HDATAA of 2026 (H.R. 9228)

Summary

Requires health insurance providers to share claims and cost data with the employer health plans they service, aiming to increase price transparency.

What problem does this solve?

Many employer health plans cannot see detailed information about their own medical claims because of restrictive contracts with insurance companies. This bill makes those restrictive contract terms illegal, allowing employers to review their data to find savings and check for errors.

What does this bill do?

Mandates access to health claims data

Makes any contract between a group health plan and a service provider unreasonable if it does not allow the plan to access all of its claims and encounter information.

Voids restrictive contract provisions

Makes any contract term void if it limits or delays a health plan's access to its claims data, effectively banning 'gag clauses' on data sharing.

Establishes penalties for violations

Allows the Secretary of Labor to fine a service provider up to $10,000 for each day it violates the data access rules.

Requires annual compliance attestation

Requires health plans to annually confirm to the government that they are complying with the law and that their contracts do not restrict data access.

Sets standards for data formatting

Requires that claims and payment data be provided in specific, standardized electronic formats (like ASC X12N 837 and 835) at no cost to the health plan.

Defines 'network service provider'

Adds a broad definition for 'network service provider' to ensure the law applies to third-party administrators, pharmacy benefit managers, and other intermediaries.

Maintains HIPAA privacy rules

Clarifies that all data sharing must be done in a way that is consistent with HIPAA privacy and security regulations.

Who does this affect?

Employers with group health plans
Health insurance companies
Third-party administrators and pharmacy benefit managers

What is the real world impact?

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Empowers employers to lower health costs

Gives employers who provide health insurance the data they need to analyze spending, identify waste or fraud, and negotiate better rates with providers. This could lead to lower premium costs for both the company and its employees.

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Increases transparency in the healthcare market

Forces insurance companies and other service providers to be more open about their pricing and payment arrangements. This reduces their ability to hide fees or complex payment formulas that might disadvantage health plans.

When does this start?

The new rules will apply to health plans starting one year after the bill becomes law.

Effective Date

Applies to health plans for the first plan year that starts on or after one year from the date the Act is passed.