Sec. 2. Promoting group health plan and group health insurance coverage price transparency

6,645 words·~30 min read·/bill/118/hr/4507/rh/section-2·

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Section 719 of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185h ) is amended to read as follows: A group health plan, and a health insurance issuer offering group health insurance coverage, shall make available to the public accurate and timely disclosures of the following information: Claims payment policies and practices. Periodic financial disclosures. Data on enrollment. Data on disenrollment. Data on the number of claims that are denied. Data on rating practices.

Information on cost-sharing and payments with respect to any out-of-network coverage (or with respect to any item and service furnished under such a plan or such group health insurance coverage that does not use a network of providers). Information on participant and beneficiary rights under this part. Rate and payment information described in subsection (d). Other information as determined appropriate by the Secretary. Rate and payment information described in paragraph

(9)shall be made available to the public not later than January 10, 2025, and not later than the tenth day of every month thereafter, in the manner described in subsection (d)(2)(A), and, beginning on January 1, 2027, in real-time through an application program interface (or successor technology) described in subsection (d)(2)(B). The information required to be submitted under subsection

(a)shall be provided in plain language. The term plain language means language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is clear, concise, well-organized, accurately describes the information, and follows other best practices of plain language writing. The Secretary, jointly with the Secretary of Health and Human Services and the Secretary of Labor, shall develop and issue standards for plain language writing for purposes of this section and shall develop a standardized reporting template and standardized definitions of terms to allow for comparison across group health plans and health insurance coverage. A group health plan, and a health insurance issuer offering group health insurance coverage, shall, upon request of a participant or beneficiary and in a timely manner, provide to the participant or beneficiary a statement of the amount of cost-sharing (including deductibles, copayments, and coinsurance) under the participant’s or beneficiary’s plan or coverage that the participant or beneficiary would be responsible for paying with respect to the furnishing of a specific item or service by a provider. At a minimum, such information shall include the information specified in paragraph

(2)and shall be made available at no cost to the participant or beneficiary through a self-service tool that meets the requirements of paragraph

