[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8098 Introduced in House (IH)]

<DOC>






116th CONGRESS
  2d Session
                                H. R. 8098

     To address hospital consolidation and promote hospital price 
                 transparency, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            August 25, 2020

  Mr. Banks 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 the Judiciary, 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 address hospital consolidation and promote hospital price 
                 transparency, 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 ``Hospital Competition Act of 2020''.

SEC. 2. HOSPITAL CONSOLIDATION.

    (a) Authorization of Appropriations.--There is authorized to be 
appropriated $160,000,000 to the Federal Trade Commission to hire staff 
to investigate, as consistent with the Sherman Antitrust Act and other 
relevant Federal laws, anti-competitive mergers and practices under 
such laws to the extent such mergers and practices relate to providers 
of inpatient and outpatient health care services, as defined by the 
Secretary of Health and Human Services.
    (b) Medicare Advantage Rates Applied to Certain HHI Hospitals.--
            (1) In general.--Section 1866(a) of the Social Security Act 
        (42 U.S.C. 1395cc(a)) is amended--
                    (A) in paragraph (1)--
                            (i) in subparagraph (X), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (Y), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by inserting after subparagraph (Y) 
                        the following new subparagraph:
                    ``(Z) subject to paragraph (4), in the case of a 
                hospital located in a county whose population density 
                is above the median population density for all counties 
                in the United States with respect to which there is a 
                Herfindahl-Hirschman Index (HHI) of greater than 4,000, 
                to apply the average reimbursement rate with respect to 
                individuals (regardless of whether such an individual 
                is entitled to or eligible for benefits under this 
                title, but excluding individuals eligible for medical 
                assistance under a State plan under title XIX) 
                furnished items and services at such hospital that 
                would be billable under this title for such items and 
                services if furnished by such hospital to an individual 
                enrolled under part C.''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(4)(A) The requirement under paragraph (1)(Z) shall not 
        apply in the case of a hospital in a hospital referral region 
        if--
                    ``(i) the HRR market share of such hospital (as 
                determined under subparagraph (B)) is less than 0.15; 
                or
                    ``(ii) the hospital is located in a rural area (as 
                defined in section 1886(d)(2)(D));
            ``(B) For purposes of subparagraph (A), the HRR market 
        share of a hospital in a hospital referral region is equal to--
                    ``(i) the total revenue of the hospital, divided by
                    ``(ii) the total revenue of all hospital in the 
                hospital referral region.''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply with respect to items and services furnished on or 
        after January 1, 2021.
    (c) Grants for Hospital Infrastructure Improvement.--
            (1) In general.--The Secretary of Health and Human Services 
        shall carry out a grant program under which the Secretary shall 
        provide grants to eligible States, in accordance with this 
        subsection.
            (2) Uses.--An eligible State receiving a grant under this 
        subsection may use such grant to improve the State hospital 
        infrastructure and to supplement any other funds provided for a 
        purpose authorized under a State or local hospital grant 
        programs under State law.
            (3) Eligibility.--
                    (A) In general.--An eligible State may receive not 
                more than one grant under this subsection with respect 
                to each qualifying criterion described in subparagraph 
                (B) that is met by the State.
                    (B) Eligible state.--For purposes of this 
                subsection, the term ``eligible State'' means a State 
                that meets any one or more of the following qualifying 
                criteria:
                            (i) The State does not have in effect any 
                        State certificate of need law that requires a 
                        health care provider to provide to a regulatory 
                        body a certification that the community needs 
                        the services provided by the health care 
                        provider.
                            (ii) The State has in effect State scope of 
                        practice laws that--
                                    (I) allow advanced practice 
                                providers (such as nurse practitioners, 
                                advanced practice registered nurses, 
                                clinical nurse specialists, and 
                                physician assistants) to evaluate 
                                patients; diagnose, order, and 
                                interpret diagnostic tests; and 
                                initiate and manage treatments; or
                                    (II) provide that the only 
                                justification for limiting the scope of 
                                practice of a health care provider is 
                                safety to the public.
                            (iii) The State does not have in effect any 
                        State laws that require managed care plans to 
                        accept into the network of such plan any 
                        qualified provider who is willing to accept the 
                        terms and conditions of the managed care plan.
                            (iv) The State does not have in effect any 
                        Certificate of Public Advantage laws that 
                        clearly articulate the State's intent to 
                        displace competition in favor of regulation or 
                        that violate State or Federal antitrust laws.
                            (v) The State does not have in effect any 
                        network adequacy laws regulating a health 
                        plan's ability to deliver benefits by providing 
                        reasonable access to a sufficient number of in-
                        network primary care and specialty physicians, 
                        as well as all health care services included 
                        under the terms of an insuree's contract with a 
                        health insurer.
            (4) Funding.--There is authorized to be appropriated to 
        carry out this subsection $1,000,000,000 for each of the fiscal 
        years 2021 through 2030. Funds appropriated under this 
        paragraph shall remain available until expended.
    (d) Critical Access Hospital Reimbursement Rates.--
            (1) Part a.--Section 1814(l)(1) of the Social Security Act 
        (42 U.S.C. 1395f(l)(1)) is amended by inserting ``(or, for 
        2021, 102, plus 1 percentage point for each subsequent year 
        through 2029, and 110 for each subsequent year thereafter)'' 
        after ``101''.
            (2) Part b.--Section 1834(g)(1) of such Act (42 U.S.C. 
        1395m(g)(1)) is amended by inserting ``(or, for 2021, 102, plus 
        1 percentage point for each subsequent year through 2029, and 
        110 for each subsequent year thereafter)'' after ``101''.

SEC. 3. PRICE TRANSPARENCY.

    Section 1866 of the Social Security Act (42 U.S.C. 1395cc), as 
amended by section 401, is further amended--
            (1) in subsection (a)(1)--
                    (A) in subparagraph (Y), by striking ``and'' at the 
                end;
                    (B) in subparagraph (Z), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by inserting after subparagraph (Z) the 
                following new subparagraph:
            ``(AA) in the case of a hospital, to comply with the 
        requirement under subsection (l).''; and
            (2) by adding at the end the following new subsection:
    ``(l) Requirement Relating to Publishing Certain Hospital Prices.--
            ``(1) In general.--For purposes of subsection (a)(1)(AA), 
        the requirement described in this subsection is, with respect 
        to a hospital and year (beginning with 2021), for the hospital 
        to publicly post, through the system established under 
        paragraph (3), for each commonly shoppable service included in 
        the list published under paragraph (2) for such year, the 
        volume-weighted average price charged by the hospital to--
                    ``(A) individuals enrolled during such year in 
                group health plans or health insurance coverage offered 
                in the individual or group market (as such terms are 
                defined in section 2791 of the Public Health Service 
                Act); and
                    ``(B) individuals who are not enrolled in any 
                health insurance coverage or health benefits plan and 
                individuals who are enrolled in such coverage or plan 
                but such coverage or plan does not provide benefits for 
                the service.
            ``(2) Commonly shoppable services.--For purposes of 
        subsection (a)(1)(AA) and this subsection, the Secretary shall, 
        for 2021 and each subsequent year, publish a list of the 100 
        commonly shoppable services that are the most highly utilized 
        in a hospital-based setting.
            ``(3) Standardized digital reporting system.--Not later 
        than January 1, 2021, the Secretary shall establish a 
        standardized digital system for purposes of paragraph (1).''.

