§9824 Increasing Transparency by Removing Gag Clauses on Price and Quality Information

Summary

Stops group health plans from signing contracts that block them from sharing provider cost or quality information. Plans must be able to give provider-specific price and quality data to referring doctors, the plan sponsor, plan members, or people who could join the plan. Plans must also be able to get, electronically and de-identified, claims and encounter data for each member if asked, under the privacy rules in section 264(c) of the Health Insurance Portability and Accountability Act of 1996, the Genetic Information Nondiscrimination Act of 2008, and the Americans with Disabilities Act of 1990. Per claim, that can include the allowed amount or other provider contract financial obligations, provider name and clinical role, service codes, and any other claim data. Plans may share this data with a business associate as defined in 45 CFR 160.103 (or successor rules), following those privacy rules. A provider or network can still set reasonable limits on making the information public. Each group health plan must each year send the Secretary a statement saying it follows these rules. Nothing here changes or reduces existing state or federal privacy protections or the data access allowed under the cited privacy rules.