H.R. 9228 — Health DATA Act of 2026

This section defines "network service provider" under the Employee Retirement Income Security Act of 1974 to include third-party administrators, health insurance issuers, pharmacy benefit managers, and intermediaries serving group health plans. It requires that any contract or arrangement between a group health plan and a network service provider or other entity allow the responsible plan fiduciary and designated agent access to all claims and encounter information, supporting documentation, pricing terms for alternative payment arrangements, overpayment data, and extra-contractual terms, with no limits on volume or audit scope and with delivery required within 15 days (or a shorter period set by the Secretary) in HIPAA-compliant formats.

This section requires contracts between group health plans and network service providers (including health insurance issuers, third-party administrators, pharmacy benefit managers, and intermediaries) to grant the responsible plan fiduciary and its designated agent access to all claims, encounter data, pricing terms, overpayment information, and related documentation. Contracts may not impose delays longer than 15 days, limit data volume or frequency, restrict auditor selection, or bar disclosure of fees, alternative payment terms, or extra-contractual pricing methodologies, while requiring compliance with HIPAA privacy and security rules.