Title: Know Your Provider Act of 2020
Policy area: Health

Summary:
Know Your Provider Act of 2020  This bill requires private health insurance plans to
Further, providers and facilities must establish processes for submitting current information to contracted health plans.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5807 Introduced in House (IH)]

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116th CONGRESS
  2d Session
                                H. R. 5807

  To amend title XXVII of the Public Health Service Act, the Internal 
 Revenue Code of 1986, the Employee Retirement Income Security Act of 
     1974, and title XI of the Social Security Act to improve the 
   availability and accuracy of provider directory information made 
 available by group health plans and health insurance issuers offering 
            group or individuals health insurance coverage.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 7, 2020

Mr. Larson of Connecticut (for himself and Mr. Wenstrup) introduced the 
   following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committees on Ways and Means, and 
Education and Labor, 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 title XXVII of the Public Health Service Act, the Internal 
 Revenue Code of 1986, the Employee Retirement Income Security Act of 
     1974, and title XI of the Social Security Act to improve the 
   availability and accuracy of provider directory information made 
 available by group health plans and health insurance issuers offering 
            group or individuals health insurance 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 ``Know Your Provider Act of 2020''.

SEC. 2. IMPROVING THE AVAILABILITY AND ACCURACY OF PROVIDER DIRECTORY 
              INFORMATION MADE AVAILABLE BY GROUP HEALTH PLANS AND 
              HEALTH INSURANCE ISSUERS OFFERING GROUP OR INDIVIDUALS 
              HEALTH INSURANCE COVERAGE.

    (a) Group Health Plan and Health Insurance Issuer Requirements.--
            (1) Public health service act.--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 new 
        section:

``SEC. 2730. PROVIDER DIRECTORY REQUIREMENTS.

    ``(a) In General.--Beginning not later than January 1, 2022, each 
group health plan and health insurance issuer offering group or 
individual health insurance coverage shall--
            ``(1) establish the verification process described in 
        subsection (b);
            ``(2) establish the response protocol described in 
        subsection (c);
            ``(3) establish the database described in subsection (d); 
        and
            ``(4) include in any directory (other than the database 
        described in paragraph (3)) containing provider directory 
        information with respect to such plan or such coverage the 
        information described in subsection (e).
    ``(b) Verification Process.--The verification process described in 
this subsection is, with respect to a group health plan or a health 
insurance issuer offering group or individual health insurance 
coverage, a process--
            ``(1) under which such plan or such issuer (as applicable) 
        verifies and updates the provider directory information 
        included on the database described in subsection (d) of such 
        plan or issuer of--
                    ``(A) not less frequently than once every 90 days, 
                a random sample of at least 10 percent of health care 
                providers and health care facilities included in such 
                database; and
                    ``(B) any such provider or such facility included 
                in such database that has not submitted any claim to 
                such plan or such issuer (as applicable) during a 12-
                month period;
            ``(2) that establishes a procedure for the removal from 
        such database of such a provider or facility with respect to 
        which such plan or issuer has been unable to verify such 
        information during a period specified by the plan or issuer; 
        and
            ``(3) that provides for the update of such database within 
        2 business days of such plan or such issuer (as applicable) 
        receiving from such a provider or facility information pursuant 
        to section 1150C of the Social Security Act.
    ``(c) Response Protocol.--The response protocol described in this 
subsection is, in the case of an individual enrolled under a group 
health plan or group or individual health insurance coverage offered by 
a health insurance issuer who requests information through a telephone 
call or email on whether a health care provider or health care facility 
has a contractual relationship to furnish items and services under such 
plan or such coverage, a protocol under which such plan or such issuer 
(as applicable)--
            ``(1) responds to such individual as soon as practicable, 
        and in no case later than 1 business day after such call or 
        email is received, through a written electronic communication; 
        and
            ``(2) retains such communication in such individual's file 
        for at least 2 years following such response.
    ``(d) Database.--The database described in this subsection is, with 
respect to a group health plan or health insurance issuer offering 
group or individual health insurance coverage, a database on the public 
website of such plan or issuer that contains--
            ``(1) a list of each health care provider and health care 
        facility with which such plan or such issuer has a contractual 
        relationship for furnishing items and services under such plan 
        or such coverage; and
            ``(2) provider directory information with respect to each 
        such provider and facility.
    ``(e) Information.--The information described in this subsection 
is, with respect to a directory containing provider directory 
information with respect to a group health plan or individual or group 
health insurance coverage offered by a health insurance issuer, a 
notification that such information contained in such directory was 
accurate as of the date of publication of such directory and that an 
individual enrolled under such plan or such coverage should consult the 
database described in subsection (d) with respect to such plan or such 
coverage or contact such plan or the issuer of such coverage to obtain 
the most current provider directory information with respect to such 
plan or such coverage.
    ``(f) Definition.--For purposes of this section, the term `provider 
directory information' includes, with respect to a group health plan 
and a health insurance issuer offering group or individual health 
insurance coverage, the name, address, specialty, and telephone number 
of each health care provider or health care facility with which such 
plan or such issuer has a contractual relationship for furnishing items 
and services under such plan or such coverage.''.
            (2) Internal revenue code of 1986.--
                    (A) 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. PROVIDER DIRECTORY REQUIREMENTS.

