Patient Choice and Access Act of 2026

This Act may be cited as the “Patient Choice and Access Act of 2026”.

(a) In general.— Section 1311(c)(2) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(2)) is amended—

(1) in the paragraph heading, by inserting “; clarification on use of provider networks” after “Rule of construction”;

(2) by striking “Nothing in” and inserting:

“(A) Rule of construction.— Nothing in”; and

(3) by adding at the end the following new subparagraph:

“(B) Clarification on use of provider networks.— For plan years beginning on or after January 1, 2027, the Secretary may not require a plan to maintain a provider network in order to meet the criteria established under subparagraphs (B) and (C) of paragraph (1).”.

(b) Exchange certification.— Section 1311(e)(1)(B) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(e)(1)(B)) is amended—

(1) in clause (ii), by striking “or” at the end;

(2) in clause (iii), by striking the period at the end and inserting “; or”; and

(3) by adding at the end the following new clause:

“(iv) for plan years beginning on or after January 1, 2027, on the basis that the plan does not maintain a provider network.”.

(c) Transparency requirements for qualified health plans without provider networks.— Section 1311(c)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(1)) is amended—

(1) in subparagraph (H), by striking “and” at the end;

(2) in subparagraph (I), by striking the period at the end and inserting “; and”; and

(3) by adding at the end the following new subparagraph:

“(J) for plan years beginning on or after January 1, 2027, in the case of a plan that does not maintain a provider network—

(i) provide information in plain language to plan enrollees and potential enrollees with respect to expected out-of-pocket costs and the potential for balance billing; and

(ii) provide adequate customer service or online provider search assistance resources to assist plan enrollees and potential enrollees in finding providers in their area who will accept the plan’s benefit amounts as payment in full for items and services for which benefits are available under the plan.”.