,i #aafth ,,congress #ast ,session ,h4 ,r4 #cejb ,,in ,,the ,,house ,,of ,,representatives ,june #bf1 #bjai,mr4 ,ruiz 7for himself1 ,mr4 ,bucshon1 ,mr4 ,morelle1 ,mr4 ,bera1 ,mr4 ,wenstrup1 ,ms4 ,shalala1 ,mr4 ,taylor1 ,mr4 ,david ,p4 ,roe of ,tennessee1 ,mr4 ,banks1 ,mr4 ,higgins of ,new ,york1 ,mr4 ,grijalva1 ,mr4 ,cisneros1 ,mr4 ,soto1 ,mr4 ,harris1 ,mr4 ,hudson1 ,ms4 ,schrier1 ,mr4 ,marshall1 ,mr4 ,dunn1 ,mr4 ,stivers1 ,mr4 ,des,jarlais1 ,mr4 ,burchett1 ,mr4 ,riggleman1 ,mr4 ,watkins1 ,mr4 ,joyce of ,pennsylvania1 ,mr4 ,smucker1 ,ms4 ,stefanik1 ,mr4 ,thompson of ,pennsylvania1 ,mr4 ,wright1 ,mr4 ,norcross1 ,mrs4 ,lowey1 ,mr4 ,crdenas1 ,mr4 ,de,saulnier1 and ,ms4 ,kelly of ,illinois7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 ,oversight and ,reform1 and ,education and ,labor1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend the ,public ,health ,service ,act and title ,,xi of the ,social ,security ,act to protect health care consumers from surprise billing practices1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,protecting ,people ,from ,surprise ,medical ,bills ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,preventing surprise medical bills4 ,sec4 #c4 ,transparency regarding in-network and out-of-network deductibles4 ,sec4 #d4 ,transparency for in-network patients4 ,sec4 #e4 ,reporting requirements4 ,sec4 #f4 ,billing statute of limitations4 ,sec4 #g4 ,application4 ,sec4 #h4 ,studies by ,secretaries of ,health and ,human ,services and of ,labor4 ,sec4 #i4 ,regulations4 #b4 ,preventing surprise medical bills 7a7 ,emergency services performed by nonparticipating providers ,section #bgai;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ai;a7 is amended-- 7#a7 in subsection 7b7-- 7,a7 in paragraph 7#a7-- 7i7 in the matter preceding subparagraph 7,a7-- 7,i7 by striking offering group or individual health insurance issuer and inserting offering group or individual health insurance coverage2 and 7,,ii7 by striking paragraph 7#b77;,b7 and inserting paragraph 7#b72 7ii7 in subparagraph 7,b71 by inserting or a participating emergency facility1 as applicable1 after participating provider2 and 7iii7 in subparagraph 7,c7-- 7,i7 in the matter preceding clause 7i71 by inserting by a nonparticipating provider or a nonparticipating emergency facility after enrollee2 7,,ii7 by striking clause 7i72 7,,iii7 by striking 7ii77,i7 such services and inserting 7i7 such services2 7,,iv7 by striking where the provider of services does not have a contractual relationship with the plan for the providing of services2 7,v7 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 7,,vi7 by striking 7,,ii7 if such services and all that follows through were provided in-network and inserting the following3 7ii7 the cost-sharing requirement 7expressed as a copayment amount1 coinsurance rate1 or deductible7 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 7,,vii7 by adding at the end the following new clauses3 7iii7 the group health plan or health insurance issuer offering group or individual health insurance coverage pays to such provider or facility1 respectively1 subject to subsection 7f71 the amount by which the commercially reasonable rate1 as determined by the plan or issuer1 for such services exceeds the cost-sharing amount for such services 7as determined in accordance with clause 7ii7 and1 if applicable1 any amount to reconcile the difference between such rate so paid and the specified rate determined under subsection 7f77#a77 for such services2 and 7iv7 there shall be counted toward any deductible or out-of-pocket maximums applied under the plan any cost-sharing payments made by the participant1 beneficiary1 or enrollee with respect to such emergency services so furnished 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 facility4 2 and 7,b7 in paragraph 7#b7-- 7i7 in the matter preceding subparagraph 7,a71 by inserting and subsection 7e7 after this subsection2 7ii7 by redesignating subparagraph 7,c7 as subparagraph 7,h72 and 7iii7 by inserting after subparagraph 7,c7 the following subparagraphs3 7,d7 ,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 group health plan or health insurance coverage offered by a health insurance issuer1 an emergency department of a hospital or an independent freestanding emergency department1 that does not have a contractual relationship with the plan or coverage for furnishing such item or service4 7ii7 ,participating emergency facility ,the term participating emergency facility means1 with respect to an item or service and a group health plan or health insurance coverage offered by a health insurance issuer1 an emergency department of a hospital or an independent freestanding emergency department1 that has a contractual relationship with the plan or coverage for furnishing such item or service4 7,e7 ,nonparticipating providers2 participating providers 7i7 ,nonparticipating provider ,the term nonparticipating provider means1 with respect to an item or service and a group health plan or health insurance coverage offered by a health insurance issuer1 a physician or other health professional who is licensed by the ,state involved to furnish such item or service and who does not have a contractual relationship with the plan or coverage for furnishing such item or service4 7ii7 ,participating provider ,the term participating provider means1 with respect to an item or service and a group health