,,ii  #aae? ,,congress  #b;d ,session   
,s4 #ceib  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,octob] #aa1 #bjah ,ms4
 ,hassan 7= h]self & ,mrs4 ,%ahe57      
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 prev5t surprise m$ical  
bill+ practices1 & = o!r purposes4  #a4 
,%ort title  ,?is ,act may be cit$ z !  
,no ,m ,surprise ,m$ical ,bills ,act (  
#bjah4  #b4 ,prev5t+ surprise bill+     
practices  7a7 ,9 g5]al  7#a7           
,prohibition ,subp>t ,,ii ( "p ,a (     
title ,,xxvii ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et     
seq47 is am5d$ by add+ at ! end !       
foll[+3  #bgbi4 ,prev5t+ surprise bill+ 
practices  7a7 ,def9itions ,9 ?is       
section3 7#a7 ,heal? c>e provid] ,! t]m 
heal? c>e provid] means--  7,a7 a       
hospital 7z def9$ 9 section #ahfa7;e7 ( 
! ,social ,security ,act72  7,b7 a      
critical access hospital 7z def9$ 9     

section #ahfa7mm7 ( su* ,act72  7,c7 an 
ambulatory surgical c5t] z describ$ 9   
section #ahcc7;i77#a77;,a7 ( su* ,act2  
or  7,d7 a provid] ( s]vices or suppli] 
furni%+ s]vices at su* hospital1        
critical access hospital1 or ambulatory 
surgical c5t]4  7#b7 ,9-network heal?   
c>e provid] ,! t]m 9-network heal? c>e  
provid]1 ) respect to a gr\p heal? plan 
or heal? insurance cov]age (f]$ 9 ! gr\p
 m>ket1 means a heal? c>e provid] t is  
)9 ! heal? c>e provid] network ( ! plan 
or cov]age or is o!rwise a p>ticipat+   
provid] ( s]vices or suppli] ) respect  
to su* plan or cov]age4  7#c7           
,out-(-network heal? c>e provid] ,! t]m 
out-(-network heal? c>e provid]1 )      
respect to a gr\p heal? plan or heal?   
insurance cov]age (f]$ 9 ! gr\p m>ket1  
means a heal? c>e provid] t is n )9 !   
heal? c>e provid] network ( ! plan or   
cov]age or is n o!rwise a p>ticipat+    
provid] ( s]vices or suppli] ) respect  
to su* plan or cov]age4  7b7 ,requirem5t
 = notice & cons5t  7#a7 ,notice ,a     

heal? c>e provid]1 9 ! case ( an        
individual enroll$ 9 a gr\p heal? plan  
or heal? insurance cov]age (f]$ 9 ! gr\p
 m>ket1 :o seeks to be furni%$ items or 
s]vices or is to be furni%$ items or    
s]vices by ! provid]1 %all--  7,a7 7i7  
provide 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]vices--  7,i7 an oral explanation ( ! 
writt5 notification describ$ 9 subclause
 7,,ii7 & su* docum5tation ( ! provision
 ( su* explanation1 z ! ,secret>y       
det]m9es appropriate2 &  7,,ii7 a writt5
 notice specifi$ by ! ,secret>y ?r\gh   
rulemak+ t-- 7aa7 conta9s ! in=mation   
requir$ "u p>agraph 7#b72 &  7bb7 is    
sign$ & dat$ by ! individual2 &  7ii7   
reta91 = a p]iod specifi$ ?r\gh rulemak+
 by ! ,secret>y1 a copy ( ! docum5tation
 describ$ 9 clause 7i77,i7 & ! writt5   
notice describ$ 9 clause 7i77,,ii72 &   

7,b7 9 ! case t su* provid] is an       
out-(-network heal? c>e provid]1 obta9 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 !  
individual describ$ 9 su* p>agraph1 a   
notification ( ea* ( ! foll[+3  7,a7    
,:e!r ! heal? c>e provid] is an         
out-(-network heal? c>e provid] )       
respect to ! gr\p heal? plan1 or heal?  
insurance cov]age (f]$ 9 ! gr\p m>ket1 (
 su* individual4  7,b7 ,if ! heal? c>e  
provid] is su* an out-(-network heal?   
c>e provid]1 ! e/imat$ am\nt t su*      
provid] w *>ge ! individual = su* items 
& s]vices 9 excess ( any co/ %>+        
obligations t ! individual w\ld o!rwise 
h "u su* plan or cov]age = su* items &  
s]vices if ! heal? c>e provid] 7 an     
9-network heal? c>e provid] ) respect to
 ! plan or cov]age ( su* individual4    
7,c7 ,9 ! case ( a heal? c>e provid] t  
is a hospital1 critical access hospital1
 or ambulatory surgical c5t] z describ$ 