    ``(a) In General.--Beginning not later than January 1, 2022, each 
group health plan shall--
            ``(1) establish the verification process described in 
        subsection (b);
            ``(2) establish the response protocol described in 
        subsection (c);
            ``(3) establish the database described in subsection (d); 
        and
            ``(4) include in any directory (other than the database 
        described in paragraph (3)) containing provider directory 
        information with respect to such plan the information described 
        in subsection (e).
    ``(b) Verification Process.--The verification process described in 
this subsection is, with respect to a group health plan, a process--
            ``(1) under which such plan verifies and updates the 
        provider directory information included on the database 
        described in subsection (d) of such plan of--
                    ``(A) not less frequently than once every 90 days, 
                a random sample of at least 10 percent of health care 
                providers and health care facilities included in such 
                database; and
                    ``(B) any such provider or such facility included 
                in such database that has not submitted any claim to 
                such plan during a 12-month period;
            ``(2) that establishes a procedure for the removal from 
        such database of such a provider or facility with respect to 
        which such plan has been unable to verify such information 
        during a period specified by the plan; and
            ``(3) that provides for the update of such database within 
        2 business days of such plan receiving from such a provider or 
        facility information pursuant to section 1150C of the Social 
        Security Act.
    ``(c) Response Protocol.--The response protocol described in this 
subsection is, in the case of an individual enrolled under a group 
health plan who requests information through a telephone call or email 
on whether a health care provider or health care facility has a 
contractual relationship to furnish items and services under such plan, 
a protocol under which such plan--
            ``(1) responds to such individual as soon as practicable, 
        and in no case later than 1 business day after such call or 
        email is received, through a written electronic communication; 
        and
            ``(2) retains such communication in such individual's file 
        for at least 2 years following such response.
    ``(d) Database.--The database described in this subsection is, with 
respect to a group health plan, a database on the public website of 
such plan that contains--
            ``(1) a list of each health care provider and health care 
        facility with which such plan has a contractual relationship 
        for furnishing items and services under such plan; and
            ``(2) provider directory information with respect to each 
        such provider and facility.
    ``(e) Information.--The information described in this subsection 
is, with respect to a directory containing provider directory 
information with respect to a group health plan, a notification that 
such information contained in such directory was accurate as of the 
date of publication of such directory and that an individual enrolled 
under such plan should consult the database described in subsection (d) 
with respect to such plan or contact such plan to obtain the most 
current provider directory information with respect to such plan.
    ``(f) Definition.--For purposes of this section, the term `provider 
directory information' includes, with respect to a group health plan, 
the name, address, specialty, and telephone number of each health care 
provider or health care facility with which such plan has a contractual 
relationship for furnishing items and services under such plan or such 
coverage.''.
                    (B) Conforming amendment.--Section 9815(a) of the 
                Internal Revenue Code of 1986 is amended--
                            (i) in paragraph (1), by striking ``(as 
                        amended by the Patient Protection and 
                        Affordable Care Act)'' and inserting ``(other 
                        than the provisions of section 2730 of such 
                        Act)''; and
                            (ii) in paragraph (2), by inserting 
                        ``(other than the provisions of section 2730 of 
                        such Act)'' after the first occurrence of 
                        ``such part A''.
                    (C) Clerical amendment.--The table of sections for 
                such subchapter is amended by adding at the end the 
                following new items:

``Sec. 9815. Additional market reforms.
``Sec. 9816. Provider directory requirements.''.
            (3) Employee retirement income security act of 1974.--
                    (A) 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. 716. PROVIDER DIRECTORY REQUIREMENTS.

    ``(a) In General.--Beginning not later than January 1, 2022, each 
group health plan and health insurance issuer offering group health 
insurance coverage shall--
            ``(1) establish the verification process described in 
        subsection (b);
            ``(2) establish the response protocol described in 
        subsection (c);
            ``(3) establish the database described in subsection (d); 
        and
            ``(4) include in any directory (other than the database 
        described in paragraph (3)) containing provider directory 
        information with respect to such plan or such coverage the 
        information described in subsection (e).
    ``(b) Verification Process.--The verification process described in 
this subsection is, with respect to a group health plan or a health 
insurance issuer offering group health insurance coverage, a process--
            ``(1) under which such plan or such issuer (as applicable) 
        verifies and updates the provider directory information 
        included on the database described in subsection (d) of such 
        plan or issuer of--
                    ``(A) not less frequently than once every 90 days, 
                a random sample of at least 10 percent of health care 
                providers and health care facilities included in such 
                database; and
                    ``(B) any such provider or such facility included 
                in such database that has not submitted any claim to 
                such plan or such issuer (as applicable) during a 12-
                month period;
            ``(2) that establishes a procedure for the removal from 
        such database of such a provider or facility with respect to 
        which such plan or issuer has been unable to verify such 
        information during a period specified by the plan or issuer; 
        and
            ``(3) that provides for the update of such database within 
        2 business days of such plan or such issuer (as applicable) 
        receiving from such a provider or facility information pursuant 
        to section 1150C of the Social Security Act.
    ``(c) Response Protocol.--The response protocol described in this 
subsection is, in the case of an individual enrolled under a group 
health plan or group health insurance coverage offered by a health 
insurance issuer who requests information through a telephone call or 
email on whether a health care provider or health care facility has a 
contractual relationship to furnish items and services under such plan 
or such coverage, a protocol under which such plan or such issuer (as 
applicable)--
            ``(1) responds to such individual as soon as practicable, 
        and in no case later than 1 business day after such call or 
        email is received, through a written electronic communication; 
        and
            ``(2) retains such communication in such individual's file 
        for at least 2 years following such response.
    ``(d) Database.--The database described in this subsection is, with 
respect to a group health plan or health insurance issuer offering 
group health insurance coverage, a database on the public website of 
such plan or issuer that contains--
            ``(1) a list of each health care provider and health care 
        facility with which such plan or such issuer has a contractual 
        relationship for furnishing items and services under such plan 
        or such coverage; and
            ``(2) provider directory information with respect to each 
        such provider and facility.
    ``(e) Information.--The information described in this subsection 
is, with respect to a directory containing provider directory 
information with respect to a group health plan or group health 
insurance coverage offered by a health insurance issuer, a notification 
that such information contained in such directory was accurate as of 
the date of publication of such directory and that an individual 
enrolled under such plan or such coverage should consult the database 
described in subsection (d) with respect to such plan or such coverage 
or contact such plan or the issuer of such coverage to obtain the most 
current provider directory information with respect to such plan or 
such coverage.
    ``(f) Definition.--For purposes of this section, the term `provider 
directory information' includes, with respect to a group health plan 
and a health insurance issuer offering group health insurance coverage, 
the name, address, specialty, and telephone number of each health care 
provider or health care facility with which such plan or such issuer 
has a contractual relationship for furnishing items and services under 
such plan or such coverage.''.
                    (B) Conforming amendment.--Section 715(a) of the 
                Employee Retirement Income Security Act of 1974 (29 
                U.S.C. 1185d(a)) is amended--
                            (i) in paragraph (1), by striking ``(as 
                        amended by the Patient Protection and 
                        Affordable Care Act)'' and inserting ``(other 
                        than the provisions of section 2730 of such 
                        Act)''; and
                            (ii) in paragraph (2), by inserting 
                        ``(other than the provisions of section 2730 of 
                        such Act)'' after the first occurrence of 
                        ``such part A''.
                    (C) 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. 715. Additional market reforms.
``Sec. 716. Provider directory requirements.''.
    (b) Health Care Providers.--Part A of title XI of the Social 
Security Act (42 U.S.C. 13010 et seq.) is amended by adding at the end 
the following new section:

``SEC. 1150C. SUBMISSION OF INFORMATION TO HEALTH PLANS OF CERTAIN 
              PROVIDER INFORMATION.

    ``(a) In General.--Beginning not later than 1 year after the date 
of the enactment of this section, each health care provider and health 
care facility shall establish a process under which such provider or 
facility transmits, to each health insurance issuer offering group or 
individual health insurance coverage and group health plan with which 
such provider or supplier has in effect a contractual relationship for 
furnishing items and services under such coverage or such plan, 
provider directory information (as defined in section 2730(e) of the 
Public Health Service Act, section 716(e) of the Employee Retirement 
Income Security Act of 1974, or section 9816(e) of the Internal Revenue 
Code of 1986, as applicable) with respect to such provider or facility, 
as applicable. Such provider or facility shall so transmit such 
information to such issuer offering such coverage or such group health 
plan--
            ``(1) when there are any material changes (including a 
        change in address, telephone number, or other contact 
        information) to such provider directory information of the 
        provider or facility with respect to such coverage offered by 
        such issuer or with respect to such plan; and
            ``(2) at any other time (including upon the request of such 
        issuer or plan) determined appropriate by the provider, 
        facility, or the Secretary.
    ``(b) Penalty.--
            ``(1) In general.--Each health care provider or health care 
        facility that fails to transmit information as required under 
        subsection (a) shall be subject to a civil monetary penalty of 
        $1,000 for each day such provider or facility (as applicable) 
        fails to so transmit such information.
            ``(2) Application of provisions.--The provisions of section 
        1128A (other than subsection (a), subsection (b), the first 
        sentence of subsection (c)(1), subsection (d), and subsection 
        (o)) shall apply with respect to a civil monetary penalty 
        imposed under this subsection in the same manner as such 
        provisions apply with respect to a penalty or proceeding under 
        subsection (a) of such section.
    ``(c) Definitions.--In this section, the terms `health insurance 
issuer', `group health plan', `group health insurance coverage', and 
`individual health insurance coverage' have the meaning given such 
terms, respectively, in section 2791 of the Public Health Service Act 
(42 U.S.C. 300gg-91 et seq.).''.
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