[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6004 Introduced in House (IH)]

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116th CONGRESS
  2d Session
                                H. R. 6004

 To amend title XXVII of the Public Health Service Act to require the 
Secretary of Health and Human Services to establish a grant program for 
  purposes of facilitating State efforts to establish or maintain all-
            payer claims databases, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 27, 2020

 Mr. Lipinski introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
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 to require the 
Secretary of Health and Human Services to establish a grant program for 
  purposes of facilitating State efforts to establish or maintain all-
            payer claims databases, 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; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Transparency and 
Accountability in Health Care Costs and Prices Act of 2020''.
    (b) Findings.--Congress finds the following:
            (1) According to official estimates published by the 
        Centers for Medicare & Medicaid Services, Americans spent a 
        total of $3.6 trillion on health care in 2018, or $11,172 per 
        person.
            (2) Spending on hospital care services reached $1.2 
        trillion in 2018 and rose by 4.5 percent from the previous 
        year. This growth occurred even as Americans made fewer 
        hospital visits because of growth in hospital prices.
            (3) Spending on physician visits and clinical services 
        reached $725.6 billion in 2018 and rose by 4.1 percent from the 
        previous year.
            (4) Spending on prescription drugs reached $335 billion in 
        2018 and rose by 2.5 percent from the previous year.
            (5) According to a 2019 analysis of a subset of commercial 
        insurance claims by the independent, non-partisan Health Care 
        Cost Institute, prices for common medical services could vary 
        up to 25 times between different metro areas and up to 39 times 
        for the same service within the same metro area.
            (6) A 2015 analysis of a subset of commercial insurance 
        claims by Yale, University of Pennsylvania, Carnegie Mellon, 
        and MIT researchers found that even within one hospital, prices 
        for certain common services like lower limb MRIs, knee 
        replacements, and colonoscopies could vary by 23.5 percent on 
        average depending on which insurer covered the patient.
            (7) Information about contracts between providers and 
        insurers available to researchers, policymakers, and the public 
        is limited or incomplete because these contracts frequently 
        prohibit disclosure of information about how providers are 
        paid.
            (8) All-payer claims databases (APCDs) are large-scale 
        databases increasingly adopted by States to collect health care 
        claims data across different payers such as private insurers, 
        government employee health plans, Medicare, and Medicaid.
            (9) APCD data can be shared with vetted and authorized 
        users to make it easier to track trends in health care prices, 
        create tools for consumers to check price and quality, assist 
        employers and health plans in making more informed decisions 
        when developing employer-sponsored health plans, test new ideas 
        for holding down health care costs, and guide policymakers in 
        developing health care policy.
            (10) In 2019, the independent, non-partisan RAND 
        Corporation published the first broad-based study reporting 
        prices paid by private health plans to hospitals identified by 
        name. This important study tracked important disparities in 
        price trends across the nation, with relative prices increasing 
        rapidly from 2015 to 2017 for hospitals in some States, while 
        falling in others. This work was made possible in part through 
        the use of data from APCDs in New Hampshire and Colorado.
            (11) Since 2015, Oregon has used data from its APCD to 
        review insurers' proposed premium rates, including determining 
        whether or not proposed premiums are excessive. Oregon has also 
        used its APCD to create an annual report on hospital 
        reimbursement variations from different insurers.
            (12) Minnesota and Virginia have used data from their APCDs 
        to shine a spotlight on spending for low-value--possibly even 
        unnecessary--medical services.
            (13) Washington State has used data from its APCD to create 
        the Washington HealthCareCompare tool that helps patients learn 
        about local prices for medical services at local doctors' 
        offices, hospitals, and outpatient centers, and puts those 
        prices in context by highlighting what kinds of prices can be 
        considered typical, low, or high. Additional States that have 
        developed price transparency tools from their APCDs include New 
        Hampshire, Maine, Massachusetts, Colorado, Maryland, and Rhode 
        Island.
            (14) According to the APCD Council, a learning 
        collaborative of public and private organizations working on 
        developing and establishing APCDs, at least 18 States have 
        enacted State laws establishing APCDs.
            (15) While many States have or are considering establishing 
        APCDs, current APCDs vary in the types of data collected, the 
        types of users allowed to access the data, the types of data 
        that can be published, and how much authorized users are 
        charged to access the data.
            (16) A 2016 Supreme Court decision, Gobeille v. Liberty 
        Mutual Insurance Co., prohibited States from requiring claim 
        submissions to APCDs from large employers that pay for health 
        benefits directly instead of purchasing health coverage from 
        insurance companies. This limited the data that States could 
        mandate for inclusion in an APCD.
            (17) Supporting the establishment of APCDs is an important 
        way to promote transparency and understanding of overall health 
        care spending.
            (18) State APCDs should be encouraged to collect data from 
        more types of payers; make it easier and more affordable for 
        APCD data to be used to assist patients and providers in making 
        informed choices about care; make it easier and more affordable 
        for APCD data to be used for efforts to bring health care cost 
        growth under control and improve insurance coverage; and permit 
        their data to be used to report provider-level prices.

SEC. 2. REQUIRING THE SECRETARY OF HEALTH AND HUMAN SERVICES TO 
              ESTABLISH A GRANT PROGRAM FOR PURPOSES OF FACILITATING 
              STATE EFFORTS TO ESTABLISH OR MAINTAIN ALL-PAYER CLAIMS 
              DATABASES.

    Part C of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg-91 et seq.) is amended by adding at the end the following new 
section:

``SEC. 2795. ALL-PAYER CLAIMS DATABASE GRANT PROGRAM.