SEC. 4. REPEALING ELIGIBILITY OF CERTAIN ACOS.

    (a) In General.--Section 1899(b)(1) of the Social Security Act (42 
U.S.C. 1395jjj(b)(1)) is amended by striking subparagraphs (C) through 
(E).
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on January 1, 2021.

SEC. 5. OFF-CAMPUS PROVIDER-BASED DEPARTMENT MEDICARE SITE NEUTRAL 
              PAYMENT.

    (a) In General.--Section 1834 of the Social Security Act (42 U.S.C. 
1395m) is amended by adding at the end the following new subsection:
    ``(x) Off-Campus Provider-Based Department Site Neutral Payment.--
            ``(1) In general.--With respect to items and services 
        furnished in an off-campus provider-based department, payment 
        under this section for such items and services shall be the 
        amount determined under the fee schedule under section 1848 for 
        such items and services furnished if furnished in a physician 
        office setting.
            ``(2) Off-campus provider-based department.--For purposes 
        of this subsection, the term `off-campus provider-based 
        department' has such meaning as specified by the Secretary.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply with respect to items and services furnished on or after January 
1, 2021.

SEC. 6. REPEAL OF HEALTH CARE REFORM PROVISIONS LIMITING MEDICARE 
              EXCEPTION TO THE PROHIBITION ON CERTAIN PHYSICIAN 
              REFERRALS FOR HOSPITALS.

    Sections 6001 and 10601 of the Patient Protection and Affordable 
Care Act (Public Law 111-148; 124 Stat. 684, 1005) and section 1106 of 
the Health Care and Education Reconciliation Act of 2010 (Public Law 
111-152; 124 Stat. 1049) are repealed and the provisions of law amended 
by such sections are restored as if such sections had never been 
enacted.

SEC. 7. ADVISORY GROUP ON REDUCING BURDEN OF HOSPITAL ADMINISTRATIVE 
              REQUIREMENTS.

    (a) In General.--Not later than January 1, 2021, the Secretary of 
Health and Human Services shall convene an advisory group to provide, 
in accordance with this section, recommendations on ways the Federal 
Government could reduce the burden of administrative requirements on 
hospitals.
    (b) Recommendations.--Not later than January 1, 2022, the advisory 
board convened under this section shall--
            (1) submit to the Secretary of Health and Human Services 
        recommendations described under subsection (a) for executive 
        action and any recommendations for State actions for potential 
        consideration in making grants under section 2(c) to States; 
        and
            (2) submit to Congress recommendations described under 
        subsection (a) for legislative proposals.
    (c) Membership.--The advisory board under this section shall 
consist of the following members:
            (1) Three representatives of companies that have--
                    (A) geographically distributed workforces;
                    (B) at least 10,000 employees; and
                    (C) no more than 10 percent of such employees in 
                any single State.
            (2) Three representatives of health insurance issuers and 
        health plans, consisting of--
                    (A) one representative of for-profit health 
                insurance issuers and health plans with at least 
                20,000,000 enrollees in the employer-sponsored market;
                    (B) one representative of non-profit health 
                insurance issuers and health plans operating in at 
                least 5 States; and
                    (C) one representative of non-profit health 
                insurance issuers and health plans operating in a rural 
                State (as defined by the Census Bureau).
            (3) Seven public policy experts in the field of hospital 
        consolidation.

SEC. 8. AUTHORITY OF FEDERAL TRADE COMMISSION OVER CERTAIN TAX-EXEMPT 
              ORGANIZATIONS.

    Section 4 of the Federal Trade Commission Act (15 U.S.C. 44) is 
amended, in the undesignated paragraph relating to the definition of 
the term ``Corporation''--
            (1) by striking ``, and any'' and inserting ``, any''; and
            (2) by inserting before the period at the end the 
        following: ``, and any organization described in section 
        501(c)(3) of the Internal Revenue Code of 1986 that is exempt 
        from taxation under section 501(a) of such Code''.

SEC. 9. LEVELING THE PLAYING FIELD BETWEEN PROVIDERS AND PAYERS.

    (a) Exemption.--It shall not be a violation of the antitrust laws 
for one or more private health insurer issuers or their designated 
agents to jointly negotiate prices of particular hospital services with 
a hospital provider with regards to the reimbursement policies of the 
insurers for those services.
    (b) Definitions.--For purposes of this section:
            (1) Antitrust laws.--The term ``antitrust laws'' has the 
        meaning given it in subsection (a) of the 1st section of the 
        Clayton Act (15 U.S.C. 12(a)), except that such term includes 
        section 5 of the Federal Trade Commission Act (15 U.S.C. 45) to 
        the extent such section 5 applies to unfair methods of 
        competition.
            (2) Health insurance issuer.--The term ``health insurance 
        issuer'' means an insurance company, insurance service, or 
        insurance organization (including a health maintenance 
        organization, as defined in subparagraph (C)) which is licensed 
        to engage in the business of insurance in a State and which is 
        subject to State law which regulates insurance (within the 
        meaning of section 514(b)(2) of the Employee Retirement Income 
        Security Act of 1974 (29 U.S.C. 1144(b)(2)). Such term does not 
        include a group health plan.
            (3) Health maintenance organization.--The term ``health 
        maintenance organization'' means--
                    (A) a federally qualified health maintenance 
                organization (as defined in section 300e(a) of title 42 
                of the Code of Federal Regulations),
                    (B) an organization recognized under State law as a 
                health maintenance organization, or
                    (C) a similar organization regulated under State 
                law for solvency in the same manner and to the same 
                extent as such a health maintenance organization.
    (c) Effective Date.--This section shall take effect on the date of 
the enactment of this Act but shall not apply with respect to conduct 
that occurs before such date.

SEC. 10. 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.), as amended by section 103, is amended 
by adding at the end the following:

``SEC. 2729B. INCREASING TRANSPARENCY BY REMOVING GAG CLAUSES ON PRICE 
              AND QUALITY INFORMATION.

    ``(a) Increasing Price and Quality Transparency for Plan Sponsors 
and Group and Individual Market and Consumers.--
            ``(1) Group health plans.--A group health plan or 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, enrollees, 
                or eligible enrollees of the plan or coverage; or
                    ``(B) sharing, for plan design, plan 
                administration, and plan, financial, legal, and quality 
                improvement activities, 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.
            ``(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, plan 
        sponsor, or health insurance issuer 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.''.

SEC. 11. BANNING ANTICOMPETITIVE TERMS IN FACILITY AND INSURANCE 
              CONTRACTS THAT LIMIT ACCESS TO HIGHER QUALITY, LOWER COST 
              CARE.