9 subp>agraph 7,a71 7,b71 or 7,c7 (     
subsection 7a77#a71 respectively--  7i7 
:e!r any ( ! provid]s ( s]vices or      
suppli]s furni%+ items or s]vices at su*
 hospital1 critical access hospital1 or 
ambulatory surgical c5t] :o w furni% !  
items or s]vices to ! individual are    
out-(-network heal? c>e provid]s )      
respect to ! gr\p heal? plan1 or heal?  
insurance cov]age (f]$ 9 ! gr\p m>ket1 (
 su* individual2 &  7ii7 if any su*     
provid]s ( s]vices or suppli]s are su*  
out-(-network heal? c>e provid]s1 !     
e/imat$ am\nt t su* provid]s 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 or
 suppli]s 7 9-network heal? c>e provid]s
 ) respect to ! plan or cov]age ( su*   
individual4  7#c7 ,cons5t describ$ ,=   
purposes ( p>agraph 7#a77;,b71 ! cons5t 
describ$ 9 ?is p>agraph1 ) respect to an
 individual enroll$ 9 a gr\p heal? plan1
 or heal? insurance cov]age (f]$ 9 !    

gr\p m>ket1 :o is to be furni%$ items or
 s]vices by an out-(-network heal? c>e  
provid]1 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* heal? c>e provid]1 & t-- 
7,a7 ackn[l$ges t ! individual has be5--
 7i7 provid$ ) a writt5 e/imate & an    
oral explanation ( ! *>ge t ! individual
 w be assess$ = ! items or s]vices      
anticipat$ to be furni%$ to ! individual
 by su* out-(-network heal? c>e provid]2
 &  7ii7 in=m$ t ! paym5t ( su* *>ge by 
! individual w n accrue t[>d meet+ any  
limitation t ! gr\p heal? plan1 or heal?
 insurance cov]age (f]$ 9 ! gr\p m>ket1 
places on co/-%>+2 &  7,b7 docum5ts !   
cons5t ( ! individual to-- 7i7 be       
furni%$ ) su* items or s]vices by su*   
out-(-network heal? c>e provid]2 &  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  7c7 ,limitations on  
balance bill+ 9 surprise bill+          
situations  7#a7 ,9 case ( noncompliance
 ) notice & cons5t requirem5ts ,9 ! case
 ( an individual enroll$ 9 a gr\p heal? 
plan1 or heal? insurance cov]age (f]$ 9 
! gr\p m>ket1 :o is furni%$ items or    
s]vices by an out-(-network heal? c>e   
provid] ) respect to su* plan or        
cov]age1 if ! out-(-network heal? c>e   
provid] does n comply ) ! requirem5ts ( 
subsection 7b7 ) respect to ! furni%+ ( 
su* items or s]vices to su* individual1 
! out-(-network heal? c>e provid] 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 an 9-network heal? c>e       
provid] ) respect to su* plan or        
cov]age4  7#b7 ,9 case ( same-day       
em]g5cy s]vices ,9 ! case ( an          
individual enroll$ 9 a gr\p heal? plan  
or heal? insurance cov]age (f]$ 9 ! gr\p
 m>ket :o is furni%$ items or s]vices by

