209 
2008, and the Americans with Disabilities Act of 
1990.’’. 
SEC. 306. BANNING ANTICOMPETITIVE TERMS IN FACILITY 
AND INSURANCE CONTRACTS THAT LIMIT AC-
CESS TO HIGHER QUALITY, LOWER COST 
CARE. 
(a) IN GENERAL.—Section 2729B of the Public 
Health Service Act, as added by section 301, is amended 
by adding at the end the following: 
‘‘(b) PROTECTING HEALTH PLANS NETWORK DE-
SIGN FLEXIBILITY.— 
‘‘(1) IN GENERAL.—A group health plan or a 
health insurance issuer offering group or individual 
health insurance coverage shall not enter into an 
agreement with a provider, network or association of 
providers, or other service provider offering access to 
a network of service providers if such agreement, di-
rectly or indirectly— 
‘‘(A) restricts the group health plan or 
health insurance issuer from— 
‘‘(i) directing or steering enrollees to 
other health care providers; or 
‘‘(ii) offering incentives to encourage 
enrollees to utilize specific health care pro-
viders; 
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‘‘(B) requires the group health plan or 
health insurance issuer to enter into any addi-
tional contract with an affiliate of the provider, 
such as an affiliate of the provider, as a condi-
tion of entering into a contract with such pro-
vider; 
‘‘(C) requires the group health plan or 
health insurance issuer to agree to payment 
rates or other terms for any affiliate not party 
to the contract of the provider involved; or 
‘‘(D) restricts other group health plans or 
health insurance issuers not party to the con-
tract from paying a lower rate for items or 
services than the contracting plan or issuer 
pays for such items or services. 
‘‘(2) ADDITIONAL REQUIREMENT FOR SELF-IN-
SURED
PLANS.—A self-insured group health plan 
shall not enter into an agreement with a provider, 
network or association of providers, third-party ad-
ministrator, or other service provider offering access 
to a network of providers if such agreement directly 
or indirectly requires the group health plan to cer-
tify, attest, or otherwise confirm in writing that the 
group health plan is bound by restrictive contracting 
terms between the service provider and a third-party 
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administrator that the group health plan is not 
party to, without a disclosure that such terms exist. 
‘‘(3) EXCEPTION FOR CERTAIN GROUP MODEL 
ISSUERS.—Paragraph (1)(A) shall not apply to a 
group health plan or health insurance issuer offering 
group or individual health insurance coverage with 
respect to— 
‘‘(A) a health maintenance organization 
(as defined in section 2791(b)(3)), if such 
health maintenance organization operates pri-
marily through exclusive contracts with multi- 
specialty physician groups, nor to any arrange-
ment between such a health maintenance orga-
nization and its affiliates; or 
‘‘(B) a value-based network arrangement, 
such as an exclusive provider network, account-
able care organization, center of excellence, a 
provider sponsored health insurance issuer that 
operates primarily through aligned multi-spe-
cialty physician group practices or integrated 
health systems, or such other similar network 
arrangements as determined by the Secretary 
through rulemaking. 
‘‘(4) ATTESTATION.—A group health plan or 
health insurance issuer offering group or individual 
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health insurance coverage shall annually submit to, 
as applicable, the applicable authority described in 
section 2723 or the Secretary of Labor, an attesta-
tion that such plan or issuer is in compliance with 
the requirements of this subsection. 
‘‘(c) MAINTENANCE OF EXISTING HIPAA, GINA, 
AND ADA PROTECTIONS.—Nothing in this section shall 
modify, reduce, or eliminate the existing privacy protec-
tions and standards provided by reason of State and Fed-
eral law, including the requirements of parts 160 and 164 
of title 45, Code of Federal Regulations (or any successor 
regulations). 
‘‘(d) REGULATIONS.—The Secretary, not later than 
1 year after the date of enactment of the Fair Care Act 
of 2020, shall promulgate regulations to carry out this sec-
tion. 
‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to limit network design or cost or 
quality initiatives by a group health plan or health insur-
ance issuer, including accountable care organizations, ex-
clusive provider organizations, networks that tier providers 
by cost or quality or steer enrollees to centers of excel-
lence, or other pay-for-performance programs. 
‘‘(f) CLARIFICATION WITH RESPECT TO ANTITRUST 
LAWS.—Compliance with this section does not constitute 
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compliance with the antitrust laws, as defined in sub-
section (a) of the first section of the Clayton Act (15 
U.S.C. 12(a)).’’. 
