H.R. 6248

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6248 Introduced in House (IH)]

<DOC>

119th CONGRESS
1st Session
H. R. 6248

To ban anticompetitive terms in facility and insurance contracts that 
limit access to higher quality, lower cost care.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

November 21, 2025

Mr. Arrington (for himself, Mr. Davis of North Carolina, and Mr. Allen) 
introduced the following bill; which was referred to the Committee on 
Energy and Commerce, and in addition to the Committees on Education and 
Workforce, and Ways and Means, 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 ban anticompetitive terms in facility and insurance contracts that 
limit access to higher quality, lower cost care.

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 ``Healthy Competition for Better Care 
Act''.

SEC. 2. BANNING ANTICOMPETITIVE TERMS IN FACILITY AND INSURANCE 
CONTRACTS THAT LIMIT ACCESS TO HIGHER QUALITY, LOWER COST 
CARE.

(a) In General.--
(1) PHSA.--
(A) In general.--Section 2799A-9 of the Public 
Health Service Act (42 U.S.C. 300gg-119) is amended by 
adding at the end the following:
``(b) Protecting Health Plans Network Design Flexibility.--
``(1) In general.--A group health plan or a health 
insurance issuer offering group or individual health insurance 
coverage may not enter into an agreement with a covered entity 
(as defined in paragraph (3)) if such agreement, directly or 
indirectly--
``(A) restricts (including by operation of any 
agreement in effect between such covered entity and 
another covered entity) the group health plan (whether 
self-insured or fully insured) or health insurance 
issuer from--
``(i) directing or steering participants or 
beneficiaries to other health care providers 
who are not subject to such agreement; or
``(ii) offering incentives to encourage 
participants or beneficiaries to utilize 
specific health care providers;
``(B) requires the group health plan or health 
insurance issuer to enter into any additional agreement 
with an affiliate of the covered entity;
``(C) requires the group health plan or health 
insurance issuer to agree to payment rates or other 
terms for any affiliate of the covered entity not party 
to the agreement; or
``(D) restricts other group health plans or health 
insurance issuers not party to the agreement from 
paying a lower rate for items or services than the plan 
or issuer involved in the agreement pays for such items 
or services.
``(2) Exceptions for certain provider group and value-based 
network designs.--Paragraph (1)(A) shall not apply to a group 
health plan or health insurance issuer offering group or 
individual health insurance coverage with respect to--
``(A) a health maintenance organization (as defined 
in section 2791(b)(3)), if such health maintenance 
organization operates primarily through exclusive 
contracts with multi-specialty physician groups, nor to 
any arrangement between such a health maintenance 
organization and its affiliates; or
``(B) a value-based network arrangement, such as an 
exclusive provider network, accountable care 
organization, center of excellence, a provider 
sponsored health insurance issuer that operates 
primarily through aligned multi-specialty physician 
group practices or integrated health systems, or such 
other similar network arrangements as determined by the 
Secretary through guidance or rulemaking.
``(3) Covered entity defined.--For purposes of this 
subsection, the term `covered entity' means a health care 
provider, network or association of providers, third-party 
administrator, or other service provider offering access to a 
network of providers.
``(4) Rule of construction.--Except as provided in 
paragraph (1), nothing in this subsection shall be construed to 
limit network design or cost or quality initiatives by a group 
health plan or health insurance issuer, including accountable 
care organizations, exclusive provider organizations, networks 
that tier providers by cost or quality or steer enrollees to 
centers of excellence, or other pay-for-performance 
programs.''.
(B) Regulations.--Not later than 1 year after the 
date of the enactment of this Act, the Secretary of 
Health and Human Services, in consultation with the 
Secretary of Labor and the Secretary of the Treasury, 
shall promulgate regulations to carry out the 
amendments made by this paragraph.
(2) Employee retirement income security act of 1974.--
(A) In general.--Section 724 of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 
1185m) is amended--
(i) in the header, by striking ``by 
removing'' and all that follows through 
``information'' and inserting ``; prohibition 
on anticompetitive agreements'';
(ii) in subsection (a)(4), in the first 
sentence, by striking ``section'' and inserting 
``subsection''; and
(iii) by adding at the end the following:
``(b) Protecting Health Plans Network Design Flexibility.--
``(1) In general.--A group health plan or a health 
insurance issuer offering group health insurance coverage may 
not enter into an agreement with a covered entity (as defined 
in paragraph (3)) if such agreement, directly or indirectly--
``(A) restricts (including by operation of any 
agreement in effect between such covered entity and 
another covered entity) the group health plan (whether 
self-insured or fully insured) or health insurance 
issuer from--
``(i) directing or steering participants or 
beneficiaries to other health care providers 
who are not subject to such agreement; or
``(ii) offering incentives to encourage 
participants or beneficiaries to utilize 
specific health care providers;
``(B) requires the group health plan or health 
insurance issuer to enter into any additional agreement 
with an affiliate of the covered entity;
``(C) requires the group health plan or health 
insurance issuer to agree to payment rates or other 
terms for any affiliate of the covered entity not party 
to the agreement; or
``(D) restricts other group health plans or health 
insurance issuers not party to the agreement from 
paying a lower rate for items or services than the plan 
or issuer involved in the agreement pays for such items 
or services.
``(2) Exceptions for certain provider group and value-based 
network designs.--Paragraph (1)(A) shall not apply to a group 
health plan or health insurance issuer offering group health 
insurance coverage with respect to--
``(A) a health maintenance organization (as defined 
in section 733(b)(3)), if such health maintenance 
organization operates primarily through exclusive 
contracts with multi-specialty physician groups, nor to 
any arrangement between such a health maintenance 
organization and its affiliates; or
``(B) a value-based network arrangement, such as an 
exclusive provider network, accountable care 
organization, center of excellence, a provider 
sponsored health insurance issuer that operates 
primarily through aligned multi-specialty physician 
group practices or integrated health systems, or such 
other similar network arrangements as determined by the 
Secretary through guidance or rulemaking.
``(3) Covered entity defined.--For purposes of this 
subsection, the term `covered entity' means a health care 
provider, network or association of providers, third-party 
administrator, or other service provider offering access to a 
network of providers.
``(4) Rule of construction.--Except as provided in 
paragraph (1), nothing in this subsection shall be construed to 
limit network design or cost or quality initiatives by a group 
health plan or health insurance issuer, including accountable 
care organizations, exclusive provider organizations, networks 
that tier providers by cost or quality or steer enrollees to 
centers of excellence, or other pay-for-performance 
programs.''.
(B) Clerical amendment.--The table of contents in 
section 1 of such Act is amended, in the entry relating 
to section 724, by amending such entry to read as 
follows:

