IB 
Union Calendar No. 210 
118TH CONGRESS 
1ST SESSION H. R. 4527 
[Report No. 118–260] 
To amend the Employee Retirement Income Security Act of 1974 to ensure 
plan fiduciaries may access de-identified information relating to health 
claims, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 11, 2023 
Mrs. CHAVEZ-DEREMER (for herself, Mr. TAKANO, and Ms. MANNING) intro-
duced the following bill; which was referred to the Committee on Edu-
cation and the Workforce 
NOVEMBER 1, 2023 
Reported with an amendment, committed to the Committee of the Whole 
House on the State of the Union, and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of introduced bill, see copy of bill as introduced on July 11, 2023] 
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A BILL 
To amend the Employee Retirement Income Security Act 
of 1974 to ensure plan fiduciaries may access de-identi-
fied information relating to health claims, and for other 
purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Data Access, 
Transparency, and Affordability Act of 2023’’ or the 
‘‘Health DATA Act of 2023’’. 
SEC. 2. PLAN FIDUCIARY ACCESS TO INFORMATION. 
(a) IN GENERAL.—Paragraph (2) of section 408(b) of 
the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1108(b)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(C) No contract or arrangement for services be-
tween a group health plan and any other entity, such 
as a health care provider, network or association of 
providers, third-party administrator, or pharmacy 
benefit manager, is reasonable within the meaning of 
this paragraph unless such contract or agreement— 
‘‘(i) allows the responsible plan fiduciary to 
audit all de-identified claims and encounter in-
formation 
or 
data 
described 
in 
section 
724(a)(1)(B) to— 
‘‘(I) ensure that such entity complies 
with the terms of the plan and any applica-
ble law; and 
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‘‘(II) determine the reasonableness of 
compensation paid by the plan; and 
‘‘(ii) does not— 
‘‘(I) unreasonably limit the number of 
audits permitted during a given period of 
time; 
‘‘(II) limit the number of de-identified 
claims and encounter information or data 
that the responsible plan fiduciary may ac-
cess during an audit; 
‘‘(III) limit the disclosure of pricing 
terms for value based payment arrange-
ments, including— 
‘‘(aa) payment calculations and 
formulas; 
‘‘(bb) quality measures; 
‘‘(cc) contract terms; 
‘‘(dd) payment amounts; 
‘‘(ee) measurement periods for all 
incentives; and 
‘‘(ff) other payment methodologies 
furnished by a health care provider, 
network or association of providers, 
third-party administrator, or phar-
macy benefit manager; 
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‘‘(IV) limit the disclosure of overpay-
ments and overpayment recovery terms; 
‘‘(V) limit the right of the responsible 
plan fiduciary to select an auditor; 
‘‘(VI) otherwise limit or unduly delay 
by greater than 60 days the responsible 
plan fiduciary from auditing such informa-
tion or data; or 
‘‘(VII) charge a fee beyond the reason-
able direct costs to administer the operation 
of conducting such audits.’’. 
(b) CIVIL ENFORCEMENT.— 
(1) IN GENERAL.—Subsection (c) of section 502 
of such Act (29 U.S.C. 1132) is amended by adding 
at the end the following new paragraph: 
‘‘(13) In the case of an agreement between a group 
health plan and a health care provider, network or associa-
tion of providers, third-party administrator, pharmacy 
benefit manager, or other service provider that violates the 
provisions of section 724, the Secretary may assess a civil 
penalty against such provider, network or association, 
third-party administrator, pharmacy benefit manager, or 
other service provider in the amount of $10,000 for each 
day during which such violation continues. Such penalty 
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shall be in addition to other penalties as may be prescribed 
by law.’’. 
(2) CONFORMING AMENDMENT.—Paragraph (6) 
of section 502(a) of such Act is amended by striking 
‘‘or (9)’’ and inserting ‘‘(9), or (13)’’; and 
(c) EXISTING PROVISIONS VOID.—Section 410 of such 
Act is amended by adding at the end the following new sub-
section: 
‘‘(c) Any provision in an agreement or instrument 
shall be void as against public policy if such provision— 
‘‘(1) unduly delays or limits a plan fiduciary 
from accessing the de-identified claims and encounter 
information 
or 
data 
described 
in 
section 
724(a)(1)(B); or 
‘‘(2) 
violates 
the 
requirements 
of 
section 
408(b)(2)(C).’’. 
