,,ib ,union ,calendar ,no4 #ehg #aafth ,,congress #b;d ,session ,h4 ,r4 #bcbh ,report ,no4 #aaf-ccb1 ,part ,i ,,in ,,the ,,house ,,of ,,representatives ,april #ae1 #bjai,mr4 ,o',halleran 7for himself and ,ms4 ,stefanik7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,december #i1 #bjai,reported with amendments and referred to the ,committee on ,transportation and ,infrastructure for a period ending not later than ,january #bi1 #bjbj1 for consideration of such provisions of the bill as fall within the jurisdiction of that committee pursuant to clause #a7r7 of rule ,x,strike out all after the enacting clause and insert the part printed in italic ,january #bi1 #bjbj,referral to the ,committee on ,transportation and ,infrastructure extended for a period ending not later than ,february #ai1 #bjbj ,february #ai1 #bjbj,referral to the ,committee on ,transportation and ,infrastructure extended for a period ending not later than ,april #bc1 #bjbj ,april #bc1 #bjbj,referral to the ,committee on ,transportation and ,infrastructure extended for a period ending not later than ,july #ca1 #bjbj ,july #ca1 #bjbj,referral to the ,committee on ,transportation and ,infrastructure extended for a period ending not later than ,september #ba1 #bjbj ,september #ba1 #bjbj,referral to the ,committee on ,transportation and ,infrastructure extended for a period ending not later than ,november #bj1 #bjbj ,november #ag1 #bjbj,referral to the ,committee on ,transportation and ,infrastructure extended for a period ending not later than ,december #ca1 #bjbj ,december #ca1 #bjbj;,additional sponsors3 ,mr4 ,swalwell of ,california1 ,mr4 ,espaillat1 ,ms4 ,gabbard1 ,ms4 ,omar1 ,ms4 ,mc,collum1 ,mr4 ,smith of ,washington1 ,mr4 ,khanna1 ,mr4 ,cohen1 ,mr4 ,grijalva1 ,mr4 ,courtney1 ,mrs4 ,hartzler1 ,ms4 ,mucarsel-,powell1 ,ms4 ,jayapal1 ,ms4 ,kuster of ,new ,hampshire1 ,mrs4 ,davis of ,california1 ,mr4 ,rush1 ,mr4 ,lipinski1 ,mr4 ,engel1 ,mr4 ,schiff1 ,mr4 ,cicilline1 ,mr4 ,serrano1 ,mr4 ,larsen of ,washington1 ,mr4 ,krishnamoorthi1 ,mr4 ,peters1 ,ms4 ,lee of ,california1 ,mr4 ,kilmer1 ,mr4 ,schrader1 ,mr4 ,turner1 ,mr4 ,king of ,new ,york1 ,mr4 ,yarmuth1 ,mr4 ,vela1 ,mr4 ,heck1 ,mr4 ,la,malfa1 ,mr4 ,young1 ,mr4 ,delgado1 ,mr4 ,tipton1 ,ms4 ,johnson of ,texas1 ,mr4 ,hastings1 ,mr4 ,sires1 ,ms4 ,blunt ,rochester1 ,mr4 ,bergman1 ,mrs4 ,watson ,coleman1 ,mr4 ,johnson of ,georgia1 ,mr4 ,cole1 ,mr4 ,gomez1 ,ms4 ,kelly of ,illinois1 ,miss ,rice of ,new ,york1 ,mr4 ,zeldin1 ,mr4 ,newhouse1 ,mr4 ,rodney ,davis of ,illinois1 ,ms4 ,clarke of ,new ,york1 ,mr4 ,de,fazio1 ,mr4 ,nadler1 ,mr4 ,meeks1 ,mr4 ,stivers1 ,mrs4 ,carolyn ,b4 ,maloney of ,new ,york1 ,mr4 ,rose of ,new ,york1 ,mr4 ,lamborn1 ,mr4 ,balderson1 ,mr4 ,fleischmann1 ,mr4 ,gallego1 ,ms4 ,schakowsky1 ,mr4 ,welch1 ,mrs4 ,lowey1 ,ms4 ,ocasio-,cortez1 ,mr4 ,sean ,patrick ,maloney of ,new ,york1 ,ms4 ,bass1 ,mr4 ,norman1 ,mr4 ,takano1 ,mr4 ,lujn1 ,mr4 ,raskin1 ,ms4 ,judy ,chu of ,california1 ,mr4 ,levin of ,michigan1 ,mrs4 ,dingell1 ,ms4 ,pingree1 ,mr4 ,ted ,lieu of ,california1 ,ms4 ,torres ,small of ,new ,mexico1 ,mr4 ,de,saulnier1 ,mr4 ,katko1 ,mr4 ,sablan1 ,ms4 ,roybal-,allard1 ,mr4 ,bishop of ,utah1 ,mr4 ,griffith1 ,mrs4 ,radewagen1 ,mr4 ,bost1 ,mr4 ,walden1 ,mr4 ,stanton1 ,mr4 ,correa1 ,ms4 ,lofgren1 ,mr4 ,curtis1 ,mr4 ,lowenthal1 ,ms4 ,slotkin1 ,ms4 ,finkenauer1 ,mr4 ,foster1 ,mr4 ,langevin1 ,mrs4 ,bustos1 ,ms4 ,kaptur1 ,mr4 ,stewart1 ,mr4 ,huffman1 ,mr4 ,schneider1 ,mr4 ,mc,adams1 ,ms4 ,velzquez1 ,ms4 ,jackson ,lee1 ,mr4 ,soto1 ,mr4 ,cooper1 ,mr4 ,austin ,scott of ,georgia1 ,ms4 ,underwood1 ,mr4 ,brindisi1 ,mr4 ,stauber1 ,mr4 ,cleaver1 ,mr4 ,peterson1 ,mr4 ,mc,nerney1 ,mr4 ,keating1 ,ms4 ,spanberger1 ,mr4 ,perlmutter1 ,mr4 ,aguilar1 ,mr4 ,cox of ,california1 ,mr4 ,harder of ,california1 ,ms4 ,kendra ,s4 ,horn of ,oklahoma1 ,mr4 ,price of ,north ,carolina1 ,mrs4 ,miller1 ,mr4 ,van ,drew1 ,mr4 ,fitzpatrick1 ,mr4 ,cisneros1 ,mr4 ,larson of ,connecticut1 ,mrs4 ,demings1 and ,mrs4 ,hayes ,december #ca1 #bjbj;,committee on ,transportation and ,infrastructure discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed,for text of introduced bill1 see copy of bill as introduced on ,april #ae1 #bjai ,a ,,bill ,to reauthorize and extend funding for community health centers and the ,national ,health ,service ,corps4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,reauthorizing and ,extending ,america's ,community ,health ,act or the ,,reach ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,title ,i--,public ,health ,extenders,sec4 #aja4 ,extension for community health centers1 the ,national ,health ,service ,corps1 and teaching health centers that operate ,,gme programs4,sec4 #ajb4 ,extension for special diabetes programs4,sec4 #ajc4 ,extension of ,personal ,responsibility ,education ,program4,sec4 #ajd4 ,extension of sexual risk avoidance education program4,title ,,ii--,medicare ,extenders,sec4 #bja4 ,extension of the work geographic index floor under the ,medicare program4,sec4 #bjb4 ,extension of funding outreach and assistance for low-income programs4,sec4 #bjc4 ,extension of funding for quality measure endorsement1 input1 and selection under the ,medicare program4,sec4 #bjd4 ,extension of the ,independence at ,home ,medical ,practice ,demonstration ,program under the ,medicare program4,sec4 #bje4 ,extension of appropriations and transfers to the ,patient-,centered ,outcomes ,research ,trust ,fund2 extension of certain health insurance fees4,sec4 #bjf4 ,transitional coverage and retroactive ,medicare part ,d coverage for certain low-income beneficiaries4,sec4 #bjg4 ,health ,equity and ,access for ,returning ,troops and ,servicemembers ,act of #bjai4,sec4 #bjh4 ,exclusion of complex rehabilitative manual wheelchairs from ,medicare competitive acquisition program2 ,non-application of ,medicare fee-schedule adjustments for certain wheelchair accessories and cushions4,title ,,iii--,medicaid ,provisions,sec4 #cja4 ,modification of reductions in ,medicaid ,,dsh allotments4,sec4 #cjb4 ,public availability of hospital upper payment limit demonstrations4,sec4 #cjc4 ,report by ,comptroller ,general4,sec4 #cjd4 ,sense of ,congress regarding the need to develop a more permanent legislative solution to provide the territories with a reliable and consistent source of ,federal funding under the ,medicaid program4,title ,,iv--,no ,surprises ,act,sec4 #dja4 ,short title4,sec4 #djb4 ,preventing surprise medical bills4,sec4 #djc4 ,government ,accountability ,office study on profit- and revenue-sharing in health care4,sec4 #djd4 ,state ,all ,payer ,claims ,databases4,sec4 #dje4 ,air ambulance cost data reporting program4,sec4 #djf4 ,report by ,secretary of ,labor4,sec4 #djg4 ,billing statute of limitations4,sec4 #djh4 ,,gao report on impact of surprise billing provisions4,sec4 #dji4 ,report by the ,secretary of ,health and ,human ,services4,title ,v--,territories ,health ,care ,improvement ,act,sec4 #eja4 ,short title4,sec4 #ejb4 ,medicaid payments for ,puerto ,rico and the other territories for certain fiscal years4,sec4 #ejc4 ,application of certain requirements under ,medicaid program to certain territories4,sec4 #ejd4 ,additional program integrity requirements4 ,i ,public ,health ,extenders #aja4 ,extension for community health centers1 the ,national ,health ,service ,corps1 and teaching health centers that operate ,,gme programs 7a7 ,community ,health ,centers ,section #ajejc7;b77#a77;,f7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bed;b-#b7;b77#a77;,f77 is amended by striking fiscal year #bjai and inserting each of fiscal years #bjai through #bjbc4 7b7 ,national ,health ,service ,corps ,section #ajejc7;b77#b77;,f7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bed;b-#b7;b77#b77;,f77 is amended by striking #bjah and #bjai and inserting #bjai through #bjbc4 7c7 ,teaching health centers that operate graduate medical education programs ,section #cdj;,h7g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;h7g77#a77 is amended by striking #bjah and #bjai and inserting #bjai through #bjbc4 7d7 ,application ,amounts appropriated for a program pursuant to the amendments made by subsection 7a71 7b71 or 7c7 for fiscal years #bjbj through #bjbc are subject to the requirements and limitations of the most recently enacted regular or full-year continuing appropriations ,act or resolution 7as of the date of obligation of current funds7 applicable to the respective program4 #ajb4 ,extension for special diabetes programs 7a7 ,reauthorization of special diabetes programs for ,type ,i diabetes ,section #ccj;,b7b77#b77;,d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#b7;b77#b77;,d77 is amended by striking each of fiscal years #bjah and #bjai and inserting fiscal years #bjai through #bjbc4 7b7 ,reauthorization of special diabetes programs for ,indians for diabetes services ,section #ccj;,c7c77#b77;,d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#c7;c77#b77;,d77 is amended by striking fiscal years #bjah and #bjai and inserting fiscal years #bjai through #bjbc4 #ajc4 ,extension of ,personal ,responsibility ,education ,program ,section #eac of the ,social ,security ,act 7#db ,u4,s4,c4 #gac7 is amended-- 7#a7 in paragraphs 7#a77;,a7 and 7#d77;,a7 of subsection 7a71 by striking #bjai and inserting #bjbc each place it appears2 7#b7 in subsection 7a77#d77;,b77i71 by striking #bjai and inserting #bjbc2 and 7#c7 in subsection 7f71 by striking #bjai and inserting #bjbc4 #ajd4 ,extension of sexual risk avoidance education program ,section #eaj of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 is amended by striking fiscal years #bjah and #bjai each place it appears in subsections 7a77#a71 7a77#b77;,a71 7f77#a7 and 7f77#b7 and inserting fiscal years #bjai through #bjbc4 ,,ii ,medicare ,extenders #bja4 ,extension of the work geographic index floor under the ,medicare program ,section #ahdh7;e77#a77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;e77#a77;,e77 is amended by striking #bjbj and inserting #bjbc4 #bjb4 ,extension of funding outreach and assistance for low-income programs 7a7 ,additional funding for ,state health insurance programs ,subsection 7a77#a77;,b7 of section #aai of the ,medicare ,improvements for ,patients and ,providers ,act of #bjjh 7#db ,u4,s4,c4 #acie;b-#c note71 as amended by section #ccjf of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 section #faj of the ,american ,taxpayer ,relief ,act of #bjab 7,public ,law #aab-bdj71 section #aaaj of the ,pathway for ,,sgr ,reform ,act of #bjac 7,public ,law #aac-fg71 section #aaj of the ,protecting ,access to ,medicare ,act of #bjad 7,public ,law #aac-ic71 section #bjh of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae 7,public ,law #aad-aj71 and section #ejbjg of the ,bipartisan ,budget ,act of #bjah 7,public ,law #aae-abc71 is amended-- 7#a7 in clause 7vii71 by striking and at the end2 7#b7 in clause 7viii71 by striking and at the end2 7#c7 in clause 7ix71 by striking the period at the end and inserting 2 and2 and 7#d7 by inserting after clause 7ix7 the following new clause3 7x7 for each of fiscal years #bjbj through #bjbb1 of #ae1jjj1jjj4 4 7b7 ,additional funding for area agencies on aging ,subsection 7b77#a77;,b7 of such section #aai1 as so amended1 is amended-- 7#a7 in clause 7vii71 by striking and at the end2 7#b7 in clause 7viii71 by striking and at the end2 7#c7 in clause 7ix71 by striking the period at the end and inserting 2 and2 and 7#d7 by inserting after clause 7ix7 the following new clause3 7x7 for each of fiscal years #bjbj through #bjbb1 of #ae1jjj1jjj4 4 7c7 ,additional funding for aging and disability resource centers ,subsection 7c77#a77;,b7 of such section #aai1 as so amended1 is amended-- 7#a7 in clause 7vii71 by striking and at the end2 7#b7 in clause 7viii71 by striking and at the end2 7#c7 in clause 7ix71 by striking the period at the end and inserting 2 and2 and 7#d7 by inserting after clause 7ix7 the following new clause3 7x7 for each of fiscal years #bjbj through #bjbb1 of #e1jjj1jjj4 4 7d7 ,additional funding for contract with the national center for benefits and outreach enrollment ,subsection 7d77#b7 of such section #aai1 as so amended1 is amended-- 7#a7 in clause 7vii71 by striking and at the end2 7#b7 in clause 7viii71 by striking and at the end2 7#c7 in clause 7ix71 by striking the period at the end and inserting 2 and2 and 7#d7 by inserting after clause 7ix7 the following new clause3 7x7 for each of fiscal years #bjbj through #bjbb1 of #ae1jjj1jjj4 4 #bjc4 ,extension of funding for quality measure endorsement1 input1 and selection under the ,medicare program 7a7 ,in general ,section #ahij7;d77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7d77#b77 is amended-- 7#a7 by striking and #g1ejj1jjj and inserting #g1ejj1jjj2 and 7#b7 by striking and #bjai4 and inserting and #bjai1 and #cj1jjj1jjj for each of fiscal years #bjbj through #bjbb44 7b7 ,input for removal of measures ,section #ahij7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7b77 is amended by inserting after paragraph 7#c7 the following3 7#d7 ,removal of ,measures ,the entity may1 through the multistakeholder groups convened under paragraph 7#g77;,a71 provide input to the ,secretary on quality and efficiency measures described in paragraph 7#g77;,b7 that could be considered for removal4 4 7c7 ,prioritization of measure endorsement ,section #ahij7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7b771 as amended by subsection 7b71 is further amended by adding at the end the following3 7#i7 ,prioritization of measure endorsement ,the entity-- 7,a7 during the period beginning on the date of the enactment of this paragraph and ending on ,december #ca1 #bjbc1 shall prioritize the endorsement of measures relating to maternal morbidity and mortality by the entity with a contract under subsection 7a7 in connection with endorsement of measures described in paragraph 7#b72 and 7,b7 on and after ,january #a1 #bjbd1 may prioritize the endorsement of such measures by such entity4 4 #bjd4 ,extension of the ,independence at ,home ,medical ,practice ,demonstration ,program under the ,medicare program 7a7 ,in general ,section #ahff;,e7e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc-#e7;e77#a77 is amended by striking #g-year and inserting #aj-year4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect as if included in the enactment of ,public ,law #aaa-adh4 #bje4 ,extension of appropriations and transfers to the ,patient-,centered ,outcomes ,research ,trust ,fund2 extension