 a heal? c>e provid] t is an            
out-(-network heal? c>e provid] )       
respect to su* plan or cov]age on ! same
 date on :i* ! individual makes an      
appo9tm5t = su* items or s]vices 7or    
o!rwise pres5ts at ! hospital1 critical 
access hospital1 or ambulatory surgical 
c5t] = 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 ! out-(-network     
heal? c>e provid] 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  
an 9-network heal? c>e provid] ) respect
 to su* plan or cov]age4  4  7#b7       
,effective ,date ,! am5dm5t made by     
p>agraph 7#a7 %all take effect beg9n+ #b
 ye>s aft] ! date ( ! enactm5t ( ?is    
,act4  7b7 ,condition ( ,p>ticipation 9 
,m$ic>e  7#a7 ,9 g5]al ,section         
#ahff7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;cc7a77#a77 is     
am5d$-- 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         
hospital1 a critical access hospital1 or
 an ambulatory surgical c5t] describ$ 9 
section #ahcc7;i77#a77;,a71 to adopt &  
en=ce a policy to ensure compliance ) ! 
requirem5ts ( subsections 7b7 & 7c7 (   
section #bgbi ( ! ,public ,heal? ,s]vice
 ,act & to meet ! requirem5ts ( su*     
subsections 7relat+ to ! prev5tion (    
surprise bill+ practices72  4  7#b7     
,effective ,date ,! am5dm5ts made by    
p>agraph 7#a7 %all apply ) respect to   
agreem5ts "u su* section #ahff7;a77#a7 t
 are fil$ ) ! ,secret>y ( ,heal? &      
,human ,s]vices on a date t is n less   
?an #b ye>s aft] ! date ( ! enactm5t (  
?is ,act4  #c4 ,paym5ts made by insur$  
individuals 9 surprise bill+ situations 
includ$ 9 co/-%>+ limitations  7a7 ,9   
g5]al ,section #bgjg ( ! ,public ,heal? 
,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#f7 

is am5d$ by add+ at ! end ! foll[+3  7e7
 ,surprise bill+ situations ,not)/&+    
section #acjb7;c77#c77;,b7 ( ! ,pati5t  
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjbb7;c77#c77;,b771 any gr\p
 heal? plan or heal? insurance issu]    
(f]+ heal? insurance cov]age 9 ! gr\p   
m>ket %all ensure t any am\nt paid by an
 individual enroll$ 9 su* plan or       
cov]age 9 a surprise bill+ situation1 z 
def9$ 9 section #bgcj7;a71 accrues t[>ds
 meet+ any annual limitation on co/-%>+ 
"u ! plan or cov]age4  4  7b7 ,effective
 date ,! am5dm5ts made by subsection 7a7
 %all apply ) respect to any plan ye>   
beg9n+ n e>li] ?an #b ye>s aft] ! date (
 enactm5t ( ?is ,act4  #d4 ,resolv+     
paym5t disputes 9 surprise bill+        
situations  ,subp>t ,,ii ( "p ,a ( title
 ,,xxvii ( ! ,public ,heal? ,s]vice ,act
 7#db ,u4,s4,c4 #cjj;gg-#aa et seq471 z 
am5d$ by section #b7;a71 is fur!r am5d$ 
by add+ at ! end ! foll[+3  #bgcj4      
,resolv+ paym5t disputes 9 surprise     
bill+ situations  7a7 ,def9itions ,9 ?is

 section3 7#a7 ,heal? c>e provid]2      
9-network heal? c>e provid]2            
out-(-network heal? c>e provid] ,! t]ms 
heal? c>e provid]1 9-network heal? c>e  
provid]1 & out-(-network heal? c>e      
provid] h ! mean+s giv5 su* t]ms 9      
section #bgbi7;a74  7#b7 ,indep5d5t     
dispute resolution entity ,! t]m        
indep5d5t dispute resolution entity     
means an entity c]tifi$ by ! ,secret>y1 
9 consultation ) ! ,secret>y ( ,labor1  
"u subsection 7b77#b7 to conduct an     
indep5d5t dispute resolution process "u 
subsection 7d74  7#c7 ,surprise bill+   
situation ,! t]m surprise bill+         
situation means-- 7,a7 a situation 9 :i*
 an individual :o is enroll$ 9 a gr\p   
heal? plan1 or heal? insurance cov]age  
(f]$ 9 ! gr\p m>ket1 is furni%$ items or
 s]vices by an out-(-network heal? c>e  
provid] & su* provid] does n comply ) ! 
requirem5ts ( section #bgbi7;b7 )       
respect to ! furni%+ ( su* items or     
s]vices to su* individual2 or  7,b7 a   
situation 9 :i* an individual :o is     

