H.R. 9228 · On the floor · Health

Health DATA Act of 2026

What it does

Amends ERISA to require group health plan fiduciaries and their designated agents to have access to all claims, encounter information, and supporting medical records from network service providers without unreasonable delays exceeding 15 days.
Prohibits network service providers from limiting access to pricing terms, payment calculations, quality measurements, contract terms, payment amounts, and audit information requested by plan fiduciaries.
Requires claims and encounter data to be provided in standardized electronic formats (ASC X12N 837 for medical and dental claims, NCPDP for pharmacy claims, ASC X12N 835 for claim payments) at no cost to the group health plan.
Mandates that all non-claim costs be itemized and made available to group health plans in real time through web portals, APIs, and downloadable files.
Grants the Secretary of Labor authority to enforce compliance through civil enforcement mechanisms and establishes penalties for network service providers violating data access requirements under Section 724.

Sep 15, 2026: Placed on the Union Calendar, Calendar No. 724.

Committee: House Education and Workforce