Section 1 Short title
This Act may be cited as the “Insurance Accountability and Transparency Act”.
Insurance Accountability and Transparency Act
A BILL
To amend the Patient Protection and Affordable Care Act to require group health plans and health insurance coverage to have in place a process to self-audit information listed in publicly accessible provider directories of such plans and coverage.
Sec. 2 Requirement for group health plans and health insurance coverage to have in place a process to self-audit information listed in publicly accessible provider directories of such plans and coverage
PHSA—
In general— Title XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.) is amended by adding at the end the following:
“D Other Market Reforms
“2796. Process to self-audit information listed in publicly accessible provider directories
“(a) In general—An entity specified in subsection (b), with respect to a group health plan or health insurance coverage offered in the group or individual market, shall have in place a process under which, in order to self-audit the information listed in any publicly accessible provider directory for such plan or coverage, such entity—
“(1) contacts, not less than once every 6 months during each plan year, each provider listed in such directory to verify—
“(A) contact information listed in such directory with respect to such provider; and
“(B) the status of whether such provider is a provider within the network of such plan or coverage; and
“(2) in the case that such entity determines that any of the information described in subparagraph (A) or (B) of paragraph (1) with respect to a provider listed in such directory of such plan or coverage is inaccurate, not later than 30 days after making such determination, corrects and updates such information in such directory.
“(b) Entity described—For purposes of subsection (a), an entity described in this subsection is—
“(1) in the case of health insurance coverage or a group health plan this is not a self-insured plan, the health insurance issuer offering the health insurance coverage or the group health plan, respectively; and
“(2) in the case of a self-insured group health plan, the designated administrator of the plan (as such term is defined in section 3(16) of the Employee Retirement Income Security Act of 1974).”
Conforming amendments—
Section 2722 of the Public Health Service Act (42 U.S.C. 300gg–21) is amended—
in subsection (a)(1), by inserting “and part D” after “subparts 1 and 2”;
in subsection (b), by inserting “and part D” after “subparts 1 and 2”;
in subsection (c)(1), by inserting “and part D” after “subparts 1 and 2”;
in subsection (c)(2), by inserting “and part D” after “subparts 1 and 2”;
in subsection (c)(3), by inserting “and part D” after “this part”; and
in subsection (d), in the matter preceding paragraph (1), by inserting “and part D” after “this part”.
Section 2723 of the Public Health Service Act (42 U.S.C. 300gg–22) is amended—
in subsection (a)(1), by inserting “and part D” after “this part”;
in subsection (a)(2), by inserting “or part D” after “this part”;
in subsection (b)(1), by inserting “or part D” after “this part”;
in subsection (b)(2)(A), by inserting “or part D” after “this part”; and
in subsection (b)(2)(C)(ii), by inserting “and part D” after “this part”.
Section 2724 of the Public Health Service Act (42 U.S.C. 300gg–23) is amended—
in subsection (a)(1)—
by striking “this part and part C insofar as it relates to this part” and inserting “this part, part D, and part C insofar as it relates to this part or part D”; and
by inserting “or part D” after “requirement of this part”;
in subsection (a)(2), by inserting “or part D” after “this part”; and
in subsection (c), by inserting “or part D” after “this part (other than section 2704)”.
ERISA—
In general— Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181 et seq.) is amended by adding at the end the following new section:
“716. Process to self-audit information listed in publicly accessible provider directories
“(a) In general—An entity specified in subsection (b), with respect to a group health plan or health insurance coverage offered in the group market, shall have in place a process under which, in order to self-audit the information listed in any publicly accessible provider directory for such plan or coverage, such entity—
“(1) contacts, not less than once every 6 months during each plan year, each provider listed in such directory to verify—
“(A) contact information listed in such directory with respect to such provider; and
“(B) the status of whether such provider is a provider within the network of such plan or coverage; and
“(2) in the case that such entity determines that any of the information described in subparagraph (A) or (B) of paragraph (1) with respect to a provider listed in such directory of such plan or coverage is inaccurate, not later than 30 days after making such determination, corrects and updates such information in such directory.
“(b) Entity described—For purposes of subsection (a), an entity described in this subsection is—
“(1) in the case of health insurance coverage or a group health plan this is not a self-insured plan, the health insurance issuer offering the health insurance coverage or the group health plan, respectively; and
“(2) in the case of a self-insured group health plan, the designated administrator of the plan (as such term is defined in section 3(16)).”
Clerical amendment— The table of sections for part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by adding at the end the following:
IRC—
In general— Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:
“9816. Process to self-audit information listed in publicly accessible provider directories
“(a) In general—An entity specified in subsection (b), with respect to a group health plan, shall have in place a process under which, in order to self-audit the information listed in any publicly accessible provider directory for such plan, such entity—
“(1) contacts, not less than once every 6 months during each plan year, each provider listed in such directory to verify—
“(A) contact information listed in such directory with respect to such provider; and
“(B) the status of whether such provider is a provider within the network of such plan; and
“(2) in the case that such entity determines that any of the information described in subparagraph (A) or (B) of paragraph (1) with respect to a provider listed in such directory of such plan is inaccurate, not later than 30 days after making such determination, corrects and updates such information in such directory.
“(b) Entity described—For purposes of subsection (a), an entity described in this subsection is—
“(1) in the case of a group health plan this is not a self-insured plan, the health insurance issuer offering the group health plan; and
“(2) in the case of a self-insured group health plan, the designated administrator of the plan (as such term is defined in section 3(16) of the Employee Retirement Income Security Act of 1974).”
Clerical amendment— The table of sections for subchapter B of chapter 100 of such Code is amended by adding at the end the following new item:
Effective date— The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2020.