enroll$ 9 a gr\p heal? plan1 or heal?   
insurance cov]age (f]$ 9 ! gr\p m>ket1  
is furni%$ items or s]vices by an       
out-(-network heal? c>e provid] on !    
same date on :i* ! individual makes an  
appo9tm5t = su* items or s]vices 7or    
o!rwise pres5ts at ! hospital1 critical 
access hospital1 or ambulatory surgical 
c5t] = su* s]vices su* z 9 ! case (     
items & s]vices furni%$ ) respect to an 
em]g5cy m$ical condition1 z def9$ 9     
section #ahfg7;e774  7b7 ,e/abli%m5t (  
indep5d5t dispute resolution process    
7#a7 ,e/abli%m5t ,n lat] ?an #b ye>s    
aft] ! date ( enactm5t ( ?is section1 ! 
,secret>y1 9 consultation ) ! ,secret>y 
( ,labor1 %all e/abli% a process =      
resolv+ paym5t disputes betwe5 gr\p     
heal? plans1 or heal? insurance issu]s  
(f]+ heal? insurance cov]age 9 ! gr\p   
m>ket1 & out-(-network heal? c>e        
provid]s 9 surprise bill+ situations 9  
accordance ) ?is section4  7#b7         
,c]tification ( indep5d5t dispute       
resolution entities  7,a7 ,9 g5]al ,!   

,secret>y1 9 consultation ) ! ,secret>y 
( ,labor1 %all e/abli% a process ?r\gh  
rulemak+ to c]tify entities z indep5d5t 
dispute resolution entities to conduct  
indep5d5t dispute resolution processes  
"u subsection 7d74  7,b7 ,requirem5ts   
,to be eligible = c]tification "u ?is   
p>agraph1 an entity %all-- 7i7 h        
exp]i5ce 9 heal? c>e bill+1 heal? c>e   
pric+1 & arbitration2 &  7ii7 n h any   
conflict ( int]e/1 z det]m9$ 9          
accordance ) subp>agraph 7,c74  7,c7    
,conflict ( int]e/ ,! ,secret>y1 9      
consultation ) ! ,secret>y ( ,labor1    
%all det]m9e1 ?r\gh rulemak+1 ! crit]ia 
= a conflict ( int]e/ = purposes (      
subp>agraph 7,b77ii71 :i* %all include--
  7i7 hav+ any mat]ial arrangem5t1      
f9ancial or o!rwise1 t c\ld bias !      
entity1 or an employee ( ! entity work+ 
on a p>ticul> dispute2 or  7ii7 own+ or 
controll+1 be+ own$ by or controll$ by1 
or be+ "u common control (-- 7,i7 any   
ph>maceutical company1 disease gr\p1 or 
public advocacy gr\p2  7,,ii7 any       

national1 ,/ate1 or local society or    
association ( hospitals1 physicians1 or 
o!r provid]s ( heal? c>e s]vices2 or    
7,,iii7 any national1 ,/ate1 or local   
association ( heal? c>e plans4  7c7     
,pre-,indep5d5t dispute resolution      
process  7#a7 ,requirem5t to pay        
out-(-network heal? c>e provid]s  7,a7  
,requirem5t on plan ,! process e/abli%$ 
by ! ,secret>y1 9 consultation ) !      
,secret>y ( ,labor1 "u ?is section %all 
require t a gr\p heal? plan1 or heal?   
insurance issu] (f]+ heal? insurance    
cov]age 9 ! gr\p m>ket1 t receives a    
bill f an out-(-network heal? c>e       
provid] = items or s]vices furni%$ to an
 individual enroll$ 9 ! plan or cov]age 
9 a surprise bill+ situation1 n lat] ?an
 #cj days aft] receiv+ su* bill--  7i7  
pay ! out-(-network heal? c>e provid] ! 
am\nt 9 ! bill2 or  7ii7 attempt to     
negotiate ) ! out-(-network heal? c>e   
provid] an alt]native am\nt = ! plan or 
issu] to pay ! provid]4  7,b7           
,pre-indep5d5t dispute resolution       

