HR6248-119

What This Bill Does

The Healthy Competition for Better Care Act amends the Public Health Service Act, ERISA, and the Internal Revenue Code to bar group health plans and health insurance issuers from entering agreements with covered entities that restrict steering patients to unaffiliated providers, restrict incentives for using specific providers, require all-or-nothing affiliate contracting, require payment rates or other terms for affiliates not party to the agreement, or block other plans and issuers from paying lower rates for items or services. Covered entities include health care providers, provider networks or associations, third-party administrators, and other service providers offering provider-network access. The bill exempts certain HMOs and value-based network arrangements such as exclusive provider networks, accountable care organizations, centers of excellence, provider-sponsored issuers, and aligned integrated systems. HHS, Labor, and Treasury must issue regulations within one year.

Who Benefits and How

Group health plans, employers, insurers, and plan participants benefit from more freedom to steer patients toward lower-cost or higher-quality providers and to avoid forced affiliate contracting. Smaller or independent providers may benefit if dominant systems cannot use contract terms that block plans from building alternative networks. Patients may benefit when plan design can use centers of excellence, tiering, incentives, and pay-for-performance programs.

Who Bears the Burden and How

Dominant hospital systems, provider networks, third-party administrators, and other covered entities lose leverage to demand anti-steering, all-or-nothing, affiliate-rate, or parity restrictions. HHS, Labor, and Treasury must write regulations across health, ERISA, and tax-code regimes. Plans and insurers must review and renegotiate existing provider-network contracts for prohibited terms.

Key Provisions

• Prohibits health plans and issuers from entering provider-network agreements with anti-steering or anti-incentive restrictions.
• Bars contract terms that force affiliate agreements, affiliate payment rates, or restrictions preventing other plans from paying lower rates.
• Defines covered entities to include providers, provider networks, associations, third-party administrators, and network-access service providers.
• Exempts specified HMOs and value-based network arrangements such as ACOs, centers of excellence, and integrated provider-sponsored plans.
• Requires HHS, Labor, and Treasury regulations within one year.