S.Amdt. 980

SA 980. Mr. BRAUN submitted an amendment intended to be proposed to
amendment SA 891 proposed by Mr. Schumer to the bill H.R. 1319, to
provide for reconciliation pursuant to title II of S. Con. Res. 5;
which was ordered to lie on the table; as follows:

At the end of section 2801 of the amendment, add the
following:
(c) Transparency in Coverage.--Section 1311(e)(3) of the
Patient Protection and Affordable Care Act (42 U.S.C.
18031(e)(3)) is amended--
(1) in subparagraph (A)--
(A) in clause (vii), by inserting before the period the
following: ``, including, for all items and services covered
under the plan, aggregate information on specific payments
the plan has made to out-of-network health care providers on
behalf of plan enrollees''; and
(B) by designating clause (ix) as clause (x); and
(C) by inserting after clause (viii), the following:
``(ix) Information on the specific negotiated payment rates
between the plan and health care providers for all items and
services covered under the plan.'';
(2) in subparagraph (B)--
(A) in the heading, by striking ``use'' and inserting
``delivery methods and use'';
(B) by inserting ``, as applicable,'' after ``English
proficiency''; and
(C) by inserting after the second sentence, the following:
``The Secretary shall establish standards for electronic
delivery and access to such information by individuals, free
of charge, in machine readable format, through an internet
website and via open APIs.'';
(3) in subparagraph (C)--
(A) in the first sentence, by inserting ``or out-of-network
provider'' after ``item or service by a participating
provider'';
(B) in the second sentence, by striking ``through an
internet website'' and inserting ``free of charge, in machine
readable format, through an internet website, and via open
APIs, in accordance with standards established by the
Secretary,''; and
(C) by adding at the end the following: ``Such information
shall include specific negotiated rates that allow for
comparison between providers and across plans, and related to
a patient's specific plan, including after an enrollee has
exceeded their deductible responsibility.''; and
(4) in subparagraph (D) by striking ``subparagraph (A)''
and inserting ``subparagraphs (A), (B), and (C)''.
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