,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #chgg  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,septemb] #bh1        
#bjag,ms4 ,mi*elle ,lujan ,gri%am ( ,new
 ,mexico introduc$ ! foll[+ bill2 :i* 0 
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
protect heal? c>e consum]s f surprise   
bill+ practices1 & = o!r purposes4  #a4 
,%ort title ,?is ,act may be cit$ z !   
,fair ,bill+ ,act ( #bjag4  #b4         
,protect+ heal? c>e consum]s f surprise 
bill+ practices  7a7 ,provid]s ,section 
#ahff ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acie;cc7 is am5d$--  7#a7 9  
subsection 7a77#a7-- 7,a7 9 subp>agraph 
7,x71 by /rik+ & at ! end2  7,b7 9      
subp>agraph 7,y71 by /rik+ ! p]iod at ! 
end & ins]t+ 1 &2 &  7,c7 by ins]t+ aft]

 subp>agraph 7,y7 ! foll[+ new          
subp>agraph3  7,z7 9 ! case ( a hospital
 or critical access hospital1 to meet ! 
requirem5ts ( p>agraphs 7#a71 7#b71 &   
7#c7 ( subsection 7l74  2 &  7#b7 by    
add+ at ! end ! foll[+ new subsection3  
7l7 ,no surprise bill+ at 9-,network    
facilities2 em]g5cy s]vices2 ext]nal    
review ( c]ta9 paym5ts  7#a7 ,no        
surprise bill+ at 9-network facilities  
7,a7 ,9 g5]al ,subject to subp>agraph   
7,b71 9 ! case ( an individual ) b5efits
 "u a heal? c>e plan :o is furni%$ items
 or s]vices at a relevant facility      
7includ+ items or s]vices furni%$ by a  
provid] ( s]vices or suppli] at su*     
facility7 t is )9 ! heal? c>e provid]   
network or o!rwise a p>ticipat+ provid] 
( s]vices or suppli] ) respect to !     
heal? c>e plan ( su* individual1 !      
relevant facility 7or ! provid] (       
s]vices or suppli]7 may n hold !        
individual liable = m ?an ! am\nt t !   
individual w\ld h be5 requir$ to pay 9  
co/ %>+ if su* items or s]vices _h be5  

furni%$ by a relevant facility 7or1 z   
applicable1 by a provid] ( s]vices or   
suppli]7 t is )9 ! heal? c>e provid]    
network or o!rwise a p>ticipat+ provid] 
( s]vices or suppli] ) respect to !     
heal? c>e plan ( su* individual4  7,b7  
,exception = notification & writt5      
cons5t ,subp>agraph 7,a7 %all n apply 9 
! case ( a relevant facility 7or provid]
 ( s]vices or suppli] at su* facility7  
t1 n lat] ?an #gb h\rs be=e furni%+     
items or s]vices to an individual 7or1 9
 ! case :]e su* items or s]vices are    
s*$ul$ to be furni%$ less ?an #gb h\rs f
 ! "t ( s*$ul+1 #bd h\rs be=e furni%+   
su* items or s]vices71 notifies su*     
individual ( an e/imate ( ! individual's
 anticipat$ total out-(-pocket co/ ( c>e
 = su* items & s]vices & obta9s writt5  
cons5t f su* individual4  7#b7 ,em]g5cy 
s]vices ,9 ! case ( an individual )     
b5efits "u a heal? c>e plan :o is       
furni%$ items or s]vices ) respect to an
 em]g5cy m$ical condition at a hospital 
or critical access hospital 7includ+    

items or s]vices furni%$ by a provid] ( 
s]vices or a suppli] at ! hospital or   
critical access hospital71 ! hospital or
 critical access hospital 7or ! provid] 
( s]vices or suppli]7 may n *>ge !      
individual m ?an ! am\nt t ! individual 
w\ld h be5 requir$ to pay 9 co/ %>+ if  
su* items or s]vices _h be5 furni%$ by a
 hospital or critical access hospital   
7or by a provid] ( s]vices or suppli]7  
)9 su* network or o!rwise a p>ticipat+  
provid] ( s]vices4  7#c7 ,review process
 ,a relevant facility %all p>ticipate 9 
any review process reque/$1 & comply )  
any det]m9ation made1 "u section #c ( ! 
,fair ,bill+ ,act ( #bjag4  7#d7        
,def9itions ,9 ?is subsection3 7,a7     
,em]g5cy m$ical condition ,! t]m em]g5cy
 m$ical condition has ! mean+ giv5 su*  
t]m 9 section #ahfg7;e74  7,b7 ,heal?   
c>e plan ,! t]m heal? c>e plan means--  
7i7 a gr\p heal? plan2  7ii7 gr\p heal? 
insurance cov]age2  7iii7 individual    
heal? insurance cov]age2 or  7iv7 a     
,f$]al heal? c>e program 7z def9$ 9     