(3)or through a paper or phone disclosure, at the option of the participant or beneficiary, that meets such requirements as the Secretary may specify. For purposes of paragraph (1), the information specified in this paragraph is, with respect to an item or service for which benefits are available under a group health plan or group health insurance coverage (as applicable) furnished by a health care provider to a participant or beneficiary of such plan or coverage, the following: If such provider is a participating provider with respect to such item or service, the in-network rate (as defined in subsection (f)) for such item or service and for any other item or service that is inherent in the furnishing of the item or service that is the subject of such request. If such provider is not a participating provider, the allowed amount, percentage of billed charges, or other rate that such plan or coverage will recognize as payment for such item or service, along with a notice that such individual may be liable for additional charges billed by such provider. The estimated amount of cost sharing (including deductibles, copayments, and coinsurance) that the participant or beneficiary will incur for such item or service (which, in the case such item or service is to be furnished by a provider described in subparagraph (B), shall be calculated using the amount or rate described in such subparagraph (or, in the case such plan or issuer uses a percentage of billed charges to determined the amount of payment for such provider, using a reasonable estimate of such percentage of such charges)). The amount the participant or beneficiary has already accumulated with respect to any deductible or out of pocket maximum under the plan or coverage (broken down, in the case separate deductibles or maximums apply to separate participants and beneficiaries enrolled in the plan or coverage, by such separate deductibles or maximums, in addition to any cumulative deductible or maximum). Any shared savings or other benefit available to the participant or beneficiary with respect to such item or service. In the case such plan or coverage imposes any frequency or volume limitations with respect to such item or service (excluding medical necessity determinations), the amount that such participant or beneficiary has accrued towards such limitation with respect to such item or service. Any prior authorization, concurrent review, step therapy, fail first, or similar requirements applicable to coverage of such item or service under such plan or group health insurance coverage. For purposes of paragraph (1), a self-service tool established by a group health plan or health insurance issuer offering group health insurance coverage meets the requirements of this paragraph if such tool— is based on an Internet website, mobile application, or other platform determined appropriate by the Secretary; provides for real-time responses to requests described in paragraph (1); is updated in a manner such that information provided through such tool is accurate at the time such request is made; allows such a request to be made with respect to an item or service furnished by— a specific provider that is a participating provider with respect to such item or service; all providers that are participating providers with respect to such plan and such item or service for purposes of facilitating price comparisons; or a provider that is not described in clause (ii); and provides that such a request may be made with respect to an item or service through use of the billing code for such item or service or through use of a descriptive term for such item or service. The Secretary may require such tool, as a condition of complying with subparagraph (E), to link multiple billing codes to a single descriptive term if the Secretary determines that the billing codes to be so linked correspond to items and services. A group health plan, and a health insurance issuer offering group health insurance coverage, shall permit providers to learn the amount of cost-sharing (including deductibles, copayments, and coinsurance) that would apply under an individual's plan or coverage that the individual would be responsible for paying with respect to the furnishing of a specific item or service by another provider in a timely manner upon the request of the provider and with the consent of such individual in the same manner and to the same extent as if such request has been made by such individual. As part of any tool used to facilitate such requests from a provider, such plan or issuer offering health insurance coverage may include functionality that— allows providers to submit the notifications to such plan or coverage required under section 2799B–6 of the Public Health Service Act; and provides for notifications required under section 716(f) to such an individual. For purposes of subsection (a)(9), the rate and payment information described in this subsection is, with respect to a group health plan or group health insurance coverage (as applicable), the following: With respect to each item or service (other than a drug) for which benefits are available under such plan or coverage, the in-network rate (in a dollar amount) in effect as of the first day of the plan year during which such information is submitted with each provider (identified by national provider identifier) that is a participating provider with respect to such item or service (or, in the case such rate is not available in a dollar amount, such formulae, pricing methodologies, or other information used to calculate such rate). With respect to each dosage form and indication of each drug (identified by national drug code) for which benefits are available under such plan or coverage— the in-network rate (in a dollar amount) in effect as of the first day of the plan year during which such information is submitted with each provider (identified by national provider identifier) that is a participating provider with respect to such drug (or, in the case such rate is not available in a dollar amount, such formulae, pricing methodologies, or other information used to calculate such rate); and the average amount paid by such plan (net of rebates, discounts, and price concessions) for such drug dispensed or administered during the 90-day period beginning 180 days before such date of submission to each provider that was a participating provider with respect to such drug, broken down by each such provider (identified by national provider identifier), other than such an amount paid to a provider that, during such period, submitted fewer than 20 claims for such drug to such plan or coverage. With respect to each item or service for which benefits are available under such plan or coverage, the amount billed, and the amount allowed by the plan or coverage, for each such item or service furnished during the 90-day period specified in subparagraph

(B)by a provider that was not a participating provider with respect to such item or service, broken down by each such provider (identified by national provider identifier), other than items and services with respect to which fewer than 20 claims for such item or service were submitted to such plan or coverage during such period. Such rate and payment information shall be made available with respect to each individual item or service, regardless of whether such item or service is paid for as part of a bundled payment, episode of care, value-based payment arrangement, or otherwise. Rate and payment information required to be made available under subsection (a)(9) shall be so made available in dollar amounts through 3 separate machine-readable files corresponding to the information described in each of subparagraphs

(A)through

(C)of paragraph

(1)that meet such requirements as specified by the Secretary not later than 180 days after the date of the enactment of this paragraph through rulemaking. Such requirements shall ensure that such files are limited to an appropriate size, do not include information that is duplicative of information contained in the same file or in other files made available under such subsection, are made available in a widely-available format that allows for information contained in such files to be compared across group health plans and group health insurance coverage, and are accessible to individuals at no cost and without the need to establish a user account or provide other credentials. Subject to clause (ii), beginning January 1, 2026, rate and payment information required to be made available by a group health plan or health insurance issuer under subsection (a)(9) shall, in addition to being made available in the manner described in subparagraph (A), be made available through an application program interface (or successor technology) that provides access to such information in real time and that meets such technical standards as may be specified by the Secretary. Clause

