Bill > HR6248

This bill aims to ban anticompetitive contract terms between health insurance plans and healthcare providers that limit patient access to more affordable and higher-quality care. Specifically, the bill prohibits agreements that prevent health plans from directing patients to alternative healthcare providers, requiring plans to sign additional contracts with provider affiliates, mandating specific payment rates for affiliated providers, or restricting other plans from negotiating lower rates. The legislation applies to group health plans, health insurance issuers, and covers both individual and group insurance policies. The bill includes exceptions for certain types of healthcare networks, such as health maintenance organizations (HMOs) operating through exclusive multi-specialty physician group contracts and value-based network arrangements like accountable care organizations. The bill amends three key pieces of legislation: the Public Health Service Act, the Employee Retirement Income Security Act, and the Internal Revenue Code. It requires the Secretaries of Health and Human Services, Labor, and Treasury to develop implementing regulations within one year and sets an effective date 18 months after enactment, meaning the new rules will apply to contracts entered into, amended, or renewed after that time. The goal is to increase healthcare market competition and provide more flexibility for health plans to design networks that prioritize cost-effectiveness and quality of care.

Business and Industry

https://www.congress.gov/bill/119th-congress/house-bill/6248/all-info