S.Amdt. 981

SA 981. 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.--
(1) In general.--Section 1311(e)(3) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031(e)(3)) is
amended--
(A) in subparagraph (A)--
(i) 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
(ii) by designating clause (ix) as clause (x); and
(iii) 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.'';
(B) in subparagraph (B)--
(i) in the heading, by striking ``use'' and inserting
``delivery methods and use'';
(ii) by inserting ``, as applicable,'' after ``English
proficiency''; and
(iii) 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.'';
(C) in subparagraph (C)--
(i) in the first sentence, by inserting ``or out-of-network
provider'' after ``item or service by a participating
provider'';
(ii) 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
(iii) 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
(D) in subparagraph (D) by striking ``subparagraph (A)''
and inserting ``subparagraphs (A), (B), and (C)''.
(2) Enforcement.--In addition to any other enforcement
actions or penalties that may apply with respect to the
amendments made by paragraph (1), a hospital that fails to
provide the information required under such amendments shall
be subject to a civil monetary penalty of an amount not to
exceed $1000 per person per day that the violation is ongoing
as determined by the Secretary. Such penalty shall be imposed
and collected in the same manner as civil money penalties
under subsection (a) of section 1128A of the Social Security
Act are imposed and collected.
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