(d) TECHNICAL AMENDMENT.—Clause (i) of section 
408(b)(2)(B) of such Act is amended by striking ‘‘this 
clause’’ and inserting ‘‘this paragraph’’. 
SEC. 3. UPDATED ATTESTATION FOR PRICE AND QUALITY 
INFORMATION. 
Section 724(a)(3) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1185m(a)(3)) is amended 
to read as follows: 
‘‘(3) ATTESTATION.— 
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‘‘(A) IN
GENERAL.—Subject to subpara-
graph (C), the fiduciary of a group health plan 
or issuer offering group health insurance cov-
erage shall annually submit to the Secretary an 
attestation that such plan or issuer of such cov-
erage is in compliance with the requirements of 
this subsection. Such attestation shall also in-
clude a statement verifying that— 
‘‘(i) the information or data described 
under subparagraphs (A) and (B) of para-
graph (1) is available upon request and 
provided to the plan fiduciary, the plan ad-
ministrator, or the issuer in a timely man-
ner; and 
‘‘(ii) there are no terms in the agree-
ment under such paragraph (1) that di-
rectly or indirectly restrict or unduly delay 
a plan fiduciary, the plan administrator, or 
the issuer from auditing, reviewing, or oth-
erwise accessing such information. 
‘‘(B) LIMITATION ON SUBMISSION.—Subject 
to clause (ii), a group health plan or issuer offer-
ing group health insurance coverage may not 
enter into an agreement with a third-party ad-
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ministrator or other service provider to submit 
the attestation required under subparagraph (A). 
‘‘(C) EXCEPTION.—In the case of a group 
health plan or issuer offering group health insur-
ance coverage that is unable to obtain the infor-
mation or data needed to submit the attestation 
required under subparagraph (A), such plan or 
issuer may submit a written statement in lieu of 
such attestation that includes— 
‘‘(i) an explanation of why such plan 
or issuer was unsuccessful in obtaining such 
information or data, including whether such 
plan or issuer was limited or prevented 
from auditing, reviewing, or otherwise ac-
cessing such information or data; 
‘‘(ii) a description of the efforts made 
by the plan fiduciary to remove any gag 
clause provisions from the agreement under 
paragraph (1); and 
‘‘(iii) a description of any response by 
the third-party administrator or other serv-
ice provider with respect to efforts to com-
ply with the attestation requirement under 
subparagraph (A).’’. 
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SEC. 4. STUDY ON PLAN ASSETS. 
Not later than 1 year after the date of enactment of 
this Act, the Secretary of Labor shall submit to the Com-
mittee on Education and the Workforce of the House of Rep-
resentatives a report on the status of de-identified claims 
and encounter information or data described in section 
724(a)(1)(B) of the Employee Retirement Income Security 
Act of 1974 (29 U.S.C. 1185m), including information on 
the following: 
(1) Circumstances under current law where such 
information or data could be deemed a group health 
plan asset (as defined under section 3(42) of such 
Act). 
(2) Whether restrictions on the ability of a plan 
fiduciary to access such information or data violates 
a requirement of current law. 
(3) The existing regulatory authority of the Sec-
retary to clarify whether such information or data be-
longs to a group health plan, rather than a service 
provider. 
(4) Legislative actions that may be taken to es-
tablish that such information or data related to a 
plan belongs to a group health plan and is handled 
in the best interests of plan participants and bene-
ficiaries. 
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Union Calendar No. 210 
118TH CONGRESS 
1ST SESSION 
H. R. 4527 
[Report No. 118–260] 
A BILL 
To amend the Employee Retirement Income Secu-
rity Act of 1974 to ensure plan fiduciaries may 
access de-identified information relating to health 
claims, and for other purposes. 
NOVEMBER 1, 2023 
Reported with an amendment, committed to the Com-
mittee of the Whole House on the State of the Union, 
and ordered to be printed 
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00:29 Nov 02, 2023
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