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H.R. 7267 - Patients Before Profits Act of 2020

JUN. 18, 2020

H.R. 7267; Patients Before Profits Act of 2020

DATED JUN. 18, 2020
DOCUMENT ATTRIBUTES
  • Authors
    Porter, Rep. Katie
  • Institutional Authors
    U.S. House of Representatives
  • Subject Area/Tax Topics
  • Industry Groups
    Health care
    Insurance
  • Jurisdictions
  • Tax Analysts Document Number
    2020-26910
  • Tax Analysts Electronic Citation
    2020 TNTF 135-16
Citations: H.R. 7267; Patients Before Profits Act of 2020

116TH CONGRESS
2D SESSION

H.R. 7267

To amend title XXVII of the Public Health Service Act,
the Employee Retirement Income Security Act of 1974,
and the Internal Revenue Code of 1986 to prohibit a group health
plan and a health insurance issuer offering group or individual health
insurance coverage from reducing contracted rates, or terminating
contracts, with health care providers during a public health emergency.

IN THE HOUSE OF REPRESENTATIVES

JUNE 18, 2020

Ms. PORTER (for herself and Ms. DELAURO) introduced the following bill;
which was referred to the Committee on Energy and Commerce,
and in addition to the Committees on Ways and Means, and Education
and Labor, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within
the jurisdiction of the committee concerned

A BILL

To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to prohibit a group health plan and a health insurance issuer offering group or individual health insurance coverage from reducing contracted rates, or terminating contracts, with health care providers during a public health emergency.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the "Patients Before Profits Act of 2020".

SEC. 2. PROHIBITING A GROUP HEALTH PLAN AND A HEALTH INSURANCE ISSUER OFFERING GROUP OR INDIVIDUAL HEALTH INSURANCE COVERAGE FROM REDUCING CONTRACTED RATES, OR TERMINATING CONTRACTS, WITH HEALTH CARE PROVIDERS DURING A PUBLIC HEALTH EMERGENCY

(a) PHSA. — Subpart II of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–11 et seq.) is amended by adding at the end the following new section:

"SEC. 2730. PROHIBITION ON REDUCTION OF RATES AND TERMINATION OF CONTRACTS DURING PUBLIC HEALTH EMERGENCIES.

"(a) IN GENERAL. — A group health plan and a health insurance issuer offering group or individual health insurance coverage may not, with respect to a health care provider located in an emergency area during an emergency period that, as of the day before the date of the beginning of such period, had in effect a contractual relationship for furnishing items and services under such plan or coverage —

"(1) provide for an amount of reimbursement for any such item or service furnished by such provider during such period that is less than the amount of such reimbursement that would have been payable under such plan or coverage had such item or service been furnished by such provider on such day; or

"(2) terminate such relationship during such period; unless such lesser reimbursement or such termination is based on fraud, abuse, or other quality concerns with respect to such provider or such provider being placed on the exclusion list maintained by the Inspector General of the Department of Health and Human Services.

"(b) DEFINITIONS. — For purposes of this section, an 'emergency area' is a geographical area in which, and an 'emergency period' is the period during which, there exists a public health emergency declared by the Secretary pursuant to section 319.".

(b) ERISA. —

(1) 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. 1185 et seq.) is amended by adding at the end the following new section:

SEC. 716. PROHIBITION ON REDUCTION OF RATES AND TERMINATION OF CONTRACTS DURING PUBLIC HEALTH EMERGENCIES.

"(a) IN GENERAL. — A group health plan and a health insurance issuer offering group health insurance coverage may not, with respect to a health care provider located in an emergency area during an emergency period that, as of the day before the date of the beginning of such period, had in effect a contractual relationship for furnishing items and services under such plan or coverage —

"(1) provide for an amount of reimbursement for any such item or service furnished by such provider during such period that is less than the amount of such reimbursement that would have been payable under such plan or coverage had such item or service been furnished by such provider on such day; or

"(2) terminate such relationship during such period;

unless such lesser reimbursement or such termination is based on fraud, abuse, or other quality concerns with respect to such provider or such provider being placed on the exclusion list maintained by the Inspector General of the Department of Health and Human Services.

"(b) DEFINITIONS. — For purposes of this section, an 'emergency area' is a geographical area in which, and an 'emergency period' is the period during which, there exists a public health emergency declared by the Secretary pursuant to section 319.".

(2) CLERICAL AMENDMENT. — The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 is amended by inserting after the item relating to section 714 the following new items:

"Sec. 715. Additional market reforms.

"Sec. 716. Prohibition on reduction of rates and termination of contracts during public health emergencies.".

(c) IRC. —

(1) 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:

"SEC. 9816. PROHIBITION ON REDUCTION OF RATES AND TERMINATION OF CONTRACTS DURING PUBLIC HEALTH EMERGENCIES.

"(a) IN GENERAL. — A group health plan may not, with respect to a health care provider located in an emergency area during an emergency period that, as of the day before the date of the beginning of such period, had in effect a contractual relationship for furnishing items and services under such plan —

"(1) provide for an amount of reimbursement for any such item or service furnished by such provider during such period that is less than the amount of such reimbursement that would have been payable under such plan had such item or service been furnished by such provider on such day; or

"(2) terminate such relationship during such period;

unless such lesser reimbursement or such termination is based on fraud, abuse, or other quality concerns with respect to such provider or such provider being placed on the exclusion list maintained by the Inspector General of the Department of Health and Human Services.

"(b) DEFINITIONS. — For purposes of this section, an 'emergency area' is a geographical area in which, and an 'emergency period' is the period during which, there exists a public health emergency declared by the Secretary pursuant to section 319.".

(2) CLERICAL AMENDMENT. — The table of sections for such subchapter is amended by adding at the end the following new items:

"Sec. 9815. Additional market reforms.

"Sec. 9816. Prohibition on reduction of rates and termination of contracts during public health emergencies.".

(d) EFFECTIVE DATE. — The amendment made by this section shall apply with respect to public health emergencies declared by the Secretary of Health and Human Services on or after January 31, 2020, and items and services furnished, and terminations occurring, on or after the date of the enactment of this Act.

DOCUMENT ATTRIBUTES
  • Authors
    Porter, Rep. Katie
  • Institutional Authors
    U.S. House of Representatives
  • Subject Area/Tax Topics
  • Industry Groups
    Health care
    Insurance
  • Jurisdictions
  • Tax Analysts Document Number
    2020-26910
  • Tax Analysts Electronic Citation
    2020 TNTF 135-16
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