[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3120 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 3120
To ban anticompetitive terms in facility and insurance contracts that
limit access to higher quality, lower cost care.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 5, 2023
Mrs. Steel introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Education and the Workforce, and Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To ban anticompetitive terms in facility and insurance contracts that
limit access to higher quality, lower cost care.
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 ``Healthy Competition for Better Care
Act''.
SEC. 2. BANNING ANTICOMPETITIVE TERMS IN FACILITY AND INSURANCE
CONTRACTS THAT LIMIT ACCESS TO HIGHER QUALITY, LOWER COST
CARE.
(a) In General.--
(1) PHSA.--Section 2799A-9 of the Public Health Service Act
(42 U.S.C. 300gg-119) 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;
``(B) requires the group health plan or health
insurance issuer to enter into any additional contract
with 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 or other alternative payment model, 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, in consultation with the
Secretary of Labor and the Secretary of the Treasury, not later than 1
year after the date of enactment of this section, 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)).''.
(2) ERISA.--Section 724 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185m) 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 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;
``(B) requires the group health plan or health
insurance issuer to enter into any additional contract
with 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 health insurance coverage with
respect to--
``(A) a health maintenance organization (as defined
in section 733(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 or other alternative payment model, 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 health insurance coverage shall annually
submit to 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, in consultation with the
Secretary of Health and Human Services and the Secretary of the
Treasury, not later than 1 year after the date of enactment of this
section, 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)).''.
(3) IRC.--Section 9824 of the Internal Revenue Code of 1986
is amended by adding at the end the following:
``(b) Protecting Health Plans Network Design Flexibility.--
``(1) In general.--A group health plan 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 from--
``(i) directing or steering enrollees to
other health care providers; or
``(ii) offering incentives to encourage
enrollees to utilize specific health care
providers;
``(B) requires the group health plan to enter into
any additional contract with an affiliate of the
provider as a condition of entering into a contract
with such provider;
``(C) requires the group health plan 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 not party
to the contract, from paying a lower rate for items or
services than the contracting plan 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 with respect to--
``(A) a health maintenance organization (as defined
in section 9832(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 or other alternative payment model, 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 shall annually
submit to the Secretary of Labor an attestation that such plan
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, in consultation with the
Secretary of Health and Human Services and the Secretary of Labor, not
later than 1 year after the date of enactment of this section, 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, 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.--The amendments made 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 amendments shall apply on the earlier of the date of
renewal of such contract or 3 years after such date of enactment.
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