Title: Know the Price Act
Policy area: Health

Summary:
Know the Price Act  This bill prohibits private health insurance plans from entering agreements with a health care service provider, or network of such providers, that restricts the plan from accessing and sharing cost or quality of care information. Plans may share such information with referring providers, plan sponsors, and plan enrollees, consistent with privacy rules.
Further, agreements with providers may not restrict group health plans from electronically accessing anonymous claims information upon request, consistent with privacy rules.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6005 Introduced in House (IH)]

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116th CONGRESS
  2d Session
                                H. R. 6005

   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.


_______________________________________________________________________


                    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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Know the Price Act''.

SEC. 2. INCREASING TRANSPARENCY BY REMOVING GAG CLAUSES ON PRICE AND 
              QUALITY INFORMATION.

    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 INFORMATION.

    ``(a) Increasing Price and Quality Transparency 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 referring providers, the plan 
                sponsor, enrollees, or eligible enrollees of the plan 
                or coverage;
                    ``(B) electronically accessing de-identified claims 
                and encounter data for each enrollee in the plan or 
                coverage, upon request and consistent with 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 
                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 provider 
                        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 subparagraph (A) or 
                (B) with a business associate as defined in section 
                160.103 of title 45, Code of Federal Regulations (or 
                successor regulations), consistent with 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 
                Information Nondiscrimination Act of 2008, and the 
                Americans with Disabilities Act of 1990.
            ``(2) Individual health insurance coverage.--A health 
        insurance issuer offering individual 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 referring providers or the plan 
                sponsor, enrollees, or eligible enrollees of the plan 
                or coverage; or
                    ``(B) sharing data described in subparagraph (A) 
                with a business associate as defined in section 160.103 
                of title 45, Code of Federal Regulations (or successor 
                regulations), consistent with 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 Information 
                Nondiscrimination Act of 2008, and the Americans with 
                Disabilities Act of 1990, for plan design, plan 
                administration, and plan, financial, legal, and quality 
                improvement activities.
            ``(3) Clarification regarding public disclosure 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 attestation 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 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 Information 
        Nondiscrimination Act of 2008, and the Americans with 
        Disabilities Act of 1990.''.
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