H.R. 3020 — Addressing Anti-Competitive Health Care Contract Clauses Act

This section directs 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, to conduct a study on anticompetitive contract clauses (anti-steering clauses, anti-tiering clauses, all-or-nothing clauses, and gag clauses) in health insurer-provider contracts. The study must (1) evaluate effects on health care industry consolidation, consumer prices for medical services, and consumer access to health care; (2) list all related actions by the Federal Trade Commission and Department of Justice; (3) assess whether those agencies have sufficient resources and capability to enforce federal antitrust laws against such clauses; and (4) include recommendations for legislative or administrative actions if needed to increase resources. The Comptroller General must submit the report to specified committees of the House and Senate not later than 18 months after enactment of this Act.

This section defines key terms used in the Act, including (1) all-or-nothing clause (i.e., a health care contract provision requiring a health insurance carrier or health plan administrator to include all members of a health care provider in a network plan or to contract with the provider's affiliate); (2) anti-steering clause (i.e., a provision restricting a carrier or administrator from encouraging enrollees to use competitors of a hospital or health system, including through incentives); (3) anti-tiering clause (i.e., a provision restricting tiered network modifications or requiring all members of a provider in the same tier); (4) gag clause (i.e., a provision restricting disclosure of price, quality, or out-of-pocket cost information to specified parties such as enrollees, plan sponsors, or government entities); and (5) tiered network plan (i.e., a health benefit plan sorting providers into groups with differing reimbursement, cost sharing, or access requirements for the same services).