42 U.S.C. § 300gg–139 — Provider requirements to protect patients and improve the accuracy of provider directory information

(a) Provider business processes. Starting no later than January 1, 2022, every health care provider and health care facility must have business processes in place to give provider directory information to group health plans and health insurance issuers on time — so those plans and issuers can meet their own directory-accuracy duties under section 300gg–115(a)(1) of this title (or the matching tax code and labor code sections). At a minimum, providers and facilities must submit this information: (1) when they start a network agreement with a plan or issuer; (2) when they end a network agreement with a plan or issuer; (3) when there is a material change to their directory information; and (4) at any other time the provider, facility, or the Secretary decides is appropriate — including when the plan or issuer asks. (b) Refunds to enrollees. Say a provider bills an enrollee cost-sharing that is higher than the normal in-network cost-sharing for that treatment — something the law already forbids under section 300gg–115(b) of this title (or its tax code/labor code equivalents) — and the enrollee pays that bill. The provider must then reimburse the enrollee for the full amount paid above the correct in-network cost-sharing, plus interest at a rate the Secretary sets. (c) Limitation. Nothing here stops a provider from putting these terms in a contract, or in the terms for ending one, with a group health plan or issuer: (1) that the plan or issuer must remove the provider from its directory once the contract ends; or (2) that the plan or issuer will bear financial responsibility — including under section 300gg–115(b) of this title — for giving an enrollee inaccurate network-status information. (d) Definition. "Provider directory information" means: the names, addresses, specialty, phone numbers, and digital contact information of individual health care providers; and the names, addresses, phone numbers, and digital contact information of each medical group, clinic, or facility under contract to participate in the plan's or coverage's networks. (e) Rule of construction. This section does not override any state law about health care provider directories.