[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4506 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 4506

 To amend the Public Health Service Act to help health care consumers 
    comparison shop for medical services based on quality and cost.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 9, 2016

 Mr. Fortenberry introduced the following bill; which was referred to 
                  the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act to help health care consumers 
    comparison shop for medical services based on quality and cost.

    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 Before You Go Act of 2016''.

SEC. 2. EXPENDITURES FOR TRANSPARENCY TOOLS TREATED AS ACTIVITIES THAT 
              IMPROVE HEALTH CARE QUALITY FOR THE PURPOSE OF 
              DETERMINING MEDICAL LOSS RATIO.

    Section 2718(c) of the Public Health Service Act (42 U.S.C. 300gg-
18(c)) is amended--
            (1) by striking ``Not later than'' and inserting the 
        following:
            ``(1) In general.--Not later than''; and
            (2) by adding at the end the following new paragraph:
            ``(2) Spending on transparency tools as activities that 
        improve health care quality.--
                    ``(A) In general.--In the case of a health 
                insurance issuer offering group or individual health 
                insurance coverage, in applying this section to such 
                issuer with respect to a plan year beginning after the 
                date of the enactment of this paragraph, the activities 
                described in subsection (a)(2) shall include 
                implementing, promoting, maintaining, or improving a 
                transparency tool with respect to such coverage if such 
                issuer has, during such plan year--
                            ``(i) significantly increased (compared to 
                        the previous plan year) the percentage of 
                        enrollees under such coverage who are using 
                        such transparency tool by such issuer;
                            ``(ii) provided the estimates under 
                        subparagraph (B)(iii) of cost-sharing 
                        obligations of a similarly situated enrollee 
                        under such coverage to each individual that 
                        requests such estimate with respect to such 
                        coverage; and
                            ``(iii) made available to each individual 
                        seeking enrollment under health insurance 
                        coverage offered by such issuer a list of 
                        coverage options offered by such issuer that 
                        qualify as high deductible health plans (as 
                        defined in section 223(c)(2) of the Internal 
                        Revenue Code of 1986).
                    ``(B) Transparency tool.--For the purposes of 
                subparagraph (A), a transparency tool, with respect to 
                a health insurance issuer offering group or individual 
                health insurance coverage, includes a website and 
                telephone support that makes available to each enrollee 
                under such coverage, with respect to common episodes of 
                care, the following information:
                            ``(i) Comparisons among in-network 
                        providers with respect to quality of care.
                            ``(ii) Comparisons among different types of 
                        in-network providers of the estimated cost-
                        sharing obligation, before application of any 
                        deductible, of an enrollee under such coverage 
                        for each such episode of care.
                            ``(iii) The estimated cost-sharing 
                        obligation, after application of any 
                        deductible, of an enrollee under such coverage 
                        for each such episode of care at a specific in-
                        network provider.''.
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