section #aabh;,b7f774  7,c7 ,public     
,heal? ,s]vice ,act t]ms ,! t]ms gr\p   
heal? plan1 gr\p heal? insurance        
cov]age1 & individual heal? insurance   
cov]age h ! mean+s giv5 ^? t]ms1        
respectively1 "u section #bgia ( !      
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#ia74  7,d7 ,relevant 
facility ,! t]m relevant facility means 
a hospital or critical access hospital4 
4  7b7 ,insur]s ,section #bgai;,a ( !   
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#ai;a7 is am5d$ by    
add+ at ! end ! foll[+ new subsection3  
7e7 ,paym5t review process ,a gr\p heal?
 plan or a heal? insurance issu] (f]+   
gr\p or individual heal? insurance %all 
p>ticipate 9 any review process reque/$1
 & comply ) any det]m9ation made1 "u    
section #c ( ! ,fair ,bill+ ,act (      
#bjag4  4  7c7 ,effective date ,!       
am5dm5ts made by ?is section %all apply 
) respect to items or s]vices furni%$ on
 or aft] ! date t is "o ye> aft] ! date 
( ! enactm5t ( ?is ,act4  #c4 ,review   

process = surprise bill+ practices  7a7 
,/ate election ,ea* ,/ate may elect1 at 
su* "t & 9 su* mann] z ! ,secret>y (    
,heal? & ,human ,s]vices 7! ,secret>y7  
%all prescribe1 to e/abli% a review     
process describ$ 9 subsection 7c7 to be 
available at ! reque/ ( a heal? c>e plan
 or provid] ( s]vices or suppli]4  7b7  
,failure ,to e/abli% an ext]nal review  
process or implem5t /&>ds ,9 ! case ( a 
,/ate t does n elect "u subsection 7a7  
to e/abli% a review process describ$ 9  
subsection 7c71 ! ,secret>y %all make   
available )9 ! ,/ate su* a review       
process to be available at ! reque/ ( a 
heal? c>e plan or provid] ( s]vices or  
suppli]4  7c7 ,review process ,9 ! case 
( paym5t f a heal? c>e plan to a provid]
 ( s]vices or suppli] = items or s]vices
 furni%$ by su* provid] or suppli] to an
 individual ) b5efits "u su* plan 9 a   
case 9 :i* section #ahff7l77#a77;,a7 or 
subsection 7l77#b7 ( su* section applies
 & su* plan or su* provid] or suppli]   
reque/s a review ( su* paym5t1 a review 

process describ$ 9 ?is subsection is a  
process by :i* an indep5d5t heal? c>e   
exp]t det]m9es ! am\nt ( ! paym5t to be 
made by su* plan to su* provid] or      
suppli] us+ ! me?odology describ$ 9     
subsection 7d7 & notifies ! individual  
furni%$ su* items or s]vices ( su*      
det]m9ation )9 #cj days ( mak+ su*      
det]m9ation4  7d7 ,me?odology ,9 ! case 
( paym5t f a heal? c>e plan to a provid]
 ( s]vices or suppli] = items or s]vices
 furni%$ by su* provid] or suppli] to an
 individual ) b5efits "u su* plan1 !    
me?odology describ$ 9 ?is subsection    
consi/s ( an indep5d5t heal? c>e exp]t  
det]m9+ an am\nt to be paid by ! plan to
 ! provid] or suppli] by select+ "o ( ! 
foll[+ am\nts3  7#a7 ,! less] (-- 7,a7  
an am\nt propos$ by ! provid] ( s]vices 
or suppli] t furni%$ su* items or       
s]vices2 &  7,b7 an am\nt t is equal to 
! #hj? p]c5tile ( ! am\nt paid = su*    
items & s]vices1 z report$ by a national
 all-pay] claims database or1 if        
available1 a ,/ate or regional all-pay] 