``Sec. 724. Increasing transparency; prohibition on anticompetitive 
agreements.''.
(C) Regulations.--Not later than 1 year after the 
date of the enactment of this Act, the Secretary of 
Labor, in consultation with the Secretary of Health and 
Human Services and the Secretary of the Treasury, shall 
promulgate regulations to carry out the amendments made 
by this paragraph.
(3) IRC.--
(A) In general.--Section 9824 of the Internal 
Revenue Code of 1986 is amended--
(i) in the header, by striking ``by 
removing'' and all that follows through 
``information'' and inserting ``; prohibition 
on anticompetitive agreements'';
(ii) in subsection (a)(4), in the first 
sentence, by striking ``section'' and inserting 
``subsection''; and
(iii) by adding at the end the following:
``(b) Protecting Health Plans Network Design Flexibility.--
``(1) In general.--A group health plan may not enter into 
an agreement with a covered entity (as defined in paragraph 
(3)) if such agreement, directly or indirectly--
``(A) restricts (including by operation of any 
agreement in effect between such covered entity and 
another covered entity) the group health plan (whether 
self-insured or fully insured) from--
``(i) directing or steering participants or 
beneficiaries to other health care providers 
who are not subject to such agreement; or
``(ii) offering incentives to encourage 
participants or beneficiaries to utilize 
specific health care providers;
``(B) requires the group health plan to enter into 
any additional agreement with an affiliate of the 
covered entity;
``(C) requires the group health plan to agree to 
payment rates or other terms for any affiliate of the 
covered entity not party to the agreement; or
``(D) restricts other group health plans not party 
to the agreement from paying a lower rate for items or 
services than the plan involved in the agreement pays 
for such items or services.
``(2) Exceptions for certain provider group and value-based 
network designs.--Paragraph (1)(A) shall not apply to a group 
health plan with respect to--
``(A) a health maintenance organization (as defined 
in section 9832(b)(3)), if such health maintenance 
organization operates primarily through exclusive 
contracts with multi-specialty physician groups, nor to 
any arrangement between such a health maintenance 
organization and its affiliates; or
``(B) a value-based network arrangement, such as an 
exclusive provider network, accountable care 
organization, center of excellence, a provider 
sponsored health insurance issuer that operates 
primarily through aligned multi-specialty physician 
group practices or integrated health systems, or such 
other similar network arrangements as determined by the 
Secretary through guidance or rulemaking.
``(3) Covered entity defined.--For purposes of this 
subsection, the term `covered entity' means a health care 
provider, network or association of providers, third-party 
administrator, or other service provider offering access to a 
network of providers.
``(4) Rule of construction.--Except as provided in 
paragraph (1), nothing in this subsection shall be construed to 
limit network design or cost or quality initiatives by a group 
health plan, including accountable care organizations, 
exclusive provider organizations, networks that tier providers 
by cost or quality or steer enrollees to centers of excellence, 
or other pay-for-performance programs.''.
(B) Clerical amendment.--The table of contents in 
section 1 of such Act is amended, in the entry relating 
to section 9824, by amending such entry to read as 
follows:

``Sec. 9824. Increasing transparency; prohibition on anticompetitive 
agreements.''.
(C) Regulations.--Not later than 1 year after the 
date of the enactment of this Act, the Secretary of the 
Treasury, in consultation with the Secretary of Health 
and Human Services and the Secretary of Labor, shall 
promulgate regulations to carry out the amendments made 
by this paragraph.
(b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to any contract entered into, amended, or renewed on 
or after the date that is 18 months after the date of enactment of this 
Act.
<all>