of certain health insurance fees 7a7 ,in general 7#a7 ,internal ,revenue ,code ,section #ieaa of the ,internal ,revenue ,code of #aihf is amended-- 7,a7 in subsection 7b77#a77;,e71 by striking #bjad and all that follows through #bjai and inserting #bjad through #bjbb2 7,b7 in subsection 7d77#b77;,a71 by striking #bjai and inserting #bjbb2 and 7,c7 in subsection 7f71 by striking #bjai and inserting #bjbb4 7#b7 ,title ,,xi ,section #aahc7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;e-#b7;a77#b77 is amended by striking #bjad and all that follows through #bjai and inserting #bjad through #bjbb4 7b7 ,extension of certain health insurance fees 7#a7 ,health insurance policies ,section #dcge7;e7 of the ,internal ,revenue ,code of #aihf is amended by striking #bjai and inserting #bjbb4 7#b7 ,self-insured health plans ,section #dcgf7;e7 of the ,internal ,revenue ,code of #aihf is amended by striking #bjai and inserting #bjbb4 #bjf4 ,transitional coverage and retroactive ,medicare part ,d coverage for certain low-income beneficiaries ,section #ahfj;,d-#ad of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7 is amended-- 7#a7 by redesignating subsection 7e7 as subsection 7f72 and 7#b7 by adding after subsection 7d7 the following new subsection3 7e7 ,limited income newly eligible transition program 7#a7 ,in general ,beginning not later than ,january #a1 #bjba1 the ,secretary shall carry out a program to provide transitional coverage for covered part ,d drugs for ,,li ,,net eligible individuals in accordance with this subsection4 7#b7 ,,li net eligible individual defined ,for purposes of this subsection1 the term ,,li ,,net eligible individual means a part ,d eligible individual who-- 7,a7 meets the requirements of clauses 7ii7 and 7iii7 of subsection 7a77#c77;,a72 and 7,b7 has not yet enrolled in a prescription drug plan or an ,,ma-,,pd plan1 or1 who has so enrolled1 but with respect to whom coverage under such plan has not yet taken effect4 7#c7 ,transitional coverage ,for purposes of this subsection1 the term transitional coverage means1 with respect to an ,,li ,,net eligible individual-- 7,a7 immediate access to covered part ,d drugs at the point of sale during the period that begins on the first day of the month such individual is determined to meet the requirements of clauses 7ii7 and 7iii7 of subsection 7a77#c77;,a7 and ends on the date that coverage under a prescription drug plan or ,,ma-,,pd plan takes effect with respect to such individual2 and 7,b7 in the case of an ,,li ,,net eligible individual who is a full-benefit dual eligible individual 7as defined in section #aice7;c77#f77 or a recipient of supplemental security income benefits under title ,,xvi1 retroactive coverage 7in the form of reimbursement of the amounts that would have been paid under this part had such individual been enrolled in a prescription drug plan or ,,ma-,,pd plan7 of covered part ,d drugs purchased by such individual during the period that begins on the date that is the later of-- 7i7 the date that such individual was first eligible for a low-income subsidy under this part2 or 7ii7 the date that is #cf months prior to the date such individual enrolls in a prescription drug plan or ,,ma-,,pd plan1 and ends on the date that coverage under such plan takes effect4 7#d7 ,program administration 7,a7 ,single point of contact ,the ,secretary shall1 to the extent feasible1 administer the program under this subsection through a contract with a single program administrator4 7,b7 ,benefit design ,the ,secretary shall ensure that the transitional coverage provided to ,,li ,,net eligible individuals under this subsection-- 7i7 provides access to all covered part ,d drugs under an open formulary2 7ii7 permits all pharmacies determined by the ,secretary to be in good standing to process claims under the program2 7iii7 is consistent with such requirements as the ,secretary considers necessary to improve patient safety and ensure appropriate dispensing of medication2 and 7iv7 meets such other requirements as the ,secretary may establish4 7#e7 ,relationship to other provisions of this title2 waiver authority 7,a7 ,in general ,the following provisions shall not apply with respect to the program under this subsection3 7i7 ,paragraphs 7#a7 and 7#c77;,b7 of section #ahfj;,d-#d7;a7 7relating to dissemination of general information2 availability of information on changes in formulary through the internet74 7ii7 ,subparagraphs 7,a7 and 7,b7 of section #ahfj;,d-#d7;b77#c7 7relating to requirements on development and application of formularies2 formulary development74 7iii7 ,paragraphs 7#a77;,c7 and 7#b7 of section #ahfj;,d-#d7;c7 7relating to medication therapy management program74 7,b7 ,waiver authority ,the ,secretary may waive such other requirements of titles ,,xi and this title as may be necessary to carry out the purposes of the program established under this subsection4 4 #bjg4 ,health ,equity and ,access for ,returning ,troops and ,servicemembers ,act of #bjai 7a7 ,modification of requirement for certain former members of the ,armed ,forces to enroll in ,medicare ,part ,b to be eligible for ,,tricare for ,life 7#a7 ,,tricare eligibility 7,a7 ,in general ,subsection 7d7 of section #ajhf of title #aj1 ,united ,states ,code1 is amended by adding at the end the following new paragraph3 7#f7 7,a7 ,the requirement in paragraph 7#b77;,a7 to enroll in the supplementary medical insurance program under part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;j et seq47 shall not apply to a person described in subparagraph 7,b7 during any month in which such person is not entitled to a benefit described in subparagraph 7,a7 of section #bbf7;b77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dbf7;b77#b77 if such person has received the counseling and information under subparagraph 7,c74 7,b7 ,a person described in this subparagraph is a person-- 7i7 who is under #fe years of age2 7ii7 who is entitled to hospital insurance benefits under part ,a of title ,,xviii of the ,social ,security ,act pursuant to subparagraph 7,a7 or 7,c7 of section #bbf7;b77#b7 of such ,act 7#db ,u4,s4,c4 #dbf7;b77#b772 7iii7 whose entitlement to a benefit described in subparagraph 7,a7 of such section has terminated due to performance of substantial gainful activity2 and 7iv7 who is retired under chapter #fa of this title4 7,c7 ,the ,secretary of ,defense shall coordinate with the ,secretary of ,health and ,human ,services and the ,commissioner of ,social ,security to notify persons described in subparagraph 7,b7 of1 and provide information and counseling regarding1 the effects of not enrolling in the supplementary medical insurance program under part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;j et seq471 as described in subparagraph 7,a74 4 7,b7 ,conforming amendment ,paragraph 7#b77;,a7 of such subsection is amended by striking is enrolled and inserting except as provided by paragraph 7#f71 is enrolled4 7,c7 ,identification of persons ,section #aaaj;a of such title is amended by adding at the end the following new subsection3 7c7 ,certain individuals not required ,to enroll in ,medicare ,part ,b ,in carrying out subsection 7a71 the ,secretary of ,defense shall coordinate with the ,secretary of ,health and ,human ,services and the ,commissioner of ,social ,security to-- 7#a7 identify persons described in subparagraph 7,b7 of section #ajhf7;d77#f7 of this title2 and 7#b7 provide information and counseling pursuant to subparagraph 7,c7 of such section4 4 7#b7 ,non-,application of ,medicare ,part ,b late enrollment penalty ,section #ahci7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7b77 is amended1 in the second sentence1 by inserting or months for which the individual can demonstrate that the individual is an individual described in paragraph 7#f77;,b7 of section #ajhf7;d7 of title #aj1 ,united ,states ,code1 who is enrolled in the ,,tricare program pursuant to such section after an individual described in section #ahcg7k77#c74 7#c7 ,report ,not later than ,october #a1 #bjbd1 the ,secretary of ,defense1 the ,secretary of ,health and ,human ,services1 and the ,commissioner of ,social ,security shall jointly submit to the ,committees on ,armed ,services of the ,house of ,representatives and the ,senate1 the ,committee on ,ways and ,means and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 and the ,committee on ,finance of the ,senate a report on the implementation of section #ajhf7;d77#f7 of title #aj1 ,united ,states ,code1 as added by paragraph 7#a74 ,such report shall include1 with respect to the period covered by the report-- 7,a7 the number of individuals enrolled in ,,tricare for ,life who are not enrolled in the supplementary medical insurance program under part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;j et seq47 by reason of such section #ajhf7;d77#f72 and 7,b7 the number of individuals who-- 7i7 are retired from the ,armed ,forces under chapter #fa of title #aj1 ,united ,states ,code2 7ii7 are entitled to hospital insurance benefits under part ,a of title ,,xviii of the ,social ,security ,act pursuant to receiving benefits for #bd months as described in subparagraph 7,a7 or 7,c7 of section #bbf7;b77#b7 of such ,act 7#db ,u4,s4,c4 #dbf7;b77#b772 and 7iii7 because of such entitlement1 are no longer enrolled in ,,tricare ,standard1 ,,tricare ,prime1 ,,tricare ,extra1 or ,,tricare ,select under chapter #ee of title #aj1 ,united ,states ,code4 7#d7 ,deposit of savings into ,medicare improvement fund ,section #ahih7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;iii7b77#a77 is amended by striking during and after fiscal year #bjba1 #j and inserting during and after fiscal year #bjbd1 #e1jjj1jjj4 7#e7 ,application ,the amendments made by paragraphs 7#a7 and 7#b7 shall apply with respect to a person who1 on or after ,october #a1 #bjbc1 is a person described in section #ajhf7;d77#f77;,b7 of title #aj1 ,united ,states ,code1 as added by paragraph 7#a74 7b7 ,coverage of certain ,,dna specimen provenance assay tests under ,medicare 7#a7 ,benefit 7,a7 ,coverage ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended-- 7i7 in subsection 7s77#b7-- 7,i7 in subparagraph 7,,gg71 by striking and at the end2 7,,ii7 in subparagraph 7,,hh71 by striking the period and inserting 2 and2 and 7,,iii7 by adding at the end the following new subparagraph3 7,,ii7 a prostate cancer ,,dna ,specimen ,provenance ,assay test 7,,dspa test7 7as defined in subsection 7kkk772 2 and 7ii7 by adding at the end the following new subsection3 7kkk7 ,prostate cancer ,,dna ,specimen ,provenance ,assay ,test ,the term prostate cancer ,,dna ,specimen ,provenance ,assay ,test 7,,dspa test7 means a test that1 after a determination of cancer in one or more prostate biopsy specimens obtained from an individual1 assesses the identity of the ,,dna in such specimens by comparing such ,,dna with the ,,dna that was separately taken from such individual at the time of the biopsy4 4 7,b7 ,exclusion from coverage ,section #ahfb7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#a77 is amended-- 7i7 in subparagraph 7,o71 by striking and at the end2 7ii7 in subparagraph 7,p71 by striking the semicolon at the end and inserting 1 and2 and 7iii7 by adding at the end the following new subparagraph3 7,q7 in the case of a prostate cancer ,,dna ,specimen ,provenance ,assay test 7,,dspa test7 7as defined in section #ahfa7kkk771 unless such test is furnished on or after ,january #a1 #bjba1 and before ,january #a1 #bjbf1 and such test is ordered by the physician who furnished the prostate cancer biopsy that obtained the specimen tested2 4 7#b7 ,payment amount and related requirements ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7x7 ,prostate cancer ,,dna ,specimen ,provenance ,assay tests 7#a7 ,payment for covered tests 7,a7 ,in general ,subject to subparagraph 7,b71 the payment amount for a prostate cancer ,,dna ,specimen ,provenance ,assay test 7,,dspa test7 7as defined in section #ahfa7kkk77 shall be #bjj4 ,such payment shall be payment for all of the specimens obtained from the biopsy furnished to an individual that are tested4 7,b7 ,limitation ,payment for a ,,dspa test under subparagraph 7,a7 may only be made on an assignment-related basis4 7,c7 ,prohibition on separate payment ,no separate payment shall be made for obtaining ,,dna that was separately taken from an individual at the time of a biopsy described in subparagraph 7,a74 7#b7 ,,hcpcs code and modifier assignment 7,a7 ,in general ,the ,secretary shall assign one or more ,,hcpcs codes to a prostate cancer ,,dna ,specimen ,provenance ,assay test and may use a modifier to facilitate making payment under this section for such test4 7,b7 ,identification of ,,dna match on claim ,the ,secretary shall require an indication on a claim for a prostate cancer ,,dna ,specimen ,provenance ,assay test of whether the ,,dna of the prostate biopsy specimens match the ,,dna of the individual diagnosed with prostate cancer4 ,such indication may be made through use of a ,,hcpcs code1 a modifier1 or other means1 as determined appropriate by the ,secretary4 7#c7 ,,dna match review 7,a7 ,in general ,the ,secretary shall review at least three years of claims under part ,b for prostate cancer ,,dna ,specimen ,provenance ,assay tests to identify whether the ,,dna of the prostate biopsy specimens match the ,,dna of the individuals diagnosed with prostate cancer4 7,b7 ,posting on internet website ,not later than ,july #a1 #bjbc1 the ,secretary shall post on the internet website of the ,centers for ,medicare ,medicaid ,services the findings of the review conducted under subparagraph 7,a74 4 7#c7 ,cost-,sharing ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7,a7 by striking and 7,,cc7 and inserting 7,,cc72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,dd7 with respect to a prostate cancer ,,dna ,specimen ,provenance ,assay test 7,,dspa test7 7as defined in section #ahfa7kkk771 the amount paid shall be an amount equal to #hj percent of the lesser of the actual charge for the test or the amount specified under section #ahcd7x74 #bjh4 ,exclusion of complex rehabilitative manual wheelchairs from ,medicare competitive acquisition program2 ,non-application of ,medicare fee-schedule adjustments for certain wheelchair accessories and cushions 7a7 ,exclusion of complex rehabilitative manual wheelchairs from competitive acquisition program ,section #ahdg7;a77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#b77;,a77 