(b) EFFECTIVE DATE.—Section 2729B of the Public 
Health Service Act (as added by section 301 and amended 
by subsection (a)) shall apply with respect to any contract 
entered into on or after the date that is 18 months after 
the date of enactment of this Act. With respect to an ap-
plicable contract that is in effect on the date of enactment 
of this Act, such section 2729B shall apply on the earlier 
of the date of renewal of such contract or 3 years after 
such date of enactment. 
SEC. 307. REPEALING ELIGIBILITY OF CERTAIN ACOS. 
(a) IN GENERAL.—Section 1899(b)(1) of the Social 
Security Act (42 U.S.C. 1395jjj(b)(1)) is amended by 
striking subparagraphs (C) through (E). 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on January 1, 2021. 
SEC. 308. REPEAL OF HEALTH CARE REFORM PROVISIONS 
LIMITING MEDICARE EXCEPTION TO THE 
PROHIBITION ON CERTAIN PHYSICIAN RE-
FERRALS FOR HOSPITALS. 
Sections 6001 and 10601 of the Patient Protection 
and Affordable Care Act (Public Law 111–148; 124 Stat. 
684, 1005) and section 1106 of the Health Care and Edu-
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cation Reconciliation Act of 2010 (Public Law 111–152; 
124 Stat. 1049) are repealed and the provisions of law 
amended by such sections are restored as if such sections 
had never been enacted. 
SEC. 309. ALTERNATIVE PAYMENT MODEL FOR CERTAIN 
SHOPPABLE PROCEDURES. 
(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group or individual health insur-
ance coverage (as such terms are defined in section 2791 
of the Public Health Service Act (42 U.S.C. 300gg–91)) 
may elect, with respect to a plan year, to provide a set 
payment amount to an enrollee under such plan or cov-
erage for certain shoppable procedures (as defined in sub-
section (b)) in accordance with the provisions of this sec-
tion in lieu of otherwise providing coverage for such a pro-
cedure under such plan or coverage, but only if the en-
rollee so agrees to such set payment amount. 
(b) DEFINITION.—For purposes of this section, the 
term ‘‘shoppable procedure’’ means a procedure specified 
by the Secretary of Health and Human Services (in this 
section referred to as the ‘‘Secretary’’) with respect to 
which individuals may be expected to compare prices for 
such procedure of health care providers and facilities, in-
cluding primary and preventive services, prenatal care and 
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childbirth, common surgeries that can be scheduled, and 
other similar services. 
(c) SET PAYMENT RULES.—A set payment described 
in subsection (a) under a group health plan or group or 
individual health insurance coverage offered by a health 
insurance issuer shall— 
(1) be disclosed prior to beginning of each plan 
year such payment is in effect and shall not vary 
during such plan year; 
(2) be the same amount with respect to the 
same shoppable procedure furnished in a geographic 
area (as defined by the Secretary); 
(3) not be less than the median negotiated rate 
for all group health plans and health insurance cov-
erage offered in such area for such procedure; 
(4) be made available to an enrolled under such 
plan or such coverage regardless of the provider or 
facility furnishing the shoppable procedure; 
(5) represent the entirety of the payment obli-
gation of such plan or such issuer with respect to 
such procedure; and 
(6) may be retained by such enrollee to the ex-
tent that the amount of such payment exceeds the 
amount charged by such provider or facility for such 
procedure. 
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(d) PROVISION
OF
PRICE
INFORMATION.—Each 
health care provider and facility that may furnish a 
shoppable procedure during a year shall post in a public 
area a notice containing the prices that will be charged 
by such provider of facility with respect to each such pro-
cedure to individuals making payment for such services 
pursuant to a set payment amount described in subsection 
(a). 
(e) EHB WAIVER AUTHORITY.—The Secretary may 
waive such provisions of section 1302(b) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18022(b)) 
with respect to a group health plan, health insurance 
issuer offering group or individual health insurance cov-
erage, and a plan year as the Secretary determines nec-
essary to allow for the provision of set payment amounts 
described in subsection (a). 
Subtitle B—Price Transparency 
SEC. 321. PRICE TRANSPARENCY. 
Section 1866 of the Social Security Act (42 U.S.C. 
1395cc), as amended by section 301, is further amended— 
(1) in subsection (a)(1)— 
(A) in subparagraph (Y), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (Z), by striking the 
period at the end and inserting ‘‘; and’’; and 
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(C) by inserting after subparagraph (Z) 
the following new subparagraph: 
‘‘(AA) in the case of a hospital, to comply with 
the requirement under subsection (l).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(l) REQUIREMENT RELATING TO PUBLISHING CER-
TAIN HOSPITAL PRICES.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a)(1)(AA), the requirement described in this sub-
section is, with respect to a hospital and year (begin-
ning with 2021), for the hospital to publicly post, 
through the system established under paragraph (3), 
for each common shoppable service included in the 
list published under paragraph (2) for such year, the 
volume-weighted average price charged by the hos-
pital to— 
‘‘(A) individuals enrolled during such year 
in group health plans or health insurance cov-
erage offered in the individual or group market 
(as such terms are defined in section 2791 of 
the Public Health Service Act); and 
‘‘(B) individuals who are not enrolled in 
any health insurance coverage or health benefits 
plan and individuals who are enrolled in such 
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coverage or plan but such coverage or plan does 
not provide benefits for the service. 
