[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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