    (a) In General.--Section 2729B of the Public Health Service Act, as 
added by section 301, is amended by adding at the end the following:
    ``(b) Protecting Health Plans Network Design Flexibility.--
            ``(1) In general.--A group health plan or a health 
        insurance issuer offering group or individual health insurance 
        coverage shall not enter into an agreement with a provider, 
        network or association of providers, or other service provider 
        offering access to a network of service providers if such 
        agreement, directly or indirectly--
                    ``(A) restricts the group health plan or health 
                insurance issuer from--
                            ``(i) directing or steering enrollees to 
                        other health care providers; or
                            ``(ii) offering incentives to encourage 
                        enrollees to utilize specific health care 
                        providers; or
                    ``(B) requires the group health plan or health 
                insurance issuer to enter into any additional contract 
                with an affiliate of the provider, such as an affiliate 
                of the provider, as a condition of entering into a 
                contract with such provider;
                    ``(C) requires the group health plan or health 
                insurance issuer to agree to payment rates or other 
                terms for any affiliate not party to the contract of 
                the provider involved; or
                    ``(D) restricts other group health plans or health 
                insurance issuers not party to the contract from paying 
                a lower rate for items or services than the contracting 
                plan or issuer pays for such items or services.
            ``(2) Additional requirement for self-insured plans.--A 
        self-insured group health plan shall not enter into an 
        agreement with a provider, network or association of providers, 
        third-party administrator, or other service provider offering 
        access to a network of providers if such agreement directly or 
        indirectly requires the group health plan to certify, attest, 
        or otherwise confirm in writing that the group health plan is 
        bound by restrictive contracting terms between the service 
        provider and a third-party administrator that the group health 
        plan is not party to, without a disclosure that such terms 
        exist.
            ``(3) Exception for certain group model issuers.--Paragraph 
        (1)(A) shall not apply to a group health plan or health 
        insurance issuer offering group or individual health insurance 
        coverage with respect to--
                    ``(A) a health maintenance organization (as defined 
                in section 2791(b)(3)), if such health maintenance 
                organization operates primarily through exclusive 
                contracts with multi-specialty physician groups, nor to 
                any arrangement between such a health maintenance 
                organization and its affiliates; or
                    ``(B) a value-based network arrangement, such as an 
                exclusive provider network, accountable care 
                organization, center of excellence, a provider 
                sponsored health insurance issuer that operates 
                primarily through aligned multi-specialty physician 
                group practices or integrated health systems, or such 
                other similar network arrangements as determined by the 
                Secretary through rulemaking.
            ``(4) Attestation.--A group health plan or 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.
    ``(c) Maintenance of Existing HIPAA, GINA, and ADA Protections.--
Nothing in this section shall modify, reduce, or eliminate the existing 
privacy protections and standards provided by reason of State and 
Federal law, including the requirements of parts 160 and 164 of title 
45, Code of Federal Regulations (or any successor regulations).
    ``(d) Regulations.--The Secretary, not later than 1 year after the 
date of enactment of the Hospital Competition Act of 2020, shall 
promulgate regulations to carry out this section.
    ``(e) Rule of Construction.--Nothing in this section shall be 
construed to limit network design or cost or quality initiatives by a 
group health plan or health insurance issuer, including accountable 
care organizations, exclusive provider organizations, networks that 
tier providers by cost or quality or steer enrollees to centers of 
excellence, or other pay-for-performance programs.
    ``(f) Clarification With Respect to Antitrust Laws.--Compliance 
with this section does not constitute compliance with the antitrust 
laws, as defined in subsection (a) of the first section of the Clayton 
Act (15 U.S.C. 12(a)).''.
    (b) Effective Date.--Section 2729B of the Public Health Service Act 
(as added by section 301 and amended by subsection (a)) shall apply 
with respect to any contract entered into on or after the date that is 
18 months after the date of enactment of this Act. With respect to an 
applicable contract that is in effect on the date of enactment of this 
Act, such section 2729B shall apply on the earlier of the date of 
renewal of such contract or 3 years after such date of enactment.

SEC. 12. DESIGNATION OF A NONGOVERNMENTAL, NONPROFIT TRANSPARENCY 
              ORGANIZATION TO LOWER AMERICANS' HEALTH CARE COSTS.

    (a) In General.--Subpart C of title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg-91 et seq.), as amended by section 102, is 
further amended by adding at the end the following:

``SEC. 2796. DESIGNATION OF A NONGOVERNMENTAL, NONPROFIT TRANSPARENCY 
              ORGANIZATION TO LOWER AMERICANS' HEALTH CARE COSTS.

    ``(a) In General.--The Secretary, in consultation with the 
Secretary of Labor, not later than 1 year after the date of enactment 
of the Hospital Competition Act of 2020, shall enter into contracts 
with at least 2 nonprofit entities to support the establishment and 
maintenance of a database that receives and utilizes health care claims 
information and related information and issues reports that are 
available to the public and authorized users, and are submitted to the 
Department of Health and Human Services.
    ``(b) Requirements.--
            ``(1) In general.--The database established under 
        subsection (a) shall--
                    ``(A) improve transparency by using de-identified 
                health care data to--
                            ``(i) inform patients about the cost, 
                        quality, and value of their care;
                            ``(ii) assist providers and hospitals, as 
                        they work with patients, to make informed 
                        choices about care;
                            ``(iii) enable providers, hospitals, and 
                        communities to improve services and outcomes 
                        for patients by benchmarking their performance 
                        against that of other providers, hospitals, and 
                        communities;
                            ``(iv) enable purchasers, including 
                        employers, employee organizations, and health 
                        plans, to develop value-based purchasing 
                        models, improve quality, and reduce the cost of 
                        health care and insurance coverage for 
                        enrollees;
                            ``(v) enable employers and employee 
                        organizations to evaluate network design and 
                        construction, and the cost of care for 
                        enrollees;
                            ``(vi) facilitate State-led initiatives to 
                        lower health care costs and improve quality; 
                        and
                            ``(vii) promote competition based on 
                        quality and cost;
                    ``(B) collect medical claims, prescription drug 
                claims, and remittance data consistent with the 
                protections and requirements of subsection (d);
                    ``(C) be established in such a manner that allows 
                the data collected pursuant to subparagraph (B) to be 
                shared with any State all-payer claims database or 
                regional database operated with authorization from 
                States, at cost, using a standardized format, if such 
                State or regional database also submits claims data to 
                the database established under this section; and
                    ``(D) be available to--
                            ``(i) 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 
                        Payment Advisory Commission, upon request, 
                        subject to the privacy and security 
                        requirements of authorized users under 
                        subsection (e)(2); and
                            ``(ii) authorized users, including 
                        employers, employee organizations, providers, 
                        group health plans, health insurance issuers, 
                        researchers, and policymakers, subject to 
                        subsection (e).
            ``(2) Privacy and security; breach notifications.--
                    ``(A) Regulations.--
                            ``(i) In general.--The Secretary shall 
                        issue regulations prescribing the extent to 
                        which, and the manner in which, the following 
                        rules (and any successors of such rules) shall 
                        apply to the activities under this section of 
                        an entity receiving a contract under subsection 
                        (a):
                                    ``(I) The Privacy Rule under part 
                                160 and subparts A and E of part 164 of 
                                title 45, Code of Federal Regulations 
                                (or any successor regulations).
                                    ``(II) The Security Rule under part 
                                160 and subparts A and C of part 164 of 
                                such title 45 (or any successor 
                                regulations).
                                    ``(III) The Breach Notification 
                                Rule under part 160 and subparts A and 
                                D of part 164 of such title 45 (or any 
                                successor regulations).
                            ``(ii) Supplemental regulations.--In order 
                        to ensure data privacy and security and the 
                        notification of breaches, the Secretary may 
                        issue such supplemental regulations on the 
                        subjects of the rules listed under clause (i) 
                        as the Secretary determines appropriate to 
                        address differences between the activities 
                        described by this section and the activities 
                        covered by such rules.
                    ``(B) Enforcement.--Section 1176 of Social Security 
                Act shall apply with respect to a violation of this 
                paragraph in the same manner such section 1176 applies 
                to a violation of part C of title XI of the Social 
                Security Act, and the Secretary may include in the 
                regulations promulgated under this section provisions 
                to apply such section to this paragraph.
                    ``(C) Procedure.--
                            ``(i) Timing.--The Secretary shall issue 
                        the initial set of regulations under this 
                        paragraph not later than 1 year after the date 
                        of enactment of the Hospital Competition Act of 
                        2020.
                            ``(ii) Authority to use interim final 
                        procedures.--The Secretary may make such 
                        initial set of regulations effective and final 
                        immediately upon issuance, on an interim basis, 
                        and provide for a period of public comment on 
                        such initial set of regulations after the date 
                        of publication.
                    ``(D) Requirements of entity.--An entity receiving 
                the contract under this section shall--
                            ``(i) not disclose to the public any 
                        individually identifiable health information;
                            ``(ii) strictly limit staff access to the 
                        data to staff with appropriate training, 
                        clearance, and background checks and require 
                        regular privacy and security training;
                            ``(iii) maintain effective security 
                        standards for transferring data or making data 
                        available to authorized users;
                            ``(iv) develop a process for providing 
                        access to data to authorized users, in a secure 
                        manner that maintains privacy and 
                        confidentiality of data; and
                            ``(v) adhere to current best security 
                        practices with respect to the management and 
                        use of such data for health services research, 
                        in accordance with applicable Federal privacy 
                        law.
            ``(3) Consultation.--
                    ``(A) Advisory committee.--Not later than 180 days 
                after the date of enactment of the Hospital Competition 
                Act of 2020, the Secretary shall convene an Advisory 
                Committee (referred to in this section as the 
                `Committee'), consisting of 13 members, to advise the 
                Secretary, a contracting entity, and Congress on the 
                establishment, operations, and use of the database 
                established under this section.
                    ``(B) Membership.--
                            ``(i) Appointment.--In accordance with 
                        clause (ii), the Secretary, in consultation 
                        with the Secretary of Labor and the Comptroller 
                        General of the United States shall, not later 
                        than 180 days after the date of enactment of 
                        the Hospital Competition Act of 2020, appoint 
                        members to the Committee who have distinguished 
                        themselves in the fields of health services 
                        research, health economics, health informatics, 
                        or the governance of State all-payer claims 
                        databases, or who represent organizations 
                        likely to submit data to or use the database, 
                        including patients, employers, or employee 
                        organizations that sponsor group health plans, 
                        health care providers, health insurance 
                        issuers, or third-party administrators of group 
                        health plans. Such members shall serve 3-year 
                        terms on a staggered basis. Vacancies on the 
                        Committee shall be filled by appointment 
                        consistent with this subsection not later than 
                        3 months after the vacancy arises.
                            ``(ii) Composition.--In accordance with 
                        clause (i)--
                                    ``(I) the Secretary, in 
                                consultation with the Secretary of 
                                Labor, shall appoint to the Committee--
                                            ``(aa) 1 member selected by 
                                        the Secretary, in coordination 
                                        with the Secretary of Labor, to 
                                        serve as the chair of the 
                                        Committee;
                                            ``(bb) the Assistant 
                                        Secretary for Planning and 
                                        Evaluation of the Department of 
                                        Health and Human Services, or a 
                                        designee of such Assistant 
                                        Secretary;
                                            ``(cc) 1 representative of 
                                        the Centers for Medicare & 
                                        Medicaid Services;
                                            ``(dd) 1 representative of 
                                        the Agency for Health Research 
                                        and Quality;
                                            ``(ee) 1 representative of 
                                        the Office for Civil Rights of 
                                        the Department of Health and 
                                        Human Services with expertise 
                                        in data privacy and security;
                                            ``(ff) 1 representative of 
                                        the National Center for Health 
                                        Statistics; and
                                            ``(gg) 1 representative of 
                                        the Employee Benefits and 
                                        Security Administration of the 
                                        Department of Labor; and
                                    ``(II) the Comptroller General of 
                                the United States shall appoint to the 
                                Committee--
                                            ``(aa) 1 representative of 
                                        an employer that sponsors a 
                                        group health plan;
                                            ``(bb) 1 representative of 
                                        an employee organization that 
                                        sponsors a group health plan;
                                            ``(cc) 1 academic 
                                        researcher with expertise in 
                                        health economics or health 
                                        services research;
                                            ``(dd) 1 consumer advocate; 
                                        and
                                            ``(ee) 2 additional 
                                        members.
                    ``(C) Duties.--The Committee shall--
                            ``(i) advise the Secretary on the 
                        management of the contract under subsection 
                        (a);
                            ``(ii) assist and advise the entities 
                        receiving the contract under subsection (a) in 
                        establishing--
                                    ``(I) the scope and format of the 
                                data to be submitted under subsection 
                                (d);
                                    ``(II) best practices with respect 
                                to de-identification of data, as 
                                appropriate;
                                    ``(III) the appropriate uses of 
                                data by authorized users, including 
                                developing standards for the approval 
                                of requests by organizations to access 
                                and use the data; and
                                    ``(IV) the appropriate formats and 
                                methods for making reports and analyses 
                                based on the database to the public;
                            ``(iii) conduct an annual review of whether 
                        data was used according to the appropriate uses 
                        as described in clause (ii)(II), and advise the 
                        designated entities on using the data for 
                        authorized purposes;
                            ``(iv) report, as appropriate, to the 
                        Secretary and Congress on the operation of the 
                        database and opportunities to better achieve 
                        the objectives of this section;
                            ``(v) establish additional restrictions on 
                        researchers who receive compensation from 
                        entities described in subsection (e)(2)(B)(ii), 
                        in order to protect individually identifiable 
                        health information; and
                            ``(vi) establish objectives for research 
                        and public reporting.
            ``(4) State requirements.--A State may require health 
        insurance issuers and other payers to submit claims data to the 
        database established under this section, provided that such 
        data is submitted to the entities awarded contracts under this 
        section in a form and manner established by the Secretary, and 
        pursuant to subsection (d)(4)(B).
            ``(5) Sanctions.--The Secretary shall take appropriate 
        action to sanction users who attempt to re-identify data 
        accessed pursuant to paragraph (1)(D).
    ``(c) Contract Requirements.--
            ``(1) Competitive procedures.--The Secretary shall enter 
        into the contract under subsection (a) using full and open 
        competition procedures pursuant to chapter 33 of title 41, 
        United States Code.
            ``(2) Eligible entities.--To be eligible to enter into a 
        contract described in subsection (a), an entity shall--
                    ``(A) be a private nonprofit entity governed by a 
                board that includes representatives of the academic 
                research community and individuals with expertise in 
                employer-sponsored insurance, research using health 
                care claims data and actuarial analysis;
                    ``(B) conduct its business in an open and 
                transparent manner that provides the opportunity for 
