,,ii  #aae? ,,congress  #b;d ,session   
,s4 #ceda  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,octob] #c 7legislative
 day1 ,septemb] #bh71 #bjah ,mrs4 ,%ahe5
 7= h]self1 ,mrs4 ,mc,caskill1 ,ms4     
,baldw91 & ,ms4 ,hassan7 introduc$ !    
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,heal?1 ,education1  
,labor1 & ,p5sions  ,a ,,bill  ,to am5d 
! ,public ,heal? ,s]vice ,act to e/abli%
 limitations on co/-%>+ = out-(-network 
s]vices1 to prohibit balance bill+ = su*
 s]vices1 & = o!r purposes4  #a4 ,%ort  
title  ,?is ,act may be cit$ z ! ,r$uc+ 
,co/s = ,out-(-,network ,s]vices ,act ( 
#bjah4  #b4 ,limitations on co/-%>+ =   
out-(-network s]vices  7a7 ,9 g5]al     
,subp>t ,,ii ( "p ,a ( title ,,xxvii ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #cjj;gg-#aa et seq47 is am5d$ 
by add+ at ! end ! foll[+3  #bgbi4      
,limitations on co/-%>+ = out-(-network 
s]vices  7a7 ,heal? insurance issu]     
requirem5t ,a heal? insurance issu] (f]+
 individual heal? insurance cov]age t   

(f]s b5efits ) respect to a heal? c>e   
s]vice provid$ 9 a ,/ate by a p>ticipat+
 provid] %all ensure t ! co/-%>+        
requirem5t ) respect to su* s]vice      
provid$ 9 ! ,/ate by a nonp>ticipat+    
provid] does n exce$ ! rate select$ by !
 applicable ,/ate au?ority "u subsection
 7c77#a7 = su* s]vice4  7b7 ,limitation 
on *>ges by heal? c>e provid]s  7#a7 ,9 
g5]al ,a heal? c>e provid] may n *>ge a 
pati5t = heal? c>e s]vices 9 excess ( ! 
foll[+3  7,a7 ,9 ! case ( a pati5t :o is
 enroll$ 9 individual heal? insurance   
cov]age t does n provide out-(-network  
b5efits = a giv5 s]vice1 ! heal? c>e    
provid] may *>ge su* pati5t no m ?an !  
rate select$ by ! applicable ,/ate      
au?ority "u subsection 7c77#a74  7,b7 ,9
 ! case ( a pati5t enroll$ 9 individual 
heal? insurance cov]age t provides      
out-(-network b5efits = a giv5 s]vice1 !
 heal? c>e provid] may *>ge su* pati5t  
no m ?an--  7i7 ! rate select$ by !     
applicable ,/ate au?ority "u subsection 
7c77#a72 m9us  7ii7 ! sum (--  7,i7 !   

paym5t made to ! heal? c>e provid]      
pursuant to su* cov]age2 &  7,,ii7 !    
out-(-network co/-%>+ am\nt requir$ "u  
su* cov]age4  7,c7 ,9 ! case ( an       
un9sur$ individual1 ! heal? c>e provid] 
may *>ge su* pati5t no m ?an ! l[] (--  
7i7 ! rate select$ by ! applicable ,/ate
 au?ority "u subsection 7c77#b72 or     
7ii7 ! rate o!rwise all[$ to be *>g$ to 
su* an individual = su* a s]vice "u     
,/ate law4  7#b7 ,en=cem5t ,a heal? c>e 
provid] t violates ! requirem5t "u      
p>agraph 7#a7 %all be subject to ! same 
civil monet>y p5alties describ$ 9       
p>agraph 7#a7 ( section #ibb7;f71       
includ+ ! provisions describ$ 9 p>agraph
 7#b7 ( su* section1 z a p]son :o       
commits a violation describ$ 9 p>agraph 
7#a7 ( su* section4  7c7 ,rate  7#a7    
,individuals enroll$ 9 individual heal? 
insurance cov]age ,an applicable ,/ate  
au?ority %all select = ! ,/ate z        
applicable = purposes ( subsection 7a7 &
 subp>agraphs 7,a7 & 7,b7 ( subsection  
7b77#a7 "o ( ! foll[+ z a maximum rate =