is amended-- 7#a7 by inserting 1 complex rehabilitative manual wheelchairs 7as determined by the ,secretary71 and certain manual wheelchairs 7identified1 as of ,october #a1 #bjah1 by ,,hcpcs codes ,e#abce1 ,e#abcf1 ,e#abcg1 ,e#abch1 and ,k#jjjh or any successor to such codes7 after group #c or higher2 and 7#b7 by striking such wheelchairs and inserting such complex rehabilitative power wheelchairs1 complex rehabilitative manual wheelchairs1 and certain manual wheelchairs4 7b7 ,non-,application of ,medicare fee schedule adjustments for wheelchair accessories and seat and back cushions when furnished in connection with complex rehabilitative manual wheelchairs 7#a7 ,in general ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services shall not1 during the period beginning on ,january #a1 #bjbj1 and ending on ,december #ca1 #bjbj1 use information on the payment determined under the competitive acquisition programs under section #ahdg of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7 to adjust the payment amount that would otherwise be recognized under section #ahcd7;a77#a77;,b77ii7 of such ,act 7#db ,u4,s4,c4 #aciem7a77#a77;,b77ii77 for wheelchair accessories 7including seating systems7 and seat and back cushions when furnished in connection with complex rehabilitative manual wheelchairs 7as determined by the ,secretary71 and certain manual wheelchairs 7identified1 as of ,october #a1 #bjah1 by ,,hcpcs codes ,e#abce1 ,e#abcf1 ,e#abcg1 ,e#abch1 and ,k#jjjh or any successor to such codes74 7#b7 ,implementation ,notwithstanding any other provision of law1 the ,secretary may implement this subsection by program instruction or otherwise4 ,,iii ,medicaid ,provisions #cja4 ,modification of reductions in ,medicaid ,,dsh allotments ,section #aibc7;f77#g77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77#g77;,a77 is amended-- 7#a7 in clause 7i71 in the matter preceding subclause 7,i71 by striking #bjbj and inserting #bjbb2 and 7#b7 in clause 7ii7-- 7,a7 in subclause 7,i71 by striking #bjbj and inserting #bjbb2 and 7,b7 in subclause 7,,ii71 by striking for each of fiscal years #bjba through #bjbe and inserting for each of fiscal years #bjbc through #bjbe4 #cjb4 ,public availability of hospital upper payment limit demonstrations ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended by adding at the end the following new subsection3 7bb7 ,public availability of hospital upper payment limit demonstrations ,the ,secretary shall make publicly available upper payment limit demonstrations for hospital services that a ,state submits with respect to a fiscal year of the ,state 7beginning with ,state fiscal year #bjbb7 to the ,administrator of the ,centers for ,medicare ,medicaid ,services4 4 #cjc4 ,report by ,comptroller ,general ,not later than the date that is #ba months after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall identify and report to ,congress policy considerations for legislative action with respect to establishing an equitable formula for determining disproportionate share hospital allotments for ,states under section #aibc of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7 that takes into account the following factors3 7#a7 ,the level of uncompensated care costs of hospitals in a ,state4 7#b7 ,expenditures of a ,state with respect to hospitals1 including payment adjustments made under such section #aibc to disproportionate share hospitals 7as defined under the ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 pursuant to subsection 7a77#a77;,a7 of such section #aibc71 upper payment limit supplemental payments1 and other related payments that hospitals may receive from the ,state4 7#c7 ,state policy decisions that may affect the level of uncompensated care costs of hospitals in a ,state4 #cjd4 ,sense of ,congress regarding the need to develop a more permanent legislative solution to provide the territories with a reliable and consistent source of ,federal funding under the ,medicaid program ,it is the sense of ,congress that-- 7#a7 the territories of ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 ,guam1 ,puerto ,rico1 and the ,united ,states ,virgin ,islands are currently subject to ,federal funding caps for their ,medicaid programs2 7#b7 as a result of these ,federal funding caps1 which have not been adjusted over time1 the territories continue to struggle in managing their ,medicaid programs1 including planning for their respective financial obligations and managing health care services for low-income adults1 children1 pregnant women1 elderly adults1 and persons with disabilities2 7#c7 to address this disparate funding treatment and to provide the territories with some measure of relief1 ,congress has had to enact legislation six times in the last #ae years1 including multiple temporary increases in the ,federal funding caps1 higher ,federal medical assistance percentage rates1 and billions of dollars in supplemental block grants2 7#d7 the supplemental funding provided to the territories under title ,v with respect to their ,medicaid programs continues ,congress' commitment to ensuring the sustainability of these critically important programs and the people these programs serve2 and 7#e7 a more permanent legislative solution must be developed in order to provide the territories with a reliable and consistent source of ,federal funding under their ,medicaid programs so that the territories can continue to meet the health care needs of vulnerable populations4 ,,iv ,no ,surprises ,act #dja4 ,short title ,this title may be cited as the ,no ,surprises ,act4 #djb4 ,preventing surprise medical bills 7a7 ,coverage of emergency services ,section #bgai;,a7b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ai;a7b77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in the matter preceding subparagraph 7,a7-- 7i7 by striking a group health plan1 or a health insurance issuer offering group or individual health insurance issuer1 and inserting a health plan 7as defined in subsection 7e77#b77;,a772 7ii7 by inserting or1 for plan year #bjba or a subsequent plan year1 with respect to emergency services in an independent freestanding emergency department 7as defined in paragraph 7#c77;,d77 after emergency department of a hospital2 7iii7 by striking the plan or issuer and inserting the plan2 and 7iv7 by striking paragraph 7#b77;,b7 and inserting paragraph 7#c77;,c72 7,b7 in subparagraph 7,b71 by inserting or a participating emergency facility1 as applicable1 after participating provider2 and 7,c7 in subparagraph 7,c7-- 7i7 in the matter preceding clause 7i71 by inserting by a nonparticipating provider or a nonparticipating emergency facility after enrollee2 7ii7 by striking clause 7i72 7iii7 by striking 7ii77,i7 such services and inserting 7i7 such services2 7iv7 by striking where the provider of services does not have a contractual relationship with the plan for the providing of services2 7v7 by striking emergency department services received from providers who do have such a contractual relationship with the plan2 and and inserting emergency services received from participating providers and participating emergency facilities with respect to such plan22 7vi7 by striking 7,,ii7 if such services and all that follows through were provided in-network2 and inserting the following3 7ii7 the cost-sharing requirement 7expressed as a copayment amount or coinsurance rate7 is not greater than the requirement that would apply if such services were provided by a participating provider or a participating emergency facility2 2 and 7vii7 by adding at the end the following new clauses3 7iii7 such requirement is calculated as if the total amount that would have been charged for such services by such participating provider or participating emergency facility were equal to-- 7,i7 in the case of such services furnished in a ,state described in paragraph 7#c77;,h77ii71 the median contracted rate 7as defined in paragraph 7#c77;,e77i77 for such services2 and 7,,ii7 in the case of such services furnished in a ,state described in paragraph 7#c77;,h77i71 the lesser of-- 7aa7 the amount determined by such ,state for such services in accordance with the method described in such paragraph2 and 7bb7 the median contracted rate 7as so defined7 for such services2 7iv7 the health plan pays to such provider or facility1 respectively1 the amount by which the recognized amount 7as defined in paragraph 7#c77;,h77 for such services exceeds the cost-sharing amount for such services 7as determined in accordance with clauses 7ii7 and 7iii772 and 7v7 any cost-sharing payments made by the participant1 beneficiary1 or enrollee with respect to such emergency services so furnished shall be counted toward any in-network deductible or out-of-pocket maximums applied under the plan 7and such in-network deductible shall be applied7 in the same manner as if such cost-sharing payments were with respect to emergency services furnished by a participating provider and a participating emergency facility2 and 2 7#b7 by redesignating paragraph 7#b7 as paragraph 7#c72 7#c7 by inserting after paragraph 7#a7 the following new paragraph3 7#b7 ,audit process for median contracted rates 7,a7 ,in general ,not later than ,july #a1 #bjbj1 the ,secretary1 in consultation with appropriate ,state agencies1 shall establish through rulemaking a process1 in accordance with subparagraph 7,b71 under which health plans are audited by such ,secretaries to ensure that-- 7i7 such plans are in compliance with the requirement of applying a median contracted rate under this section2 and 7ii7 that such median contracted rate so applied satisfies the definition under paragraph 7#c77;,e7 with respect to the year involved1 including with respect to a health plan described in clause 7ii7 of such paragraph4 7,b7 ,audit samples ,under the process established pursuant to subparagraph 7,a71 the ,secretary-- 7i7 shall conduct audits described in such subparagraph1 with respect to a year 7beginning with #bjba71 of a sample with respect to such year of claims data from not more than #be health plans2 and 7ii7 may audit any health plan if the ,secretary has received any complaint about such plan that involves the compliance of the plan with either of the requirements described in clauses 7i7 and 7ii7 of such subparagraph4 2 and 7#d7 in paragraph 7#c71 as redesignated by paragraph 7#b7 of this subsection-- 7,a7 in the matter preceding subparagraph 7,a71 by inserting and subsection 7e7 after this subsection2 7,b7 by redesignating subparagraphs 7,a7 through 7,c7 as subparagraphs 7,b7 through 7,d71 respectively2 7,c7 by inserting before subparagraph 7,b71 as redesignated by subparagraph 7,b7 of this paragraph1 the following new subparagraph3 7,a7 ,emergency department of a hospital ,the term emergency department of a hospital includes a hospital outpatient department that provides emergency services4 2 7,d7 by amending subparagraph 7,c71 as redesignated by subparagraph 7,b7 of this paragraph1 to read as follows3 7,c7 ,emergency services 7i7 ,in general ,the term emergency services1 with respect to an emergency medical condition1 means-- 7,i7 a medical screening examination 7as required under section #ahfg of the ,social ,security ,act1 or as would be required under such section if such section applied to an independent freestanding emergency department7 that is within the capability of the emergency department of a hospital or of an independent freestanding emergency department1 as applicable1 including ancillary services routinely available to the emergency department to evaluate such emergency medical condition2 and 7,,ii7 within the capabilities of the staff and facilities available at the hospital or the independent freestanding emergency department1 as applicable1 such further medical examination and treatment as are required under section #ahfg of such ,act1 or as would be required under such section if such section applied to an independent freestanding emergency department1 to stabilize the patient4 7ii7 ,inclusion of poststabilization services ,for purposes of this subsection and section #bgii1 in the case of an individual enrolled in a health plan who is furnished services described in clause 7i7 by a provider or facility to stabilize such individual with respect to an emergency medical condition1 the term emergency services shall include such items and services in addition to those described in clause 7i7 that such a provider or facility determines are needed to be furnished 7after such stabilization but during such visit in which such individual is so stabilized7 to such individual1 unless each of the following conditions are met3 7,i7 ,such a provider or facility determines such individual is able to travel using nonmedical transportation or nonemergency medical transportation4 7,,ii7 ,such provider furnishing such additional items and services is in compliance with section #bgii;,a7d7 with respect to such items and services4 2 7,e7 by redesignating subparagraph 7,d71 as redesignated by subparagraph 7,b7 of this paragraph1 as subparagraph 7,i72 and 7,f7 by inserting after subparagraph 7,c71 as redesignated by subparagraph 7,b7 of this paragraph1 the following new subparagraphs3 7,d7 ,independent freestanding emergency department ,the term independent freestanding emergency department means a facility that-- 7i7 is geographically separate and distinct and licensed separately from a hospital under applicable ,state law2 and 7ii7 provides emergency services4 7,e7 ,median contracted rate 7i7 ,in general ,the term median contracted rate means1 with respect to an item or service and a health plan 7as defined in subsection 7e77#b77;,a77-- 7,i7 for #bjba1 the median of the negotiated rates recognized by the sponsor or issuer of such plan 7determined with respect to all such plans of such sponsor or such issuer that are within the same line of business7 as the total maximum payment 7including the cost-sharing amount imposed for such services 7as determined in accordance with clauses 7ii7 and 7iii7 of paragraph 7#a77;,c7 or subparagraphs 7,a7 and 7,b7 of subsection 7e77#a71 as applicable7 and the amount to be paid by the plan or issuer7 under such plans in #bjai for the same or a similar item or service that is provided by a provider in the same or similar specialty and provided in the geographic region in which the item or service is furnished1 consistent with the methodology established by the ,secretary under