Health DATA Act of 2026

This legislation, titled the Health Data Access, Transparency, and Affordability Act of 2026, significantly amends the Employee Retirement Income Security Act of 1974 (ERISA) to enhance data transparency for group health plans. It requires that contracts between group health plans and various service providers, including health care providers, third-party administrators, and pharmacy benefit managers , permit the plan to audit all de-identified claims and encounter information. These audits are intended to ensure compliance with plan terms and assess the reasonableness of compensation, with strict prohibitions against limiting the scope, frequency, or auditor selection for such reviews. The bill specifies that these contracts must not restrict the disclosure of pricing terms for value-based or capitated payment arrangements , overpayment recovery terms, or unduly delay audit access. All data provided for audits must comply with existing HIPAA privacy regulations, and entities cannot charge excessive fees for providing the required information. Furthermore, the legislation establishes civil penalties of $10,000 per day for service providers who violate these new transparency requirements. The Act also clarifies that a plan fiduciary's duty under ERISA extends to the use, management, and safeguarding of data generated or maintained by the plan or its service providers. It mandates the Secretary of Labor to collect attestations regarding gag clauses, ensuring that service providers submitting these attestations have no conflicts of interest. Crucially, the bill prohibits employers, plan sponsors, administrators, and fiduciaries from discriminating against participants or beneficiaries based on plan data, with violations incurring a civil monetary penalty of $100 per day per affected individual. Participants are also granted the right to seek enforcement without exhausting administrative remedies.