I 
116TH CONGRESS 
2D SESSION 
H. R. 5807 
To amend title XXVII of the Public Health Service Act, the Internal Revenue 
Code of 1986, the Employee Retirement Income Security Act of 1974, 
and title XI of the Social Security Act to improve the availability and 
accuracy of provider directory information made available by group health 
plans and health insurance issuers offering group or individuals health 
insurance coverage. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 7, 2020 
Mr. LARSON of Connecticut (for himself and Mr. WENSTRUP) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Ways and Means, and Edu-
cation 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 Internal Revenue Code of 1986, the Employee Retire-
ment Income Security Act of 1974, and title XI of the 
Social Security Act to improve the availability and accu-
racy of provider directory information made available 
by group health plans and health insurance issuers offer-
ing group or individuals health insurance coverage. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Know Your Provider 
Act of 2020’’. 
SEC. 2. IMPROVING THE AVAILABILITY AND ACCURACY OF 
PROVIDER DIRECTORY INFORMATION MADE 
AVAILABLE BY GROUP HEALTH PLANS AND 
HEALTH 
INSURANCE 
ISSUERS 
OFFERING 
GROUP OR INDIVIDUALS HEALTH INSUR-
ANCE COVERAGE. 
(a) GROUP HEALTH PLAN AND HEALTH INSURANCE 
ISSUER REQUIREMENTS.— 
(1) PUBLIC HEALTH SERVICE ACT.—Subpart II 
of part A of title XXVII of the Public Health Serv-
ice Act (42 U.S.C. 300gg–11 et seq.) is amended by 
adding at the end the following new section: 
‘‘SEC. 2730. PROVIDER DIRECTORY REQUIREMENTS. 
‘‘(a) IN GENERAL.—Beginning not later than Janu-
ary 1, 2022, each group health plan and health insurance 
issuer offering group or individual health insurance cov-
erage shall— 
‘‘(1) establish the verification process described 
in subsection (b); 
‘‘(2) establish the response protocol described in 
subsection (c); 
‘‘(3) establish the database described in sub-
section (d); and 
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‘‘(4) include in any directory (other than the 
database described in paragraph (3)) containing pro-
vider directory information with respect to such plan 
or such coverage the information described in sub-
section (e). 
‘‘(b) VERIFICATION
PROCESS.—The verification 
process described in this subsection is, with respect to a 
group health plan or a health insurance issuer offering 
group or individual health insurance coverage, a process— 
‘‘(1) under which such plan or such issuer (as 
applicable) verifies and updates the provider direc-
tory information included on the database described 
in subsection (d) of such plan or issuer of— 
‘‘(A) not less frequently than once every 90 
days, a random sample of at least 10 percent 
of health care providers and health care facili-
ties included in such database; and 
‘‘(B) any such provider or such facility in-
cluded in such database that has not submitted 
any claim to such plan or such issuer (as appli-
cable) during a 12-month period; 
‘‘(2) that establishes a procedure for the re-
moval from such database of such a provider or fa-
cility with respect to which such plan or issuer has 
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been unable to verify such information during a pe-
riod specified by the plan or issuer; and 
‘‘(3) that provides for the update of such data-
base within 2 business days of such plan or such 
issuer (as applicable) receiving from such a provider 
or facility information pursuant to section 1150C of 
the Social Security Act. 
‘‘(c) RESPONSE PROTOCOL.—The response protocol 
described in this subsection is, in the case of an individual 
enrolled under a group health plan or group or individual 
health insurance coverage offered by a health insurance 
issuer who requests information through a telephone call 
or email 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)— 
‘‘(1) responds to such individual as soon as 
practicable, and in no case later than 1 business day 
after such call or email is received, through a writ-
ten electronic communication; and 
‘‘(2) retains such communication in such indi-
vidual’s file for at least 2 years following such re-
sponse. 
‘‘(d) DATABASE.—The database described in this 
subsection is, with respect to a group health plan or health 
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insurance issuer offering group or individual health insur-
ance coverage, a database on the public website of such 
plan or issuer that contains— 
‘‘(1) a list of each health care provider and 
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; 
and 
‘‘(2) provider directory information with respect 
to each such provider and facility. 
‘‘(e) INFORMATION.—The information described in 
this subsection is, with respect to a directory containing 
provider directory information with respect to a group 
health plan or individual or group health insurance cov-
erage offered by a health insurance issuer, a notification 
that such information contained in such directory was ac-
curate as of the date of publication of such directory and 
that an individual enrolled under such plan or such cov-
erage should consult the database described in subsection 
(d) 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. 
‘‘(f) DEFINITION.—For purposes of this section, the 
term ‘provider directory information’ includes, with re-
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spect to a group health plan and a health insurance issuer 
offering group or individual health insurance coverage, the 
name, address, specialty, and telephone number of each 
health care provider or health care facility with which such 
plan or such issuer has a contractual relationship for fur-
nishing items and services under such plan or such cov-
erage.’’. 
(2) INTERNAL REVENUE CODE OF 1986.— 
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986 
is amended by adding at the end the following 
new section: 
‘‘SEC. 9816. PROVIDER DIRECTORY REQUIREMENTS. 
‘‘(a) IN GENERAL.—Beginning not later than Janu-
ary 1, 2022, each group health plan shall— 
‘‘(1) establish the verification process described 
in subsection (b); 
‘‘(2) establish the response protocol described in 
subsection (c); 
‘‘(3) establish the database described in sub-
section (d); and 
‘‘(4) include in any directory (other than the 
database described in paragraph (3)) containing pro-
vider directory information with respect to such plan 
the information described in subsection (e). 
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‘‘(b) VERIFICATION
PROCESS.—The verification 
process described in this subsection is, with respect to a 
group health plan, a process— 
‘‘(1) under which such plan verifies and updates 
the provider directory information included on the 
database described in subsection (d) of such plan 
of— 
‘‘(A) not less frequently than once every 90 
days, a random sample of at least 10 percent 
of health care providers and health care facili-
ties included in such database; and 
‘‘(B) any such provider or such facility in-
cluded in such database that has not submitted 
any claim to such plan during a 12-month pe-
riod; 
‘‘(2) that establishes a procedure for the re-
moval from such database of such a provider or fa-
cility with respect to which such plan has been un-
able to verify such information during a period spec-
ified by the plan; and 
‘‘(3) that provides for the update of such data-
base within 2 business days of such plan receiving 
from such a provider or facility information pursu-
ant to section 1150C of the Social Security Act. 
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‘‘(c) RESPONSE PROTOCOL.—The response protocol 
described in this subsection is, in the case of an individual 
enrolled under a group health plan who requests informa-
tion through a telephone call or email on whether a health 
care provider or health care facility has a contractual rela-
tionship to furnish items and services under such plan, 
a protocol under which such plan— 
‘‘(1) responds to such individual as soon as 
practicable, and in no case later than 1 business day 
after such call or email is received, through a writ-
ten electronic communication; and 
‘‘(2) retains such communication in such indi-
vidual’s file for at least 2 years following such re-
sponse. 
‘‘(d) DATABASE.—The database described in this 
subsection is, with respect to a group health plan, a data-
base on the public website of such plan that contains— 
‘‘(1) a list of each health care provider and 
health care facility with which such plan has a con-
tractual relationship for furnishing items and serv-
ices under such plan; and 
‘‘(2) provider directory information with respect 
to each such provider and facility. 
‘‘(e) INFORMATION.—The information described in 
this subsection is, with respect to a directory containing 
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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 sub-
section (d) with respect to such plan or contact such plan 
to obtain the most current provider directory information 
with respect to such plan. 
‘‘(f) DEFINITION.—For purposes of this section, the 
term ‘provider directory information’ includes, with re-
spect to a group health plan, the name, address, specialty, 
and telephone number 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 or such coverage.’’. 
(B) CONFORMING
AMENDMENT.—Section 
9815(a) of the Internal Revenue Code of 1986 
is amended— 
(i) in paragraph (1), by striking ‘‘(as 
amended by the Patient Protection and Af-
fordable Care Act)’’ and inserting ‘‘(other 
than the provisions of section 2730 of such 
Act)’’; and 
(ii) in paragraph (2), by inserting 
‘‘(other than the provisions of section 2730 
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of such Act)’’ after the first occurrence of 
‘‘such part A’’. 
(C) CLERICAL AMENDMENT.—The table of 
sections for such subchapter is amended by 
adding at the end the following new items: 
‘‘Sec. 9815. Additional market reforms. 
‘‘Sec. 9816. Provider directory requirements.’’. 
(3) EMPLOYEE RETIREMENT INCOME SECURITY 
ACT OF 1974.— 
(A) 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.) is amended by adding at the end the 
following new section: 
‘‘SEC. 716. PROVIDER DIRECTORY REQUIREMENTS. 
‘‘(a) IN GENERAL.—Beginning not later than Janu-
ary 1, 2022, each group health plan and health insurance 
issuer offering group health insurance coverage shall— 
‘‘(1) establish the verification process described 
in subsection (b); 
‘‘(2) establish the response protocol described in 
subsection (c); 
‘‘(3) establish the database described in sub-
section (d); and 
‘‘(4) include in any directory (other than the 
database described in paragraph (3)) containing pro-
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vider directory information with respect to such plan 
or such coverage the information described in sub-
section (e). 
‘‘(b) VERIFICATION
PROCESS.—The verification 
process described in this subsection is, with respect to a 
group health plan or a health insurance issuer offering 
group health insurance coverage, a process— 
‘‘(1) under which such plan or such issuer (as 
applicable) verifies and updates the provider direc-
tory information included on the database described 
in subsection (d) of such plan or issuer of— 
‘‘(A) not less frequently than once every 90 
days, a random sample of at least 10 percent 
of health care providers and health care facili-
ties included in such database; and 
‘‘(B) any such provider or such facility in-
cluded in such database that has not submitted 
any claim to such plan or such issuer (as appli-
cable) during a 12-month period; 
‘‘(2) that establishes a procedure for the re-
moval from such database of such a provider or fa-
cility with respect to which such plan or issuer has 
been unable to verify such information during a pe-
riod specified by the plan or issuer; and 
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‘‘(3) that provides for the update of such data-
base within 2 business days of such plan or such 
issuer (as applicable) receiving from such a provider 
or facility information pursuant to section 1150C of 
the Social Security Act. 
‘‘(c) RESPONSE PROTOCOL.—The response protocol 
described in this subsection is, in the case of an individual 
enrolled under a group health plan or group health insur-
ance coverage offered by a health insurance issuer who 
requests information through a telephone call or email 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)— 
‘‘(1) responds to such individual as soon as 
practicable, and in no case later than 1 business day 
after such call or email is received, through a writ-
ten electronic communication; and 
‘‘(2) retains such communication in such indi-
vidual’s file for at least 2 years following such re-
sponse. 
‘‘(d) DATABASE.—The database described in this 
subsection is, with respect to a group health plan or health 
insurance issuer offering group health insurance coverage, 
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a database on the public website of such plan or issuer 
that contains— 
‘‘(1) a list of each health care provider and 
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; 
and 
‘‘(2) provider directory information with respect 
to each such provider and facility. 
‘‘(e) INFORMATION.—The information described in 
this subsection is, with respect to a 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 informa-
tion 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 subsection (d) 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. 
‘‘(f) DEFINITION.—For purposes of this section, the 
term ‘provider directory information’ includes, with re-
spect to a group health plan and a health insurance issuer 
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offering group health insurance coverage, the name, ad-
dress, specialty, and telephone number 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.’’. 
(B) CONFORMING
AMENDMENT.—Section 
715(a) of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1185d(a)) is 
amended— 
(i) in paragraph (1), by striking ‘‘(as 
amended by the Patient Protection and Af-
fordable Care Act)’’ and inserting ‘‘(other 
than the provisions of section 2730 of such 
Act)’’; and 
(ii) in paragraph (2), by inserting 
‘‘(other than the provisions of section 2730 
of such Act)’’ after the first occurrence of 
‘‘such part A’’. 
(C) CLERICAL AMENDMENT.—The table of 
contents in section 1 of the Employee Retire-
ment Income Security Act of 1974 is amended 
by inserting after the item relating to section 
714 the following new items: 
‘‘Sec. 715. Additional market reforms. 
‘‘Sec. 716. Provider directory requirements.’’. 
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(b) HEALTH CARE PROVIDERS.—Part A of title XI 
of the Social Security Act (42 U.S.C. 13010 et seq.) is 
amended by adding at the end the following new section: 
‘‘SEC. 1150C. SUBMISSION OF INFORMATION TO HEALTH 
PLANS OF CERTAIN PROVIDER INFORMA-
TION. 
‘‘(a) IN GENERAL.—Beginning not later than 1 year 
after the date of the enactment of this section, each health 
care provider and health care facility shall establish a 
process under which such provider or facility transmits, 
to each health insurance issuer offering group or indi-
vidual health insurance coverage and group health plan 
with which such provider or supplier has in effect a con-
tractual relationship for furnishing items and services 
under such coverage or such plan, provider directory infor-
mation (as defined in section 2730(e) of the Public Health 
Service Act, section 716(e) of the Employee Retirement 
Income Security Act of 1974, or section 9816(e) of the 
Internal Revenue Code of 1986, as applicable) with re-
spect to such provider or facility, as applicable. Such pro-
vider or facility shall so transmit such information to such 
issuer offering such coverage or such group health plan— 
‘‘(1) when there are any material changes (in-
cluding a change in address, telephone number, or 
other contact information) to such provider directory 
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information of the provider or facility with respect to 
such coverage offered by such issuer or with respect 
to such plan; and 
‘‘(2) at any other time (including upon the re-
quest of such issuer or plan) determined appropriate 
by the provider, facility, or the Secretary. 
‘‘(b) PENALTY.— 
‘‘(1) IN GENERAL.—Each health care provider 
or health care facility that fails to transmit informa-
tion as required under subsection (a) shall be subject 
to a civil monetary penalty of $1,000 for each day 
such provider or facility (as applicable) fails to so 
transmit such information. 
‘‘(2) APPLICATION OF PROVISIONS.—The provi-
sions of section 1128A (other than subsection (a), 
subsection (b), the first sentence of subsection 
(c)(1), subsection (d), and subsection (o)) shall 
apply with respect to a civil monetary penalty im-
posed under this subsection in the same manner as 
such provisions apply with respect to a penalty or 
proceeding under subsection (a) of such section. 
‘‘(c) DEFINITIONS.—In this section, the terms ‘health 
insurance issuer’, ‘group health plan’, ‘group health insur-
ance coverage’, and ‘individual health insurance coverage’ 
have the meaning given such terms, respectively, in section 
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2791 of the Public Health Service Act (42 U.S.C. 300gg– 
91 et seq.).’’. 
Æ 
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