negotiations ,if1 n lat] ?an #cj days   
aft] ! date on :i* negotiations beg9 "u 
subp>agraph 7,a77ii71 an out-(-network  
heal? c>e provid] & gr\p heal? plan1 or 
heal? insurance issu] (f]+ heal?        
insurance cov]age 9 ! gr\p m>ket1       
describ$ 9 subp>agraph 7,a7 h n agre$ ^u
 an alt]native am\nt = ! plan or issu]  
to pay ! provid]1 ! plan or issu] %all--
  7i7 pay ! provid] ! am\nt ! plan or   
issu] det]m9es reasonable = ! s]vices   
7less ! co/-%>+ am\nt paid by !         
individual enroll$ 9 ! plan or cov]age72
 &  7ii7 provide in=mation to ! provid] 
on h[ ! provid] may initiate an         
indep5d5t dispute resolution process "u 
p>agraph 7#b74  7#b7 ,initiat+ an       
indep5d5t dispute resolution process    
7,a7 ,9 g5]al ,if1 aft] a good fai?     
attempt to negotiate "u p>agraph        
7#a77;,a77ii71 ! out-(-network heal? c>e
 provid] & gr\p heal? plan1 or heal?    
insurance issu] (f]+ heal? insurance    
cov]age 9 ! gr\p m>ket1 describ$ 9      
p>agraph 7#a77;,a7 are unable to rea* an

 agreem5t on an am\nt = ! plan or issu] 
to pay ! provid]1 any p>ty to ! dispute 
may1 n lat] ?an #cj days ( be+ unable to
 come to an agreem5t1 z det]m9$ by !    
,secret>y1 9 consultation ) ! ,secret>y 
( ,labor1 initiate an indep5d5t dispute 
resolution process "u subsection 7d7 by 
submitt+ a reque/ = su* process to !    
,secret>y1 & ! ,secret>y ( ,labor1 or   
directly to an indep5d5t dispute        
resolution entity1 9 accordance ) !     
process e/abli%$ by ! ,secret>y1 9      
consultation ) ! ,secret>y ( ,labor1 "u 
?is section4  7,b7 ,reque/ ,a reque/    
submitt$ "u subp>agraph 7,a7 %all       
indicate-- 7i7 ! am\nt ! out-(-network  
heal? c>e provid] reque/$ 9 ! bill      
describ$ 9 subp>agraph 7,a7 ( p>agraph  
7#a7 or aft] attempt$ negotiations 9    
accordance ) su* p>agraph2 &  7ii7 !    
am\nt ! gr\p heal? plan1 or heal?       
insurance issu] (f]+ heal? insurance    
cov]age 9 ! gr\p m>ket1 paid !          
out-(-network heal? c>e provid] 9       
accordance ) p>agraph 7#a77;,b7 aft] su*

 negotiations4  7,c7 ,notice to o!r p>ty
 ,a p>ty initiat+ an indep5d5t dispute  
resolution process "u subp>agraph 7,a7  
%all1 n lat] ?an #aj days aft] submitt+ 
a reque/ "u su* subp>agraph1 notify !   
o!r p>ty t su* reque/ has be5 submitt$4 
7d7 ,indep5d5t dispute resolution       
process  7#a7 ,9 g5]al ,! ,secret>y1 9  
consultation ) ! ,secret>y ( ,labor1    
%all e/abli% proc$ures = indep5d5t      
dispute resolution entities to conduct  
indep5d5t dispute resolution processes  
"u ?is subsection to resolve paym5t     
disputes betwe5 gr\p heal? plans1 or    
heal? insurance issu]s (f]+ heal?       
insurance cov]age 9 ! gr\p m>ket1 &     
out-(-network heal? c>e provid]s4  7#b7 
,tim+ ,an indep5d5t dispute resolution  
entity t receives a reque/ "u subsection
 7c77#b77;,a7 %all1 n lat] ?an #cj days 
aft] receiv+ su* reque/1 det]m9e ! am\nt
 ! gr\p heal? plan1 or heal? insurance  
issu] (f]+ heal? insurance cov]age 9 !  
gr\p m>ket1 is requir$ to pay !         
out-(-network heal? c>e provid]4 ,su*   

