Health Data Access, Transparency, and Affordability Act of 2026
Sponsored By: Representative Onder, Robert F. [R-MO-3]
Introduced
Summary
Comprehensive access to health claims data for ERISA group health plans would be required. This bill would give plan fiduciaries broad, timely access to claims and encounter records, standardize data formats and access methods, and add enforcement tools to stop gag clauses and data delays.
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- Families and plan members: Fiduciaries would have broader, faster access to claims data to support oversight and detect potentially erroneous or fraudulent claims, which could improve plan auditing and benefit oversight.
- Employers and plan sponsors: Plans would face new annual attestations confirming data availability and that contracts do not block audits; plans and issuers cannot delegate attestations to third-party administrators.
- Providers and vendors: The bill defines "network service provider" and bars contract terms that delay or limit access, forbids indemnifying providers for civil penalties, and requires standardized files: ASC X12N 837 for claims, NCPCP/NCPDP for pharmacy, ASC X12N 835 for payments, and real-time or downloadable itemized non-claim costs.
- Regulators and enforcement: The Secretary would get rulemaking authority and could impose civil penalties up to $10,000 per day for continuing violations; contracts that limit access or delay data beyond 15 days would be void as against public policy.
(Effective for plan years beginning one year after enactment.)
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 0 benefits, 0 costs, 2 mixed.
More data access for group health plans
If enacted, group health plans and their fiduciaries would have full access to claims, encounter data, and supporting records. The bill would define many vendors as "network service providers" (but not clinicians simply for providing care) so these rules apply broadly. Claims must be provided in standard electronic formats (ASC X12N 837 for medical/dental, NCPDP for pharmacy, and ASC X12N 835 for payment notices) and non-claim costs must be itemized and available in real time via a portal, API, or downloadable CSV. Plans and anyone handling the data would have to follow HIPAA privacy and security rules, and the Secretary could issue detailed rules; these changes would start for plan years beginning one year after enactment.
New fines and limits for health vendors
If enacted, the Secretary of Labor could assess civil penalties of up to $10,000 per day for each day a person or entity violates the new access rules. Contract terms that delay or limit required data access or that indemnify a party against these penalties would be void as against public policy. Each group health plan or issuer would also have to file an annual attestation that required data is available, that access is timely, and that no agreement blocks audits; plans may not have a vendor submit the attestation for them. These rules would take effect for plan years beginning one year after enactment.
Sponsors & CoSponsors
Sponsor
Onder, Robert F. [R-MO-3]
MO • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov