H.R. 6248 — Healthy Competition for Better Care Act

This section revises the header of section 724 of the Employee Retirement Income Security Act of 1974 (ERISA); makes a clerical change in subsection (a)(4); and adds subsection (b) prohibiting a group health plan or health insurance issuer offering group coverage from entering into an agreement with a covered entity (i.e., health care provider, network or association of providers, third-party administrator, or other service provider offering network access) that directly or indirectly—(1) restricts the plan or issuer from steering or incentivizing enrollees to non-contracting providers; (2) requires an agreement with an affiliate of the covered entity; (3) requires agreeing to payment rates or terms for such an affiliate; or (4) restricts other plans or issuers from paying lower rates for the same items or services. Subsection (b)(2) exempts health maintenance organizations operating via exclusive multi-specialty physician group contracts and value-based arrangements (e.g., accountable care organizations, centers of excellence, provider-sponsored issuers with aligned physician groups or integrated systems); subsection (b)(4) preserves other network design and pay-for-performance initiatives. (As background, existing subsection (a) prohibits contract terms restricting plans and issuers from providing, accessing, or sharing provider-specific cost and quality data or de-identified claims data with plan sponsors, enrollees, and business associates.)