am\nt %all be--  7,a7 ! am\nt det]m9$ by
 ! p>ties ?r\gh a settlem5t "u p>agraph 
7#c72 or  7,b7 ! am\nt det]m9$          
reasonable by ! entity 9 accordance )   
p>agraph 7#d74  7#c7 ,settlem5t  7,a7 ,9
 g5]al ,if ! indep5d5t dispute          
resolution entity det]m9es1 bas$ on !   
am\nts indicat$ 9 ! reque/ "u subsection
 7c77#b77;,b71 t a settlem5t betwe5 !   
gr\p heal? plan1 or heal? insurance     
issu] (f]+ heal? insurance cov]age 9 !  
gr\p m>ket1 & out-(-network heal? c>e   
provid] is likely or t ! am\nts provid$ 
9 su* subsection ea* repres5t           
unreasonable extremes1 ! indep5d5t      
dispute resolution entity may direct !  
p>ties to attempt1 = a p]iod n to exce$ 
#aj days1 a good fai? negotiation = a   
settlem5t4  7,b7 ,tim+ ,! p]iod = a     
settlem5t describ$ 9 subp>agraph 7,a7   
%all accrue t[>ds ! #cj-;day p]iod      
requir$ "u p>agraph 7#b74  7#d7         
,det]m9ation ( am\nt  7,a7 ,f9al (f]s ,9
 ! abs5ce ( a settlem5t "u p>agraph     
7#c71 ! gr\p heal? plan1 or heal?       

insurance issu] (f]+ heal? insurance    
cov]age 9 ! gr\p m>ket1 & out-(-network 
heal? c>e provid] %all ea* submit to !  
indep5d5t dispute resolution entity an  
am\nt z a f9al (f]4 ,su* entity %all    
det]m9e :i* ( ^? #b am\nts is m         
reasonable bas$ on ! factors describ$ 9 
subp>agraph 7,d74  7,b7 ,f9al decisions 
,! am\nt t is det]m9$ to be ! m         
reasonable am\nt "u subp>agraph 7,a7    
%all be ! f9al decision ( ! indep5d5t   
dispute resolution entity z to ! am\nt !
 gr\p heal? plan1 or heal? insurance    
issu] (f]+ heal? insurance cov]age 9 !  
gr\p m>ket1 is requir$ to pay !         
out-(-network heal? c>e provid]4  7,c7  
,s]vice units ,a f9al (f] submitt$ "u   
subp>agraph 7,a7 %all be made p] s]vice 
unit1 z def9$ by ! ,secret>y1 9         
consultation ) ! ,secret>y ( ,labor1    
?r\gh regulations4 ,a f9al decision "u  
subp>agraph 7,b7 may include !          
resolution ( disputes = multiple items  
or s]vices = a s+le pati5t1 su* z =     
in/ances 9 :i* multiple speciali/s are  

involv$4  7,d7 ,factors ,9 det]m9+ :i*  
f9al (f] to select z ! m reasonable     
am\nt "u subp>agraph 7,a71 ! indep5d5t  
dispute resolution entity %all consid]  
relevant factors includ+--  7i7 ! av]age
 9-network paym5t rate = comp>able items
 or s]vices 9 ! same geographic region1 
includ+ z calculat$ by an indep5d5t     
database or an all-pay] claims database2
  7ii7 ! level ( tra9+1 education1 &    
exp]i5ce ( ! out-(-network heal? c>e    
provid]2  7iii7 ! circum/ances &        
complexity ( ! p>ticul> dispute1 includ+
 ! "t & place ( ! s]vice2 &  7iv7 !     
paym5t rate det]m9$ = ! item or s]vice  
"u ! orig9al ,m$ic>e fee-=-s]vice       
program "u p>ts ,a & ,b ( title ,,xviii 
( ! ,social ,security ,act4  7#e7       
,effect ( decision ,a f9al decision ( an
 indep5d5t dispute resolution entity "u 
p>agraph 7#d77;,b7-- 7,a7 %all be b9d+2 
&  7,b7 %all n be subject to judicial   
review1 except 9 cases comp>able to ^?  
describ$ 9 section #aj7;a7 ( title #i1  
,unit$ ,/ates ,code1 z det]m9$ by !     

,secret>y 9 consultation ) ! ,secret>y (
 ,labor4  7#f7 ,privacy laws ,an        
indep5d5t dispute resolution entity     
%all1 9 conduct+ an indep5d5t dispute   
resolution process "u ?is subsection1   
comply ) all applicable ,f$]al & ,/ate  
privacy laws4  7e7 ,responsibility ,to  
pay co/s ,! co/s = an indep5d5t dispute 
resolution process "u subsection 7d7    
%all be paid = 9 accordance ) ! foll[+3 
7#a7 ,9 a case 9 :i* ! indep5d5t dispute
 resolution entity det]m9es t ! am\nt 9 
! f9al (f] submitt$ "u subsection       
7d77#d77;,a7 by ! out-(-network heal?   
c>e provid] is ! m reasonable am\nt1 !  
gr\p heal? plan1 or heal? insurance     
issu] (f]+ heal? insurance cov]age 9 !  
gr\p m>ket1 %all pay all co/s ( !       
indep5d5t dispute resolution process4   
7#b7 ,9 a case 9 :i* ! indep5d5t dispute
 resolution entity det]m9es t ! am\nt 9 
! f9al (f] submitt$ "u subsection       
7d77#d77;,a7 by ! gr\p heal? plan1 or   
heal? insurance issu] (f]+ heal?        
insurance cov]age 9 ! gr\p m>ket1 is ! m

 reasonable am\nt1 ! out-(-network heal?
 c>e provid] %all pay all co/s ( !      
indep5d5t dispute resolution process4   
7#c7 ,9 a case 9 :i* a settlem5t is     
rea*$ "u subsection 7d77#c71 ! gr\p     
heal? plan1 or heal? insurance issu]    
(f]+ heal? insurance cov]age 9 ! gr\p   
m>ket1 & ! out-(-network heal? c>e      
provid] %all ea* pay half ( ! co/s ( !  
indep5d5t dispute resolution process4   
7f7 ,reports  7#a7 ,entity reports ,n   
lat] ?an #d ye>s aft] ! date ( enactm5t 
( ?is section1 & ea* ye> !reaft]1 ea*   
indep5d5t dispute resolution entity %all
 submit to ! ,secret>y1 & ! ,secret>y ( 
,labor1 a report on all indep5d5t       
dispute resolution processes conduct$ by
 ! entity "u subsection 7d7 = ! p]iod ( 
! report4 ,ea* su* report %all conta9   
in=mation det]m9$ appropriate by !      
,secret>y1 9 consultation ) ! ,secret>y 
( ,labor1 9 ord] to prep>e ! report     
requir$ "u p>agraph 7#b74  7#b7 ,reports
 by ,secret>ies  7,a7 ,9 g5]al ,n lat]  
?an #e ye>s aft] ! date ( enactm5t ( ?is

 section1 & ea* ye> !reaft]1 !          
,secret>y1 9 consultation ) ! ,secret>y 
( ,labor1 %all bas$ on ! reports        
submitt$ "u p>agraph 7#a7 prep>e a      
report1 disaggregat$ by ,/ate1 t conta9s
 ea* ( ! foll[+ = ! p]iod ( ! report3   
7i7 ,! total numb] ( indep5d5t dispute  
resolution processes initiat$ "u        
subsection 7c77#b77;,a71 includ+ an     
indication ( ! numb] ( in/ances 9 :i*-- 
7,i7 ! am\nt 9 ! f9al (f] "u subsection 
7d77#d77;,a7 made by ! gr\p heal? plan1 
or heal? insurance issu] (f]+ heal?     
insurance cov]age 9 ! gr\p m>ket1 0     
det]m9$ to be m reasonable ?an ! am\nt 9
 ! f9al (f] "u su* subsection made by ! 
out-(-network heal? c>e provid]2  7,,ii7
 ! am\nt 9 ! f9al (f] "u subsection     
7d77#d77;,a7 made by ! out-(-network    
heal? c>e provid] 0 det]m9$ to be m     
reasonable ?an ! am\nt 9 ! f9al (f] "u  
su* subsection made by ! gr\p heal?     
plan1 or heal? insurance issu] (f]+     
heal? insurance cov]age 9 ! gr\p m>ket2 
&  7,,iii7 a settlem5t 0 rea*$ "u       

