,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #hag  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,febru>y #b1 #bjag,mr4
 ,doggett 7= himself1 ,mr4 ,butt]field1 
,mr4 ,c>twright1 ,ms4 ,judy ,*u (       
,cali=nia1 ,mr4 ,cicill9e1 ,ms4 ,cl>ke (
 ,new ,york1 ,mr4 ,coh51 ,mr4 ,c\rtney1 
,mr4 ,danny ,k4 ,davis ( ,ill9ois1 ,ms4 
,de,lauro1 ,mr4 ,gallego1 ,mr4 ,g>am5di1
 ,mr4 ,g5e ,gre5 ( ,texas1 ,mr4         
,grijalva1 ,mr4 ,ha/+s1 ,ms4 ,kelly (   
,ill9ois1 ,mr4 ,langev91 ,ms4 ,lee1 ,mr4
 ,lewis ( ,georgia1 ,mr4 ,lip9ski1 ,ms4 
,l(gr51 ,ms4 ,moore1 ,mr4 ,nadl]1 ,ms4  
,norton1 ,mr4 ,pocan1 ,ms4 ,s*ak[sky1   
,mr4 ,tonko1 ,mr4 ,wel*1 ,mr4 ,cony]s1  
,mr4 ,ellison1 ,mr4 ,espaillat1 ,mrs4   
,lawr5ce1 & ,ms4 ,%ea-,port]7 introduc$ 
! foll[+ bill2 :i* 0 ref]r$ to !        
,committee on ,ways & ,means1 & 9       
addition to ! ,committee on ,en]gy &    
,comm]ce1 = 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 prev5t        
surprise bill+ practices1 & = o!r       
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,end ,surprise ,bill+ ,act 
( #bjag4  #b4 ,prev5t+ surprise bill+   
practices  7a7 ,condition ( p>ticipation
 9 ,m$ic>e ,section #ahff ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acie;cc7 
is am5d$--  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+
 at ! end ! p]iod & ins]t+ 1 &2 &  7,c7 
by ins]t+ aft] su* subp>agraph 7,y7 !   
foll[+ new subp>agraph3  7,z7 9 ! case (
 a hospital or critical access hospital1
 to adopt & en=ce a policy to ensure    
compliance ) ! requirem5ts ( p>agraphs  
7#a7 & 7#d7 ( subsection 7l7 & to meet !
 requirem5ts ( su* p>agraphs 7relat+ to 
! prev5tion ( surprise bill+ practices74
  2 &  7#b7 by add+ at ! end ! foll[+   
new subsection3  7l7 ,requirem5t =      
purposes ( prev5t+ surprise bill+  7#a7 
,9 g5]al ,= purposes ( subsection       

7a77#a77,z71 ! requirem5ts describ$ 9   
?is p>agraph are1 ) respect to a        
hospital or critical access hospital1 9 
! case ( an individual ) heal? b5efits  
cov]age1 includ+ b5efits "u a gr\p heal?
 plan or heal? insurance cov]age (f]$ 9 
! gr\p or individual m>ket 7z su* t]ms  
are def9$ 9 section #bgia ( ! ,public   
,heal? ,s]vice ,act7 or "u ?is title1   
title ,,xix1 title ,,xxi1 or ano!r      
gov]nm5t-sponsor$ heal? plan or program1
 :o seeks to be furni%$ items or s]vices
 or is to be furni%$ items or s]vices by
 ! hospital or critical access hospital 
7includ+ by a provid] ( s]vices or      
suppli] t furni%es items or s]vices at !
 hospital or critical access hospital71 
t ! hospital or critical access         
hospital--  7,a7  7i7 provides to !     
individual 7or to a repres5tative ( !   
individual71 on ! date on :i* !         
individual makes an appo9tm5t to be     
furni%$ su* items or s]vices1 if        
applicable1 & on ! date on :i* !        
individual is furni%$ su* items &       