    ``(a) In General.--Not later than 1 year after the date of the 
enactment of this section, the Secretary shall establish a grant 
program (in this section referred to as the `program') for purposes of 
awarding grants to States to facilitate such States in establishing or 
maintaining an all-payer claims database.
    ``(b) Use of Funds.--A State use funds from a grant awarded under 
the program for any of the following:
            ``(1) To establish a State or regional all-payer claims 
        database or to maintain an existing such database.
            ``(2) To expand the capabilities of an existing such 
        database (such as through improving the collection of data 
        contained in such database or improving the dissemination of 
        such data).
    ``(c) Eligibility.--To be eligible to receive a grant under the 
program, a State (or compact of States) shall submit to the Secretary 
an application at such time, in such manner, and containing such 
information as the Secretary may specify. Such information shall 
include the following:
            ``(1) A specification of how the State (or compact of 
        States) will ensure uniform data collection through the all-
        payer claims database.
            ``(2) A description of privacy and security protections for 
        data submitted to such database, including a specification of 
        how the State (or compact of States) will ensure that--
                    ``(A) no individually identifiable health 
                information is disclosed to the public;
                    ``(B) access to such information is limited to 
                staff with appropriate security and privacy training;
                    ``(C) effective security standards for transferring 
                such data or making such data available to authorized 
                uses of such database are maintained;
                    ``(D) a process for providing access to such data 
                for such users is secure and maintains the 
                confidentiality of any individually identifiable health 
                information is established;
                    ``(E) such database adheres to best security 
                practices relating to the management and use of such 
                data, consistent with any applicable Federal law; and
                    ``(F) users of such database are prohibited from 
                attempting to reidentify such data and penalized for 
                any such attempt.
            ``(3) A specification of whether submission of data to such 
        database is (or will be) mandatory or voluntary.
            ``(4) A specification of which type of entities (such as 
        group health plans, health insurance issues, nonfederal 
        governmental plans, and Federal health care programs) are (or 
        will be) submitting such data to such database.
            ``(5) A description of the types of claims included in such 
        database (such as medical claims, pharmacy claims, and dental 
        claims).
            ``(6) A description of the data release policy in effect 
        (or proposed to be put into effect) with respect to data 
        contained in such database, including a description of the type 
        of users who are (or will be) authorized to access such data 
        (such as employers, employee organizations, health care 
        providers, researchers, and policymakers).
            ``(7) Any other information determined appropriate by the 
        Secretary.
    ``(d) Award Priority.--In making grants under the program, the 
Secretary shall prioritize applications submitted under subsection (c) 
that demonstrate any of the following (with higher priority being given 
to applications that demonstrate the greatest number of the following):
            ``(1) The all-payer claims database to be established, 
        maintained, or expanded through such grant requires mandatory 
        reporting of claims data to such database.
            ``(2) Such database will transition to require such 
        mandatory reporting.
            ``(3) Data contained in such database is (or will be) 
        easily accessible and affordable for users to access.
            ``(4) Such database permits (or will permit) such data to 
        be viewed in a provider-specific manner.
            ``(5) A history of (or planned) partnerships with users of 
        such database to facilitate the use of such data in--
                    ``(A) informing individuals about the cost, 
                quality, and value of health care;
                    ``(B) assisting health care providers, including 
                hospitals, in working with individuals to make informed 
                decisions regarding health care;
                    ``(C) enabling health care providers, including 
                hospitals, and communities to improve the furnishing of 
                items and services and health outcomes for individuals 
                through comparisons of such outcomes with other such 
                providers and hospitals;
                    ``(D) enabling entities that pay for items and 
                services, including employers, employee organizations, 
                group health plans, and health insurance issuers, to 
                develop value-based purchasing models and improve the 
                quality and cost of care furnished to employees or 
                enrollees;
                    ``(E) enabling group health plans and health 
                insurance issuers to evaluate network design, network 
                construction, and the cost of care furnished to 
                enrollees;
                    ``(F) facilitating State-led initiatives to lower 
                health care costs and improve health care quality; or
                    ``(G) promoting competition based on quality and 
                cost.
    ``(e) Privacy Regulations.--The Secretary shall promulgate 
regulations specifying the extent and manner to which any applicable 
Federal law or regulation relating to privacy shall apply to activities 
carried out pursuant to a grant made under the program and may issue 
any additional regulation determined necessary by the Secretary to 
ensure appropriate confidentiality of data associated with such 
activities.
    ``(f) Disclosure of Data.--Any State (or compact of States) 
receiving a grant under the program to establish, maintain, or expand 
an all-payer claims database shall work to make all information 
contained in such database available to the Director of the 
Congressional Budget Office, the Comptroller General of the United 
States, the Executive Director of the Medicare Payment Advisory 
Commission, and the Executive Director of the Medicaid and CHIP 
Advisory Committee upon request, subject to any regulation described in 
subsection (e) and State law. Such information may be made available in 
the form of raw data, summary reports, or such other format determined 
appropriate by the requesting entity and the State (or compact of 
States).
    ``(g) Definition.--For purposes of this section, the term `all-
payer claims database' means, with respect to a State (or compact of 
States), a State or regional database operated by (or under contract 
with) a State (or compact of States) that may include medical claims, 
pharmacy claims, dental claims, member eligibility, and provider files 
which are collected from private and public payers.
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated $100,000,000 to carry out this section.''.

SEC. 3. ALLOWING FOR COLLECTION OF INFORMATION FROM SELF-INSURED GROUP 
              HEALTH PLANS.

    Section 514(b) of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1144(b)) is amended by adding at the end the following 
new paragraph:
    ``(10) Subsection (a) shall not apply to any State law requiring a 
group health plan (including a self-insured group health plan) to 
provide claims data to an all-payer claims database (as defined in 
section 2795(g) of the Public Health Service Act).''.
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