section #djb7;e7 of the ,no ,surprises ,act1 increased by the percentage increase in the consumer price index for all urban consumers 7,united ,states city average7 over #bjai and #bjbj2 and 7,,ii7 for #bjbb and each subsequent year1 the median contracted rate determined under this clause for the previous year1 increased by the percentage increase in the consumer price index for all urban consumers 7,united ,states city average7 over such previous year4 7ii7 ,special rule ,the ,secretary shall provide pursuant to rulemaking described in section #djb7;e7 of the ,no ,surprises ,act that-- 7,i7 if the sponsor or issuer of a health plan does not have sufficient information to calculate a median contracted rate for an item or service or provider type1 or amount of1 claims for items or services 7as determined by the ,secretary7 provided in a particular geographic area 7other than in a case described in item 7bb771 such sponsor or issuer shall demonstrate that such sponsor or issuer will use any database free of conflicts of interest that has sufficient information reflecting allowed amounts paid to a health care provider for relevant services provided in the applicable geographic region 7such as ,state ,all ,payer ,claims ,databases 7as defined in section #djd7;d7 of such ,act771 and that such sponsor or issuer will use any such database to determine a median contracted rate and cover the cost of accessing any such database2 and 7,,ii7 in the case of a sponsor or issuer offering a health plan in a geographic region that did not offer any health plan in such region during #bjai1 such sponsor or issuer shall use a methodology established by the ,secretary for determining the median contracted rate for items and services covered by such plan for the first year in which such plan is offered in such region1 and that1 for each succeeding year1 the median contracted rate for such items and services under such plan shall be the median contracted rate for such items and services under such plan for the previous year1 increased by the percentage increase in the consumer price index for all urban consumers 7,united ,states city average7 over such previous year4 7,f7 ,nonparticipating emergency facility2 participating emergency facility 7i7 ,nonparticipating emergency facility ,the term nonparticipating emergency facility means1 with respect to an item or service and a health plan1 an emergency department of a hospital1 or an independent freestanding emergency department1 that does not have a contractual relationship with the plan 7or1 if applicable1 issuer offering the plan7 for furnishing such item or service under the plan4 7ii7 ,participating emergency facility ,the term participating emergency facility means1 with respect to an item or service and a health plan1 an emergency department of a hospital1 or an independent freestanding emergency department1 that has a contractual relationship with the plan 7or1 if applicable1 issuer offering the plan7 for furnishing such item or service under the plan4 7,g7 ,nonparticipating providers2 participating providers 7i7 ,nonparticipating provider ,the term nonparticipating provider means1 with respect to an item or service and a health plan1 a physician or other health care provider who is acting within the scope of practice of that provider's license or certification under applicable ,state law and who does not have a contractual relationship with the plan 7or1 if applicable1 issuer offering the plan7 for furnishing such item or service under the plan4 7ii7 ,participating provider ,the term participating provider means1 with respect to an item or service and a health plan1 a physician or other health care provider who is acting within the scope of practice of that provider's license or certification under applicable ,state law and who has a contractual relationship with the plan 7or1 if applicable1 issuer offering the plan7 for furnishing such item or service under the plan4 7,h7 ,recognized amount ,the term recognized amount means1 with respect to an item or service-- 7i7 in the case of such item or service furnished in a ,state that has in effect a ,state law that provides for a method for determining the amount of payment that is required to be covered by a health plan regulated by such ,state in the case of a participant1 beneficiary1 or enrollee covered under such plan and receiving such item or service from a nonparticipating provider or facility1 not more than the amount determined in accordance with such law plus the cost-sharing amount imposed under the plan for such item or service 7as determined in accordance with clauses 7ii7 and 7iii7 of paragraph 7#a77;,c7 or subparagraphs 7,a7 and 7,b7 of subsection 7e77#a71 as applicable72 or 7ii7 in the case of such item or service furnished in a ,state that does not have in effect such a law1 an amount that is at least the median contracted rate 7as defined in subparagraph 7,e77i7 and determined in accordance with rulemaking described in section #djb7;e7 of the ,no ,surprises ,act7 for such item or service4 4 7b7 ,coverage of non-emergency services performed by nonparticipating providers at certain participating facilities2 independent dispute resolution process ,section #bgai;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ai;a7 is amended by adding at the end the following new subsections3 7e7 ,coverage of non-emergency services performed by nonparticipating providers at certain participating facilities 7#a7 ,in general ,subject to paragraph 7#c71 in the case of items or services 7other than emergency services to which subsection 7b7 applies7 furnished to a participant1 beneficiary1 or enrollee of a health plan 7as defined in paragraph 7#b77;,a77 by a nonparticipating provider 7as defined in subsection 7b77#c77;,g77i77 during a visit 7as defined by the ,secretary in accordance with paragraph 7#b77;,c77 at a participating health care facility 7as defined in paragraph 7#b77;,b771 with respect to such plan1 the plan-- 7,a7 shall not impose on such participant1 beneficiary1 or enrollee a cost-sharing amount 7expressed as a copayment amount or coinsurance rate7 for such items and services so furnished that is greater than the cost-sharing amount that would apply under such plan had such items or services been furnished by a participating provider 7as defined in subsection 7b77#c77;,g77ii772 7,b7 shall calculate such cost-sharing amount as if the amount that would have been charged for such items and services by such participating provider were equal to-- 7i7 in the case of such items and services furnished in a ,state described in subsection 7b77#c77;,h77ii71 the median contracted rate 7as defined in subsection 7b77#c77;,e77i77 for such items and services2 and 7ii7 in the case of such items and services furnished in a ,state described in subsection 7b77#c77;,h77i71 the lesser of-- 7,i7 the amount determined by such ,state for such items and services in accordance with the method described in such subsection2 and 7,,ii7 the median contracted rate 7as so defined7 for such items and services2 7,c7 shall pay to such provider furnishing such items and services to such participant1 beneficiary1 or enrollee the amount by which the recognized amount 7as defined in subsection 7b77#c77;,h77 for such items and services exceeds the cost-sharing amount imposed under the plan for such items and services 7as determined in accordance with subparagraphs 7,a7 and 7,b772 and 7,d7 shall count toward any in-network deductible or out-of-pocket maximums applied under the plan any cost-sharing payments made by the participant1 beneficiary1 or enrollee 7and such in-network deductible shall be applied7 with respect to such items and services so furnished in the same manner as if such cost-sharing payments were with respect to items and services furnished by a participating provider4 7#b7 ,definitions ,in this subsection and subsection 7b73 7,a7 ,health plan ,the term health plan means a group health plan and health insurance coverage offered by a heath insurance issuer in the group or individual market and includes a grandfathered health plan 7as defined in section #abea7;e7 of the ,patient ,protection and ,affordable ,care ,act74 7,b7 ,participating health care facility 7i7 ,in general ,the term participating health care facility means1 with respect to an item or service and a health plan1 a health care facility described in clause 7ii7 that has a contractual relationship with the plan 7or1 if applicable1 issuer offering the plan7 for furnishing such item or service4 7ii7 ,health care facility described ,a health care facility described in this clause is each of the following3 7,i7 ,a hospital 7as defined in #ahfa7;e7 of the ,social ,security ,act74 7,,ii7 ,a critical access hospital 7as defined in section #ahfa7mm7 of such ,act74 7,,iii7 ,an ambulatory surgical center 7as defined in section #ahcc7;i77#a77;,a7 of such ,act74 7,,iv7 ,a laboratory4 7,v7 ,a radiology facility or imaging center4 7,c7 ,during a visit ,the term during a visit shall1 with respect to items and services furnished to an individual at a participating health care facility1 include equipment and devices1 telemedicine services1 imaging services1 laboratory services1 and such other items and services as the ,secretary may specify1 regardless of whether or not the provider furnishing such items or services is at the facility4 7#c7 ,exception ,paragraph 7#a7 shall not apply to a health plan in the case of items or services 7other than emergency services to which subsection 7b7 applies7 furnished to a participant1 beneficiary1 or enrollee of a health plan 7as defined in paragraph 7#b77;,a77 by a nonparticipating provider 7as defined in subsection 7b77#c77;,g77i77 during a visit 7as defined by the ,secretary in accordance with paragraph 7#b77;,c77 at a participating health care facility 7as defined in paragraph 7#b77;,b77 if such provider is in compliance with section #bgii;,a7d7 with respect to such items and services4 7f7 ,independent dispute resolution process 7#a7 ,establishment 7,a7 ,in general ,not later than #a year after the date of the enactment of this subsection1 the ,secretary1 in consultation with the ,secretary of ,labor1 shall establish by regulation an independent dispute resolution process 7referred to in this subsection as the ,,idr process7 under which-- 7i7 a nonparticipating provider 7as defined in subparagraph 7,g7 of subsection 7b77#c771 nonparticipating emergency facility 7as defined in subparagraph 7,f7 of such subsection71 or health plan 7as defined in subsection 7e77#b77;,a77 may submit a request for resolution by an entity certified under paragraph 7#b7 7in this subsection referred to as a certified ,,idr entity7 of a specified claim2 and 7ii7 in the case a settlement described in subparagraph 7,b7 of paragraph 7#d7 is not reached with respect to such claim1 such entity so resolves such claim in accordance with such paragraph4 7,b7 ,definitions ,in this subsection3 7i7 ,specified claim 7,i7 ,in general ,subject to subclause 7,,ii71 the term specified claim means a claim by a nonparticipating provider1 a nonparticipating emergency facility1 or a health plan with respect to qualifying items and services 7as defined in clause 7ii77 furnished by such provider or facility in a ,state described in subparagraph 7,h77ii7 of subsection 7b77#c7 for which a health plan is required to make payment pursuant to subsection 7b77#a7 or subsection 7e77#a7-- 7aa7 that such payment should be increased or decreased2 and 7bb7 that is made not later than-- 7,,aa7 in the case of such a claim filed by such a provider or facility1 the date on which the appeal with respect to such items and services described in clause 7ii77,i77aa77,,aa7 has been resolved 7or the date that is #cj days after such appeal is filed1 whichever is earlier72 or 7,,bb7 in the case of such a claim filed by such plan1 the date on which the period described in clause 7ii77,i77bb77,,bb7 with respect to such items and services elapses4 7,,ii7 ,limitation on packaging of items and services in a specified claim ,the term specified claim shall not include1 in the case such claim is made by such provider1 facility1 or plan with respect to multiple items and services1 any claim with respect to items and services furnished by such provider or facility if-- 7aa7 such items and services were not furnished by the same provider or facility2 7bb7 payment for such items and services made pursuant to subsection 7b77#a7 or subsection 7e77#a7 was made by multiple health plans2 7cc7 such items and services are not related to the treatment of the same condition2 or 7dd7 such items and services were not furnished within #cj days of the date of the earliest item or service furnished that is included in such claim4 7ii7 ,qualifying items and services 7,i7 ,in general ,subject to subclause 7,,ii71 the term qualifying items and services means-- 7aa7 with respect to a specified claim made by a nonparticipating provider or nonparticipating emergency facility1 items and services furnished by such provider or facility for which a health plan is required to make payment pursuant to subsection 7b77#a7 or subsection 7e77#a71 but only if-- 7,,aa7 such items and services are included in an appeal filed under such plan's internal appeals process not later than #cj days after such payment is received2 and 7,,bb7 such appeal under such plan's internal appeals process has been resolved1 or a #cj-;day period has elapsed since such appeal was so filed2 and 7bb7 with respect to a specified claim made by a health plan1 items and services furnished by such a provider or facility for which such health plan is required to make payment pursuant to subsection 7b77#a7 or subsection 7e77#a71 but only if-- 7,,aa7 such plan submits a notice to such provider or facility not later than #cj days after such provider or facility receives such payment that such plan disputes the amount of such payment with respect to such items and services2 and 7,,bb7 a #cj-;day period has elapsed since the submission of such notice4 7,,ii7 ,limitation ,the term qualifying items and services shall not include an item or service furnished in a geographic area during a year by such provider or facility for which a health plan is required to make payment pursuant to subsection 7b77#a7 or subsection 7e77#a7 if the median contracted rate 7as defined in subsection 7b77#c77;,e77 under such plan for such year with respect to such item or service