                public comment on its activities; and
                    ``(C) agree to comply with any requirements imposed 
                under the rulemaking described in subsection (d)(4)(A).
            ``(3) Considerations.--In awarding a contract under 
        subsection (a), the Secretary shall consider an entity's 
        experience in--
                    ``(A) health care claims data collection, 
                aggregation, quality assurance, analysis, and security;
                    ``(B) supporting academic research on health costs, 
                spending, and utilization for and by privately insured 
                patients;
                    ``(C) working with large health insurance issuers 
                and third-party administrators to assemble a national 
                claims database;
                    ``(D) effectively collaborating with and engaging 
                stakeholders to develop reports;
                    ``(E) meeting budgets and timelines, including in 
                connection with report generation; and
                    ``(F) facilitating the creation of, or supporting, 
                State all-payer claims databases.
            ``(4) Contract term.--A contract awarded under this section 
        shall be for a period of 5 years, and may be renewed after a 
        subsequent competitive bidding process under this section.
            ``(5) Transition of contract.--If the Secretary, following 
        a competitive process at the end of the contract period, 
        selects a new entity to maintain the database, all data shall 
        be transferred to the new entity according to a schedule and 
        process to be determined by the Secretary. Upon termination of 
        a contract, no entity may keep data held by the database or 
        disclose such data to any entity other than the entity so 
        designated by the Secretary. The Secretary shall include 
        enforcement terms in any contract with an organization chosen 
        under this section, to ensure the timely transfer of all data, 
        and any associated code or algorithms, to a new entity in the 
        event of contract termination.
    ``(d) Receiving Health Information.--
            ``(1) Requirements.--
                    ``(A) In general.--The Secretary of Labor shall 
                ensure that the applicable self-insured group health 
                plan, through its third-party administrator, pharmacy 
                benefit manager, or other entity designated by the 
                group health plan, as applicable, electronically 
                submits all claims data with respect to the plan, 
                pursuant to subparagraph (B).
                    ``(B) Scope of information and format of 
                submission.--An entity awarded the contract under 
                subsection (a), in consultation with the Committee 
                described in subsection (b)(3), and pursuant to the 
                privacy and security requirements of subsection (b)(2), 
                shall--
                            ``(i) specify the data elements required to 
                        be submitted under subparagraph (A), which 
                        shall include all data related to transactions 
                        described in subparagraphs (A) and (E) of 
                        section 1173(a)(2) of the Social Security Act, 
                        including all data elements normally present in 
                        such transactions when adjudicated, and 
                        enrollment information;
                            ``(ii) specify the form and manner for such 
                        submissions, and the historical period to be 
                        included in the initial submission; and
                            ``(iii) offer an automated submission 
                        option to minimize administrative burdens for 
                        entities required to submit data.
                    ``(C) De-identification of data.--An entity awarded 
                the contract under subsection (a) shall--
                            ``(i) establish a process under which data 
                        is de-identified consistent with the de-
                        identification requirements under section 
                        164.514 of title 45, Code of Federal 
                        Regulations (or any successor regulations), 
                        while retaining the ability to link data 
                        longitudinally for the purposes of research on 
                        cost and quality, and the ability to complete 
                        risk adjustment and geographic analysis;
                            ``(ii) ensure that any third-party 
                        subcontractors who perform the de-
                        identification process described in clause (i) 
                        retain only the minimum necessary information 
                        to perform such a process, and adhere to 
                        effective security and encryption practices in 
                        data storage and transmission;
                            ``(iii) store claims and other data 
                        collected under this subsection only in de-
                        identified form, in accordance with section 
                        164.514 of title 45, Code of Federal 
                        Regulations (or any successor regulations); and
                            ``(iv) ensure that individually 
                        identifiable data is encrypted, in accordance 
                        with guidance issued by the Secretary under 
                        section 13402(h)(2) of the HITECH Act.
            ``(2) Applicable self-insured group health plan.--For 
        purposes of paragraph (1), a self-insured group health plan is 
        an applicable self-insured group health plan if such plan is 
        self-administered, or is administered by a third-party plan 
        administrator that meets 1 or both of the following criteria:
                    ``(A) Administers health, medical, or pharmacy 
                benefits for more than 50,000 enrollees.
                    ``(B) Is one of the 5 largest administrators or 
                issuers of self-insured group health plans in a State 
                in which such administrator operates, as measured by 
                the aggregate number of enrollees in plans administered 
                by such administrator in such State, as determined by 
                the Secretary.
            ``(3) Third-party administrators.--In the case of a third-
        party administrator that is required under this subsection to 
        submit claims data with respect to an applicable self-insured 
        group health plan, such administrator shall submit claims data 
        with respect to all self-insured group health plans that the 
        administrator administers, including such plans that are not 
        applicable self-insured group health plans, as described in 
        paragraph (2).
            ``(4) Receiving other information.--
                    ``(A) Medicare data.--The Secretary, through 
                rulemaking, shall ensure that the data made available 
                to such entity is available to qualified entities under 
                section 1874(e) of the Social Security Act is made 
                available to each entity awarded a contract under 
                subsection (a).
                    ``(B) State data.--An entity awarded a contract 
                under subsection (a) shall collect data from State all 
                payer claims databases that seek access to the database 
                established under this section.
            ``(5) Availability of data.--An entity required to submit 
        data under this subsection may not place any restrictions on 
        the use of such data by authorized users.
    ``(e) Uses of Information.--
            ``(1) In general.--An entity awarded a contract under 
        subsection (a) shall make the database available to users who 
        are authorized under this subsection, without charge, and 
        reports and analyses based on the data available to the public 
        with no charge.
            ``(2) Authorization of users.--
                    ``(A) In general.--An entity may request 
                authorization by an entity awarded a contract under 
                subsection (a) for access to the database in accordance 
                with this paragraph.
                    ``(B) Application.--An entity desiring 
                authorization under this paragraph shall submit to an 
                entity awarded a contract an application for such 
                access, which shall include--
                            ``(i) in the case of an entity requesting 
                        access for research purposes--
                                    ``(I) a description of the uses and 
                                methodologies for evaluating health 
                                system performance using such data; and
                                    ``(II) documentation of approval of 
                                the research by an institutional review 
                                board, if applicable for a particular 
                                plan of research; or
                            ``(ii) in the case of an entity such as an 
                        employer, health insurance issuer, third-party 
                        administrator, or health care provider, 
                        requesting access for the purpose of quality 
                        improvement or cost-containment, a description 
                        of the intended uses for such data.
                    ``(C) Requirements.--
                            ``(i) Research.--Upon approval of an 
                        application for research purposes under 
                        subparagraph (B)(i), the authorized user shall 
                        enter into a data use and confidentiality 
                        agreement with an entity awarded a contract 
                        under subsection (a), which shall include a 
                        prohibition on attempts to reidentify and 
                        disclose individually identifiable health 
                        information.
                            ``(ii) Quality improvement and cost-
                        containment.--In consultation with the 
                        Committee described in subsection (b)(3), the 
                        Secretary shall, through rulemaking, establish 
                        the form and manner in which authorized users 
                        described in subparagraph (B)(ii) may access 
                        data. Data provided to such authorized users 
                        shall be provided in a form and manner such 
                        that users may not obtain individually 
                        identifiable price information with respect to 
                        direct competitors. Upon approval, such 
                        authorized user shall enter into a data use and 
                        confidentiality agreement with the entity.
                            ``(iii) Customized reports.--Employers and 
                        employer organizations may request customized 
                        reports from an entity awarded a contract under 
                        subsection (a), at cost, subject to the 
                        requirements of this section with respect to 
                        privacy and security.
                            ``(iv) Non-customized reports.--An entity 
                        awarded a contract under subsection (a), in 
                        consultation with the Committee, shall make 
                        available to all authorized users aggregate 
                        data sets, free of charge.
    ``(f) Funding.--
            ``(1) Initial funding.--There are authorized to be 
        appropriated, and there are appropriated, out of monies in the 
        Treasury not otherwise appropriated, $20,000,000 for fiscal 
        year 2020, for the implementation of the initial contract and 
        establishment of the database under this section.
            ``(2) Ongoing funding.--There are authorized to be 
        appropriated $15,000,000 for each of fiscal years 2021 through 
        2025, for purposes of carrying out this section (other than the 
        grant program under subsection (h)).
    ``(g) Annual Report.--
            ``(1) Submission.--On each of the dates described in 
        paragraph (2), an entity receiving a contract under subsection 
        (a) shall submit to Congress, the Secretary of Health and Human 
        Services, and the Secretary of Labor and publish online for 
        access by the general public, a report containing a description 
        of--
                    ``(A) trends in the price, utilization, and total 
                spending on health care services, including a 
                geographic analysis of differences in such trends;
                    ``(B) limitations in the data set;
                    ``(C) progress towards the objectives of this 
                section; and
                    ``(D) the performance by the entity of the duties 
                required under such contract.
            ``(2) Dates described.--The reports described in paragraph 
        (1) shall be submitted--
                    ``(A) not later than 3 years after the date of 
                enactment of the Hospital Competition Act of 2020;
                    ``(B) the later of 1 year after the date that is 3 
                years after such date of enactment or March 1 of the 
                year after the date that is 3 years after such date of 
                enactment; and
                    ``(C) March 1 of each year thereafter.
            ``(3) Public reports and research.--An entity receiving a 
        contract under subsection (a) shall, in coordination with 
        authorized users, make analyses and research available to the 
        public on an ongoing basis to promote the objectives of this 
        section.
    ``(h) Grants to States.--
            ``(1) In general.--The Secretary, in consultation with the 
        Secretary of Labor, may award grants to States for the purpose 
        of establishing and maintaining State all-payer claims 
        databases that improve transparency of data in order to meet 
        the goals of subsection (a)(1).
            ``(2) Requirement.--To be eligible to receive the funding 
        under paragraph (1), a State shall submit data to the database 
        as described in subsection (b)(1)(C), using the format 
        described in subsection (d)(1).
            ``(3) Funding.--There is authorized to be appropriated 
        $100,000,000 for the period of fiscal years 2020 through 2029 
        for the purpose of awarding grants to States under this 
        subsection.
    ``(i) Exemption From Public Disclosure.--
            ``(1) In general.--Claims data provided to the database, 
        and the database itself shall not be considered public records 
        and shall be exempt from public disclosure requirements.
            ``(2) Restrictions on uses for certain proceedings.--Data 
        disclosed to authorized users shall not be subject to discovery 
        or admission as public information, or evidence in judicial or 
        administrative proceedings without consent of the affected 
        parties.
    ``(j) Individually Identifiable Health Information Defined.--The 
term `individually identifiable health information' has the meaning 
given such term in section 1171(6) of the Social Security Act.
    ``(k) Rule of Construction.--Nothing in this section shall be 
construed to affect or modify enforcement of the privacy, security, or 
breach notification rules promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act of 1996 (or 
successor regulations).''.
    (b) GAO Report.--
            (1) In general.--The Comptroller General of the United 
        States shall conduct a study on--
                    (A) the performance of the entity awarded a 
                contract under section 2795(a) of the Public Health 
                Service Act, as added by subsection (a), under such 
                contract;
                    (B) the privacy and security of the information 
                reported to the entity; and
                    (C) the costs incurred by such entity in performing 
                such duties.
            (2) Reports.--Not later than 2 years after the effective 
        date of the first contract entered into under section 2795(a) 
        of the Public Health Service Act, as added by subsection (a), 
        and again not later than 4 years after such effective date, the 
        Comptroller General of the United States shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller 
        General determines appropriate.

SEC. 13. PROTECTING PATIENTS AND IMPROVING THE ACCURACY OF PROVIDER 
              DIRECTORY INFORMATION.

    (a) In General.--Subpart II of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-11 et seq.), as amended by sections 
301 and 302, is further amended by adding at the end the following:

``SEC. 2729C. PROTECTING PATIENTS AND IMPROVING THE ACCURACY OF 
              PROVIDER DIRECTORY INFORMATION.

    ``(a) Network Status of Providers.--
            ``(1) In general.--Beginning on the date that is one year 
        after the date of enactment of this section, a group health 
        plan or a health insurance issuer offering group or individual 
        health insurance coverage shall--
                    ``(A) establish business processes to ensure that 
                all enrollees in such plan or coverage receive proof of 
                a health care provider's network status, based on what 
                a plan or issuer knows or could reasonably know--
                            ``(i) through a written electronic 
                        communication from the plan or issuer to the 
                        enrollee, as soon as practicable and not later 
                        than 1 business day after a telephone inquiry 
                        is made by such enrollee for such information;
                            ``(ii) through an oral confirmation, 
                        documented by such issuer or coverage, and kept 
                        in the enrollee's file for a minimum of 2 
                        years; and
                            ``(iii) in real-time through an online 
                        health care provider directory search tool 
                        maintained by the plan or issuer; and
                    ``(B) include in any print directory a disclosure 
                that the information included in the directory is 
                accurate as of the date of the last data update and 
                that enrollees or prospective enrollees should consult 
                the group health plan or issuer's electronic provider 
                directory on its website or call a specified customer 
                service telephone number to obtain the most current 
                provider directory information.
            ``(2) Group health plan and health insurance issuer 
        business processes.--Beginning on the date that is one year 
        after the date of enactment of the Hospital Competition Act of 
        2020, a group health plan or a health insurance issuer offering 
        group or individual health insurance coverage shall establish 
        business processes to--
                    ``(A) verify and update, at least once every 90 
                days, the provider directory information for all 
                providers included in the online health care provider 
                directory search tool described in paragraph 
                (1)(A)(iii); and
                    ``(B) remove any provider from such online 
                directory search tool if such provider has not verified 
                the directory information within the previous 6 months 
                or the plan or issuer has been unable to verify the 
                provider's network participation.
    ``(b) Cost-Sharing Limitations.--
            ``(1) In general.--A group health plan or a health 
        insurance issuer offering group or individual health insurance 
        coverage shall not apply, and shall ensure that no provider 
        applies cost-sharing to an enrollee for treatment or services 
        provided by a health care provider in excess of the normal 
        cost-sharing applied for in-network care (including any balance 
        bill issued by the health care provider involved), if such 
        enrollee, or health care provider referring such enrollee, 
        demonstrates (based on the electronic, written information 
        described in subsection (a)(1)(A)(i), the oral confirmation 
        described in subsection (a)(1)(A)(ii), or a copy of the online 
        provider directory described in subsection (a)(1)(A)(iii) on 
        the date the enrollee attempted to obtain the provider's 
        network status) that the enrollee relied on the information 
        described in subsection (a)(1), if the provider's network 
        status or directory information on such directory was incorrect 
        at the time the treatment or services involved was provided.
            ``(2) Refunds to enrollees.--If a health care provider 
        submits a bill to an enrollee in violation of paragraph (1), 
        and the enrollee pays such bill, the provider shall reimburse 
        the enrollee for the full amount paid by the enrollee in excess 
        of the in-network cost-sharing amount for the treatment or 
        services involved, plus interest, at an interest rate 
        determined by the Secretary.
    ``(c) Provider Business Processes.--A health care provider shall 
have in place business processes to ensure the timely provision of 
provider directory information to a group health plan or a health 
insurance issuer offering group or individual health insurance coverage 
to support compliance by such plans or issuers with subsection (a)(1). 
Such providers shall submit provider directory information to a plan or 
issuers, at a minimum--
            ``(1) when the provider begins a network agreement with a 
        plan or with an issuer with respect to certain coverage;
            ``(2) when the provider terminates a network agreement with 
        a plan or with an issuer with respect to certain coverage;
            ``(3) when there are material changes to the content of 
        provider directory information described in subsection (a)(1); 
        and
            ``(4) every 90 days throughout the duration of the network 
        agreement with a plan or issuer.
    ``(d) Enforcement.--
            ``(1) In general.--Subject to paragraph (2), a health care 
        provider that violates a requirement under subsection (c) or 
        takes actions that prevent a group health plan or health 
        insurance issuer from complying with subsection (a)(1) or (b) 
        shall be subject to a civil monetary penalty of not more than 
        $10,000 for each act constituting such violation.
            ``(2) Safe harbor.--The Secretary may waive the penalty 
        described under paragraph (1) with respect to a health care 
        provider that unknowingly violates subsection (b)(1) with 
        respect to an enrollee if such provider rescinds the bill 
        involved and, if applicable, reimburses the enrollee within 30 
        days of the date on which the provider billed the enrollee in 
        violation of such subsection.
            ``(3) Procedure.--The provisions of section 1128A of the 
        Social Security Act, other than subsections (a) and (b) and the 
        first sentence of subsection (c)(1) of such section, shall 
        apply to civil money penalties under this subsection in the 
        same manner as such provisions apply to a penalty or proceeding 
        under section 1128A of the Social Security Act.
    ``(e) Savings Clause.--Nothing in this section shall prohibit a 
provider from requiring in the terms of a contract, or contract 
termination, with a group health plan or health insurance issuer--
            ``(1) that the plan or issuer remove, at the time of 
        termination of such contract, the provider from a directory of 
        the plan or issuer described in subsection (a)(1); or
            ``(2) that the plan or issuer bear financial 
        responsibility, including under subsection (b), for providing 
        inaccurate network status information to an enrollee.
    ``(f) Definition.--For purposes of this section, the term `provider 
directory information' includes the names, addresses, specialty, and 
telephone numbers of individual health care providers, and the names, 
addresses, and telephone numbers of each medical group, clinic, or 
facility contracted to participate in any of the networks of the group 
health plan or health insurance coverage involved.
    ``(g) Rule of Construction.--Nothing in this section shall be 
construed to preempt any provision of State law relating to health care 
provider directories or network adequacy.''.
    (b) Effective Date.--Section 2729C of the Public Health Service 
Act, as added by subsection (a), shall take effect with respect to plan 
years beginning on or after the date that is 18 months after the date 
of enactment of this Act.