 heal? c>e s]vices = individuals enroll$
 9 individual heal? insurance cov]age3  
7,a7 #abe p]c5t 7or1 9 a case describ$ 9
 p>agraph 7#c7 & at ! discretion ( !    
applicable ,/ate au?ority1 #bjj p]c5t7 (
 ! all[$ *>ges det]m9$ = ! item or      
s]vice "u ! orig9al ,m$ic>e fee-=-s]vice
 program "u p>ts ,a & ,b ( title ,,xviii
 ( ! ,social ,security ,act4  7,b7 #hj  
p]c5t ( ! usual1 cu/om>y1 & reasonable  
*>ge = ! s]vice1 z det]m9$ by a database
 ( usual1 cu/om>y1 & reasonable *>ges   
*os5 by ! applicable ,/ate au?ority &   
approv$ z appropriate by ! ,secret>y4   
7,c7 #ajj p]c5t ( ! all[$ *>ges = !     
s]vice if ! s]vice 7 provid$ by a       
p>ticipat+ provid]1 :i* %all be det]m9$ 
bas$ ^u ! actual all[$ rate "u !        
cov]age4  7#b7 ,un9sur$ individuals ,an 
applicable ,/ate au?ority %all select = 
! ,/ate z applicable = purposes (       
subsection 7b77#a77;,c7 "o ( ! foll[+ z 
a maximum rate = heal? c>e s]vices =    
un9sur$ individuals3  7,a7 ,! rate      
describ$ 9 subp>agraph 7,a7 ( p>agraph  

7#a74  7,b7 ,! rate describ$ 9          
subp>agraph 7,b7 ( p>agraph 7#a74  7#c7 
,s]vices provid$ 9 rural areas ,a case  
describ$ 9 ?is p>agraph is a case 9 :i* 
! item or s]vice is furni%$ by a provid]
 ( s]vices 7z def9$ 9 subsection 7u7 (  
section #ahfa ( ! ,social ,security     
,act7 or suppli] 7z def9$ 9 subsection  
7d7 ( su* section7 9 a rural area 7z    
def9$ 9 section #ahhf7;d77#b77;,d7 ( su*
 ,act74  7#d7 ,default rate ,9 ! case 9 
:i* an applicable ,/ate au?ority does n 
select a rate "u p>agraph 7#a7 or 7#b7 =
 a s]vice1 ! maximum rate applicable 9 !
 ,/ate = ! s]vice = purposes (          
subsections 7a7 & 7b7 %all--  7,a7 be ! 
rate describ$ 9 subp>agraph 7,a7 (      
p>agraph 7#a71 if ! s]vice is cov]$ "u !
 orig9al ,m$ic>e fee-=-s]vice program "u
 p>ts ,a & ,b ( title ,,xviii ( !       
,social ,security ,act2 or  7,b7 be a   
rate e/abli%$ by ! ,secret>y1 if !      
s]vice is n cov]$ "u su* program4  7#e7 
,cl>ification ,9 select+ a rate "u      
p>agraph 7#a7 or 7#b7 = a heal? c>e     

s]vice1 ! applicable ,/ate may select a 
rate t diff]s f ! rate select$ "u su*   
p>agraph = a diff]5t heal? c>e s]vice4  
7d7 ,def9itions ,= purposes ( ?is       
section3 7#a7 ,heal? c>e provid] ,! t]m 
heal? c>e provid] includes a hospital 7z
 def9$ 9 section #ahfa7;e7 ( ! ,social  
,security ,act71 a critical access      
hospital 7z def9$ 9 section #ahfa7mm7 ( 
su* ,act71 a physician 7z def9$ 9       
section #ahfa7r7 ( su* ,act71 & o!r     
provid]s z det]m9$ by ! ,secret>y4  7#b7
 ,un9sur$ individual ,! t]m un9sur$     
individual1 ) respect to an individual  
receiv+ a heal? c>e s]vice1 means an    
individual :o1 at ! "t at :i* ! s]vice 0
 furni%$1 0 n enroll$ 9 a plan t        
provides m$ical c>e b5efits1 includ+ any
 ,f$]al heal? b5efit program1 z det]m9$ 
by ! ,secret>y4  4  7b7 ,effective date 
,section #bgbi ( ! ,public ,heal?       
,s]vice ,act1 z add$ by subsection 7a71 
%all take effect on ,janu>y #a1 #bjbj4  
#c4 ,grants = gr\p m>ket  7a7 ,9 g5]al  
,! ,secret>y ( ,heal? & ,human ,s]vices 

%all aw>d grants to ,/ates = ! purpose (
 /udy+ ! pot5tial = impos+ limitations  
on *>ges = heal? c>e s]vices provid$ to 
individuals enroll$ 9 gr\p heal? plans  
or gr\p heal? insurance cov]age (f]$ by 
a heal? insurance issu] t are simil> to 
! limitations t apply "u section #bgbi (
 ! ,public ,heal? ,s]vice ,act1 z add$  
by section #b4  7b7 ,au?orization (     
appropriations ,!re are au?oriz$ to be  
appropriat$ su* sums z may be necess>y  
to c>ry out ?is section4  7c7           
,def9itions ,9 ?is section1 ! t]ms gr\p 
heal? plan1 gr\p heal? insurance        
cov]age1 & heal? insurance issu] h !    
mean+s giv5 su* t]ms 9 section #bgia ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #cjj;gg-#ia74