furnished by such a provider or such a facility in such area does not exceed-- 7aa7 with respect to an item or service furnished during #bjba1 #a1bej2 and 7bb7 with respect to an item or service furnished during a subsequent year1 the amount specified under this subclause for the previous year1 increased by the percentage increase in the consumer price index for all urban consumers 7,united ,states city average7 over such previous year4 7#b7 ,certification of entities 7,a7 ,process of certification ,the process described in paragraph 7#a7 shall include a certification process under which eligible entities may be certified to carry out the ,,idr process4 7,b7 ,eligibility 7i7 ,in general ,for purposes of subparagraph 7,a71 an eligible entity is an entity that is a nongovernmental entity that agrees to comply with the fee limitations described in clause 7ii74 7ii7 ,fee limitation ,for purposes of clause 7i71 the fee limitations described in this clause are limitations established by the ,secretary on the amount a certified ,,idr entity may charge a nonparticipating provider1 nonparticipating emergency facility1 or health plan for services furnished by such entity with respect to the resolution of a specified claim of such provider1 facility1 or plan under the process described in paragraph 7#a74 7#c7 ,selection of certified ,,idr entity for a specified claim ,with respect to the resolution of a specified claim under the ,,idr process1 the health plan and the nonparticipating provider or the nonparticipating emergency facility 7as applicable7 involved shall agree on a certified ,,idr entity to resolve such claim4 ,in the case that such plan and such provider or facility 7as applicable7 cannot so agree1 such an entity shall be selected by the ,secretary at random4 7#d7 ,payment determination 7,a7 ,timing ,a certified ,,idr entity selected under paragraph 7#c7 by a health plan and a nonparticipating provider or a nonparticipating emergency facility 7as applicable7 with respect to a specified claim shall1 subject to subparagraph 7,b71 not later than #cj days after being so selected1 determine the total reimbursement that should have been made for items and services included in such claim in accordance with subparagraph 7,c74 7,b7 ,settlement 7i7 ,in general ,if such entity determines that a settlement between the health plan and the provider or facility is likely with respect to a specified claim1 the entity may direct the parties to attempt1 for a period not to exceed #aj days1 a good faith negotiation for a settlement of such claim4 7ii7 ,timing ,the period for a settlement described in clause 7i7 shall accrue towards the #cj-;day period described in subparagraph 7,a74 7,c7 ,determination of amount 7i7 ,in general ,the health plan and the nonparticipating provider or nonparticipating emergency facility 7as applicable7 shall1 with respect to a specified claim1 each submit to the certified ,,idr entity a final offer of payment or reimbursement 7as applicable7 with respect to items and services which are the subject of the specified claim4 ,such entity shall determine which such offer is the most reasonable in accordance with clause 7ii74 7ii7 ,considerations in determination 7,i7 ,in general ,in determining which final offer is the most reasonable under clause 7i71 the certified ,,idr entity shall consider-- 7aa7 the median contracted rates 7as defined in subsection 7b77#c77;,e77 for items or services that are comparable to the items and services included in the specified claim and that are furnished in the same geographic area 7as defined by the ,secretary for purposes of such subsection7 as such items and services 7not including any facility fees with respect to such rates72 and 7bb7 the circumstances described in subclause 7,,ii71 if any information with respect to such circumstances is submitted by either party4 7,,ii7 ,additional circumstances ,for purposes of subclause 7,i77bb71 the circumstances described in this subclause are1 with respect to items and services included in the specified claim of a nonparticipating provider1 nonparticipating emergency facility1 or health plan1 the following3 7aa7 ,the level of training1 education1 experience1 and quality and outcomes measurements of the provider or facility that furnished such items and services4 7bb7 ,any other extenuating circumstances with respect to the furnishing of such items and services that relate to the acuity of the individual receiving such items and services or the complexity of furnishing such items and services to such individual4 7,,iii7 ,prohibition on consideration of billed charges ,in determining which final offer is the most reasonable under clause 7i7 with respect to items and services furnished by a provider or facility and included in a specified claim1 the certified ,,idr entity may not consider the amount that would have been billed by such provider or facility with respect to such items and services had the provisions of section #bgii or #bgii;,a 7as applicable7 not applied4 7iii7 ,effect of determination ,a determination of a certified ,,idr entity under clause 7i7-- 7,i7 shall be binding2 and 7,,ii7 shall not be subject to judicial review1 except in a case described in any of paragraphs 7#a7 through 7#d7 of section #aj7;a7 of title #i1 ,united ,states ,code4 7iv7 ,costs of independent dispute resolution process ,in the case of a specified claim made by a nonparticipating provider1 nonparticipating emergency facility1 or health plan and submitted to a certified ,,idr entity-- 7,i7 if such entity makes a determination with respect to such claim under clause 7i71 the party whose offer is not chosen under such clause shall be responsible for paying all fees charged by such entity2 and 7,,ii7 if the parties reach a settlement with respect to such claim prior to such a determination1 such fees shall be divided equally between the parties1 unless the parties otherwise agree4 7v7 ,payment ,not later than #cj days after a determination described in clause 7i7 is made with respect to a specified claim of a nonparticipating provider1 nonparticipating emergency facility1 or health plan-- 7,i7 in the case that such determination finds that the amount paid with respect to such specified claim by the health plan should have been greater than the amount so paid1 such plan shall pay directly to the provider or facility 7as applicable7 the difference between the amount so paid and the amount so determined2 and 7,,ii7 in the case that such determination finds that the amount paid with respect to such specified claim by the health plan should have been less than the amount so paid1 the provider or facility 7as applicable7 shall pay directly to the plan the difference between the amount so paid and the amount so determined4 7#e7 ,publication of information relating to disputes 7,a7 ,in general ,for #bjba and each subsequent year1 the ,secretary and the ,secretary of ,labor shall publish on the public website of the ,department of ,health and ,human ,services and the ,department of ,labor1 respectively-- 7i7 the number of specified claims filed during such year2 7ii7 the number of such claims with respect to which a final determination was made under paragraph 7#d77;,c77i72 and 7iii7 the information described in subparagraph 7,b7 with respect to each specified claim with respect to which such a decision was so made4 7,b7 ,information with respect to specified claims ,for purposes of subparagraph 7,a71 the information described in this subparagraph is1 with respect to a specified claim of a nonparticiapting provider1 nonparticipating emergency facility1 or health plan-- 7i7 a description of each item and service included in such claim2 7ii7 the amount of the offer submitted under paragraph 7#d77;,c77i7 by the health plan and by the nonparticipating provider or nonparticipating emergency facility 7as applicable72 7iii7 whether the offer selected by the certified ,,idr entity under such paragraph was the offer submitted by such plan or by such provider or facility 7as applicable7 and the amount of such offer so selected2 and 7iv7 the category and practice specialty of each such provider or facility involved in furnishing such items and services4 7,c7 ,confidentiality of parties ,none of the information published under this paragraph may specify the identity of a health plan1 provider1 facility1 or individual with respect to a specified claim4 4 7c7 ,provider directory requirements2 disclosure on patient protections ,section #bgai;,a of the ,public ,health ,service ,act1 as amended by subsection 7b71 is further amended by adding at the end the following new subsections3 7g7 ,provider directory information requirements 7#a7 ,in general ,not later than #a year after the date of the enactment of this subsection1 each group health plan and health insurance issuer offering group or individual health insurance coverage shall-- 7,a7 establish the verification process described in paragraph 7#b72 7,b7 establish the response protocol described in paragraph 7#c72 7,c7 establish the database described in paragraph 7#d72 and 7,d7 include in any print directory containing provider directory information with respect to such plan or such coverage the information described in paragraph 7#e74 7#b7 ,verification process ,the verification process described in this paragraph is1 with respect to a group health plan or a health insurance issuer offering group or individual health insurance coverage1 a process-- 7,a7 under which not less frequently than once every #ij days1 such plan or such issuer 7as applicable7 verifies and updates the provider directory information included on the database described in paragraph 7#d7 of such plan or issuer of each health care provider and health care facility included in such database2 and 7,b7 that establishes a procedure for the removal of such a provider or facility with respect to which such plan or issuer has been unable to verify such information during a period specified by the plan or issuer4 7#c7 ,response protocol ,the response protocol described in this paragraph is1 in the case of an individual enrolled under a group health plan or group or individual health insurance coverage offered by a health insurance issuer who requests information on whether a health care provider or health care facility has a contractual relationship to furnish items and services under such plan or such coverage1 a protocol under which such plan or such issuer 7as applicable71 in the case such request is made through a telephone call-- 7,a7 responds to such individual as soon as practicable and in no case later than #a business day after such call is received through a written electronic communication2 and 7,b7 retains such communication in such individual's file for at least #b years following such response4 7#d7 ,database ,the database described in this paragraph is1 with respect to a group health plan or health insurance issuer offering group or individual health insurance coverage1 a database on the public website of such plan or issuer that contains-- 7,a7 a list of each health care provider and health care facility with which such plan or such issuer has a contractual relationship for furnishing items and services under such plan or such coverage2 and 7,b7 provider directory information with respect to each such provider and facility4 7#e7 ,information ,the information described in this paragraph is1 with respect to a print directory containing provider directory information with respect to a group health plan or individual or group health insurance coverage offered by a health insurance issuer1 a notification that such information contained in such directory was accurate as of the date of publication of such directory and that an individual enrolled under such plan or such coverage should consult the database described in paragraph 7#d7 with respect to such plan or such coverage or contact such plan or the issuer of such coverage to obtain the most current provider directory information with respect to such plan or such coverage4 7#f7 ,definition ,for purposes of this subsection1 the term provider directory information includes1 with respect to a group health plan and a health insurance issuer offering group or individual health insurance coverage1 the name1 address1 specialty1 and telephone number of each health care provider or health care facility with which such plan or such issuer has a contractual relationship for furnishing items and services under such plan or such coverage4 7h7 ,disclosure on patient protections ,each group health plan and health insurance issuer offering group or individual health insurance coverage shall make publicly available1 and 7if applicable7 post on a public website of such plan or issuer-- 7#a7 information in plain language on-- 7,a7 the requirements and prohibitions applied under sections #bgii and #bgii;,a 7relating to prohibitions on balance billing in certain circumstances72 7,b7 if provided for under applicable ,state law1 any other requirements on providers and facilities regarding the amounts such providers and facilities may1 with respect to an item or service1 charge a participant1 beneficiary1 or enrollee of such plan or coverage with respect to which such a provider or facility does not have a contractual relationship for furnishing such item or service under the plan or coverage after receiving payment from the plan or coverage for such item or service and any applicable cost-sharing payment from such participant1 beneficiary1 or enrollee2 and 7,c7 the requirements applied under subsections 7b7 and 7e72 and 7#b7 information on contacting appropriate ,state and ,federal agencies in the case that an individual believes that such a provider or facility has violated any requirement described in paragraph 7#a7 with respect to such individual4 4 7d7 ,preventing certain cases of balance billing ,title ,,xxvii of the ,public ,health ,service ,act is amended by adding at the end the following new part3 ,d ,preventing ,certain ,cases of ,balance ,billing #bgii4 ,balance billing in cases of emergency services 7a7 ,in general ,in the case of a participant1 beneficiary1 or enrollee with benefits under a health plan who is furnished on or after ,january #a1 #bjba1 emergency services with respect to an emergency medical condition during a visit at an emergency department of a hospital or an independent freestanding emergency department-- 7#a7 the emergency department