SEC. 14. TIMELY BILLS FOR PATIENTS.

    (a) In General.--
            (1) Amendment.--Part P of title III of the Public Health 
        Service Act (42 U.S.C. 280g et seq.) is amended by adding at 
        the end the following:

``SEC. 399V-7. TIMELY BILLS FOR PATIENTS.

    ``(a) In General.--The Secretary shall require--
            ``(1) health care facilities, or in the case of 
        practitioners providing services outside of such a facility, 
        practitioners, to provide to patients a list of services 
        rendered during the visit to such facility or practitioner, 
        and, in the case of a facility, the name of the provider for 
        each such service, upon discharge or end of the visit or by 
        postal or electronic communication as soon as practicable and 
        not later than 5 calendar days after discharge or date of 
        visit; and
            ``(2) health care facilities and practitioners to furnish 
        all adjudicated bills to the patient as soon as practicable, 
        but not later than 45 calendar days after discharge or date of 
        visit.
    ``(b) Payment After Billing.--No patient may be required to pay a 
bill for health care services any earlier than 35 days after the 
postmark date of a bill for such services.
    ``(c) Effect of Violation.--
            ``(1) Notification and refund requirements.--
                    ``(A) Provider lists.--If a facility or 
                practitioner fails to provide a patient a list as 
                required under subsection (a)(1), such facility or 
                practitioner shall report such failure to the 
                Secretary.
                    ``(B) Billing.--If a facility or practitioner bills 
                a patient after the 45-calendar-day period described in 
                subsection (a)(2), such facility or practitioner 
                shall--
                            ``(i) report such bill to the Secretary; 
                        and
                            ``(ii) refund the patient for the full 
                        amount paid in response to such bill with 
                        interest, at a rate determined by the 
                        Secretary.
            ``(2) Civil monetary penalties.--
                    ``(A) In general.--The Secretary may impose civil 
                monetary penalties of up to $10,000 a day on any 
                facility or practitioner that--
                            ``(i) fails to provide a list required 
                        under subsection (a)(1) more than 10 times, 
                        beginning on the date of such tenth failure;
                            ``(ii) submits more than 10 bills outside 
                        of the period described in subsection (a)(2), 
                        beginning on the date on which such facility or 
                        practitioner sends the tenth such bill;
                            ``(iii) fails to report to the Secretary 
                        any failure to provide lists as required under 
                        paragraph (1)(A), beginning on the date that is 
                        45 calendar days after discharge or visit; or
                            ``(iv) fails to send any bill as required 
                        under subsection (a)(2), beginning on the date 
                        that is 45 calendar days after the date of 
                        discharge or visit, as applicable.
                    ``(B) Procedure.--The provisions of section 1128A 
                of the Social Security Act, other than subsections (a) 
                and (b) and the first sentence of subsection (c)(1) of 
                such section, shall apply to civil money penalties 
                under this subsection in the same manner as such 
                provisions apply to a penalty or proceeding under 
                section 1128A of the Social Security Act.
            ``(3) Safe harbor.--The Secretary may exempt a practitioner 
        or facility from the penalties under paragraph (2)(A) or extend 
        the period of time specified under subsection (a)(2) for 
        compliance with such subsection if a practitioner or facility--
                    ``(A) makes a good-faith attempt to send a bill 
                within 30 days but is unable to do so because of an 
                incorrect address; or
                    ``(B) experiences extenuating circumstances (as 
                defined by the Secretary), such as a hurricane or 
                cyberattack, that may reasonably delay delivery of a 
                timely bill.''.
            (2) Rulemaking.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary shall promulgate final 
        regulations to define the term ``extenuating circumstance'' for 
        purposes of section 399V-7(c)(3)(B) of the Public Health 
        Service Act, as added by paragraph (1).
    (b) Group Health Plan and Health Insurance Issuer Requirements.--
Subpart II of part A of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg-11), as amended by section 304, is further amended by 
adding at the end the following:

``SEC. 2729D. TIMELY BILLS FOR PATIENTS.

    ``(a) In General.--A group health plan or health insurance issuer 
offering group or individual health insurance coverage shall have in 
place business practices with respect to in-network facilities and 
practitioners to ensure that claims are adjudicated in order to 
facilitate facility and practitioner compliance with the requirements 
under section 399V-7(a).
    ``(b) Clarification.--Nothing in subsection (a) prohibits a 
provider and a group health plan or health insurance issuer from 
establishing in a contract the timeline for submission by either party 
to the other party of billing information, adjudication, sending of 
remittance information, or any other coordination required between the 
provider and the plan or issuer necessary for meeting the deadline 
described in section 399V-7(a)(2).''.
    (c) Effective Date.--The amendments made by subsections (a) and (b) 
shall take effect 6 months after the date of enactment of this Act.

SEC. 15. GOVERNMENT ACCOUNTABILITY OFFICE STUDY ON PROFIT- AND REVENUE-
              SHARING IN HEALTH CARE.

    (a) Study.--Not later than 1 year after the date of enactment of 
this Act, the Comptroller General of the United States shall conduct a 
study to--
            (1) describe what is known about profit- and revenue-
        sharing relationships in the commercial health care markets, 
        including those relationships that--
                    (A) involve one or more--
                            (i) physician groups that practice within a 
                        hospital included in the profit- or revenue-
                        sharing relationship, or refer patients to such 
                        hospital;
                            (ii) laboratory, radiology, or pharmacy 
                        services that are delivered to privately 
                        insured patients of such hospital;
                            (iii) surgical services;
                            (iv) hospitals or group purchasing 
                        organizations; or
                            (v) rehabilitation or physical therapy 
                        facilities or services; and
                    (B) include revenue- or profit-sharing whether 
                through a joint venture, management or professional 
                services agreement, or other form of gain-sharing 
                contract;
            (2) describe Federal oversight of such relationships, 
        including authorities of the Department of Health and Human 
        Services and the Federal Trade Commission to review such 
        relationships and their potential to increase costs for 
        patients, and identify limitations in such oversight; and
            (3) as appropriate, make recommendations to improve Federal 
        oversight of such relationships.
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, the Comptroller General of the United States shall prepare 
and submit a report on the study conducted under subsection (a) to the 
Committee on Health, Education, Labor, and Pensions of the Senate and 
the Committee on Education and Labor and Committee on Energy and 
Commerce of the House of Representatives.

SEC. 16. ENSURING ENROLLEE ACCESS TO COST-SHARING INFORMATION.

    (a) In General.--Subpart II of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-11 et seq.), as amended by section 
306, is further amended by adding at the end the following:

``SEC. 2729F. PROVISION OF COST-SHARING INFORMATION.

    ``(a) Provider Disclosures.--A provider that is in-network with 
respect to a group health plan or a health insurance issuer offering 
group or individual health insurance coverage shall provide to an 
enrollee in the plan or coverage who submits a request for the 
information described in paragraph (1) or (2), together with accurate 
and complete information about the enrollee's coverage under the 
applicable plan or coverage--
            ``(1) as soon as practicable and not later than 2 business 
        days after the enrollee requests such information, a good faith 
        estimate of the expected enrollee cost-sharing for the 
        provision of a particular health care service (including any 
        service that is reasonably expected to be provided in 
        conjunction with such specific service); and
            ``(2) as soon as practicable and not later than 2 business 
        days after an enrollee requests such information, the contact 
        information for any ancillary providers for a scheduled health 
        care service.
    ``(b) Insurer Disclosures.--A group health plan or a health 
insurance issuer offering group or individual health insurance coverage 
shall provide an enrollee in the plan or coverage with a good faith 
estimate of the enrollee's cost-sharing (including deductibles, 
copayments, and coinsurance) for which the enrollee would be 
responsible for paying with respect to a specific health care service 
(including any service that is reasonably expected to be provided in 
conjunction with such specific service), as soon as practicable and not 
later than 2 business days after a request for such information by an 
enrollee.
    ``(c) Enforcement.--
            ``(1) In general.--Subject to paragraph (2), a health care 
        provider that violates a requirement under subsection (a) shall 
        be subject to a civil monetary penalty of not more than $10,000 
        for each act constituting such violation.
            ``(2) Procedure.--The provisions of section 1128A of the 
        Social Security Act, other than subsections (a) and (b) and the 
        first sentence of subsection (c)(1) of such section, shall 
        apply to civil money penalties under this subsection in the 
        same manner as such provisions apply to a penalty or proceeding 
        under section 1128A of the Social Security Act.''.
    (b) Effective Date.--Section 2729G of the Public Health Service 
Act, as added by subsection (a), shall apply with respect to plan years 
beginning on or after the date that is 18 months after the date of 
enactment of this Act.

SEC. 17. GROUP HEALTH PLAN REPORTING REQUIREMENTS.

    Part C of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg-91 et seq.), as amended by section 303, is further amended by 
adding at the end the following:

``SEC. 2797. GROUP HEALTH PLAN REPORTING.

    ``(a) In General.--A group health plan or health insurance issuer 
offering group or individual health insurance coverage shall submit to 
the Secretary, not later than March 1 of each year, the following 
information with respect to the health plan in the previous plan year:
            ``(1) The beginning and end dates of the plan year.
            ``(2) The number of enrollees.
            ``(3) Each State in which the plan is offered.
            ``(4) The 50 brand prescription drugs most frequently 
        dispensed by pharmacies for claims paid by the issuer, and the 
        total number of paid claims for each such drug.
            ``(5) The 50 most costly prescription drugs with respect to 
        the plan by total annual spending, and the annual amount spent 
        by the plan for each such drug.
            ``(6) The 50 prescription drugs with the greatest increase 
        in plan expenditures over the plan year preceding the plan year 
        that is the subject of the report, and, for each such drug, the 
        change in amounts expended by the plan in each such plan year.
            ``(7) Total spending on health care services by such group 
        health plan, broken down by--
                    ``(A) the type of costs, including--
                            ``(i) hospital costs;
                            ``(ii) health care provider and clinical 
                        service costs;
                            ``(iii) costs for prescription drugs; and
                            ``(iv) other medical costs; and
                    ``(B) spending on prescription drugs by--
                            ``(i) the health plan; and
                            ``(ii) the enrollees.
            ``(8) The average monthly premium--
                    ``(A) paid by employers on behalf of enrollees; and
                    ``(B) paid by enrollees.
            ``(9) Any impact on premiums by rebates, fees, and any 
        other remuneration paid by drug manufacturers to the plan or 
        its administrators or service providers, with respect to 
        prescription drugs prescribed to enrollees in the plan, 
        including--
                    ``(A) the amounts so paid for each therapeutic 
                class of drugs; and
                    ``(B) the amounts so paid for each of the 25 drugs 
                that yielded the highest amount of rebates and other 
                remuneration under the plan from drug manufacturers 
                during the plan year.
            ``(10) Any reduction in premiums and out-of-pocket costs 
        associated with rebates, fees, or other remuneration described 
        in paragraph (9).
    ``(b) Report.--Not later than 18 months after the date on which the 
first report is required under subsection (a) and biannually 
thereafter, the Secretary, acting through the Assistant Secretary of 
Planning and Evaluation and in coordination with the Inspector General 
of the Department of Health and Human Services, shall make available on 
the internet website of the Department of Health and Human Services a 
report on prescription drug reimbursements under group health plans, 
prescription drug pricing trends, and the role of prescription drug 
costs in contributing to premium increases or decreases under such 
plans, aggregated in such a way as no drug or plan specific information 
will be made public.
    ``(c) Privacy Protections.--No confidential or trade secret 
information submitted to the Secretary under subsection (a) shall be 
included in the report under subsection (b).''.
                                 <all>