I 
116TH CONGRESS 
1ST SESSION H. R. 5144 
To amend the Patient Protection and Affordable Care Act to require group 
health plans and health insurance coverage to have in place a process 
to self-audit information listed in publicly accessible provider directories 
of such plans and coverage. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 18, 2019 
Ms. DAVIDS of Kansas introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees 
on Education and Labor, and Ways and Means, for a period to be subse-
quently 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 the Patient Protection and Affordable Care Act 
to require group health plans and health insurance cov-
erage to have in place a process to self-audit information 
listed in publicly accessible provider directories of such 
plans and coverage. 
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 ‘‘Insurance Account-
ability and Transparency Act’’. 
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SEC. 2. REQUIREMENT FOR GROUP HEALTH PLANS AND 
HEALTH INSURANCE COVERAGE TO HAVE IN 
PLACE A PROCESS TO SELF-AUDIT INFORMA-
TION LISTED IN PUBLICLY ACCESSIBLE PRO-
VIDER DIRECTORIES OF SUCH PLANS AND 
COVERAGE. 
(a) PHSA.— 
(1) IN GENERAL.—Title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg et seq.) is 
amended by adding at the end the following: 
‘‘PART D—OTHER MARKET REFORMS 
‘‘SEC. 2796. PROCESS TO SELF-AUDIT INFORMATION LISTED 
IN PUBLICLY ACCESSIBLE PROVIDER DIREC-
TORIES. 
‘‘(a) IN GENERAL.—An entity specified in subsection 
(b), with respect to a group health plan or health insur-
ance coverage offered in the group or individual market, 
shall have in place a process under which, in order to self- 
audit the information listed in any publicly accessible pro-
vider directory for such plan or coverage, such entity— 
‘‘(1) contacts, not less than once every 6 
months during each plan year, each provider listed 
in such directory to verify— 
‘‘(A) contact information listed in such di-
rectory with respect to such provider; and 
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‘‘(B) the status of whether such provider is 
a provider within the network of such plan or 
coverage; and 
‘‘(2) in the case that such entity determines 
that any of the information described in subpara-
graph (A) or (B) of paragraph (1) with respect to 
a provider listed in such directory of such plan or 
coverage is inaccurate, not later than 30 days after 
making such determination, corrects and updates 
such information in such directory. 
‘‘(b) ENTITY DESCRIBED.—For purposes of sub-
section (a), an entity described in this subsection is— 
‘‘(1) in the case of health insurance coverage or 
a group health plan this is not a self-insured plan, 
the health insurance issuer offering the health insur-
ance coverage or the group health plan, respectively; 
and 
‘‘(2) in the case of a self-insured group health 
plan, the designated administrator of the plan (as 
such term is defined in section 3(16) of the Em-
ployee Retirement Income Security Act of 1974).’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 2722 of the Public Health 
Service Act (42 U.S.C. 300gg–21) is amend-
ed— 
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(i) in subsection (a)(1), by inserting 
‘‘and part D’’ after ‘‘subparts 1 and 2’’; 
(ii) in subsection (b), by inserting 
‘‘and part D’’ after ‘‘subparts 1 and 2’’; 
(iii) in subsection (c)(1), by inserting 
‘‘and part D’’ after ‘‘subparts 1 and 2’’; 
(iv) in subsection (c)(2), by inserting 
‘‘and part D’’ after ‘‘subparts 1 and 2’’; 
(v) in subsection (c)(3), by inserting 
‘‘and part D’’ after ‘‘this part’’; and 
(vi) in subsection (d), in the matter 
preceding paragraph (1), by inserting ‘‘and 
part D’’ after ‘‘this part’’. 
(B) Section 2723 of the Public Health 
Service Act (42 U.S.C. 300gg–22) is amend-
ed— 
(i) in subsection (a)(1), by inserting 
‘‘and part D’’ after ‘‘this part’’; 
(ii) in subsection (a)(2), by inserting 
‘‘or part D’’ after ‘‘this part’’; 
(iii) in subsection (b)(1), by inserting 
‘‘or part D’’ after ‘‘this part’’; 
(iv) in subsection (b)(2)(A), by insert-
ing ‘‘or part D’’ after ‘‘this part’’; and 
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‘‘SEC. 716. PROCESS TO SELF-AUDIT INFORMATION LISTED 
IN PUBLICLY ACCESSIBLE PROVIDER DIREC-
TORIES. 
‘‘(a) IN GENERAL.—An entity specified in subsection 
(b), with respect to a group health plan or health insur-
ance coverage offered in the group market, shall have in 
place a process under which, in order to self-audit the in-
formation listed in any publicly accessible provider direc-
tory for such plan or coverage, such entity— 
‘‘(1) contacts, not less than once every 6 
months during each plan year, each provider listed 
in such directory to verify— 
‘‘(A) contact information listed in such di-
rectory with respect to such provider; and 
‘‘(B) the status of whether such provider is 
a provider within the network of such plan or 
coverage; and 
‘‘(2) in the case that such entity determines 
that any of the information described in subpara-
graph (A) or (B) of paragraph (1) with respect to 
a provider listed in such directory of such plan or 
coverage is inaccurate, not later than 30 days after 
making such determination, corrects and updates 
such information in such directory. 
‘‘(b) ENTITY DESCRIBED.—For purposes of sub-
section (a), an entity described in this subsection is— 
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‘‘(1) in the case of health insurance coverage or 
a group health plan this is not a self-insured plan, 
the health insurance issuer offering the health insur-
ance coverage or the group health plan, respectively; 
and 
‘‘(2) in the case of a self-insured group health 
plan, the designated administrator of the plan (as 
such term is defined in section 3(16)).’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for part 7 of subtitle B of title I of the Em-
ployee Retirement Income Security Act of 1974 is 
amended by adding at the end the following: 
‘‘Sec. 716. Process to self-audit information listed in publicly accessible pro-
vider directories.’’. 
(c) IRC.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986 is amend-
ed by adding at the end the following new section: 
‘‘SEC. 9816. PROCESS TO SELF-AUDIT INFORMATION LISTED 
IN PUBLICLY ACCESSIBLE PROVIDER DIREC-
TORIES. 
‘‘(a) IN GENERAL.—An entity specified in subsection 
(b), with respect to a group health plan, shall have in place 
a process under which, in order to self-audit the informa-
tion listed in any publicly accessible provider directory for 
such plan, such entity— 
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‘‘(1) contacts, not less than once every 6 
months during each plan year, each provider listed 
in such directory to verify— 
‘‘(A) contact information listed in such di-
rectory with respect to such provider; and 
‘‘(B) the status of whether such provider is 
a provider within the network of such plan; and 
‘‘(2) in the case that such entity determines 
that any of the information described in subpara-
graph (A) or (B) of paragraph (1) with respect to 
a provider listed in such directory of such plan is in-
accurate, not later than 30 days after making such 
determination, corrects and updates such informa-
tion in such directory. 
‘‘(b) ENTITY DESCRIBED.—For purposes of sub-
section (a), an entity described in this subsection is— 
‘‘(1) in the case of a group health plan this is 
not a self-insured plan, the health insurance issuer 
offering the group health plan; and 
‘‘(2) in the case of a self-insured group health 
plan, the designated administrator of the plan (as 
such term is defined in section 3(16) of the Em-
ployee Retirement Income Security Act of 1974).’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for subchapter B of chapter 100 of such Code 
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is amended by adding at the end the following new 
item: 
‘‘Sec. 9816. Process to self-audit information listed in publicly accessible pro-
vider directories.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning on or after January 1, 2020. 
Æ 
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