of a hospital or independent freestanding emergency department shall not hold the participant1 beneficiary1 or enrollee liable for a payment amount for such emergency services so furnished that is more than the cost-sharing amount for such services 7as determined in accordance with clauses 7ii7 and 7iii7 of section #bgai;,a7b77#a77;,c772 and 7#b7 a health care provider shall not hold such participant1 beneficiary1 or enrollee liable for a payment amount for an emergency service furnished to such individual by such provider with respect to such emergency medical condition and visit for which the individual receives emergency services at the hospital or emergency department that is more than the cost-sharing amount for such services furnished by the provider 7as determined in accordance with clauses 7ii7 and 7iii7 of section #bgai;,a7b77#a77;,c774 7b7 ,definitions ,in this section3 7#a7 ,the terms emergency department of a hospital1 emergency medical condition1 emergency services1 and independent freestanding emergency department have the meanings given such terms1 respectively1 in section #bgai;,a7b77#c74 7#b7 ,the term health plan has the meaning given such term in section #bgai;,a7e74 7#c7 ,the term during a visit shall have such meaning as applied to such term for purposes of section #bgai;,a7e74 #bgii;,a4 ,balance billing in cases of non-emergency services performed by nonparticipating providers at certain participating facilities 7a7 ,in general ,subject to subsection 7b71 in the case of a participant1 beneficiary1 or enrollee with benefits under a health plan 7as defined in section #bgii7;b77 who is furnished on or after ,january #a1 #bjba1 items or services 7other than emergency services to which section #bgii applies7 at a participating health care facility by a nonparticipating provider1 such provider shall not hold such participant1 beneficiary1 or enrollee liable for a payment amount for such an item or service furnished by such provider during a visit at such facility that is more than the cost-sharing amount for such item or service 7as determined in accordance with subparagraphs 7,a7 and 7,b7 of section #bgai;,a7e77#a774 7b7 ,exception 7#a7 ,in general ,subsection 7a7 shall not apply to a nonparticipating provider 7other than a specified provider at a participating health care facility71 with respect to items or services furnished by the provider to a participant1 beneficiary1 or enrollee of a health plan1 if the provider is in compliance with the notice and consent requirements of subsection 7d74 7#b7 ,specified provider defined ,for purposes of paragraph 7#a71 the term specified provider1 with respect to a participating health care facility-- 7,a7 means a facility-based provider1 including emergency medicine providers1 anesthesiologists1 pathologists1 radiologists1 neonatologists1 assistant surgeons1 hospitalists1 intensivists1 or other providers as determined by the ,secretary2 and 7,b7 includes1 with respect to an item or service1 a nonparticipating provider if there is no participating provider at such facility who can furnish such item or service4 7c7 ,clarification ,in the case of a nonparticipating provider 7other than a specified provider at a participating health care facility7 that complies with the notice and consent requirements of subsection 7d7 with respect to an item or service 7referred to in this subsection as a covered item or service71 such notice and consent requirements may not be construed as applying with respect to any item or service that is furnished as a result of unforeseen medical needs that arise at the time such covered item or service is furnished4 7d7 ,compliance with notice and consent requirements 7#a7 ,in general ,a nonparticipating provider or nonparticipating facility is in compliance with this subsection1 with respect to items or services furnished by the provider or facility to a participant1 beneficiary1 or enrollee of a health plan1 if the provider 7or1 if applicable1 the participating health care facility on behalf of such provider7 or nonparticipating facility-- 7,a7 provides to the participant1 beneficiary1 or enrollee 7or to an authorized representative of the participant1 beneficiary1 or enrollee7 on the date on which the individual is furnished such items or services and1 in the case that the participant1 beneficiary1 or enrollee makes an appointment to be furnished such items or services1 on such date the appointment is made-- 7i7 an oral explanation of the written notice described in clause 7ii72 and 7ii7 a written notice specified by the ,secretary1 not later than ,july #a1 #bjbj1 through guidance 7which shall be updated as determined necessary by the ,secretary7 that-- 7,i7 contains the information required under paragraph 7#b72 and 7,,ii7 is signed and dated by the participant1 beneficiary1 or enrollee 7or by an authorized representative of the participant1 beneficiary1 or enrollee7 and1 with respect to items or services to be furnished by such a provider that are not poststabilization services described in section #bgai;,a7b77#c77;,c77ii71 is so signed and dated not less than #gb hours prior to the participant1 beneficiary1 or enrollee being furnished such items or services by such provider2 and 7,b7 obtains from the participant1 beneficiary1 or enrollee 7or from such an authorized representative7 the consent described in paragraph 7#c74 7#b7 ,information required under written notice ,for purposes of paragraph 7#a77;,a77ii77,i71 the information described in this paragraph1 with respect to a nonparticipating provider or nonparticipating facility and a participant1 beneficiary1 or enrollee of a health plan1 is each of the following3 7,a7 ,notification1 as applicable1 that the health care provider is a nonparticipating provider with respect to the health plan or the health care facility is a nonparticipating facility with respect to the health plan4 7,b7 ,notification of the estimated amount that such provider or facility may charge the participant1 beneficiary1 or enrollee for such items and services involved4 7,c7 ,in the case of a nonparticipating facility1 a list of any participating providers at the facility who are able to furnish such items and services involved and notification that the participant1 beneficiary1 or enrollee may be referred1 at their option1 to such a participating provider4 7#c7 ,consent described ,for purposes of paragraph 7#a77;,b71 the consent described in this paragraph1 with respect to a participant1 beneficiary1 or enrollee of a health plan who is to be furnished items or services by a nonparticipating provider or nonparticipating facility1 is a document specified by the ,secretary through rulemaking that-- 7,a7 is signed by the participant1 beneficiary1 or enrollee 7or by an authorized representative of the participant1 beneficiary1 or enrollee7 and1 with respect to items or services to be furnished by such a provider or facility that are not poststabilization services described in section #bgai;,a7b77#c77;,c77ii71 is so signed not less than #gb hours prior to the participant1 beneficiary1 or enrollee being furnished such items or services by such provider or facility2 7,b7 acknowledges that the participant1 beneficiary1 or enrollee has been-- 7i7 provided with a written estimate and an oral explanation of the charge that the participant1 beneficiary1 or enrollee will be assessed for the items or services anticipated to be furnished to the participant1 beneficiary1 or enrollee by such provider or facility2 and 7ii7 informed that the payment of such charge by the participant1 beneficiary1 or enrollee may not accrue toward meeting any limitation that the health plan places on cost-sharing2 and 7,c7 documents the consent of the participant1 beneficiary1 or enrollee to-- 7i7 be furnished with such items or services by such provider or facility2 and 7ii7 in the case that the individual is so furnished such items or services1 be charged an amount that may be greater than the amount that would otherwise be charged the individual if furnished by a participating provider or participating facility with respect to such items or services and plan4 7e7 ,retention of certain documents ,a nonparticipating provider 7or1 in the case of a nonparticipating provider at a participating health care facility1 such facility7 or nonparticipating facility that obtains from a participant1 beneficiary1 or enrollee of a health plan 7or an authorized representative of such participant1 beneficiary1 or enrollee7 a written notice in accordance with subsection 7c77#a77;ii71 with respect to furnishing an item or service to such participant1 beneficiary1 or enrollee1 shall retain such notice for at least a #b-year period after the date on which such item or service is so furnished4 7f7 ,definitions ,in this section3 7#a7 ,the terms nonparticipating provider and participating provider have the meanings given such terms1 respectively1 in subsection 7b77#c7 of section #bgai;,a4 7#b7 ,the terms participating health care facility and health plan have the meanings given such terms1 respectively1 in subsection 7e77#b7 of section #bgai;,a4 7#c7 ,the term nonparticipating facility means-- 7,a7 with respect to emergency services 7as defined in section #bgai;,a7b77#c77;,c77i77 and a health plan1 an emergency department of a hospital1 or an independent freestanding emergency department1 that does not have a contractual relationship with the plan 7or1 if applicable1 issuer offering the plan7 for furnishing such services under the plan2 and 7,b7 with respect to poststabilization services described in section #bgai;,a7b77#c77;,c77ii7 and a health plan1 an emergency department of a hospital 7or other department of such hospital71 or an independent freestanding emergency department1 that does not have a contractual relationship with the plan 7or1 if applicable1 issuer offering the plan7 for furnishing such services under the plan4 7#d7 ,the term participating facility means-- 7,a7 with respect to emergency services 7as defined in section #bgai;,a7b77#c77;,c77i77 and a health plan1 an emergency department of a hospital1 or an independent freestanding emergency department1 that has a contractual relationship with the plan 7or1 if applicable1 issuer offering the plan7 for furnishing such services under the plan2 and 7,b7 with respect to poststabilization services described in section #bgai;,a7b77#c77;,c77ii7 and a health plan1 an emergency department of a hospital 7or other department of such hospital71 or an independent freestanding emergency department1 that has a contractual relationship with the plan 7or1 if applicable1 issuer offering the plan7 for furnishing such services under the plan4 #bgii;,b4 ,provider requirements with respect to provider directory information ,not later than #a year after the date of the enactment of this section1 each health care provider and health care facility shall establish a process under which such provider or facility transmits1 to each health insurance issuer offering group or individual health insurance coverage and group health plan with which such provider or facility has in effect a contractual relationship for furnishing items and services under such coverage or such plan1 provider directory information 7as defined in section #bgai;,a7g77#f77 with respect to such provider or facility1 as applicable4 ,such provider or facility shall so transmit such information to such issuer offering such coverage or such group health plan-- 7#a7 when the provider or facility enters into such a relationship with respect to such coverage offered by such issuer or with respect to such plan2 7#b7 when the provider or facility terminates such relationship with respect to such coverage offered by such issuer or with respect to such plan2 7#c7 when there are any other material changes to such provider directory information of the provider or facility with respect to such coverage offered by such issuer or with respect to such plan2 and 7#d7 at any other time 7including upon the request of such issuer or plan7 determined appropriate by the provider1 facility1 or the ,secretary4 #bgii;,c4 ,provider requirement with respect to public provision of information ,each health care provider and health care facility shall make publicly available1 and 7if applicable7 post on a public website of such provider or facility-- 7#a7 information in plain language on-- 7,a7 the requirements and prohibitions of such provider or facility under sections #bgii and #bgii;,a 7relating to prohibitions on balance billing in certain circumstances72 and 7,b7 if provided for under applicable ,state law1 any other requirements on such provider or facility regarding the amounts such provider or facility may1 with respect to an item or service1 charge a participant1 beneficiary1 or enrollee of a health plan 7as defined in section #bgai;,a7e77#b77 with respect to which such provider or facility does not have a contractual relationship for furnishing such item or service under the plan after receiving payment from the plan for such item or service and any applicable cost-sharing payment from such participant1 beneficiary1 or enrollee2 and 7#b7 information on contacting appropriate ,state and ,federal agencies in the case that an individual believes that such provider or facility has violated any requirement described in paragraph 7#a7 with respect to such individual4 #bgii;,d4 ,enforcement 7a7 ,state enforcement 7#a7 ,state authority ,each ,state may require a provider or health care facility subject to the requirements of sections #bgai;,a7f71 #bgii1 #bgii;,a1 #bgii;,b1 or #bgii;,c to satisfy such requirements applicable to the provider or facility4 7#b7 ,failure to implement requirements ,in the case of a determination by the ,secretary that a ,state has failed to substantially enforce the requirements specified in paragraph 7#a7 with respect to applicable providers and facilities in the ,state1 the ,secretary shall enforce such requirements under subsection 7b7 insofar as they relate to violations of such requirements occurring in such ,state4 7b7 ,secretarial enforcement authority 7#a7 ,in general ,if a provider or facility is found to be in violation specified in subsection 7a77#a7 by the ,secretary1 the ,secretary may apply a civil monetary penalty with respect to such provider or facility in an amount not to exceed #aj1jjj per violation4 ,the provisions of subsections 7c71 7d71 7e71 7g71 7h71 7k71 and 7l7 of section #aabh;,a