Sec. 2. Plan fiduciary access to information
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/bill/118/hr/4527/rh/section-2·A 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); and 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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