(i)shall not apply with respect to information described in such clause required to be made available by a group health plan or health insurance issuer offering health insurance coverage if such plan or coverage, as applicable, provides benefits for fewer than 500 participants and beneficiaries. The Secretary, Secretary of Health and Human Services, and Secretary of the Treasury shall jointly make available to the public instructions written in plain language explaining how individuals may search for information described in paragraph

(1)in files submitted in accordance with paragraph (2). For each year (beginning with 2025), each group health plan and health insurance issuer offering group health insurance coverage shall make public a machine-readable file meeting such standards as established by the Secretary under paragraph

(2)containing a summary of all rate and payment information made public by such plan or issuer with respect to such plan or coverage during such year (such as averages of all such information so made public). Each group health plan and health insurance issuer offering group health insurance coverage shall annually submit to the Secretary an attestation of such plan’s or such coverage’s compliance with the provisions of this section along with a link to disclosures made in accordance with subsection (a). In this subsection: The term participating provider has the meaning given such term in section 716 and includes a participating facility. The term in-network rate means, with respect to a group health plan or group health insurance coverage and an item or service furnished by a provider that is a participating provider with respect to such plan or coverage and item or service, the contracted rate (reflected as a dollar amount) in effect between such plan or coverage and such provider for such item or service. . The table of contents in section 1 of such Act is amended by striking the item relating to section 719 and inserting the following new item: Sec. 719. Price transparency requirements. . Section 9819 of the Internal Revenue Code of 1986 is amended to read as follows: A group health plan shall make available to the public accurate and timely disclosures of the following information: Claims payment policies and practices. Periodic financial disclosures. Data on enrollment. Data on disenrollment. Data on the number of claims that are denied. Data on rating practices. Information on cost-sharing and payments with respect to any out-of-network coverage (or with respect to any item and service furnished under such a plan that does not use a network of providers). Information on participant and beneficiary rights under this part. Rate and payment information described in subsection (d). Other information as determined appropriate by the Secretary. Rate and payment information described in paragraph

(a)shall be provided in plain language. The term plain language means language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is clear, concise, well-organized, accurately describes the information, and follows other best practices of plain language writing. The Secretary, jointly with the Secretary of Health and Human Services and the Secretary of Labor, shall develop and issue standards for plain language writing for purposes of this section and shall develop a standardized reporting template and standardized definitions of terms to allow for comparison across group health plans and health insurance coverage. A group health plan shall, upon request of a participant or beneficiary and in a timely manner, provide to the participant or beneficiary a statement of the amount of cost-sharing (including deductibles, copayments, and coinsurance) under the participant’s or beneficiary’s plan that the participant or beneficiary would be responsible for paying with respect to the furnishing of a specific item or service by a provider. At a minimum, such information shall include the information specified in paragraph

(2)and shall be made available at no cost to the participant or beneficiary through a self-service tool that meets the requirements of paragraph

(3)or through a paper or phone disclosure, at the option of the participant or beneficiary, that meets such requirements as the Secretary may specify. For purposes of paragraph (1), the information specified in this paragraph is, with respect to an item or service for which benefits are available under a group health plan furnished by a health care provider to a participant or beneficiary of such plan, the following: If such provider is a participating provider with respect to such item or service, the in-network rate (as defined in subsection (f)) for such item or service and for any other item or service that is inherent in the furnishing of the item or service that is the subject of such request. If such provider is not a participating provider, the allowed amount, percentage of billed charges, or other rate that such plan will recognize as payment for such item or service, along with a notice that such individual may be liable for additional charges billed by such provider. The estimated amount of cost sharing (including deductibles, copayments, and coinsurance) that the participant or beneficiary will incur for such item or service (which, in the case such item or service is to be furnished by a provider described in subparagraph (B), shall be calculated using the amount or rate described in such subparagraph (or, in the case such plan uses a percentage of billed charges to determined the amount of payment for such provider, using a reasonable estimate of such percentage of such charges)). The amount the participant or beneficiary has already accumulated with respect to any deductible or out of pocket maximum under the plan (broken down, in the case separate deductibles or maximums apply to separate participants and beneficiaries enrolled in the plan, by such separate deductibles or maximums, in addition to any cumulative deductible or maximum). Any shared savings or other benefit available to the participant or beneficiary with respect to such item or service. In the case such plan imposes any frequency or volume limitations with respect to such item or service (excluding medical necessity determinations), the amount that such participant or beneficiary has accrued towards such limitation with respect to such item or service. Any prior authorization, concurrent review, step therapy, fail first, or similar requirements applicable to coverage of such item or service under such plan. For purposes of paragraph (1), a self-service tool established by a group health plan meets the requirements of this paragraph if such tool— is based on an Internet website, mobile application, or other platform determined appropriate by the Secretary; provides for real-time responses to requests described in paragraph (1); is updated in a manner such that information provided through such tool is accurate at the time such request is made; allows such a request to be made with respect to an item or service furnished by— a specific provider that is a participating provider with respect to such item or service; all providers that are participating providers with respect to such item or service for purposes of facilitating price comparisons; or a provider that is not described in clause (ii); and provides that such a request may be made with respect to an item or service through use of the billing code for such item or service or through use of a descriptive term for such item or service. The Secretary may require such tool, as a condition of complying with subparagraph (E), to link multiple billing codes to a single descriptive term if the Secretary determines that the billing codes to be so linked correspond to items and services. A group health plan shall permit providers to learn the amount of cost-sharing (including deductibles, copayments, and coinsurance) that would apply under an individual's plan that the individual would be responsible for paying with respect to the furnishing of a specific item or service by another provider in a timely manner upon the request of the provider and with the consent of such individual in the same manner and to the same extent as if such request has been made by such individual. As part of any tool used to facilitate such requests from a provider, such plan may include functionality that— allows providers to submit the notifications to such plan or coverage required under section 2799B–6 of the Public Health Services Act; and provides for notifications required under section 9816(f) to such an individual. For purposes of subsection (a)(9), the rate and payment information described in this subsection is, with respect to a group health plan, the following: With respect to each item or service (other than a drug) for which benefits are available under such plan, the in-network rate (in a dollar amount) in effect as of the first day of the plan year during which such information is submitted with each provider (identified by national provider identifier) that is a participating provider with respect to such item or service (or, in the case such rate is not available in a dollar amount, such formulae, pricing methodologies, or other information used to calculate such rate). With respect to each dosage form and indication of each drug (identified by national drug code) for which benefits are available under such plan— the in-network rate (in a dollar amount) in effect as of the first day of the plan year during which such information is submitted with each provider (identified by national provider identifier) that is a participating provider with respect to such drug (or, in the case such rate is not available in a dollar amount, such formulae, pricing methodologies, or other information used to calculate such rate); and the average amount paid by such plan (net of rebates, discounts, and price concessions) for such drug dispensed or administered during the 90-day period beginning 180 days before such date of submission to each provider that was a participating provider with respect to such drug, broken down by each such provider (identified by national provider identifier), other than such an amount paid to a provider that, during such period, submitted fewer than 20 claims for such drug to such plan or coverage. With respect to each item or service for which benefits are available under such plan, the amount billed, and the amount allowed by the plan, for each such item or service furnished during the 90-day period specified in subparagraph