claims database1 z det]m9$ by !         
indep5d5t heal? c>e exp]t4  7#b7 ,!     
great] (-- 7,a7 an am\nt propos$ by !   
heal? plan provid+ heal? b5efits cov]age
 to su* individual ) respect to su*     
items & s]vices2 &  7,b7 #a4be multipli$
 by ! ,m$ic>e fee s*$ule = su* items &  
s]vices 7or1 if su* items & s]vices are 
n cov]$ "u ,m$ic>e1 an am\nt det]m9$ by 
! ,secret>y74  7e7 ,reconsid]ation ,an  
individual furni%$ items or s]vices by a
 provid] ( s]vices or suppli] = :i*     
paym5t is det]m9$ 9 accordance ) !      
review process describ$ 9 subsection 7c7
 may1 )9 #cj days ( receiv+ notification
 ( su* det]m9ation1 file a writt5 reque/
 = a reconsid]ation ( su* det]m9ation ) 
! indep5d5t heal? c>e exp]t mak+ su*    
det]m9ation4 ,su* exp]t %all1 )9 #cj    
days ( receiv+ su* reque/1 det]m9e :e!r 
su* det]m9ation %\ld be revis$ & notify 
su* individual ( any *ange to su*       
det]m9ation4  7f7 ,co/-,%>+ cl>ification
 ,any co/ %>+ 7includ+ any copaym5t or  
co9surance7 t an individual may be      

responsible = aft] a det]m9ation is made
 "u subsection 7c7 %all c\nt t[>ds su*  
individual's annual d$uctible ) respect 
to ! heal? c>e plan ( su* individual4   
7g7 ,def9itions ,9 ?is section3 7#a7    
,heal? c>e plan ,! t]m heal? c>e plan   
has ! mean+ giv5 su* t]m 9 section      
#ahff7l77#d7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acie;cc7l77#d774  7#b7  
,indep5d5t heal? c>e exp]t def9$ ,! t]m 
indep5d5t heal? c>e exp]t means an      
individual :o is1 ) respect to a paym5t 
= items & s]vices-- 7,a7 an exp]t 9     
heal? c>e bill+2  7,b7 free ( conflicts 
( int]e/ ) respect to su* paym5t2 &     
7,c7 appo9t$ by a ,/ate or ! ,secret>y  
to make det]m9ations "u ! ext]nal review
 process describ$ 9 subsection 7c74     
7#c7 ,provid] ( s]vices ,! t]m provid] (
 s]vices has ! mean+ giv5 su* t]m 9     
section #ahfa ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciex74  7#d7 ,/ate ,! 
t]m ,/ate has ! mean+ giv5 su* t]m 9    
section #baj ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #daj74  7#e7 ,suppli] ,! 

t]m suppli] has ! mean+ giv5 su* t]m 9  
section #ahfa ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciex74  7h7 ,grants to
 ,/ates  7#a7 ,9 g5]al ,! ,secret>y (   
,heal? & ,human ,s]vices %all provide   
grants1 n lat] ?an #ij days aft] ! date 
( ! enactm5t ( ?is ,act1 to eligible    
,/ates to e/abli% & implem5t a review   
process describ$ 9 subsection 7a74  7#b7
 ,eligible ,/ate ,= purposes ( ?is      
subsection1 ! t]m eligible ,/ate means a
 ,/ate t has elect$ "u subsection 7a7 to
 e/abli% a review process & t has       
submitt$ an application to ! ,secret>y  
at su* "t1 9 su* mann]1 & conta9+ su*   
in=mation z ! ,secret>y may require4    
7#c7 ,au?orization ( appropriations ,!re
 is au?oriz$ to be appropriat$ to !     
,secret>y ( ,heal? & ,human ,s]vices    
#d1jjj1jjj1jjj to aw>d grants "u ?is    
subsection4  7i7 ,effective date ,?is   
section %all apply ) respect to items or
 s]vices furni%$ on or aft] ! date t is 
"o ye> aft] ! date ( ! enactm5t ( ?is   
,act4