of the ,social ,security ,act shall apply to a civil monetary penalty or assessment under this subsection in the same manner as such provisions apply to a penalty1 assessment1 or proceeding under subsection 7a7 of such section4 7#b7 ,limitation ,the provisions of paragraph 7#a7 shall apply to enforcement of a provision 7or provisions7 specified in subsection 7a77#a7 only as provided under subsection 7a77#b74 7#c7 ,complaint process ,the ,secretary shall1 through rulemaking1 establish a process to receive consumer complaints of violations of such provisions and resolve such complaints within #fj days of receipt of such complaints4 7#d7 ,exception ,the ,secretary shall waive the penalties described under paragraph 7#a7 with respect to a facility or provider who does not knowingly violate1 and should not have reasonably known it violated1 section #bgii or #bgii;,a with respect to a participant1 beneficiary1 or enrollee1 if such facility or practitioner1 within #cj days of the violation1 withdraws the bill that was in violation of such provision and reimburses the health plan or enrollee1 as applicable1 in an amount equal to the difference between the amount billed and the amount allowed to be billed under the provision1 plus interest1 at an interest rate determined by the ,secretary4 7#e7 ,hardship exemption ,the ,secretary may establish a hardship exemption to the penalties under this subsection4 7c7 ,continued ,applicability of ,state ,law ,the sections specified in subsection 7a77#a7 shall not be construed to supersede any provision of ,state law which establishes1 implements1 or continues in effect any requirement or prohibition except to the extent that such requirement or prohibition prevents the application of a requirement or prohibition of such a section4 4 7e7 ,rulemaking for median contracted rates ,not later than ,july #a1 #bjbj1 the ,secretary of ,health and ,human ,services1 jointly with the ,secretary of ,labor1 shall establish through rulemaking-- 7#a7 the methodology the sponsor or issuer of a health plan 7as defined in subsection 7e7 of section #bgai;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ai;a71 as added by subsection 7b7 of this section7 shall use to determine the median contracted rate 7as defined in section #bgai;,a7b7 of such ,act1 as amended by subsection 7a7 of this section71 differentiating by business line2 7#b7 the information such sponsor or issuer shall share with the nonparticipating provider 7as defined in such section7 involved when making such a determination2 and 7#c7 the geographic regions applied for purposes of subparagraph 7,e7 of section #bgai;,a7b77#c71 as amended by subsection 7a7 of this section1 taking into account the needs of rural and underserved areas1 including health professional shortage areas4 ,such rulemaking shall take into account payments that are made by such sponsor or issuer that are not on a fee-for-service basis4 ,such methodology may account for relevant payment adjustments that take into account facility type 7including higher acuity settings and the case-mix of various facility types7 that are otherwise taken into account for purposes of determining payment amounts with respect to participating facilities4 7f7 ,effective date ,the amendments made by subsections 7a7 and 7b7 shall apply with respect to plan years beginning on or after ,january #a1 #bjba4 #djc4 ,government ,accountability ,office study on profit- and revenue-sharing in health care 7a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study to-- 7#a7 describe what is known about profit- and revenue-sharing relationships in the commercial health care markets1 including those relationships that-- 7,a7 involve one or more-- 7i7 physician groups that practice within a hospital included in the profit- or revenue-sharing relationship1 or refer patients to such hospital2 7ii7 laboratory1 radiology1 or pharmacy services that are delivered to privately insured patients of such hospital2 7iii7 surgical services2 7iv7 hospitals or group purchasing organizations2 or 7v7 rehabilitation or physical therapy facilities or services2 and 7,b7 include revenue- or profit-sharing whether through a joint venture1 management or professional services agreement1 or other form of gain-sharing contract2 7#b7 describe ,federal oversight of such relationships1 including authorities of the ,department of ,health and ,human ,services and the ,federal ,trade ,commission to review such relationships and their potential to increase costs for patients1 and identify limitations in such oversight2 and 7#c7 as appropriate1 make recommendations to improve ,federal oversight of such relationships4 7b7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall prepare and submit a report on the study conducted under subsection 7a7 to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,education and ,labor and ,committee on ,energy and ,commerce of the ,house of ,representatives4 #djd4 ,state ,all ,payer ,claims ,databases 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall make one-time grants to eligible ,states for the purposes described in subsection 7b74 7b7 ,uses ,a ,state may use a grant received under subsection 7a7 for one of the following purposes3 7#a7 ,to establish an ,all ,payer ,claims ,database for the ,state4 7#b7 ,to maintain an existing ,all ,payer ,claims ,databases for the ,state4 7c7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 a ,state shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary specifies4 ,such information shall include1 with respect to an ,all ,payer ,claims ,database for the ,state1 at least specifics on how the ,state will ensure uniform data collection through the database and the security of such data submitted to and maintained in the database4 7d7 ,all ,payer ,claims ,database ,for purposes of this section1 the term ,all ,payer ,claims ,database means1 with respect to a ,state1 a ,state database that may include medical claims1 pharmacy claims1 dental claims1 and eligibility and provider files1 which are collected from private and public payers4 7e7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated #ej1jjj1jjj1 to remain available until expended4 #dje4 ,air ambulance cost data reporting program 7a7 ,cost data reporting program 7#a7 ,in general ,not later than #f months after the date of the promulgation of the rule under subsection 7c71 and annually thereafter1 a provider of emergency air medical services shall submit to the ,secretary of ,health and ,human ,services the information specified in subsection 7b7 with respect to the preceding #ahj-;day period 7in the case of the initial period7 and the preceding #a-year period 7in each subsequent period74 7#b7 ,publication ,not later than #ahj days after the date the ,secretary of ,health and ,human ,services receives from a provider described in paragraph 7#a7 the information specified in subsection 7b71 the ,secretary shall make publicly available such information4 7b7 ,specified information ,information described in subsection 7a7 is-- 7#a7 information1 with respect to a claim for an item or service-- 7,a7 identified as paid by health insurance coverage offered in the group or individual market or a group health plan 7including a self-insured plan72 7,b7 identified as paid for non-emergent transport requiring prior authorization and emergent transport2 7,c7 identified as paid for hospital-affiliated providers and independent providers2 7,d7 identified as paid for rural transport and urban transport2 7,e7 identified as provided using rotor transport and fixed wing transport2 and 7,f7 identified as furnished by a provider of emergency air medical services that has a contractual relationship with the plan or coverage of an individual for which such item or service is provided and such a provider that does not have a contractual relationship with the plan or coverage or such an individual2 and 7#b7 cost data for an air ambulance service furnished by such a provider of emergency air medical services that the ,secretary of ,health and ,human ,services1 in consultation with suppliers and providers of such services1 determines appropriate1 separated by the cost of air travel and the cost of emergency medical services and supplies4 7c7 ,rulemaking ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall determine the form and manner for submitting the information described in subsection 7b7 through notice and comment rulemaking4 7d7 ,civil monetary penalties 7#a7 ,in general ,a provider of emergency air medical services who violates the requirements of subsection 7a77#a7 shall be subject to a civil monetary penalty of not more than #aj1jjj for each act constituting such violation4 7#b7 ,procedure ,the provisions of section #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a71 other than subsections 7a7 and 7b7 and the first sentence of subsection 7c77#a7 of such subsection1 shall apply to civil monetary penalties under this subsection in the same manner as such provisions apply to a penalty or proceeding under such section4 7e7 ,reporting 7#a7 ,secretary of ,health and ,human ,services ,not later than ,july #a1 #bjbc1 the ,secretary of ,health and ,human ,services shall submit to ,congress a report summarizing the information and data specified in subsection 7b74 7#b7 ,comptroller ,general ,not later than ,july #a1 #bjbc1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report that includes-- 7,a7 an analysis of the cost variation of providers of emergency air ambulance services by geography and status2 and 7,b7 any other recommendations the ,comptroller ,general determines appropriate1 which may include a recommendation of an adequate amount of reimbursement for such services that reflects operational costs of such providers in order to preserve access to emergency air ambulance services4 7f7 ,limitation ,the information publicly disclosed under subsection 7a7 and the reports under subsection 7f7 may not contain any proprietary information4 #djf4 ,report by ,secretary of ,labor ,not later than one year after the date of the enactment of this ,act1 and annually thereafter for each of the following #e years1 the ,secretary of ,labor shall-- 7#a7 conduct a study of-- 7,a7 the effects of the provisions of1 including amendments made by1 this ,act on premiums and out-of-pocket costs in group health plans1 including out-of-pocket costs that are permitted by reason of compliance with section #bgii;,a7d7 of the ,public ,health ,service ,act1 as added by section #b7;d72 7,b7 the adequacy of provider networks in group health plans2 and 7,c7 such other effects of such provisions1 and amendments1 as the ,secretary deems relevant2 and 7#b7 submit a report on such study to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,education and ,labor and the ,committee on ,energy and ,commerce of the ,house of ,representatives4 #djg4 ,billing statute of limitations ,notwithstanding any other provision of law1 a health care provider or health care facility 7or health insurance issuer offering health insurance coverage or group health plan7 may not initiate a process to seek reimbursement from an individual for a service furnished by such provider or facility to such individual more than a year after such date of service4 ,any provider1 facility1 issuer1 or plan that bills an individual in violation of the previous sentence shall be subject to a civil monetary penalty in such amount as specified by the ,secretary of ,health and ,human ,services4 #djh4 ,,gao report on impact of surprise billing provisions ,not later than #c years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report containing the following3 7#a7 ,what is known about the impacts of the provisions of this ,act1 including the amendments made by this ,act1 on the incidence and prevalence of the furnishing of items and services to individuals enrolled under a group health plan or health insurance coverage by health care providers and health care facilities that do not have a contractual relationship with such plan or such coverage 7as applicable7 for furnishing such items and services to such an individual4 7#b7 ,what is known about such impacts on provider shortages and accessibility to such providers1 focusing on rural and medically underserved communities4 7#c7 ,the number of grants that have been awarded under section #djd 7relating to ,state ,all ,payer ,claims ,databases7 and for what purposes ,states have used funds made available under such grants4 7#d7 ,an analysis of how data made available through ,state ,all ,payer ,claims ,databases receiving funding under such grants has been used4 #dji4 ,report by the ,secretary of ,health and ,human ,services ,not later than one year after the date of the enactment of this ,act1 and annually thereafter for each of the following #e years1 the ,secretary of ,health and ,human ,services shall-- 7#a7 conduct a study of-- 7,a7 the effects of the provisions of1 including amendments made by1 this ,act on premiums and out-of-pocket costs with respect to individual health insurance coverage and small group health plans2 7,b7 the adequacy of provider networks with respect to individual health insurance coverage and small group health plans1 taking into consideration maximum travel time and distance2 and 7,c7 such other effects of such provisions1 and amendments1 as the ,secretary deems relevant2 and 7#b7 submit a report on such study to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,education and ,labor and the ,committee on ,energy and ,commerce of the ,house of ,representatives4 ,v ,territories ,health ,care ,improvement ,act #eja4 ,short title ,this title may be cited as the ,territories ,health ,care ,improvement ,act4 #ejb4 ,medicaid payments for ,puerto ,rico and the other territories for certain fiscal years 7a7 ,treatment of cap ,section #aajh7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;g77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 in the matter preceding subparagraph 7,a71 by striking subject to and section #acbc7;a77#b7 of the ,patient ,protection and ,affordable ,care ,act paragraphs 7#c7 and 7#e7 and inserting subject to section #acbc7;a77#b7 of the ,patient ,protection and ,affordable ,care ,act and paragraphs 7#c7 and 7#e72 7,b7 in subparagraph 7,a7-- 7i7 by striking ,puerto ,rico shall not exceed the sum of and inserting ,puerto ,rico shall not exceed-- 7i7 except as provided in clause 7ii71 the sum of 2 7ii7 by striking #ajj1jjj2 and inserting #ajj1jjj2 and2 and 7iii7 by adding at the end the following new clause3 7ii7 for each of fiscal years #bjbj through #bjbc1 the amount specified in paragraph 7#f7 for each such fiscal year2 2 7,c7 in subparagraph 7,b7-- 7i7 by striking the ,virgin ,islands shall not exceed the sum of and inserting the ,virgin ,islands shall not exceed-- 7i7 except as provided in clause 7ii71 the sum of 2 7ii7 by striking #aj1jjj2 and inserting #aj1jjj2 and2 and 7iii7 by adding at the end the following new clause3 7ii7 for each of fiscal years #bjbj through #bjbe1 #abf1jjj1jjj2 2 7,d7 in subparagraph 7,c7-- 7i7 by striking ,guam shall not exceed the sum of and inserting ,guam shall not exceed-- 7i7 except as provided in clause 7ii71 the sum of 2 7ii7 by striking #aj1jjj2 and inserting #aj1jjj2 and2 and 7iii7 by adding at the end the following new clause3 7ii7 for each of fiscal years #bjbj through #bjbe1 #abg1jjj1jjj2 2 7,e7 in subparagraph 7,d7-- 7i7 by striking the ,northern ,mariana ,islands shall not exceed the sum of and inserting the ,northern ,mariana ,islands shall not exceed-- 7i7 except as provided in clause 7ii71 the sum of 2 and 7ii7 by adding at the end the following new clause3 7ii7 for each of fiscal years #bjbj through #bjbe1 #fj1jjj1jjj2 and 2 and 7,f7 in subparagraph 7,e7-- 7i7 by striking ,american ,samoa shall not exceed the sum of and inserting ,american ,samoa shall not exceed-- 7i7 except as provided in clause 7ii71 the sum of 2 7ii7 by striking #aj1jjj4 and inserting #aj1jjj2 and2 and 7iii7 by adding at the end the following new clause3 7ii7 for each of fiscal years #bjbj through #bjbe1 #hd1jjj1jjj4 2 and 7#b7 by adding at the end the following new paragraph3 7#f7 ,application to ,puerto ,rico for fiscal years #bjbj through #bjbc ,for purposes of paragraph 7#b77;,a77ii71 the amount specified in this paragraph is-- 7,a7 for fiscal year #bjbj1 #b1hbc1ahh1jjj2 7,b7 for fiscal year #bjba1 #b1iai1jgb1jjj2 7,c7 for fiscal year #bjbb1 #c1jab1faj1jjj2 and 7,d7 for fiscal year #bjbc1 #c1aad1cca1jjj4 4 7b7 ,treatment of funding under enhanced allotment program ,section #aice7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#e7;e77 is amended-- 7#a7 in paragraph 7#a77;,b71 by striking if the ,state and inserting subject to paragraph 7#d71 if the ,state2 7#b7 by redesignating paragraph 7#d7 as paragraph 7#e72 and 7#c7 by inserting after paragraph 7#c7 the following new paragraph3 7#d7 ,treatment of funding for certain fiscal years 7,a7 ,puerto ,rico ,notwithstanding paragraph 7#a77;,b71 in the case that ,puerto ,rico establishes and submits to the ,secretary a plan described in paragraph 7#b7 with respect to any of fiscal years #bjbj through #bjbc1 the amount specified in paragraph 7#c7 for ,puerto ,rico for such a year shall be taken into account in applying subparagraph 7,a77ii7 of section #aajh7;g77#b7 for such year4 7,b7 ,other territories ,notwithstanding paragraph 7#a77;,b71 in the case that the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa establishes and submits to the ,secretary a plan described in paragraph 7#b7 with respect to any of fiscal years #bjbj through #bjbe1 the amount specified in paragraph 7#c7 for the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa1 as the case may be1 shall be taken into account in applying1 as applicable1 subparagraph 7,b77ii71 7,c77ii71 7,d77ii71 or 7,e77ii7 of section #aajh7;g77#b7 for such year4 4 7c7 ,increased ,,fmap ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended-- 7#a7 in subsection 7b71 by striking and 7aa7 and inserting 7aa71 and 7ff72 and 7#b7 by adding at the end the following new subsection3 7ff7 ,temporary increase in ,,fmap for territories for certain fiscal years 7#a7 ,puerto ,rico ,notwithstanding subsection 7b7 and subject to subsection 7z77#b71 the ,federal medical assistance percentage for ,puerto ,rico shall be equal to-- 7,a7 #hc percent for fiscal years #bjbj and #bjba2 and 7,b7 #gf percent for fiscal years #bjbb and #bjbc4 7#b7 ,virgin ,islands ,notwithstanding subsection 7b7 and subject to subsection 7z77#b71 the ,federal medical assistance percentage for the ,virgin ,islands shall be equal to-- 7,a7 #ajj percent for fiscal year #bjbj2 7,b7 #hc percent for fiscal years #bjba through #bjbd2 and 7,c7 #gf percent for fiscal year #bjbe4 7#c7 ,other territories ,notwithstanding subsection 7b7 and subject to subsection 7z77#b71 the ,federal medical assistance percentage for ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa shall be equal to-- 7,a7 #ajj percent for fiscal years #bjbj and #bjba2 7,b7 #hc percent for fiscal years #bjbb through #bjbd2 and 7,c7 #gf percent for fiscal year #bjbe4 4 7d7 ,annual report ,section #aajh7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;g771 as amended by subsection 7a71 is further amended by adding at the end the following new paragraph3 7#g7 ,annual report 7,a7 ,in general ,not later than the date that is #ahj days after the end of each fiscal year 7beginning with fiscal year #bjbj and ending with fiscal year #bjbe71 in the case that a specified territory receives a ,medicaid cap increase1 or an increase in the ,federal medical assistance percentage for such territory under section #aije7;ff71 for such fiscal year1 such territory shall submit to the ,chair and ,ranking ,member of the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,chair and ,ranking ,member of the ,committee on ,finance of the ,senate a report that describes how such territory has used such ,medicaid cap increase1 or such increase in the ,federal medical assistance percentage1 as applicable1 to increase access to health care under the ,state ,medicaid plan of such territory under title ,,xix 7or a waiver of such plan74 ,such report may include-- 7i7 the extent to which such territory has1 with respect to such plan 7or waiver7-- 7,i7 increased payments to health care providers2 7,,ii7 increased covered benefits2 7,,iii7 expanded health care provider networks2 or 7,,iv7 improved in any other manner the carrying out of such plan 7or waiver72 and 7ii7 any other information as determined necessary by such territory4 7,b7 ,definitions ,in this paragraph3 7i7 ,medicaid cap increase ,the term ,medicaid cap increase means1 with respect to a specified territory and fiscal year1 any increase in the amounts otherwise determined under this subsection for such territory for such fiscal year by reason of the amendments made by section #ejb7;a7 of the ,territories ,health ,care ,improvement ,act4 7ii7 ,specified territory ,the term specified territory means ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa4 4 #ejc4 ,application of certain requirements under ,medicaid program to certain territories 7a7 ,application of payment error rate measurement requirements to ,puerto ,rico ,section #aijc7u77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7u77#d77 is amended-- 7#a7 by striking to ,puerto ,rico1 ,guam and inserting to ,guam2 and 7#b7 by striking or ,american ,samoa4 and inserting or ,american ,samoa1 or1 for fiscal years before fiscal year #bjbc1 to ,puerto ,rico44 7b7 ,application of asset verification program requirements to ,puerto ,rico and ,virgin ,islands ,section #aidj7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifw7a77 is amended-- 7#a7 in paragraph 7#c77;,a71 by adding at the end the following new clause3 7iii7 ,implementation in ,puerto ,rico and ,virgin ,islands ,the ,secretary shall require ,puerto ,rico to implement an asset verification program under this subsection by the end of fiscal year #bjbb and the ,virgin ,islands to implement such a program by the end of fiscal year #bjbc4 2 and 7#b7 in paragraph 7#d7-- 7,a7 in the paragraph heading1 by striking ,exemption of territories and inserting ,exemption of certain territories2 and 7,b7 by striking and the ,district of ,columbia and inserting 1 the ,district of ,columbia1 ,puerto ,rico1 and the ,virgin ,islands4 7c7 ,application of certain data reporting and program integrity requirements to ,northern ,mariana ,islands1 ,american ,samoa1 and ,guam 7#a7 ,in general ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended by adding at the end the following new subsection3 7qq7 ,application of certain data reporting and program integrity requirements to ,northern ,mariana ,islands1 ,american ,samoa1 and ,guam ,not later than ,october #a1 #bjbc1 the ,northern ,mariana ,islands1 ,american ,samoa1 and ,guam shall-- 7#a7 implement methods1 satisfactory to the ,secretary1 for the collection and reporting of reliable data to the ,transformed ,medicaid ,statistical ,information ,system 7,t-,,msis7 7or a successor system72 and 7#b7 demonstrate progress in establishing a ,state medicaid fraud control unit described in section #aijc7q74 4 7#b7 ,conforming amendment ,section #aijb7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is amended-- 7,a7 by striking or the requirement and inserting 1 the requirement2 and 7,b7 by inserting before the period at the end the following3 1 or the requirement under subsection 7qq77#a7 7relating to data reporting74 #ejd4 ,additional program integrity requirements 7a7 ,audit relating to fraud1 waste1 and abuse ,not sooner than the date that is one year after the date of the enactment of this ,act1 the ,inspector ,general of the ,department of ,health and ,human ,services 7referred to in this section as the ,inspector ,general7 shall conduct an audit of ,puerto ,rico with respect to any part of the administration of ,puerto ,rico's ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiver of such plan71 such as contracting protocols1 denials of care1 and financial management1 that the ,inspector ,general determines to be at high risk for waste1 fraud1 or abuse4 7b7 ,plan for audits and investigations of contracting practices ,not later than the date that is one year after the date of the enactment of this ,act1 the ,inspector ,general shall develop and submit to ,congress a plan for auditing and investigating contracting practices relating to ,puerto ,rico's ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiver of such plan74 7c7 ,report on contracting oversight and approval ,not later than the date that is two years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall issue1 and submit to the ,chair and ,ranking ,member of the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,chair and ,ranking ,member of the ,committee on ,finance of the ,senate1 a report on contracting oversight and approval with respect to ,puerto ,rico's ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiver of such plan74 ,such report shall-- 7#a7 examine-- 7,a7 the process used by ,puerto ,rico to evaluate bids and award contracts under such plan 7or waiver72 7,b7 which contracts are not subject to competitive bidding or requests for proposals under such plan 7or waiver72 and 7,c7 oversight by the ,centers for ,medicare ,medicaid ,services of contracts awarded under such plan 7or waiver72 and 7#b7 include any recommendations for ,congress1 the ,secretary of ,health and ,human ,services1 or ,puerto ,rico relating to changes that the ,inspector ,general determines necessary to improve the program integrity of such plan 7or waiver74 7d7 ,reevaluation of waivers of ,medicaid fraud control unit requirement ,not later than the date that is one year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall-- 7#a7 reevaluate any waiver approved 7and in effect as of the date of the enactment of this ,act7 for ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa under subsection 7a77#fa7 or subsection 7j7 of section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 with respect to the requirement to establish a ,state medicaid fraud control unit 7as described in section #aijc7q7 of such ,act 7#db ,u4,s4,c4 #acif;b7q772 and 7#b7 determine whether any such waiver should continue to be approved with respect to ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa1 respectively1 after ,october #a1 #bjbc4 7e7 ,system for tracking ,federal funding provided to ,puerto ,rico ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a71 as amended by section #ejc7;c71 is further amended by adding at the end the following new subsection3 7rr7 ,program integrity requirements for ,puerto ,rico 7#a7 ,system for tracking ,federal funding provided to ,puerto ,rico 7,a7 ,in general ,puerto ,rico shall establish and maintain a system for tracking any amounts paid by the ,federal ,government to ,puerto ,rico with respect to the ,state plan of ,puerto ,rico 7or a waiver of such plan74 ,under such system1 ,puerto ,rico shall ensure that information is available1 with respect to each quarter in a fiscal year 7beginning with the first quarter beginning on or after the date that is one year after the date of the enactment of this subsection71 on the following3 7i7 ,in the case of a quarter other than the first quarter of such fiscal year-- 7,i7 the total amount expended by ,puerto ,rico during any previous quarter of such fiscal year under the ,state plan of ,puerto ,rico 7or a waiver of such plan72 and 7,,ii7 a description of how such amount was so expended4 7ii7 ,the total amount that ,puerto ,rico expects to expend during the quarter under the ,state plan of ,puerto ,rico 7or a waiver of such plan71 and a description of how ,puerto ,rico expects to expend such amount4 7,b7 ,report to ,,cms ,for each quarter with respect to which ,puerto ,rico is required under subparagraph 7,a7 to ensure that information described in such subparagraph is available1 ,puerto ,rico shall submit to the ,administrator of the ,centers for ,medicare ,medicaid ,services a report on such information for such quarter4 7#b7 ,submission of documentation on contracts upon request ,puerto ,rico shall1 upon request1 submit to the ,administrator of the ,centers for ,medicare ,medicaid ,services all documentation requested with respect to contracts awarded under the ,state plan of ,puerto ,rico 7or a waiver of such plan74 4 ,amend the title so as to read3 ,a bill to reauthorize and extend funding for critical public health programs that improve access to health care and strengthen the health care workforce1 to extend provisions of the ,medicare program1 to strengthen the ,medicaid program in the territories1 to protect health care consumers from surprise billing practices1 and for other purposes44 ,december #ca1 #bjbj;,committee on ,transportation and ,infrastructure discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed