or facility 
described in section 2799A–5(a)(1), section 720(a)(1) of the 
Employee Retirement Income Security Act of 1974, or section 
9820(a)(1) of the Internal Revenue Code of 1986, as applicable; 
and
H. R. 133—1707 
‘‘(4) at any other time (including upon the request of such 
issuer or plan) determined appropriate by the provider, facility, 
or the Secretary. 
‘‘(b) REFUNDS TO ENROLLEES.—If a health care provider submits 
a bill to an enrollee based on cost-sharing for treatment or services 
provided by the health care provider that is in excess of the normal 
cost-sharing applied for such treatment or services provided in- 
network, as prohibited under section 2799A–5(b), section 720(b) 
of the Employee Retirement Income Security Act of 1974, or section 
9820(b) of the Internal Revenue Code of 1986, as applicable, and 
the enrollee pays such bill, the provider shall reimburse the enrollee 
for the full amount paid by the enrollee in excess of the in-network 
cost-sharing amount for the treatment or services involved, plus 
interest, at an interest rate determined by the Secretary. 
‘‘(c) LIMITATION.—Nothing in this section shall prohibit a pro-
vider from requiring in the terms of a contract, or contract termi-
nation, with a group health plan or health insurance issuer— 
‘‘(1) that the plan or issuer remove, at the time of termi-
nation of such contract, the provider from a directory of the 
plan or issuer described in section 2799A–5(a), section 720(a) 
of the Employee Retirement Income Security Act of 1974, or 
section 9820(a) of the Internal Revenue Code of 1986, as 
applicable; or 
‘‘(2) that the plan or issuer bear financial responsibility, 
including under section 2799A–5(b), section 720(b) of the 
Employee Retirement Income Security Act of 1974, or section 
9820(b) of the Internal Revenue Code of 1986, as applicable, 
for providing inaccurate network status information to an 
enrollee. 
‘‘(d) DEFINITION.—For purposes of this section, the term ‘pro-
vider directory information’ includes the names, addresses, spe-
cialty, telephone numbers, and digital contact information of indi-
vidual health care providers, and the names, addresses, telephone 
numbers, and digital contact information of each medical group, 
clinic, or facility contracted to participate in any of the networks 
of the group health plan or health insurance coverage involved. 
‘‘(e) RULE OF CONSTRUCTION.—Nothing in this section shall 
be construed to preempt any provision of State law relating to 
health care provider directories.’’. 
SEC. 117. ADVISORY COMMITTEE ON GROUND AMBULANCE AND 
PATIENT BILLING. 
(a) IN GENERAL.—Not later than 90 days after the date of 
enactment of this Act, the Secretary of Labor, Secretary of Health 
and Human Services, and the Secretary of the Treasury (the Secre-
taries) shall jointly establish an advisory committee for the purpose 
of reviewing options to improve the disclosure of charges and fees 
for ground ambulance services, better inform consumers of insur-
ance options for such services, and protect consumers from balance 
billing. 
(b) COMPOSITION OF THE ADVISORY COMMITTEE.—The advisory 
committee shall be composed of the following members: 
(1) The Secretary of Labor, or the Secretary’s designee. 
(2) The Secretary of Health and Human Services, or the 
Secretary’s designee. 
(3) The Secretary of the Treasury, or the Secretary’s des-
ignee.
H. R. 133—1708 
(4) One representative, to be appointed jointly by the Secre-
taries, for each of the following: 
(A) Each relevant Federal agency, as determined by 
the Secretaries. 
(B) State insurance regulators. 
(C) Health insurance providers. 
(D) Patient advocacy groups. 
(E) Consumer advocacy groups. 
(F) State and local governments. 
(G) Physician specializing in emergency, trauma, car-
diac, or stroke. 
(H) State Emergency Medical Services Officials. 
(I) Emergency medical technicians, paramedics, and 
other emergency medical services personnel. 
(5) Three representatives, to be appointed jointly by the 
Secretaries, to represent the various segments of the ground 
ambulance industry. 
(6) Up to an additional 2 representatives otherwise not 
described in paragraphs (1) through (5), as determined nec-
essary and appropriate by the Secretaries. 
(c) CONSULTATION.—The advisory committee shall, as appro-
priate, consult with relevant experts and stakeholders, including 
those not otherwise included under subsection (b), while conducting 
the review described in subsection (a). 
(d) RECOMMENDATIONS.—The advisory committee shall make 
recommendations with respect to disclosure of charges and fees 
for ground ambulance services and insurance coverage, consumer 
protection and enforcement authorities of the Departments of Labor, 
Health and Human Services, and the Treasury and State authori-
ties, and the prevention of balance billing to consumers. The rec-
ommendations shall address, at a minimum— 
(1) options, best practices, and identified standards to pre-
vent instances of balance billing; 
(2) steps that can be taken by State legislatures, State 
insurance regulators, State attorneys general, and other State 
officials as appropriate, consistent with current legal authorities 
regarding consumer protection; and 
(3) legislative options for Congress to prevent balance 
billing. 
(e) REPORT.—Not later than 180 days after the date of the 
first meeting of the advisory committee, the advisory committee 
shall submit to the Secretaries, and the Committees on Education 
and Labor, Energy and Commerce, and Ways and Means of the 
House of Representatives and the Committees on Finance and 
Health, Education, Labor, and Pensions a report containing the 
recommendations made under subsection (d). 
SEC. 118. IMPLEMENTATION FUNDING. 
(a) IN GENERAL.—For the purposes described in subsection 
(b), there are appropriated, out of amounts in the Treasury not 
otherwise appropriated, to the Secretary of Health and Human 
Services, the Secretary of Labor, and the Secretary of the Treasury, 
$500,000,000 for fiscal year 2021, to remain available until 
expended through 2024.
