119-hr3020

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3020 Introduced in House

    (IH) ]

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119th CONGRESS
 1st Session
 H. R. 3020

To require the Government Accountability Office to evaluate the effects 
 of anticompetitive contracting clauses in contracts between health 
 insurers and health care providers and to determine actions taken by 
the Federal Trade Commission and the Department of Justice relating to 
 the use of such clauses in such contracts and to assess their ability 
to effectively enforce the Federal antitrust laws with respect to such 
 use.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 April 24, 2025

 Mrs. Spartz introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
 the Judiciary, for a period to be subsequently determined by the 
 Speaker, in each case for consideration of such provisions as fall 
 within the jurisdiction of the committee concerned

_______________________________________________________________________

 A BILL

To require the Government Accountability Office to evaluate the effects 
 of anticompetitive contracting clauses in contracts between health 
 insurers and health care providers and to determine actions taken by 
the Federal Trade Commission and the Department of Justice relating to 
 the use of such clauses in such contracts and to assess their ability 
to effectively enforce the Federal antitrust laws with respect to such 
 use.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Addressing Anti-Competitive Health 
Care Contract Clauses Act''.

SEC. 2. GAO STUDY.

    (a) Study.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General of the United States, in 
coordination with the Federal Trade Commission and the Assistant 
Attorney General of the Antitrust Division of the Department of 
Justice, shall carry out a study that--

    (1) evaluates the effect of anticompetitive contract 
 clauses known as anti-steering clauses, anti-tiering clauses, 
 all-or-nothing clauses, and gag clauses in contracts between 
 health insurers and health care providers, including the 
 effects such contracts have on consolidation in the health care 
 industry, prices paid by consumers for medical services, and 
 consumer access to health care,

    (2) contains a list of all actions the Federal Trade 
 Commission and the Department of Justice have taken directly or 
 indirectly related to use of such contract clauses in contracts 
 between health insurers and health care providers,

    (3) contains an assessment of whether the Federal Trade 
 Commission and the Department of Justice have the resources and 
 the capability to effectively enforce the Federal antitrust 
 laws as applied to the use of such clauses in such contracts, 
 and

    (4) includes recommendations for legislative or 
 administrative actions if necessary to increase such resources.

    (b) Report.--The report containing the results of the study carried 
out under subsection

    (a) shall be submitted timely by the Comptroller 
General as follows:

    (1) To--
        (A) the Committee on Energy and Commerce,
        (B) the Committee on Ways and Means,
            (C) the Committee on Education and Workforce, and
            (D) the Committee on the Judiciary,
 of the House of Representatives.

    (2) To--
        (A) The Committee on Health, Education, Labor, and 
 Pensions, and
        (B) The Committee on the Judiciary,
 of the Senate.

SEC. 3. DEFINITIONS.

 For purposes of this Act:

    (1) All-or-nothing clause.--The term ``all-or-nothing 
 clause'' means a provision of a health care contract that 
 requires--
        (A) a health insurance carrier or health plan 
 administrator to include all members of a health care 
 provider in a network plan; or
        (B) a health insurance carrier or health plan 
 administrator to enter into an additional contract with 
 an affiliate of the health care provider as a condition 
 of entering into a contract with such health care 
 provider.

    (2) Anti-steering clause.--The term ``anti-steering 
 clause'' means a provision of a health care contract that 
 restricts the ability of a health insurance carrier or a health 
 plan administrator from encouraging an enrollee to obtain a 
 health care service from a competitor of the hospital or health 
 system, including offering incentives to encourage enrollees to 
 utilize specific health care providers.

    (3) Anti-tiering clause.--The term ``anti-tiering clause'' 
 means a provision in a health care contract that--
        (A) restricts the ability of a health insurance 
 carrier or a health plan administrator to introduce or 
 modify a tiered network plan or assign health care 
 providers into tiers; or
        (B) requires the health insurance carrier or health 
 plan administrator to place all members of a health 
 care provider in the same tier of a tiered network 
 plan.

    (4) Gag clause.--The term ``gag clause'' means a provision 
 of a health care contract that--
        (A) restricts the ability of a health insurance 
 carrier, a health plan administrator, or a health care 
 provider to disclose a price or quality information, 
 including the allowed amount, negotiated rates or 
 discounts, fees for services, or any other claim-
 related financial obligations included in the provider 
 contract to--
            (i) a governmental entity as authorized by 
 law,
            (ii) its contractors or agents,
            (iii) an enrollee,
            (iv) a treating health care provider of an 
 enrollee,
            (v) a plan sponsor, or
            (vi) potential eligible enrollees and plan 
 sponsors; or
        (B) restricts the ability of a health insurance 
 carrier, a health plan administrator, or a health care 
 provider to disclose out-of-pocket costs to an 
 enrollee.

    (5) Tiered network plan.--The term ``tiered network plan'' 
 means a health benefit plan that sorts some or all types of 
 health care providers into specific groups to which different 
 provider reimbursement, enrollee cost sharing, health care 
 provider access requirements, or a combination thereof, are 
 applied for the same services.
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