I.R.C. § 9824(a) Increasing Price And Quality Transparency For Plan Sponsors And Consumers
I.R.C. § 9824(a)(1) In General —
A group health 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 from—
I.R.C. § 9824(a)(1)(A) —
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;
I.R.C. § 9824(a)(1)(B) —
electronically accessing de-identified claims and encounter information or data for
each participant or beneficiary in the plan, 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, including, on a per claim basis—
I.R.C. § 9824(a)(1)(B)(i) —
financial information, such as the allowed amount, or any other claim-related financial
obligations included in the provider contract;
I.R.C. § 9824(a)(1)(B)(ii) —
provider information, including name and clinical designation;
I.R.C. § 9824(a)(1)(B)(iii) —
service codes; or
I.R.C. § 9824(a)(1)(B)(iv) —
any other data element included in claim or encounter transactions; or
I.R.C. § 9824(a)(1)(C) —
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.
I.R.C. § 9824(a)(2) Clarification Regarding Public Disclosure Of Information —
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).
I.R.C. § 9824(a)(3) Attestation —
A group health plan shall annually submit to the Secretary an attestation that such
plan is in compliance with the requirements of this subsection.
I.R.C. § 9824(a)(4) Rules Of Construction —
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 or plan sponsor
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.
(Added by Pub. L. 116-260, Div. BB, title II, Sec. 201(c), Dec. 27, 2020, 134 Stat. 1182.)
BACKGROUND NOTES
EFFECTIVE DATE
Effective December 27, 2020.