‘‘(2) COMMON
SHOPPABLE
SERVICES.—For 
purposes of subsection (a)(1)(AA) and this sub-
section, the Secretary shall, for 2021 and each sub-
sequent year, publish a list of the 100 common 
shoppable services that are the most highly utilized 
in a hospital-based setting. 
‘‘(3) STANDARDIZED DIGITAL REPORTING SYS-
TEM.—Not later than January 1, 2021, the Sec-
retary shall establish a standardized digital system 
for purposes of paragraph (1).’’. 
SEC. 322. PRICE TRANSPARENCY REQUIREMENTS. 
(a) HOSPITALS.—Section 2718(e) of the Public 
Health Service Act (42 U.S.C. 300gg–18(e)) is amend-
ed— 
(1) by striking ‘‘Each hospital’’ and inserting 
the following: 
‘‘(1) IN GENERAL.—Each hospital’’; 
(2) by inserting ‘‘, in a machine-readable for-
mat, via open application program interfaces 
(APIs)’’ after ‘‘a list’’; 
(3) by inserting ‘‘, along with such additional 
information as the Secretary may require with re-
spect to such charges for purposes of promoting 
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public awareness of hospital pricing in advance of 
receiving a hospital item or service’’ before the pe-
riod; and 
(4) by adding at the end the following: 
‘‘(2) DEFINITION
OF
STANDARD
CHARGES.— 
Notwithstanding any other provision of law, for pur-
poses of paragraph (1), the term ‘standard charges’ 
means the rates hospitals, including providers or en-
tities that contract with or practice at a hospital, 
charge for all items and services at a minimum, 
chargemaster rates, rates that hospitals negotiate 
with third party payers across all plans, including 
those related to a patient’s specific plan, discounted 
cash prices, and other rates determined by the Sec-
retary. 
‘‘(3) ENFORCEMENT.—In addition to any other 
enforcement actions or penalties that may apply 
under subsection (b)(3) or another provision of law, 
a hospital that fails to provide the information re-
quired by this subsection and has not completed a 
corrective action plan to comply with the require-
ments of such subsection shall be subject to a civil 
monetary penalty of an amount not to exceed $300 
per day that the violation is ongoing as determined 
by the Secretary. Such penalty shall be imposed and 
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collected in the same manner as civil money pen-
alties under subsection (a) of section 1128A of the 
Social Security Act are imposed and collected.’’. 
(b) 
TRANSPARENCY
IN
COVERAGE.—Section 
1311(e)(3) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18031(e)(3)) is amended— 
(1) in subparagraph (A)— 
(A) in clause (vii), by inserting before the 
period the following: ‘‘, including, for all items 
and services covered under the plan, aggregate 
information on specific payments the plan has 
made to out-of-network health care providers on 
behalf of plan enrollees’’; 
(B) by designating clause (ix) as clause 
(x); and 
(C) by inserting after clause (viii), the fol-
lowing: 
‘‘(ix) Information on the specific nego-
tiated payment rates between the plan and 
health care providers for all items and 
services covered under the plan.’’; 
(2) in subparagraph (B)— 
(A) in the heading, by striking ‘‘USE’’ and 
inserting ‘‘DELIVERY METHODS AND USE’’; 
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(B) by inserting ‘‘, as applicable,’’ after 
‘‘English proficiency’’; and 
(C) by inserting after the second sentence, 
the following: ‘‘The Secretary shall establish 
standards for electronic delivery and access to 
such information by individuals, free of charge, 
in machine readable format, through an Inter-
net website and via open APIs.’’; 
(3) in subparagraph (C)— 
(A) in the first sentence, by inserting ‘‘or 
out-of-network provider’’ after ‘‘item or service 
by a participating provider’’; 
(B) in the second sentence, by striking 
‘‘through an Internet website’’ and inserting 
‘‘free of charge, in machine readable format, 
through an Internet website, and via open 
APIs, in accordance with standards established 
by the Secretary,’’; and 
(C) by adding at the end the following: 
‘‘Such information shall include specific nego-
tiated rates that allow for comparison between 
providers and across plans, and related to a pa-
tient’s specific plan, including after an enrollee 
has exceeded their deductible responsibility.’’; 
and 
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(4) in subparagraph (D) by striking ‘‘subpara-
graph (A)’’ and inserting ‘‘subparagraphs (A), (B), 
and (C)’’. 
