Sec. 2. Plan fiduciary access to information
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/bill/118/hr/4527/ih/section-2A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Paragraph
(2)of section 408(b) of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1108(b) ) is amended by adding at the end the following new subparagraph: No contract or arrangement for services between a group health plan and any other entity, such as a health care provider, network or association of providers, third-party administrator, or pharmacy benefit manager, is reasonable within the meaning of this paragraph unless such contract or agreement— allows the responsible plan fiduciary to audit all de-identified claims and encounter information or data described in section 724(a)(1)(B) to— ensure that such entity complies with the terms of the plan and any applicable law; and determine the reasonableness of compensation paid by the plan; and does not— unreasonably limit the number of audits permitted during a given period of time; limit the number of de-identified claims and encounter information or data that the responsible plan fiduciary may access during an audit; limit the disclosure of pricing terms for value based payment arrangements, including— payment calculations and formulas; quality measures; contract terms; payment amounts; measurement periods for all incentives; and other payment methodologies furnished by a health care provider, network or association of providers, third-party administrator, or pharmacy benefit manager; limit the disclosure of overpayments and overpayment recovery terms; limit the right of the responsible plan fiduciary to select an auditor; otherwise limit or unduly delay by greater than 60 days the responsible plan fiduciary from auditing such information or data; or charge a fee beyond the reasonable direct costs to administer the operation of conducting such audits. . Subsection
(c)of section 502 of such Act ( 29 U.S.C. 1132 ) is amended by adding at the end the following new paragraph: In the case of an agreement between a group health plan and a health care provider, network or association of providers, third-party administrator, pharmacy benefit manager, or other service provider that violates the provisions of section 724, the Secretary may assess a civil penalty against such provider, network or association, third-party administrator, pharmacy benefit manager, or other service provider in the amount of $10,000 for each day during which such violation continues. Such penalty shall be in addition to other penalties as may be prescribed by law. . Paragraph
(6)of section 502(a) of such Act is amended by striking or
(9)and inserting (9), or
(13). Section 410 of such Act is amended by adding at the end the following new subsection: Any provision in an agreement or instrument shall be void as against public policy if such provision— unduly delays or limits a plan fiduciary from accessing the de-identified claims and encounter information or data described in section 724(a)(1)(B); or violates the requirements of section 408(b)(2)(C). . Clause
(i)of section 408(b)(2)(B) of such Act is amended by striking this clause and inserting this paragraph .
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