subsection 7d77#c74  7ii7 ,! numb] (    
reque/s made = an indep5d5t dispute     
resolution process "u subsection        
7c77#b77;,a7 t 7 det]m9$ to be          
ineligible = su* process & ! reason =   
su* det]m9ation4  7iii7 ,! numb] (      
indep5d5t dispute resolution processes  
conduct$ "u subsection 7d7 t-- 7,i7 7   
bas$ on a situation describ$ 9          
subsection 7a77#c77;,a72 &  7,,ii7 7    
bas$ on a situation describ$ 9          
subsection 7a77#c77;,b74  7iv7 ,! total 
numb] ( f9al decisions r5d]$ by         
indep5d5t dispute resolution entities "u
 subsection 7d77#d77;,b74  7v7 ,= ea*   
indep5d5t dispute resolution process    
conduct$ "u subsection 7d7-- 7,i7 ! type
 ( cov]age ( ! plan or issu] involv$1   
su* z :e!r ! plan or issu] is a heal?   
ma9t5ance organization or pref]r$       
provid] organization2  7,,ii7 !         
specialty ( ! out-(-network heal? c>e   
provid]1 & specific types ( s]vices1    
involv$2 &  7,,iii7 ! doll> am\nt ( !   
f9al decision "u subsection             

7d77#d77;,b74  7vi7 ,any additional     
in=mation ! ,secret>y1 9 consultation ) 
! ,secret>y ( ,labor1 det]m9es necess>y4
  7,b7 ,public access ,! ,secret>y1 9   
consultation ) ! ,secret>y ( ,labor1    
%all1 ea* ye>1 publi% ! report prep>$ "u
 subp>agraph 7,a7 & make su* report     
available to ! public4  7,c7 ,privacy ,9
 c>ry+ out ?is p>agraph1 ! ,secret>y1 9 
consultation ) ! ,secret>y ( ,labor1    
%all comply ) all applicable ,f$]al &   
,/ate privacy laws4  7g7 ,applicability 
( ,/ate law  7#a7 ,9 g5]al  ,not)/&+ any
 o!r provision 9 ?is section1 ! process 
e/abli%$ by ! ,secret>y1 9 consultation 
) ! ,secret>y ( ,labor1 "u ?is section  
%all n apply ) respect to any surprise  
bill+ situation involv+ a gr\p heal?    
plan 7o!r ?an a self-insur$ plan71 or   
heal? insurance issu] (f]+ heal?        
insurance cov]age 9 ! gr\p m>ket1 9 a   
,/ate t has 9 effect a ,/ate law t      
applies to ! dispute involv$ & meets !  
requirem5ts "u p>agraph 7#b74  7#b7     
,requirem5ts  7,a7 ,9 g5]al ,!          

requirem5ts "u ?is p>agraph are t !     
,/ate law provides1 9 a surprise bill+  
situation1 =--  7i7 a dispute resolution
 process meet+ ! requirem5ts "u         
subp>agraph 7,b72 or  7ii7 a paym5t /&>d
 t meets ! requirem5ts "u subp>agraph   
7,c74  7,b7 ,dispute resolution process 
,! requirem5ts = a dispute resolution   
process "u ?is subp>agraph are t !      
entity conduct+ ! process--  7i7 be an  
indep5d5t entity :]eby ! entity %all n  
repres5t ! int]e/s ( any p>ty to !      
dispute & %all be free ( any conflict ( 
int]e/2 &  7ii7 report to ! public on ! 
results ( ! process4  7,c7 ,paym5t /&>d 
,! requirem5ts = a paym5t /&>d "u ?is   
p>agraph are t ! gr\p heal? plan1 or    
heal? insurance issu] (f]+ heal?        
insurance cov]age 9 ! gr\p m>ket1 pay ! 
out-(-network heal? c>e provid] 9 !     
surprise bill+ situation an am\nt at a  
rate--  7i7 t does n exce$ #abe p]c5t ( 
! all[$ *>ges = items or s]vices "u !   
orig9al ,m$ic>e fee-=-s]vice program "u 
p>ts ,a & ,b ( title ,,xxviii ( !       

,social ,security ,act2 or  7ii7 t does 
n exce$ a paym5t /&>d comp>able to !    
/&>d describ$ 9 clause 7i71 z det]m9$ by
 ! ,secret>y1 9 consultation ) !        
,secret>y ( ,labor4  7#c7 ,cl>ification 
= self-insur$ gr\p heal? plans ,)       
respect to any paym5t dispute 9 a       
surprise bill+ situation involv+ a      
self-insur$ gr\p heal? plan--  7,a7 !   
process e/abli%$ by ! ,secret>y1 9      
consultation ) ! ,secret>y ( ,labor1 "u 
?is section %all apply2 &  7,b7 any     
,/ate law t meets ! requirem5ts "u      
p>agraph 7#b71 & may o!rwise apply1 %all
 n apply4  4