H. R. 133—1709 
(b) PERMITTED PURPOSES.—The purposes described in this sub-
section are limited to the following purposes, insofar as such pur-
poses are to carry out the provisions of, including the amendments 
made by, this title and title II: 
(1) Preparing, drafting, and issuing proposed and final 
regulations or interim regulations. 
(2) Preparing, drafting, and issuing guidance and public 
information. 
(3) Preparing and holding public meetings. 
(4) Preparing, drafting, and publishing reports. 
(5) Enforcement of such provisions. 
(6) Reporting, collection, and analysis of data. 
(7) Establishment and initial implementation of the proc-
esses for independent dispute resolution and implementation 
of patient-provider dispute resolution under such provisions. 
(8) Conducting audits. 
(9) Other administrative duties necessary for implementa-
tion of such provisions. 
(c) TRANSPARENCY
OF IMPLEMENTATION FUNDS.—Each Sec-
retary described in subsection (a) shall annually submit to the 
Committees on Energy and Commerce, on Ways and Means, on 
Education and Labor, and on Appropriations of the House of Rep-
resentatives and on the Committees on Health, Education, Labor, 
and Pensions and on Appropriations of the Senate a report on 
funds expended pursuant to funds appropriated under this section. 
TITLE II—TRANSPARENCY 
SEC. 201. INCREASING TRANSPARENCY BY REMOVING GAG CLAUSES 
ON PRICE AND QUALITY INFORMATION. 
(a) PHSA.—Part D of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg et seq.), as added and amended by title 
I, is further amended by adding at the end the following: 
‘‘SEC. 2799A–9. INCREASING TRANSPARENCY BY REMOVING GAG 
CLAUSES ON PRICE AND QUALITY INFORMATION. 
‘‘(a) INCREASING PRICE AND QUALITY TRANSPARENCY FOR PLAN 
SPONSORS AND GROUP AND INDIVIDUAL MARKET CONSUMERS.— 
‘‘(1) GROUP HEALTH PLANS.—A group health plan or health 
insurance issuer offering group health insurance coverage may 
not enter into an agreement with a health care provider, net-
work or association of providers, third-party administrator, or 
other service provider offering access to a network of providers 
that would directly or indirectly restrict a group health plan 
or health insurance issuer offering such coverage from— 
‘‘(A) providing provider-specific cost or quality of care 
information or data, through a consumer engagement tool 
or any other means, to referring providers, the plan 
sponsor, enrollees, or individuals eligible to become 
enrollees of the plan or coverage; 
‘‘(B) electronically accessing de-identified claims and 
encounter information or data for each enrollee in the 
plan or coverage, upon request and consistent with the 
privacy regulations promulgated pursuant to section 264(c) 
of the Health Insurance Portability and Accountability Act 
of 1996, the amendments made by the Genetic Information
H. R. 133—1710 
Nondiscrimination Act of 2008, and the Americans with 
Disabilities Act of 1990, including, on a per claim basis— 
‘‘(i) financial information, such as the allowed 
amount, or any other claim-related financial obliga-
tions included in the provider contract; 
‘‘(ii) provider information, including name and clin-
ical designation; 
‘‘(iii) service codes; or 
‘‘(iv) any other data element included in claim 
or encounter transactions; or 
‘‘(C) sharing information or data described in subpara-
graph (A) or (B), or directing that such data be shared, 
with a business associate as defined in section 160.103 
of title 45, Code of Federal Regulations (or successor regula-
tions), consistent with the privacy regulations promulgated 
pursuant to section 264(c) of the Health Insurance Port-
ability and Accountability Act of 1996, the amendments 
made by the Genetic Information Nondiscrimination Act 
of 2008, and the Americans with Disabilities Act of 1990. 
‘‘(2) INDIVIDUAL HEALTH INSURANCE COVERAGE.—A health 
insurance issuer offering individual health insurance coverage 
may not enter into an agreement with a health care provider, 
network or association of providers, or other service provider 
offering access to a network of providers that would directly 
or indirectly restrict the health insurance issuer from— 
‘‘(A) providing provider-specific price or quality of care 
information, through a consumer engagement tool or any 
other means, to referring providers, enrollees, or individ-
uals eligible to become enrollees of the plan or coverage; 
or 
‘‘(B) sharing, for plan design, plan administration, and 
plan, financial, legal, and quality improvement activities, 
data described in subparagraph (A) with a business asso-
ciate as defined in section 160.103 of title 45, Code of 
Federal Regulations (or successor regulations), consistent 
with the privacy regulations promulgated pursuant to sec-
tion 264(c) of the Health Insurance Portability and Account-
ability Act of 1996, the amendments made by the Genetic 
Information Nondiscrimination Act of 2008, and the Ameri-
cans with Disabilities Act of 1990. 
‘‘(3) CLARIFICATION
REGARDING
PUBLIC
DISCLOSURE
OF 
INFORMATION.—Nothing in paragraph (1)(A) or (2)(A) prevents 
a health care provider, network or association of providers, 
or other service provider from placing reasonable restrictions 
on the public disclosure of the information described in such 
paragraphs (1) and (2). 
‘‘(4) ATTESTATION.—A group health plan or a health insur-
ance issuer offering group or individual health insurance cov-
erage 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. 
‘‘(5) RULES OF CONSTRUCTION.—Nothing in this section shall 
be construed to modify or eliminate existing privacy protections 
and standards under State and Federal law. Nothing in this 
subsection shall be construed to otherwise limit access by a 
group health plan, plan sponsor, or health insurance issuer 
to data as permitted under the privacy regulations promulgated