SEC. 323. DESIGNATION OF NONGOVERNMENTAL, NON-
PROFIT TRANSPARENCY ORGANIZATIONS TO 
LOWER AMERICANS’ HEALTH CARE COSTS. 
(a) IN GENERAL.—Subpart C of title XXVII of the 
Public Health Service Act (42 U.S.C. 300gg–91 et seq.), 
as amended by the preceding sections, is further amended 
by adding at the end the following: 
‘‘SEC. 2796. DESIGNATION OF A NONGOVERNMENTAL, NON-
PROFIT TRANSPARENCY ORGANIZATION TO 
LOWER AMERICANS’ HEALTH CARE COSTS. 
‘‘(a) IN GENERAL.—The Secretary, in consultation 
with the Secretary of Labor, not later than 1 year after 
the date of enactment of the Fair Care Act of 2020, shall 
enter into contracts with at least 2 nonprofit entities to 
support the establishment and maintenance of a database 
that receives and utilizes health care claims information 
and related information and issues reports that are avail-
able to the public and authorized users, and are submitted 
to the Department of Health and Human Services. 
‘‘(b) REQUIREMENTS.— 
‘‘(1) IN GENERAL.—The database established 
under subsection (a) shall— 
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‘‘(A) improve transparency by using de- 
identified health care data to— 
‘‘(i) inform patients about the cost, 
quality, and value of their care; 
‘‘(ii) assist providers and hospitals, as 
they work with patients, to make informed 
choices about care; 
‘‘(iii) enable providers, hospitals, and 
communities to improve services and out-
comes for patients by benchmarking their 
performance against that of other pro-
viders, hospitals, and communities; 
‘‘(iv) enable purchasers, including em-
ployers, employee organizations, and health 
plans, to develop value-based purchasing 
models, improve quality, and reduce the 
cost of health care and insurance coverage 
for enrollees; 
‘‘(v) enable employers and employee 
organizations to evaluate network design 
and construction, and the cost of care for 
enrollees; 
‘‘(vi) facilitate State-led initiatives to 
lower health care costs and improve qual-
ity; and 
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‘‘(vii) promote competition based on 
quality and cost; 
‘‘(B) collect medical claims, prescription 
drug claims, and remittance data consistent 
with the protections and requirements of sub-
section (d); 
‘‘(C) be established in such a manner that 
allows the data collected pursuant to subpara-
graph (B) to be shared with any State all-payer 
claims database or regional database operated 
with authorization from States, at cost, using a 
standardized format, if such State or regional 
database also submits claims data to the data-
base established under this section; and 
‘‘(D) be available to— 
‘‘(i) the Director of the Congressional 
Budget Office, the Comptroller General of 
the United States, the Executive Director 
of the Medicare Payment Advisory Com-
mission, and the Executive Director of the 
Medicaid and CHIP Payment Advisory 
Commission, upon request, subject to the 
privacy and security requirements of au-
thorized users under subsection (e)(2); and 
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and D of part 164 of such title 45 (or 
any successor regulations). 
‘‘(ii) 
SUPPLEMENTAL
REGULA-
TIONS.—In order to ensure data privacy 
and security and the notification of 
breaches, the Secretary may issue such 
supplemental regulations on the subjects of 
the rules listed under clause (i) as the Sec-
retary determines appropriate to address 
differences between the activities described 
by this section and the activities covered by 
such rules. 
‘‘(B) ENFORCEMENT.—Section 1176 of 
Social Security Act shall apply with respect to 
a violation of this paragraph in the same man-
ner such section 1176 applies to a violation of 
part C of title XI of the Social Security Act, 
and the Secretary may include in the regula-
tions promulgated under this section provisions 
to apply such section to this paragraph. 
‘‘(C) PROCEDURE.— 
‘‘(i) TIMING.—The Secretary shall 
issue the initial set of regulations under 
this paragraph not later than 1 year after 
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the date of enactment of the Fair Care Act 
of 2020. 
‘‘(ii) AUTHORITY
TO
USE
INTERIM 
FINAL PROCEDURES.—The Secretary may 
make such initial set of regulations effec-
tive and final immediately upon issuance, 
on an interim basis, and provide for a pe-
riod of public comment on such initial set 
of regulations after the date of publication. 
