Addressing Anti-Competitive Contracting Clauses Act
Bill: H.R.8135 | Sponsor: Rep. Spartz, Victoria (R-IN)
Policy area: Health

Summary:
Addressing Anti-Competitive Contracting Clauses Act
This bill requires the Government Accountability Office to study and report on the effect of certain anticompetitive contract clauses in contracts between health insurers and health care providers.

To require the Government Accountability Office to evaluate the effects 
  of anticompetitive contracting clauses in contracts between health 
 insurers and health care providers and to determine actions taken by 
the Federal Trade Commission and the Department of Justice relating to 
 the use of such clauses in such contracts and to assess their ability 
to effectively enforce the Federal antitrust laws with respect to such 
                                  use.

    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 ``Addressing Anti-Competitive 
Contracting Clauses Act''.

SEC. 2. GAO STUDY.

    (a) Study.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General of the United States, in 
coordination with the Federal Trade Commission and the Assistant 
Attorney General of the Antitrust Division of the Department of 
Justice, shall carry out a study that--
            (1) evaluates the effect of anticompetitive contract 
        clauses known as anti-steering clauses, anti-tiering clauses, 
        all-or-nothing clauses, and gag clauses in contracts between 
        health insurers and health care providers, including the 
        effects such contracts have on consolidation in the health care 
        industry, prices paid by consumers for medical services, and 
        consumer access to health care,
            (2) contains a list of all actions the Federal Trade 
        Commission and the Department of Justice have taken directly or 
        indirectly related to use of such contract clauses in contracts 
        between health insurers and health care providers,
            (3) contains an assessment of whether the Federal Trade 
        Commission and the Department of Justice have the resources and 
        the capability to effectively enforce the Federal antitrust 
        laws as applied to such the use of such clauses in such 
        contracts, and
            (4) includes recommendations for legislative or 
        administrative actions if necessary to increase such resources.
    (b) Report.--The report containing the results of the study carried 
out under subsection (a) shall be submitted timely by the Comptroller 
General as follows:
            (1) To--
                    (A) the Committee on Energy and Commerce,
                    (B) the Committee on Ways and Means,
                    (C) the Committee on Education and Labor, and
                    (D) the Committee on the Judiciary,
        of the House of Representatives.
            (2) To--
                    (A) The Committee on Health, Education, Labor, and 
                Pensions, and
                    (B) The Committee on the Judiciary,
        of the Senate.

SEC. 3. DEFINITIONS.

    For purposes of this Act:
            (1) All-or-nothing clause.--The term ``all-or-nothing 
        clause'' means a provision of a health care contract that 
        requires--
                    (A) a health insurance carrier or health plan 
                administrator to include all members of a health care 
                provider in a network plan; or
                    (B) a health insurance carrier or health plan 
                administrator to enter into an additional contract with 
                an affiliate of the health care provider as a condition 
                of entering into a contract with such health care 
                provider.
            (2) Anti-steering clause.--The term ``anti-steering 
        clause'' means a provision of a health care contract that 
        restricts the ability of a health insurance carrier or a health 
        plan administrator from encouraging an enrollee to obtain a 
        health care service from a competitor of the hospital or health 
        system, including offering incentives to encourage enrollees to 
        utilize specific health care providers.
            (3) Anti-tiering clause.--The term ``anti-tiering clause'' 
        means a provision in a health care contract that--
                    (A) restricts the ability of a health insurance 
                carrier or a health plan administrator to introduce or 
                modify a tiered network plan or assign health care 
                providers into tiers; or
                    (B) requires the health insurance carrier or health 
                plan administrator to place all members of a health 
                care provider in the same tier of a tiered network 
                plan.
            (4) Gag clause.--the term ``gag clause'' means a provision 
        of a health care contract that--
                    (A) restricts the ability of a health insurance 
                carrier, a health plan administrator, or a health care 
                provider to disclose a price or quality information, 
                including the allowed amount, negotiated rates or 
                discounts, a fees for services, or any other claim-
                related financial obligations included in the provider 
                contract to--
                            (i) a governmental entity as authorized by 
                        law,
                            (ii) its contractors or agents,
                            (iii) an enrollee,
                            (iv) a treating health care provider of an 
                        enrollee,
                            (v) a plan sponsor, or
                            (vi) a potential eligible enrollees and 
                        plan sponsors; or
                    (B) restricts the ability of a health insurance 
                carrier, a health plan administrator, or a health care 
                provider to disclose out-of-pocket costs to an 
                enrollee.
            (5) Tiered network plan.--The term ``tiered network plan'' 
        means a health benefit plan that sorts some or all types of 
        health care providers into specific groups to which different 
        provider reimbursement, enrollee cost sharing, health care 
        provider access requirements, or a combination thereof, are 
        applied for the same services.
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