Title: Insurance Accountability and Transparency Act
Policy area: Health

Summary:
Insurance Accountability and Transparency Act
This bill requires private health insurance plans to periodically contact providers listed in publicly available directories to verify those providers' contact information and status within the network of such plans.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5144 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 5144

  To amend the Patient Protection and Affordable Care Act to require 
  group health plans and health insurance coverage to have in place a 
    process to self-audit information listed in publicly accessible 
            provider directories of such plans and coverage.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 18, 2019

Ms. Davids of Kansas introduced the following bill; which was referred 
    to the Committee on Energy and Commerce, and in addition to the 
Committees on Education and Labor, and Ways and Means, for a period to 
      be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend the Patient Protection and Affordable Care Act to require 
  group health plans and health insurance coverage to have in place a 
    process to self-audit information listed in publicly accessible 
            provider directories of such plans and coverage.

    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 ``Insurance Accountability and 
Transparency Act''.

SEC. 2. REQUIREMENT FOR GROUP HEALTH PLANS AND HEALTH INSURANCE 
              COVERAGE TO HAVE IN PLACE A PROCESS TO SELF-AUDIT 
              INFORMATION LISTED IN PUBLICLY ACCESSIBLE PROVIDER 
              DIRECTORIES OF SUCH PLANS AND COVERAGE.

    (a) PHSA.--
            (1) In general.--Title XXVII of the Public Health Service 
        Act (42 U.S.C. 300gg et seq.) is amended by adding at the end 
        the following:

                     ``PART D--OTHER MARKET REFORMS

``SEC. 2796. PROCESS TO SELF-AUDIT INFORMATION LISTED IN PUBLICLY 
              ACCESSIBLE PROVIDER DIRECTORIES.

    ``(a) In General.--An entity specified in subsection (b), with 
respect to a group health plan or health insurance coverage offered in 
the group or individual market, shall have in place a process under 
which, in order to self-audit the information listed in any publicly 
accessible provider directory for such plan or coverage, such entity--
            ``(1) contacts, not less than once every 6 months during 
        each plan year, each provider listed in such directory to 
        verify--
                    ``(A) contact information listed in such directory 
                with respect to such provider; and
                    ``(B) the status of whether such provider is a 
                provider within the network of such plan or coverage; 
                and
            ``(2) in the case that such entity determines that any of 
        the information described in subparagraph (A) or (B) of 
        paragraph (1) with respect to a provider listed in such 
        directory of such plan or coverage is inaccurate, not later 
        than 30 days after making such determination, corrects and 
        updates such information in such directory.
    ``(b) Entity Described.--For purposes of subsection (a), an entity 
described in this subsection is--
            ``(1) in the case of health insurance coverage or a group 
        health plan this is not a self-insured plan, the health 
        insurance issuer offering the health insurance coverage or the 
        group health plan, respectively; and
            ``(2) in the case of a self-insured group health plan, the 
        designated administrator of the plan (as such term is defined 
        in section 3(16) of the Employee Retirement Income Security Act 
        of 1974).''.
            (2) Conforming amendments.--
                    (A) Section 2722 of the Public Health Service Act 
                (42 U.S.C. 300gg-21) is amended--
                            (i) in subsection (a)(1), by inserting 
                        ``and part D'' after ``subparts 1 and 2'';
                            (ii) in subsection (b), by inserting ``and 
                        part D'' after ``subparts 1 and 2'';
                            (iii) in subsection (c)(1), by inserting 
                        ``and part D'' after ``subparts 1 and 2'';
                            (iv) in subsection (c)(2), by inserting 
                        ``and part D'' after ``subparts 1 and 2'';
                            (v) in subsection (c)(3), by inserting 
                        ``and part D'' after ``this part''; and
                            (vi) in subsection (d), in the matter 
                        preceding paragraph (1), by inserting ``and 
                        part D'' after ``this part''.
                    (B) Section 2723 of the Public Health Service Act 
                (42 U.S.C. 300gg-22) is amended--
                            (i) in subsection (a)(1), by inserting 
                        ``and part D'' after ``this part'';
                            (ii) in subsection (a)(2), by inserting 
                        ``or part D'' after ``this part'';
                            (iii) in subsection (b)(1), by inserting 
                        ``or part D'' after ``this part'';
                            (iv) in subsection (b)(2)(A), by inserting 
                        ``or part D'' after ``this part''; and
                            (v) in subsection (b)(2)(C)(ii), by 
                        inserting ``and part D'' after ``this part''.
                    (C) Section 2724 of the Public Health Service Act 
                (42 U.S.C. 300gg-23) is amended--
                            (i) in subsection (a)(1)--
                                    (I) by striking ``this part and 
                                part C insofar as it relates to this 
                                part'' and inserting ``this part, part 
                                D, and part C insofar as it relates to 
                                this part or part D''; and
                                    (II) by inserting ``or part D'' 
                                after ``requirement of this part'';
                            (ii) in subsection (a)(2), by inserting 
                        ``or part D'' after ``this part''; and
                            (iii) in subsection (c), by inserting ``or 
                        part D'' after ``this part (other than section 
                        2704)''.
    (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. 1181 et seq.) is amended by adding at the end the 
        following new section:

``SEC. 716. PROCESS TO SELF-AUDIT INFORMATION LISTED IN PUBLICLY 
              ACCESSIBLE PROVIDER DIRECTORIES.

    ``(a) In General.--An entity specified in subsection (b), with 
respect to a group health plan or health insurance coverage offered in 
the group market, shall have in place a process under which, in order 
to self-audit the information listed in any publicly accessible 
provider directory for such plan or coverage, such entity--
            ``(1) contacts, not less than once every 6 months during 
        each plan year, each provider listed in such directory to 
        verify--
                    ``(A) contact information listed in such directory 
                with respect to such provider; and
                    ``(B) the status of whether such provider is a 
                provider within the network of such plan or coverage; 
                and
            ``(2) in the case that such entity determines that any of 
        the information described in subparagraph (A) or (B) of 
        paragraph (1) with respect to a provider listed in such 
        directory of such plan or coverage is inaccurate, not later 
        than 30 days after making such determination, corrects and 
        updates such information in such directory.
    ``(b) Entity Described.--For purposes of subsection (a), an entity 
described in this subsection is--
            ``(1) in the case of health insurance coverage or a group 
        health plan this is not a self-insured plan, the health 
        insurance issuer offering the health insurance coverage or the 
        group health plan, respectively; and
            ``(2) in the case of a self-insured group health plan, the 
        designated administrator of the plan (as such term is defined 
        in section 3(16)).''.
            (2) Clerical amendment.--The table of sections for part 7 
        of subtitle B of title I of the Employee Retirement Income 
        Security Act of 1974 is amended by adding at the end the 
        following:

``Sec. 716. Process to self-audit information listed in publicly 
                            accessible provider directories.''.
    (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. 9816. PROCESS TO SELF-AUDIT INFORMATION LISTED IN PUBLICLY 
              ACCESSIBLE PROVIDER DIRECTORIES.

    ``(a) In General.--An entity specified in subsection (b), with 
respect to a group health plan, shall have in place a process under 
which, in order to self-audit the information listed in any publicly 
accessible provider directory for such plan, such entity--
            ``(1) contacts, not less than once every 6 months during 
        each plan year, each provider listed in such directory to 
        verify--
                    ``(A) contact information listed in such directory 
                with respect to such provider; and
                    ``(B) the status of whether such provider is a 
                provider within the network of such plan; and
            ``(2) in the case that such entity determines that any of 
        the information described in subparagraph (A) or (B) of 
        paragraph (1) with respect to a provider listed in such 
        directory of such plan is inaccurate, not later than 30 days 
        after making such determination, corrects and updates such 
        information in such directory.
    ``(b) Entity Described.--For purposes of subsection (a), an entity 
described in this subsection is--
            ``(1) in the case of a group health plan this is not a 
        self-insured plan, the health insurance issuer offering the 
        group health plan; and
            ``(2) in the case of a self-insured group health plan, the 
        designated administrator of the plan (as such term is defined 
        in section 3(16) of the Employee Retirement Income Security Act 
        of 1974).''.
            (2) Clerical amendment.--The table of sections for 
        subchapter B of chapter 100 of such Code is amended by adding 
        at the end the following new item:

``Sec. 9816. Process to self-audit information listed in publicly 
                            accessible provider directories.''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2020.
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