I 
116TH CONGRESS 
2D SESSION 
H. R. 6005 
To amend title XXVII of the Public Health Service Act to increase trans-
parency of group health plans and health insurance issuers offering 
group or individual health insurance coverage by removing gag clauses 
on price and quality information, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 27, 2020 
Mr. MALINOWSKI (for himself and Mr. BUCSHON) introduced the following 
bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend title XXVII of the Public Health Service Act 
to increase transparency of group health plans and 
health insurance issuers offering group or individual 
health insurance coverage by removing gag clauses on 
price and quality information, and for other purposes. 
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 ‘‘Know the Price Act’’. 
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SEC. 2. INCREASING TRANSPARENCY BY REMOVING GAG 
CLAUSES ON PRICE AND QUALITY INFORMA-
TION. 
Subpart II of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg–11 et seq.) is 
amended by adding at the end the following: 
‘‘SEC. 2729A. INCREASING TRANSPARENCY BY REMOVING 
GAG CLAUSES ON PRICE AND QUALITY IN-
FORMATION. 
‘‘(a) INCREASING
PRICE
AND
QUALITY
TRANS-
PARENCY FOR PLAN SPONSORS AND CONSUMERS.— 
‘‘(1) GROUP HEALTH PLANS.—A group health 
plan or a health insurance issuer offering group 
health insurance coverage may not enter into an 
agreement with a health care provider, network 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 
from— 
‘‘(A) providing provider-specific cost or 
quality of care information, through a consumer 
engagement tool or any other means, to refer-
ring providers, the plan sponsor, enrollees, or 
eligible enrollees of the plan or coverage; 
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‘‘(B) electronically accessing de-identified 
claims and encounter data for each enrollee in 
the plan or coverage, upon request and con-
sistent with the privacy regulations promul-
gated pursuant to section 264(c) of the Health 
Insurance Portability and Accountability Act, 
the amendments to this Act made by the Ge-
netic Information Nondiscrimination Act of 
2008, and the Americans with Disabilities Act 
of 1990, with respect to the applicable health 
plan or health insurance coverage, including, on 
a per claim basis— 
‘‘(i) financial information, such as the 
allowed amount, or any other claim-related 
financial obligations included in the pro-
vider contract; 
‘‘(ii) provider information, including 
name and clinical designation; 
‘‘(iii) service codes; or 
‘‘(iv) any other data element normally 
included in claim or encounter transactions 
when received by a plan or issuer; or 
‘‘(C) sharing data described in subpara-
graph (A) or (B) with a business associate as 
defined in section 160.103 of title 45, Code of 
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Federal Regulations (or successor regulations), 
consistent with the privacy regulations promul-
gated pursuant to section 264(c) of the Health 
Insurance Portability and Accountability Act, 
the amendments to this Act made by the Ge-
netic Information Nondiscrimination Act of 
2008, and the Americans with Disabilities Act 
of 1990. 
‘‘(2) INDIVIDUAL
HEALTH
INSURANCE
COV-
ERAGE.—A health insurance issuer offering indi-
vidual 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 refer-
ring providers or the plan sponsor, enrollees, or 
eligible enrollees of the plan or coverage; or 
‘‘(B) sharing data described in subpara-
graph (A) with a business associate as defined 
in section 160.103 of title 45, Code of Federal 
Regulations (or successor regulations), con-
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sistent with the privacy regulations promul-
gated pursuant to section 264(c) of the Health 
Insurance Portability and Accountability Act, 
the amendments to this Act made by the Ge-
netic Information Nondiscrimination Act of 
2008, and the Americans with Disabilities Act 
of 1990, for plan design, plan administration, 
and plan, financial, legal, and quality improve-
ment activities. 
‘‘(3) CLARIFICATION REGARDING PUBLIC DIS-
CLOSURE 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 insurance issuer offering group or individual 
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. 
‘‘(5) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed to otherwise limit 
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group health plan or plan sponsor access to data 
currently permitted under the privacy regulations 
promulgated pursuant to section 264(c) of the 
Health Insurance Portability and Accountability Act, 
the amendments to this Act made by the Genetic In-
formation Nondiscrimination Act of 2008, and the 
Americans with Disabilities Act of 1990.’’. 
Æ 
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