‘‘(D) REQUIREMENTS OF ENTITY.—An en-
tity receiving the contract under this section 
shall— 
‘‘(i) not disclose to the public any in-
dividually identifiable health information or 
proprietary financial information; 
‘‘(ii) strictly limit staff access to the 
data to staff with appropriate training, 
clearance, and background checks and re-
quire regular privacy and security training; 
‘‘(iii) 
maintain 
effective 
security 
standards for transferring data or making 
data available to authorized users; 
‘‘(iv) develop a process for providing 
access to data to authorized users, in a se-
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cure manner that maintains privacy and 
confidentiality of data; and 
‘‘(v) adhere to current best security 
practices with respect to the management 
and use of such data for health services re-
search, in accordance with applicable Fed-
eral privacy law. 
‘‘(3) CONSULTATION.— 
‘‘(A) ADVISORY
COMMITTEE.—Not later 
than 180 days after the date of enactment of 
the Fair Care Act of 2020, the Secretary shall 
convene an Advisory Committee (referred to in 
this section as the ‘Committee’), consisting of 
13 members, to advise the Secretary, a con-
tracting entity, and Congress on the establish-
ment, operations, and use of the database es-
tablished under this section. 
‘‘(B) MEMBERSHIP.— 
‘‘(i) APPOINTMENT.—In accordance 
with clause (ii), the Secretary, in consulta-
tion with the Secretary of Labor and the 
Comptroller General of the United States 
shall, not later than 180 days after the 
date of enactment of the Fair Care Act of 
2020, appoint members to the Committee 
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who have distinguished themselves in the 
fields of health services research, health ec-
onomics, health informatics, or the govern-
ance of State all-payer claims databases, or 
who represent organizations likely to sub-
mit data to or use the database, including 
patients, employers, or employee organiza-
tions 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 sub-
section not later than 3 months after the 
vacancy arises. 
‘‘(ii) COMPOSITION.—In accordance 
with clause (i)— 
‘‘(I) the Secretary, in consulta-
tion with the Secretary of Labor, shall 
appoint to the Committee— 
‘‘(aa) 1 member selected by 
the Secretary, in coordination 
with the Secretary of Labor, to 
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serve as the chair of the Com-
mittee; 
‘‘(bb) the Assistant Sec-
retary for Planning and Evalua-
tion of the Department of Health 
and Human Services, or a des-
ignee of such Assistant Sec-
retary; 
‘‘(cc) 1 representative of the 
Centers for Medicare & Medicaid 
Services; 
‘‘(dd) 1 representative of the 
Agency for Health Research and 
Quality; 
‘‘(ee) 1 representative of the 
Office for Civil Rights of the De-
partment of Health and Human 
Services with expertise in data 
privacy and security; 
‘‘(ff) 1 representative of the 
National Center for Health Sta-
tistics; and 
‘‘(gg) 1 representative of the 
Employee Benefits and Security 
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Administration of the Depart-
ment of Labor; and 
‘‘(II) the Comptroller General of 
the United States shall appoint to the 
Committee— 
‘‘(aa) 1 representative of an 
employer that sponsors a group 
health plan; 
‘‘(bb) 1 representative of an 
employee organization that spon-
sors a group health plan; 
‘‘(cc) 1 academic researcher 
with expertise in health econom-
ics or health services research; 
‘‘(dd) 1 consumer advocate; 
and 
‘‘(ee) 2 additional members. 
‘‘(C) DUTIES.—The Committee shall— 
‘‘(i) advise the Secretary on the man-
agement of the contract under subsection 
(a); 
‘‘(ii) assist and advise the entities re-
ceiving the contract under subsection (a) in 
establishing— 
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such plan year, the number of individuals enrolled under 
such plan or such coverage was less than 100. 
(c) PENALTY.—In the case that the Secretary of 
Health and Human Services determines that a group 
health plan or a health insurance issuer offering group 
health insurance failed to provide the notice required 
under subsection (a), the Secretary may impose a civil 
monetary penalty on the sponsor of such plan or such 
issuer, as applicable, in an amount not to exceed $100 
per individual enrolled in such plan or such coverage per 
day that such sponsor or issuer failed to provide such noti-
fication to such individual. 
(d) DEFINITIONS.—In this section, the terms ‘‘group 
health plan’’, ‘‘group health insurance coverage’’, ‘‘health 
insurance issuer’’, and ‘‘sponsor’’ have the meaning given 
such terms in section 2791 of the Public Health Service 
Act (42 U.S.C. 300gg–91). 
SEC. 332. GROUP HEALTH PLAN REPORTING REQUIRE-
MENTS. 
Part C of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg–91 et seq.), as amended by the pre-
ceding sections, is further amended by adding at the end 
the following: 
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