To amend the Employee Retirement Income Security Act of 1974 to ensure plan fiduciaries may access de-identified information relating to health claims, and for other purposes.
Sponsors
Legislative Progress
ReportedReported with an amendment, committed to the Committee of the …
Mrs. Chavez-DeRemer (for herself, Mr. Takano, and Ms. Manning) introduced …
Summary
What This Bill Does
Requires contracts between health plans and providers/PBMs to allow plan fiduciaries to audit claims data, encounter information, and pricing terms. Ensures employers can verify plan costs.
Who Benefits and How
Employers gain transparency into health plan costs and PBM practices. Plan fiduciaries can verify compliance and reasonable compensation. Employees benefit from more accountable health spending.
Who Bears the Burden and How
PBMs and healthcare providers must allow audits of pricing. Third-party administrators face disclosure requirements. Audit-resistant contracts become unenforceable.
Key Provisions
- Requires audit access to de-identified claims and encounter data
- Mandates disclosure of pricing terms and value-based arrangements
- Prohibits unreasonable limits on audit timing or scope
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Requires health plan fiduciaries to have audit access to claims data and pricing terms
Policy Domains
Legislative Strategy
"Increase employer access to health plan cost information"
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology