Patients Before Profits Act of 2022
Bill: H.R.6904 | Sponsor: Rep. Porter, Katie (D-CA)
Policy area: Health

Summary:
Patients Before Profits Act of 2022
This bill prohibits a group health insurance plan and a health insurance issuer offering group or individual health insurance coverage from reducing contracted rates or terminating contracts with health care providers during a public health emergency period.

To amend title XXVII of the Public Health Service Act, the Employee 
 Retirement Income Security Act of 1974, and the Internal Revenue Code 
 of 1986 to prohibit a group health plan and a health insurance issuer 
 offering group or individual health insurance coverage from reducing 
contracted rates, or terminating contracts, with health care providers 
                   during a public health emergency.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Patients Before Profits Act of 
2022''.

SEC. 2. PROHIBITING A GROUP HEALTH PLAN AND A HEALTH INSURANCE ISSUER 
              OFFERING GROUP OR INDIVIDUAL HEALTH INSURANCE COVERAGE 
              FROM REDUCING CONTRACTED RATES, OR TERMINATING CONTRACTS, 
              WITH HEALTH CARE PROVIDERS DURING A PUBLIC HEALTH 
              EMERGENCY.

    (a) PHSA.--Part D of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg-111 et seq.) is amended by adding at the end the 
following new section:

``SEC. 2799A-11. PROHIBITION ON REDUCTION OF RATES AND TERMINATION OF 
              CONTRACTS DURING PUBLIC HEALTH EMERGENCIES.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage may not, 
with respect to a health care provider located in an emergency area 
during an emergency period that, as of the day before the date of the 
beginning of such period, had in effect a contractual relationship for 
furnishing items and services under such plan or coverage--
            ``(1) provide for an amount of reimbursement for any such 
        item or service furnished by such provider during such period 
        that is less than the amount of such reimbursement that would 
        have been payable under such plan or coverage had such item or 
        service been furnished by such provider on such day; or
            ``(2) terminate such relationship during such period;
unless such lesser reimbursement or such termination is based on fraud, 
abuse, or other quality concerns with respect to such provider or such 
provider being placed on the exclusion list maintained by the Inspector 
General of the Department of Health and Human Services.
    ``(b) Definitions.--For purposes of this section, an `emergency 
area' is a geographical area in which, and an `emergency period' is the 
period during which, there exists a public health emergency declared by 
the Secretary pursuant to section 319.''.
    (b) ERISA.--
            (1) 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. 726. PROHIBITION ON REDUCTION OF RATES AND TERMINATION OF 
              CONTRACTS DURING PUBLIC HEALTH EMERGENCIES.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group health insurance coverage may not, with respect 
to a health care provider located in an emergency area during an 
emergency period that, as of the day before the date of the beginning 
of such period, had in effect a contractual relationship for furnishing 
items and services under such plan or coverage--
            ``(1) provide for an amount of reimbursement for any such 
        item or service furnished by such provider during such period 
        that is less than the amount of such reimbursement that would 
        have been payable under such plan or coverage had such item or 
        service been furnished by such provider on such day; or
            ``(2) terminate such relationship during such period;
unless such lesser reimbursement or such termination is based on fraud, 
abuse, or other quality concerns with respect to such provider or such 
provider being placed on the exclusion list maintained by the Inspector 
General of the Department of Health and Human Services.
    ``(b) Definitions.--For purposes of this section, an `emergency 
area' is a geographical area in which, and an `emergency period' is the 
period during which, there exists a public health emergency declared by 
the Secretary pursuant to section 319.''.
            (2) Clerical amendment.--The table of contents in section 1 
        of the Employee Retirement Income Security Act of 1974 is 
        amended by inserting after the item relating to section 714 the 
        following new items:

``Sec. 726. Prohibition on reduction of rates and termination of 
                            contracts during public health 
                            emergencies.''.
    (c) IRC.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following new section:

``SEC. 9826. PROHIBITION ON REDUCTION OF RATES AND TERMINATION OF 
              CONTRACTS DURING PUBLIC HEALTH EMERGENCIES.

    ``(a) In General.--A group health plan may not, with respect to a 
health care provider located in an emergency area during an emergency 
period that, as of the day before the date of the beginning of such 
period, had in effect a contractual relationship for furnishing items 
and services under such plan--
            ``(1) provide for an amount of reimbursement for any such 
        item or service furnished by such provider during such period 
        that is less than the amount of such reimbursement that would 
        have been payable under such plan had such item or service been 
        furnished by such provider on such day; or
            ``(2) terminate such relationship during such period;
unless such lesser reimbursement or such termination is based on fraud, 
abuse, or other quality concerns with respect to such provider or such 
provider being placed on the exclusion list maintained by the Inspector 
General of the Department of Health and Human Services.
    ``(b) Definitions.--For purposes of this section, an `emergency 
area' is a geographical area in which, and an `emergency period' is the 
period during which, there exists a public health emergency declared by 
the Secretary pursuant to section 319.''.
            (2) Clerical amendment.--The table of sections for such 
        subchapter is amended by adding at the end the following new 
        items:

``Sec. 9826. Prohibition on reduction of rates and termination of 
                            contracts during public health 
                            emergencies.''.
    (d) Effective Date.--The amendment made by this section shall apply 
with respect to public health emergencies declared by the Secretary of 
Health and Human Services on or after January 31, 2020, and items and 
services furnished, and terminations occurring, on or after the date of 
the enactment of this Act.
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