Us Congress 2025-2026 Regular Session

Us Congress House Bill HB2041 Compare Versions

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11 I
22 119THCONGRESS
33 1
44 STSESSION H. R. 2041
55 To amend the Employee Retirement Income Security Act of 1974 to clarify
66 and strengthen the application of certain employer-sponsored health plan
77 disclosure requirements.
88 IN THE HOUSE OF REPRESENTATIVES
99 MARCH11, 2025
1010 Mr. C
1111 OURTNEY(for himself and Mrs. HOUCHIN) introduced the following bill;
1212 which was referred to the Committee on Education and Workforce
1313 A BILL
1414 To amend the Employee Retirement Income Security Act
1515 of 1974 to clarify and strengthen the application of
1616 certain employer-sponsored health plan disclosure re-
1717 quirements.
1818 Be it enacted by the Senate and House of Representa-1
1919 tives of the United States of America in Congress assembled, 2
2020 SECTION 1. SHORT TITLE. 3
2121 This Act may be cited as the ‘‘Hidden Fee Disclosure 4
2222 Act of 2025’’. 5
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2626 SEC. 2. CLARIFICATION OF THE APPLICATION OF FEE DIS-1
2727 CLOSURE REQUIREMENTS TO COVERED 2
2828 SERVICE PROVIDERS. 3
2929 (a) S
3030 ERVICES.—Clause (ii)(I)(bb) of section 4
3131 408(b)(2)(B) of the Employee Retirement Income Secu-5
3232 rity Act of 1974 (29 U.S.C. 1108(b)(2)(B)) is amended— 6
3333 (1) in subitem (AA) by striking ‘‘Brokerage 7
3434 services,’’ and inserting ‘‘Services (including broker-8
3535 age services),’’; and 9
3636 (2) in subitem (BB)— 10
3737 (A) by striking ‘‘Consulting,’’ and inserting 11
3838 ‘‘Other services,’’; and 12
3939 (B) by striking ‘‘related to the development 13
4040 or implementation of plan design’’ and all that 14
4141 follows through the period at the end and in-15
4242 serting ‘‘any of the following: plan design, claim 16
4343 repricing, insurance or insurance product selec-17
4444 tion (including vision and dental), record-18
4545 keeping, medical management, benefits adminis-19
4646 tration selection (including vision and dental), 20
4747 stop-loss insurance, pharmacy benefit manage-21
4848 ment services, wellness design and management 22
4949 services, transparency tools, group purchasing 23
5050 organization agreements and services, participa-24
5151 tion in and services from preferred vendor pan-25
5252 els, disease management, compliance services, 26
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5656 employee assistance programs, or third party 1
5757 administration services, or consulting services 2
5858 related to any such services.’’. 3
5959 (b) D
6060 ISCLOSURES.—Clause (iii)(III) of section 4
6161 408(b)(2)(B) of the Employee Retirement Income Secu-5
6262 rity Act of 1974 (29 U.S.C. 1108(b)(2)(B)) is amended 6
6363 by striking ‘‘, either in the aggregate or by service,’’ and 7
6464 inserting ‘‘by service’’. 8
6565 SEC. 3. STRENGTHENING DISCLOSURE REQUIREMENTS 9
6666 WITH RESPECT TO ENTITIES PROVIDING 10
6767 PHARMACY BENEFIT MANAGEMENT SERV-11
6868 ICES AND THIRD PARTY ADMINISTRATORS 12
6969 FOR GROUP HEALTH PLANS. 13
7070 (a) C
7171 ERTAINARRANGEMENTS FOR PHARMACYBEN-14
7272 EFITMANAGEMENT SERVICESCONSIDERED AS INDI-15
7373 RECT.— 16
7474 (1) I
7575 N GENERAL.—Clause (i) of section 17
7676 408(b)(2)(B) of the Employee Retirement Income 18
7777 Security Act of 1974 (29 U.S.C. 1108(b)(2)(B)) is 19
7878 amended— 20
7979 (A) by striking ‘‘requirements of this 21
8080 clause’’ and inserting ‘‘requirements of this 22
8181 subparagraph’’; and 23
8282 (B) by adding at the end the following: 24
8383 ‘‘For purposes of applying section 406(a)(1)(C) 25
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8787 with respect to a transaction described under 1
8888 this subparagraph, a contract or arrangement 2
8989 for services between a covered plan and an enti-3
9090 ty or subsidiary providing services to the plan, 4
9191 including a health insurance issuer providing 5
9292 health insurance coverage in connection with 6
9393 the covered plan in which the entity or sub-7
9494 sidiary contracts, in connection with such plan, 8
9595 with a service provider for pharmacy benefit 9
9696 management services shall be considered an in-10
9797 direct furnishing of goods, services, or facilities 11
9898 between the covered plan and the service pro-12
9999 vider for pharmacy benefit management services 13
100100 acting as the party in interest.’’. 14
101101 (2) H
102102 EALTH INSURANCE ISSUER AND HEALTH 15
103103 INSURANCE COVERAGE DEFINED .—Clause (ii)(I)(aa) 16
104104 of section 408(b)(2)(B) of the Employee Retirement 17
105105 Income Security Act of 1974 (29 U.S.C. 18
106106 1108(b)(2)(B)) is amended by inserting before the 19
107107 period at the end ‘‘and the terms ‘health insurance 20
108108 coverage’ and ‘health insurance issuer’ have the 21
109109 meanings given such terms in section 733(b)’’. 22
110110 (3) T
111111 ECHNICAL AMENDMENT .—Section 23
112112 408(b)(2)(B)(ii)(I)(aa) of the Employee Retirement 24
113113 Income Security Act of 1974 (29 U.S.C. 25
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117117 1108(b)(2)(B)(ii)(I)(aa)) is further amended by in-1
118118 serting ‘‘in’’ after ‘‘defined’’. 2
119119 (b) S
120120 PECIFICDISCLOSUREREQUIREMENTS WITH 3
121121 R
122122 ESPECT TOENTITIESPROVIDINGPHARMACYBENEFIT 4
123123 M
124124 ANAGEMENTSERVICES.— 5
125125 (1) I
126126 N GENERAL.—Clause (iii) of section 6
127127 408(b)(2)(B) of such Act (29 U.S.C. 1108(b)(2)(B)) 7
128128 is amended by adding at the end the following: 8
129129 ‘‘(VII) In the case of a covered service pro-9
130130 vider in a contract or arrangement with a cov-10
131131 ered plan to provide pharmacy benefit manage-11
132132 ment services, as part of the description re-12
133133 quired under subclauses (III) and (IV)— 13
134134 ‘‘(aa) all compensation described in 14
135135 clause (ii)(I)(dd)(AA), including fees, re-15
136136 bates, alternative discounts, price conces-16
137137 sions, co-payment offsets, and other remu-17
138138 neration reasonably expected to be received 18
139139 by the covered service provider, an affil-19
140140 iate, or a subcontractor from a drug manu-20
141141 facturer, distributor, rebate aggregator, ac-21
142142 cumulator, maximizer, group purchasing 22
143143 organization, or any other third party; 23
144144 ‘‘(bb) the amount and form of any 24
145145 fees, rebates, alternative discounts, price 25
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149149 concessions, co-payment offsets, and other 1
150150 remuneration, including the amount ex-2
151151 pected to be passed through to the plan 3
152152 sponsor or the participants and bene-4
153153 ficiaries under the covered plan; 5
154154 ‘‘(cc) all compensation reasonably ex-6
155155 pected to be received by the covered service 7
156156 provider, an affiliate, or a subcontractor as 8
157157 a result of paying a lower amount for the 9
158158 drug than the amount charged as a copay-10
159159 ment, coinsurance amount, or deductible; 11
160160 ‘‘(dd) all compensation expected to be 12
161161 received by the covered service provider, an 13
162162 affiliate, or a subcontractor as a result of 14
163163 paying pharmacies less than the amount 15
164164 charged to the health plan, plan sponsor, 16
165165 or participants and beneficiaries (com-17
166166 monly referred to as ‘spread pricing’); 18
167167 ‘‘(ee) all compensation expected to be 19
168168 received by the covered service provider, an 20
169169 affiliate, or a subcontractor from drug 21
170170 manufacturers or any other third party in 22
171171 exchange for— 23
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175175 ‘‘(AA) administering, invoicing, 1
176176 allocating, or collecting rebates related 2
177177 to the covered plan; 3
178178 ‘‘(BB) providing access to drug 4
179179 utilization data; 5
180180 ‘‘(CC) retaining a percentage of 6
181181 the list price of a drug; or 7
182182 ‘‘(DD) any other service related 8
183183 to the role of the covered service pro-9
184184 vider as a conduit between the drug 10
185185 manufacturers or any other third 11
186186 party and the covered plan.’’. 12
187187 (2) A
188188 NNUAL DISCLOSURE .—Clause (v) of sec-13
189189 tion 408(b)(2)(B) of such Act (29 U.S.C. 14
190190 1108(b)(2)(B)) is amended by adding at the end the 15
191191 following: 16
192192 ‘‘(III) A covered service provider, with respect 17
193193 to a contract or arrangement with the covered plan 18
194194 in connection with providing pharmacy benefit man-19
195195 agement services, shall disclose, on an annual basis 20
196196 not later than 60 days after the beginning of each 21
197197 plan year, to a responsible plan fiduciary, in writing, 22
198198 the following with respect to the preceding plan 23
199199 year: 24
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203203 ‘‘(aa) All direct compensation described in 1
204204 subclause (III) of clause (iii) and indirect com-2
205205 pensation described in subclause (IV) of clause 3
206206 (iii) received by the covered service provider (in-4
207207 cluding such compensation described in sub-5
208208 clause (VII) of clause (iii)). 6
209209 ‘‘(bb) The total gross spending by the cov-7
210210 ered plan on drugs (excluding fees rebates, al-8
211211 ternative discounts, price concessions, co-pay-9
212212 ment offsets, and other remuneration). 10
213213 ‘‘(cc) The total net spending by the cov-11
214214 ered plan on drugs. 12
215215 ‘‘(dd) The total gross spending on drugs at 13
216216 all pharmacies wholly or partially owned by the 14
217217 covered service provider or any entity affiliated 15
218218 with the covered service provider, including 16
219219 mail-order, specialty and retail pharmacies, with 17
220220 a breakdown by individual pharmacy location. 18
221221 ‘‘(ee) The aggregate amount of cost-shar-19
222222 ing collected by the covered service provider 20
223223 from a pharmacy for a participant or bene-21
224224 ficiary in excess of the contracted rate from 22
225225 such pharmacies, including mail-order, spe-23
226226 cialty, and retail pharmacies, including— 24
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230230 ‘‘(AA) categorical explanations 1
231231 (grouped by the reason for collection of 2
232232 such amounts, such as contractual true-up 3
233233 provisions, overpayments, or non-covered 4
234234 medication dispensed, and including infor-5
235235 mation on the amount in each category 6
236236 that was passed through to the covered 7
237237 plan and to participants and beneficiaries 8
238238 of the covered plan); or 9
239239 ‘‘(BB) individual explanations for 10
240240 such amounts. 11
241241 ‘‘(ff) Total aggregate amounts of fees col-12
242242 lected by the covered service provider, an affil-13
243243 iate, or a subcontractor in connection with the 14
244244 provision of pharmacy benefit management 15
245245 services to the covered plan, broken down by 16
246246 the source of such fees (such as the covered 17
247247 plan, participants and beneficiaries of the cov-18
248248 ered plan, any drug manufacturer or whole-19
249249 saler, or any pharmacy entity). 20
250250 ‘‘(gg) Any information specified by the 21
251251 Secretary through regulations or guidance that 22
252252 may be necessary for a responsible plan fidu-23
253253 ciary to determine the reasonableness of the 24
254254 contract or arrangement with the covered serv-25
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258258 ice provider, any compensation paid under such 1
259259 a contract or arrangement, or any conflicts of 2
260260 interest that may exist.’’. 3
261261 (3) P
262262 HARMACY BENEFIT MANAGEMENT SERV -4
263263 ICES DEFINED .—Clause (ii)(I) of section 5
264264 408(b)(2)(B) of such Act (29 U.S.C. 1108(b)(2)(B)) 6
265265 is amended by adding at the end the following: 7
266266 ‘‘(gg) The term ‘pharmacy benefit manage-8
267267 ment services’ includes any services provided by 9
268268 a covered service provider to a covered plan 10
269269 with respect to the administration of prescrip-11
270270 tion drug benefits under the covered plan, in-12
271271 cluding— 13
272272 ‘‘(AA) the processing and payment of 14
273273 claims; 15
274274 ‘‘(BB) design of pharmacy networks; 16
275275 ‘‘(CC) negotiation, aggregation, and 17
276276 distribution of rebates, discounts, and 18
277277 other price concessions; 19
278278 ‘‘(DD) formulary design and mainte-20
279279 nance; 21
280280 ‘‘(EE) operation of pharmacies 22
281281 (whether retail, mail order, specialty drug, 23
282282 or otherwise); recordkeeping; 24
283283 ‘‘(FF) utilization review; 25
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287287 ‘‘(GG) adjudication of claims; and 1
288288 ‘‘(HH) any other services specified by 2
289289 the Secretary through guidance or rule-3
290290 making.’’. 4
291291 (c) S
292292 PECIFICDISCLOSUREREQUIREMENTS WITH 5
293293 R
294294 ESPECT TOTHIRDPARTYADMINISTRATIONSERVICES 6
295295 FORGROUPHEALTHPLANS.— 7
296296 (1) I
297297 N GENERAL.—Clause (iii) of section 8
298298 408(b)(2)(B) of such Act (29 U.S.C. 9
299299 1108(b)(2)(B)), as amended by subsection (b)(1), is 10
300300 further amended by adding at the end the following: 11
301301 ‘‘(VIII) With respect to a contract or ar-12
302302 rangement with the covered plan in connection 13
303303 with the provision of third party administration 14
304304 services for group health plans, as part of the 15
305305 description required under subclauses (III) and 16
306306 (IV)— 17
307307 ‘‘(aa) the amount and form of any re-18
308308 bates, discounts, savings fees, refunds, or 19
309309 amounts received from providers and facili-20
310310 ties, including the amounts that will be re-21
311311 tained by the covered service provider; 22
312312 ‘‘(bb) the amount and form of fees ex-23
313313 pected to be received from other service 24
314314 providers in relation to the covered plan, 25
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318318 including the amounts that will be retained 1
319319 by the covered service provider as a fee, to 2
320320 the extent feasible; and 3
321321 ‘‘(cc) the amount and form of ex-4
322322 pected recoveries by the covered service 5
323323 provider, including the amounts that will 6
324324 be retained by the covered service provider 7
325325 (disaggregated by category), as a result 8
326326 of— 9
327327 ‘‘(AA) overpayments; 10
328328 ‘‘(BB) erroneous payments; 11
329329 ‘‘(CC) uncashed checks or incom-12
330330 plete payments; 13
331331 ‘‘(DD) billing errors; 14
332332 ‘‘(EE) subrogation; 15
333333 ‘‘(FF) fraud; or 16
334334 ‘‘(GG) any other reason on behalf 17
335335 of the covered plan.’’. 18
336336 (2) A
337337 NNUAL DISCLOSURE .—Clause (v) of sec-19
338338 tion 408(b)(2)(B) of such Act (29 U.S.C. 20
339339 1108(b)(2)(B)), as amended by subsection (b)(2), is 21
340340 amended by adding at the end the following: 22
341341 ‘‘(IV) A covered service provider, with respect 23
342342 to a contract or arrangement with the covered plan 24
343343 in connection with providing third party administra-25
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347347 tion services for group health plans, shall disclose, 1
348348 on an annual basis not later than 60 days after the 2
349349 beginning of each plan year, to a responsible plan fi-3
350350 duciary, in writing, the following with respect to the 4
351351 preceding plan year: 5
352352 ‘‘(aa) All direct compensation described in 6
353353 subclause (III) of clause (iii). 7
354354 ‘‘(bb) All indirect compensation described 8
355355 in subclause (IV) of clause (iii) received by the 9
356356 covered service provider, an affiliate, or a sub-10
357357 contractor (including such compensation de-11
358358 scribed in subclause (VIII) of clause (iii)). 12
359359 ‘‘(cc) The aggregate amount for which the 13
360360 covered service provider, an affiliate, or a sub-14
361361 contractor received indirect compensation and 15
362362 the estimated amount of cost-sharing incurred 16
363363 by plan participants and beneficiaries as a re-17
364364 sult. 18
365365 ‘‘(dd) The total gross spending by the cov-19
366366 ered plan on all costs and fees arising under or 20
367367 paid under the administrative services agree-21
368368 ment with the covered service provider (not in-22
369369 cluding any amounts described in items (aa) 23
370370 through (cc) of clause (iii)(VIII)). 24
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374374 ‘‘(ee) The total net spending by the cov-1
375375 ered plan on all costs and fees arising under or 2
376376 paid under the administrative services agree-3
377377 ment with the covered service provider. 4
378378 ‘‘(ff) The aggregate fees collected by the 5
379379 covered service provider, an affiliate, or a sub-6
380380 contractor from any source. 7
381381 ‘‘(gg) Any other information specified by 8
382382 the Secretary through regulations or guidance 9
383383 that may be necessary for a responsible plan fi-10
384384 duciary to determine the reasonableness of the 11
385385 contract or arrangement with the covered serv-12
386386 ice provider any compensation paid under such 13
387387 a contractor or arrangement, or any conflicts of 14
388388 interest that may exist.’’. 15
389389 (3) T
390390 HIRD PARTY ADMINISTRATION SERVICES 16
391391 FOR GROUP HEALTH PLANS DEFINED .—Clause 17
392392 (ii)(I) of section 408(b)(2)(B) of such Act (29 18
393393 U.S.C. 1108(b)(2)(B)), as amended by subsection 19
394394 (b)(3), is amended by adding at the end the fol-20
395395 lowing: 21
396396 ‘‘(hh) The term ‘third party administration 22
397397 services for group health plans’ includes any 23
398398 services provided by a covered service provider 24
399399 to a covered plan with respect to the adminis-25
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403403 tration of health benefits under the covered 1
404404 plan, including— 2
405405 ‘‘(AA) the processing, repricing, and 3
406406 payment of claims; 4
407407 ‘‘(BB) design, creation, and mainte-5
408408 nance of provider networks; 6
409409 ‘‘(CC) negotiation of discounts off 7
410410 gross rates; 8
411411 ‘‘(DD) benefit and plan design; nego-9
412412 tiation of payment rates; 10
413413 ‘‘(EE) recordkeeping; 11
414414 ‘‘(FF) utilization review; 12
415415 ‘‘(GG) adjudication of claims; 13
416416 ‘‘(HH) regulatory compliance; and 14
417417 ‘‘(II) any other services set forth in 15
418418 an administrative services agreement or 16
419419 similar agreement or specified by the Sec-17
420420 retary through guidance or rulemaking.’’. 18
421421 (d) P
422422 RIVACYREQUIREMENTS.—Section 408(b)(2) of 19
423423 the Employee Retirement Income Security Act of 1974 20
424424 (29 U.S.C. 1108(b)(2)), as amended by subsection (c), is 21
425425 further amended by adding at the end the following: 22
426426 ‘‘(C) P
427427 RIVACY REQUIREMENTS .—Covered serv-23
428428 ice providers shall provide information under sub-24
429429 paragraph (B) in a manner consistent with the pri-25
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433433 vacy regulations promulgated under section 1
434434 13402(a) of the Health Information Technology for 2
435435 Clinical Health Act (42 U.S.C. 17932(a)), and con-3
436436 sistent with the privacy regulations promulgated 4
437437 under the Health Insurance Portability and Ac-5
438438 countability Act of 1996 in part 160 and subparts 6
439439 A and E of part 164 of title 45, Code of Federal 7
440440 Regulations (or successor regulations) and shall re-8
441441 strict the use and disclosure of such information ac-9
442442 cording to such privacy, security, and breach notifi-10
443443 cation regulations and such privacy regulations. 11
444444 ‘‘(D) D
445445 ISCLOSURE AND REDISCLOSURE .— 12
446446 ‘‘(i) L
447447 IMITATION TO BUSINESS ASSOCI -13
448448 ATES.—A responsible plan fiduciary receiving 14
449449 information disclosed under subparagraph (B) 15
450450 may disclose such information only to the entity 16
451451 from which the information was received, the 17
452452 group health plan to which the information per-18
453453 tains, or to that entity’s business associates as 19
454454 defined in section 160.103 of title 45, Code of 20
455455 Federal Regulations (or successor regulations) 21
456456 or as permitted by the HIPAA Privacy Rule 22
457457 (parts 160 and 164, subparts A and E of title 23
458458 45, Code of Federal Regulations). 24
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462462 ‘‘(ii) CLARIFICATION REGARDING PUBLIC 1
463463 DISCLOSURE OF INFORMATION .—Nothing in 2
464464 this section shall prevent a group health plan or 3
465465 health insurance issuer offering group health 4
466466 insurance coverage, or a covered service pro-5
467467 vider, from placing reasonable restrictions on 6
468468 the public disclosure of the information de-7
469469 scribed in this subparagraph, except that such 8
470470 plan, issuer, or entity may not restrict disclo-9
471471 sure of such information to the Department of 10
472472 Labor. 11
473473 ‘‘(E) A
474474 DDITIONAL PRIVACY REQUIREMENTS .— 12
475475 ‘‘(i) I
476476 N GENERAL.—Covered service pro-13
477477 viders shall ensure that information provided 14
478478 under subparagraph (B) contains only summary 15
479479 health information, as defined in section 16
480480 164.504(a) of title 45, Code of Federal Regula-17
481481 tions (or successor regulations). 18
482482 ‘‘(ii) R
483483 ESTRICTIONS.—A group health plan 19
484484 shall comply with section 164.504(f) of title 45, 20
485485 Code of Federal Regulations (or successor regu-21
486486 lations) with respect to any information re-22
487487 ceived by the plan or disclosed to a plan spon-23
488488 sor or any other entity pursuant to this section, 24
489489 and a responsible plan administrator who is a 25
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493493 plan sponsor shall act in accordance with the 1
494494 terms of the agreement described in such sec-2
495495 tion. 3
496496 ‘‘(F) R
497497 ULE OF CONSTRUCTION .—Nothing in 4
498498 this section shall be construed to modify the require-5
499499 ments for the creation, receipt, maintenance, or 6
500500 transmission of protected health information under 7
501501 the privacy regulations promulgated under the 8
502502 Health Insurance Portability and Accountability Act 9
503503 of 1996 in part 160 and subparts A and E of part 10
504504 164 of title 45, Code of Federal Regulations (or suc-11
505505 cessor regulations).’’. 12
506506 (e) R
507507 ULE OF CONSTRUCTION.—Nothing in the 13
508508 amendments made by this section shall be construed to 14
509509 imply that a practice in relation to which a covered service 15
510510 provider is required to provide information as a result of 16
511511 such amendments is permissible under Federal law. 17
512512 (f) E
513513 FFECTIVEDATE.—The amendments made by 18
514514 this subsection shall not apply to any contract or arrange-19
515515 ment entered into prior to January 1, 2026. Such amend-20
516516 ments shall apply to any contract or arrangement entered 21
517517 into on or after to such date, including any extension or 22
518518 renewal of a contract or arrangement, regardless of the 23
519519 date on which the original contract or agreement (or any 24
520520 previous extension or renewal) was entered into. 25
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523523 •HR 2041 IH
524524 SEC. 4. IMPLEMENTATION. 1
525525 Not later than 1 year after the date of enactment 2
526526 of this Act, the Secretary of Labor shall issue notice and 3
527527 comment rulemaking as necessary to implement the provi-4
528528 sions of this Act. The Secretary shall ensure that such 5
529529 rulemaking— 6
530530 (1) accounts for the varied compensation prac-7
531531 tices of covered service providers (as defined under 8
532532 section 408(b)(2)(B); and 9
533533 (2) establishes standards for the disclosure of 10
534534 expected compensation by such covered service pro-11
535535 viders. 12
536536 Æ
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