29 U.S.C. § 1185m — Increasing transparency by removing gag clauses on price and quality information
submitted 6 years ago by Pub. L. 93-406 to r/title-29-LABOR · 499 words · no verdicts yet
A group health plan or related issuer may not agree to restrict access to or sharing of provider-specific cost and quality information or de-identified claims data. Plans must annually attest to compliance, while existing privacy protections remain unchanged.
(a) Increasing price and quality transparency. (1) A plan* or related issuer may not contract with a provider, provider network or association, third-party administrator*, or network-access service provider if the contract directly or indirectly restricts the plan or issuer from: (A) giving provider-specific cost or care-quality information to referring providers, the sponsor, participants, beneficiaries, or eligible people; (B) electronically accessing, on request and consistently with the HIPAA, Genetic Information* Nondiscrimination Act, and Americans with Disabilities Act privacy rules, de-identified claims and encounter data for each participant* or beneficiary*, including per claim the allowed amount and other financial obligations, provider name and clinical designation, service codes, and every other claim or encounter data element; or (C) sharing (A) or (B) data, or directing its sharing, with a business associate defined in 45 CFR 160.103 (or successor rules), consistently with those privacy rules. (2) This does not prevent reasonable limits on public disclosure. (3) Each year the plan or issuer must attest to the Secretary* that it complies. (4) Nothing changes or removes state* or federal privacy protections or otherwise limits data access allowed by the listed privacy rules.
A group health plan* (or an issuer of health insurance coverage* offered in connection with such a plan) may not enter into an agreement with a health care provider, network or association of providers, third-party administrator*, or other service provider offering access to a network of providers that would directly or indirectly restrict a group health plan or health insurance issuer* offering such coverage from—
providing provider-specific cost or quality of care information or data, through a consumer engagement tool or any other means, to referring providers, the plan sponsor*, participants or beneficiaries, or individuals eligible to become participants or beneficiaries of the plan or coverage;
electronically accessing de-identified claims and encounter information or data for each participant* or beneficiary* in the plan or coverage, upon request and consistent with the privacy regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996, the amendments made by the Genetic Information* Nondiscrimination Act of 2008, and the Americans with Disabilities Act of 1990 [42 U.S.C. 12101 et seq.], including, on a per claim basis—
financial information, such as the allowed amount, or any other claim-related financial obligations included in the provider contract;
provider information, including name and clinical designation;
service codes; or
any other data element included in claim or encounter transactions; or
sharing information or data described in subparagraph (A) or (B), or directing that such data be shared, with a business associate as defined in section 160.103 of title 45, Code of Federal Regulations (or successor regulations), consistent with the privacy regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996, the amendments made by the Genetic Information Nondiscrimination Act of 2008, and the Americans with Disabilities Act of 1990 [42 U.S.C. 12101 et seq.].
Nothing in paragraph (1)(A) prevents a health care provider, network or association of providers, or other service provider from placing reasonable restrictions on the public disclosure of the information described in such paragraph (1).
A group health plan (or health insurance coverage offered in connection with such a plan) shall annually submit to the Secretary* an attestation that such plan or issuer of such coverage is in compliance with the requirements of this subsection.
Nothing in this section shall be construed to modify or eliminate existing privacy protections and standards under State* and Federal law. Nothing in this subsection shall be construed to otherwise limit access by a group health plan, plan sponsor, or health insurance issuer to data as permitted under the privacy regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996, the amendments made by the Genetic Information Nondiscrimination Act of 2008, and the Americans with Disabilities Act of 1990 [42 U.S.C. 12101 et seq.].
Source credit: (Pub. L. 93–406, title I, § 724, as added Pub. L. 116–260, div. BB, title II, § 201(b), Dec. 27, 2020, 134 Stat. 2892.)
- 2020Enacted · Pub. L. 93-406 · 134 Stat. 2892
A history note hasn’t been published yet. The record shows enactment by Pub. L. 93-406 on 2020-12-27.
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