(A)through

(C)of paragraph

(1)that meet such requirements as specified by the Secretary not later than 180 days after the date of the enactment of this paragraph through rulemaking. Such requirements shall ensure that such files are limited to an appropriate size, do not include information that is duplicative of information contained in other files made available under such subsection, are made available in a widely-available format that allows for information contained in such files to be compared across group health plans, and are accessible to individuals at no cost and without the need to establish a user account or provide other credentials. Subject to clause (ii), beginning January 1, 2026, rate and payment information required to be made available by a group health plan under subsection (a)(9) shall, in addition to being made available in the manner described in subparagraph (A), be made available through an application program interface (or successor technology) that provides access to such information in real time and that meets such technical standards as may be specified by the Secretary. Clause

(i)shall not apply with respect to information described in such clause required to be made available by a group health plan if such plan provides benefits for fewer than 500 participants and beneficiaries. The Secretary, Secretary of Health and Human Services, and Secretary of Labor shall jointly make available to the public instructions written in plain language explaining how individuals may search for information described in paragraph

(1)in files submitted in accordance with paragraph (2). For each year (beginning with 2025), each group health plan shall make public a machine-readable file meeting such standards as established by the Secretary under paragraph

(2)containing a summary of all rate and payment information made public by such plan with respect to such plan or coverage during such year (such as averages of all such information so made public). Each group health plan shall annually submit to the Secretary an attestation of such plan’s compliance with the provisions of this section along with a link to disclosures made in accordance with subsection (a). In this subsection: The term participating provider has the meaning given such term in section 9816 and includes a participating facility. The term in-network rate means, with respect to a group health plan and an item or service furnished by a provider that is a participating provider with respect to such plan and item or service, the contracted rate (reflected as a dollar amount) in effect between such plan and such provider for such item or service. . The item relating to section 9819 in the table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended to read as follows: Sec. 9819. Price transparency requirements. . Section 2799A–4 of the Public Health Service Act ( 42 U.S.C. 300gg–114 ) is amended to read as follows: A group health plan, and a health insurance issuer offering group or individual health insurance coverage, shall make available to the public accurate and timely disclosures of the following information: Claims payment policies and practices. Periodic financial disclosures. Data on enrollment. Data on disenrollment. Data on the number of claims that are denied. Data on rating practices. Information on cost-sharing and payments with respect to any out-of-network coverage (or with respect to any item and service furnished under such a plan or such group or individual health insurance coverage that does not use a network of providers). Information on enrollee rights under this part. Rate and payment information described in subsection (d). Other information as determined appropriate by the Secretary. Rate and payment information described in paragraph

(a)shall be provided in plain language. The term plain language means language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is clear, concise, well-organized, accurately describes the information, and follows other best practices of plain language writing. The Secretary, jointly with the Secretary of Labor and the Secretary of the Treasury, shall develop and issue standards for plain language writing for purposes of this section and shall develop a standardized reporting template and standardized definitions of terms to allow for comparison across group health plans and health insurance coverage. A group health plan, and a health insurance issuer offering group or individual health insurance coverage, shall, upon request of an enrollee and in a timely manner, provide to the enrollee a statement of the amount of cost-sharing (including deductibles, copayments, and coinsurance) under the enrollee’s plan or coverage that the enrollee would be responsible for paying with respect to the furnishing of a specific item or service by a provider. At a minimum, such information shall include the information specified in paragraph

(2)and shall be made available at no cost to the enrollee through a self-service tool that meets the requirements of paragraph

(3)or through a paper or phone disclosure, at the option of the enrollee, that meets such requirements as the Secretary may specify. For purposes of paragraph (1), the information specified in this paragraph is, with respect to an item or service for which benefits are available under a group health plan or group or individual health insurance coverage (as applicable) furnished by a health care provider to an enrollee of such plan or coverage, the following: If such provider is a participating provider with respect to such item or service, the in-network rate (as defined in subsection (f)) for such item or service and for any other item or service that is inherent in the furnishing of the item or service that is the subject of such request. If such provider is not a participating provider, the allowed amount, percentage of billed charges, or other rate that such plan or coverage will recognize as payment for such item or service, along with a notice that such enrollee may be liable for additional charges billed by such provider. The estimated amount of cost sharing (including deductibles, copayments, and coinsurance) that the enrollee will incur for such item or service (which, in the case such item or service is to be furnished by a provider described in subparagraph (B), shall be calculated using the amount or rate described in such subparagraph (or, in the case such plan or issuer uses a percentage of billed charges to determined the amount of payment for such provider, using a reasonable estimate of such percentage of such charges)). The amount the enrollee has already accumulated with respect to any deductible or out of pocket maximum under the plan or coverage (broken down, in the case separate deductibles or maximums apply to separate enrollees in the plan or coverage, by such separate deductibles or maximums, in addition to any cumulative deductible or maximum). Any shared savings or other benefit available to the enrollee with respect to such item or service. In the case such plan or coverage imposes any frequency or volume limitations with respect to such item or service (excluding medical necessity determinations), the amount that such enrollee has accrued towards such limitation with respect to such item or service. Any prior authorization, concurrent review, step therapy, fail first, or similar requirements applicable to coverage of such item or service under such plan or group or individual health insurance coverage. For purposes of paragraph (1), a self-service tool established by a group health plan or health insurance issuer offering group or individual health insurance coverage meets the requirements of this paragraph if such tool— is based on an Internet website, mobile application, or other platform determined appropriate by the Secretary; provides for real-time responses to requests described in paragraph (1); is updated in a manner such that information provided through such tool is accurate at the time such request is made; allows such a request to be made with respect to an item or service furnished by— a specific provider that is a participating provider with respect to such item or service; all providers that are participating providers with respect to such plan and such item or service for purposes of facilitating price comparisons; or a provider that is not described in clause (ii); and provides that such a request may be made with respect to an item or service through use of the billing code for such item or service or through use of a descriptive term for such item or service. The Secretary may require such tool, as a condition of complying with subparagraph (E), to link multiple billing codes to a single descriptive term if the Secretary determines that the billing codes to be so linked correspond to items and services. A group health plan, and a health insurance issuer offering group or individual health insurance coverage, shall permit providers to learn the amount of cost-sharing (including deductibles, copayments, and coinsurance) that would apply under an individual's plan or coverage that the individual would be responsible for paying with respect to the furnishing of a specific item or service by another provider in a timely manner upon the request of the provider and with the consent of such individual in the same manner and to the same extent as if such request has been made by such individual. As part of any tool used to facilitate such requests from a provider, such plan or issuer offering health insurance coverage may include functionality that— allows providers to submit the notifications to such plan or coverage required under section 2799B–6; and provides for notifications required under section 2799A–1(f) to such an individual. For purposes of subsection (a)(9), the rate and payment information described in this subsection is, with respect to a group health plan or group or individual health insurance coverage (as applicable), the following: With respect to each item or service (other than a drug) for which benefits are available under such plan or coverage, the in-network rate (in a dollar amount) in effect as of the first day of the plan year during which such information is submitted with each provider (identified by national provider identifier) that is a participating provider with respect to such item or service (or, in the case such rate is not available in a dollar amount, such formulae, pricing methodologies, or other information used to calculate such rate). With respect to each dosage form and indication of each drug (identified by national drug code) for which benefits are available under such plan or coverage— the in-network rate (in a dollar amount) in effect as of the first day of the plan year during which such information is submitted with each provider (identified by national provider identifier) that is a participating provider with respect to such drug (or, in the case such rate is not available in a dollar amount, such formulae, pricing methodologies, or other information used to calculate such rate); and the average amount paid by such plan (net of rebates, discounts, and price concessions) for such drug dispensed or administered during the 90-day period beginning 180 days before such date of submission to each provider that was a participating provider with respect to such drug, broken down by each such provider (identified by national provider identifier), other than such an amount paid to a provider that, during such period, submitted fewer than 20 claims for such drug to such plan or coverage. With respect to each item or service for which benefits are available under such plan or coverage, the amount billed, and the amount allowed by the plan or coverage, for each such item or service furnished during the 90-day period specified in subparagraph

(A)through

(C)of paragraph

(1)that meet such requirements as specified by the Secretary not later than 180 days after the date of the enactment of this paragraph through rulemaking. Such requirements shall ensure that such files are limited to an appropriate size, do not include information that is duplicative of information contained in other files made available under such subsection, are made available in a widely-available format that allows for information contained in such files to be compared across group health plans and group or individual health insurance coverage, and are accessible to individuals at no cost and without the need to establish a user account or provide other credentials. Subject to clause (ii), beginning January 1, 2026, rate and payment information required to be made available by a group health plan or health insurance issuer under subsection (a)(9) shall, in addition to being made available in the manner described in subparagraph (A), be made available through an application program interface (or successor technology) that provides access to such information in real time and that meets such technical standards as may be specified by the Secretary. Clause

(i)shall not apply with respect to information described in such clause required to be made available by a group health plan or health insurance issuer offering health insurance coverage if such plan or coverage, as applicable, provides benefits for fewer than 500 enrollees. The Secretary, Secretary of Labor, and Secretary of the Treasury shall jointly make available to the public instructions written in plain language explaining how individuals may search for information described in paragraph

(1)in files submitted in accordance with paragraph (2). For each year (beginning with 2025), each group health plan and health insurance issuer offering group or individual health insurance coverage shall make public a machine-readable file meeting such standards as established by the Secretary under paragraph

(2)containing a summary of all rate and payment information made public by such plan or issuer with respect to such plan or coverage during such year (such as averages of all such information so made public). Each group health plan and health insurance issuer offering group or individual health insurance coverage shall annually submit to the Secretary an attestation of such plan’s or such coverage’s compliance with the provisions of this section along with a link to disclosures made in accordance with subsection (a). In this subsection: The term participating provider has the meaning given such term in section 2799A–1 and includes a participating facility. The term in-network rate means, with respect to a group health plan or group or individual health insurance coverage and an item or service furnished by a provider that is a participating provider with respect to such plan or coverage and item or service, the contracted rate (reflected as a dollar amount) in effect between such plan or coverage and such provider for such item or service. . Not later than 1 year after the date of enactment of this subsection, the Secretary of Labor shall submit to Congress a report on the feasibility of including data relating to the quality of health care items and services with the price transparency information required to be made available under the amendments made by subsection (a). Such report shall include recommendations for legislative and regulatory actions to identify appropriate metrics for assessing and comparing quality of care. Not later than January 1, 2026, and biannually thereafter through 2032, the Secretary shall submit to Congress, and make publicly available on a website of the Department of Labor, a report with respect to the information described in section 719 of the Employee Retirement Income Security Act ( 29 U.S.C. 1185h ) (as amended by the Transparency in Coverage Act of 2023 ), assessing the differences in commercial negotiated prices— between rural and urban markets; in the individual, small-employer, and large-employer markets; in consolidated and non-consolidated provider markets; between non-profit and for-profit hospitals; and between non-profit and for-profit insurers. The amendments made by subsection

(a)shall apply to plan years beginning on or after January 1, 2025. Nothing in the amendments made by subsection

(a)may be construed as affecting the applicability of the rule entitled Transparency in Coverage published by the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services on November 12, 2020 (85 Fed. Reg. 72158) for plan years beginning before January 1, 2025.

Connectionstraces to 1

Traces to 1 document

U.S. Code

Maintenance of price comparison tool
§ 1185h

2 references not yet in our index

42 USC 300gg–114
85 FR 72158

Citation graph

cites case law

Sec. 2

Promoting group health plan and group health insurance coverage price transparency

U.S.C.§ 1185h

Cite42 USC 300gg–114

Fed. Reg.85 FR 72158

Cites 3Cited by 0 across 0 sources