s]vices1 a writt5 notice specifi$ by !  
,secret>y ?r\gh rulemak+ t--  7,i7      
conta9s ! in=mation requir$ "u p>agraph 
7#b72 &  7,,ii7 is sign$ & dat$ by !    
individual2 &  7ii7 reta9s a copy ( ea* 
su* notice = a p]iod specifi$ ?r\gh     
rulemak+ by ! ,secret>y2 &  7,b7 9 !    
case t su* hospital or critical access  
hospital 7or provid] ( s]vices or       
suppli] furni%+ s]vices at su* hospital 
or critical access hospital7 is n )9 !  
heal? c>e provid] network or o!rwise a  
p>ticipat+ provid] ( s]vices or suppli] 
) respect to su* heal? b5efits cov]age (
 su* individual1 obta9s f ! individual !
 cons5t describ$ 9 p>agraph 7#c74  7#b7 
,in=mation includ$ 9 notice ,! notice   
describ$ 9 p>agraph 7#a77;,a7 %all      
include1 ) respect to an individual )   
heal? b5efits cov]age describ$ 9        
p>agraph 7#a7 :o seeks to be furni%$    
items or s]vices or is to be furni%$    
items or s]vices by a hospital or       
critical access hospital 7includ+ by a  
provid] ( s]vices or suppli] t furni%es 

items or s]vices at ! hospital or       
critical access hospital71 a            
notification ( ea* ( ! foll[+3  7,a7    
,:e!r ! hospital or critical access     
hospital is n )9 ! heal? c>e provid]    
network or o!rwise a p>ticipat+ provid] 
( s]vices or suppli] ) respect to su*   
heal? b5efits cov]age ( su* individual4 
7,b7 ,if ! hospital or critical access  
hospital is n )9 su* network or o!rwise 
su* a p>ticipat+ provid] or suppli]1 !  
e/imat$ am\nt t ! hospital or critical  
access hospital w *>ge ! individual =   
su* items & s]vices 9 excess ( any co/  
%>+ obligations t ! individual w\ld     
o!rwise h "u su* heal? b5efits cov]age =
 su* items & s]vices if ! hospital or   
critical access hospital 7 )9 su*       
network or o!rwise p>ticipat+ 9 su*     
cov]age4  7,c7 ,:e!r any ( ! provid]s ( 
s]vices or suppli]s furni%+ items or    
s]vices at ! hospital or critical access
 hospital :o w furni% ! items or s]vices
 to ! individual are n )9 ! heal? c>e   
provid] network or o!rwise a p>ticipat+ 

provid] ( s]vices or suppli] ) respect  
to su* heal? b5efits cov]age ( su*      
individual4  7,d7 ,if any ( su* provid]s
 ( s]vices or suppli]s are n )9 su*     
network or o!rwise su* a p>ticipat+     
provid] or suppli]1 ! e/imat$ am\nt t   
su* provid]s ( s]vices or suppli]s w    
*>ge ! individual = su* items & s]vices 
9 excess ( any co/ %>+ obligations t !  
individual w\ld o!rwise h = su* items & 
s]vices if ! provid]s ( s]vices or      
suppli]s 7 )9 su* network or o!rwise    
p>ticipat+ 9 su* cov]age4  7#c7 ,cons5t 
describ$ ,= purposes ( p>agraph         
7#a77;,b71 ! cons5t describ$ 9 ?is      
p>agraph1 ) respect to an individual )  
heal? b5efits cov]age describ$ 9        
p>agraph 7#a7 :o is to be furni%$ items 
or s]vices by a hospital or critical    
access hospital 7or provid] ( s]vices or
 suppli] furni%+ s]vices at su* hospital
 or critical access hospital7 t is n )9 
! heal? c>e provid] network or o!rwise a
 p>ticipat+ provid] ( s]vices or suppli]
 ) respect to su* heal? b5efits cov]age 

( su* individual1 is a docum5t specifi$ 
by ! ,secret>y ?r\gh rulemak+ t is sign$
 by ! individual 7or by a repres5tative 
( ! individual7 n less ?an #bd h\rs     
prior to ! individual be+ furni%$ su*   
items or s]vices by su* hospital1       
critical access hospital1 provid] (     
s]vices1 or suppli]1 respectively1 & t--
  7,a7 ackn[l$ges t ! individual has    
be5-- 7i7 provid$ ) a writt5 e/imate ( !
 *>ge t ! individual w be assess$ = !   
items or s]vices anticipat$ to be       
furni%$ to ! individual by ! hospital1  
critical access hospital1 provid] (     
s]vices1 or suppli] t is n )9 su*       
network or o!rwise su* a p>ticipat+     
provid] ( s]vices or suppli]2 &  7ii7   
in=m$ t ! paym5t ( su* *>ge by !        
individual w n accrue t[>d any          
limitation t ! heal? b5efits cov]age    
places ^u ! annual out-(-pocket exp5ses 
to be paid by ! individual or ^u !      
9-network d$uctible to be paid by !     
individual2 &  7,b7 docum5ts ! cons5t ( 
! individual to-- 7i7 be furni%$ ) su*  

items or s]vices by su* hospital1       
critical access hospital1 provid] (     
s]vices1 or suppli]1 z applicable2 &    
7ii7 9 ! case t ! individual is s       
furni%$ su* items or s]vices1 be *>g$ an
 am\nt approximate to ! e/imat$ *>ge    
describ$ 9 subp>agraph 7,a77i7 ) respect
 to su* items or s]vices4  7#d7         
,limitations on paym5t by individual ,= 
purposes ( subsection 7a77#a77,z71 !    
requirem5ts "u ?is p>agraph are !       
foll[+3 7,a7 ,9 case ( noncompliance by 
hospitals & critical access hospitals ,9
 ! case ( an individual ) heal? b5efits 
cov]age describ$ 9 p>agraph 7#a7 :o is  
furni%$ items or s]vices by a hospital  
or critical access hospital 7or provid] 
( s]vices or suppli] furni%+ s]vices at 
su* hospital or critical access         
hospital7 t is n )9 ! heal? c>e provid] 
network or o!rwise a p>ticipat+ provid] 
( s]vices or suppli] ) respect to su*   
heal? b5efits cov]age ( su* individual1 
if ! hospital or critical access        
hospital does n comply ) ! requirem5ts (

 p>agraph 7#a7 ) respect to ! furni%+ ( 
su* items or s]vices to su* individual1 
! hospital or critical access hospital  
7or1 z applicable1 ! provid] ( s]vices  
or suppli] furni%+ su* items or s]vices 
to su* individual7 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 hospital1 z
 applicable 7or by a provid] ( s]vices  
or suppli]1 z applicable7 t is )9 su*   
network or t is o!rwise su* a p>ticipat+
 provid] ( s]vices or suppli]4  7,b7 ,9 
case ( same-day em]g5cy s]vices ,9 !    
case ( an individual ) heal? b5efits    
cov]age describ$ 9 p>agraph 7#a7 :o is  
furni%$ items or s]vices by a hospital  
or critical access hospital 7or provid] 
( s]vices or suppli] furni%+ s]vices at 
su* hospital or critical access         
hospital7 t is n )9 ! heal? c>e provid] 
network or o!rwise a p>ticipat+ provid] 
( s]vices or suppli] ) respect to su*   
heal? b5efits cov]age ( su* individual  

on ! same date on :i* ! individual makes
 an appo9tm5t = su* items or s]vices 7or
 o!rwise pres5ts at ! hospital or       
critical access hospital = su* s]vices  
su* z 9 ! case ( items & s]vices furni%$
 ) respect to an em]g5cy m$ical         
condition1 z def9$ 9 section #ahfg7;e771
 ! hospital or critical access hospital 
7or1 z applicable1 ! provid] ( s]vices  
or suppli] furni%+ su* items or s]vices 
to su* individual7 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 hospital1 z
 applicable 7or by a provid] ( s]vices  
or suppli]1 z applicable7 t is )9 su*   
network or t is o!rwise su* a p>ticipat+
 provid] ( s]vices or suppli]4  4  7b7  
,effective date ,! am5dm5ts made by     
subsection 7a7 %all apply ) respect to  
agreem5ts "u section #ahff7;a77#a7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acie;cc7a77#a77 t are fil$ ) !         
,secret>y ( ,heal? & ,human ,s]vices on 

a date t is n less ?an #ab mon?s aft] ! 
date ( ! enactm5t ( ?is ,act4