plan or health insurance coverage offered by a health insurance issuer1 a physician or other health professional who is licensed by the ,state involved to furnish such item or service and who has a contractual relationship with the plan or coverage for furnishing such item or service4 4 7b7 ,non-,emergency services performed by nonparticipating providers at certain participating facilities ,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 subsection3 7e7 ,non-,emergency services performed by nonparticipating providers at certain participating facilities 7#a7 ,in general ,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#b77;,g77 during a visit at a participating health care facility 7as defined in paragraph 7#b77;,b77 7including imaging or laboratory services so furnished by a nonparticipating provider when ordered by a participating provider or after-emergency care furnished by a nonparticipating provider in the case that the participant1 beneficiary1 or enrollee cannot travel without medical transport71 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 provider2 7,b7 shall pay to such provider furnishing such items and services to such participant1 beneficiary1 or enrollee1 subject to subsection 7f71 the amount by which the commercially reasonable rate1 as determined by the plan or issuer1 for such services exceeds the cost-sharing amount imposed for such services 7as determined in accordance with subparagraph 7,a77 and1 if applicable1 any amount to reconcile the difference between such rate so paid and the specified rate 7determined under subsection 7f77#a77 for such services2 and 7,c7 shall count toward any deductible or out-of-pocket maximums applied under the plan any cost-sharing payments made by the participant1 beneficiary1 or enrollee 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 7f73 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 market4 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 group health plan or health insurance coverage offered by a health insurance issuer1 a health care facility described in clause 7ii7 that has a contractual relationship with the plan or coverage 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 or imaging center4 7,,vi7 ,any other facility that provides services that are covered under a group health plan or health insurance coverage4 7,,vii7 ,any other facility specified by the ,secretary4 4 7c7 ,negotiation and arbitration process for determining prices ,section #bgai;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ai;a71 as amended by subsection 7b71 is further amended by adding at the end the following new subsection3 7f7 ,negotiation and arbitration process 7#a7 ,specified amount ,for purposes of subsections 7b7 and 7e7 and this subsection1 the specified amount determined under this subsection1 with respect to a health plan and nonparticipating provider for an item or service1 is-- 7,a7 in the case the plan and provider enter into negotiations pursuant to paragraph 7#b7 and such negotiations are successful1 the amount determined for such item or service pursuant to such negotiations2 or 7,b7 in the case the plans and provider enter into such negotiations but such negotiations are not successful1 the reasonable amount determined for such item or service pursuant to the independent dispute resolution process under paragraph 7#c74 7#b7 ,negotiations ,for purposes of subsections 7b77#a77;,c77iii7 and 7e77#a77;,b71 in the case of a payment of a commercially reasonable rate made by a health plan to a nonparticipating provider pursuant to such respective subsection for an item or service1 the provider and plan may1 not later than #cj days after the date of such payment1 negotiate an amount of payment 7other than the commercially reasonable rate specified in such subsection7 to be made for such item or service4 7#c7 ,independent dispute resolution 7,a7 ,in general ,if1 by the end of such #cj-;day period specified in paragraph 7#b71 the plan and provider have not determined a negotiated amount for the payment involved1 the plan or provider may initiate an independent dispute resolution process under this paragraph to determine the amount of payment4 7,b7 ,establishment of ,,idr 7i7 ,in general ,not later than ,january #a1 #bjba1 the ,secretary1 in consultation with the ,secretary of ,labor1 shall establish a process for resolving payment disputes between health plans and nonparticipating providers for purposes of determining amounts of payments to be made by the plans to the providers pursuant to subsections 7b7 and 7e7 7referred to in this section as the ,,idr process74 7ii7 ,entities ,an entity wishing to participate in the ,,idr process under this subsection shall request certification from the ,secretary4 ,the ,secretary1 in consultation with the ,secretary of ,labor1 shall determine eligibility of applicant entities1 taking into consideration whether the entity is unbiased and unaffiliated with health plans and providers and free of conflicts of interest1 in accordance with the ,secretary's rulemaking on determining criteria for conflicts of interest4 7iii7 ,applicable claims 7,i7 ,in general ,the ,,idr process shall be with respect to one or more ,current ,procedural ,terminology 7,,cpt7 codes4 7,,ii7 ,batching of claims ,claims may be batched if such claims-- 7aa7 involve identical plan or issuer and provider or facility parties2 7bb7 involve claims with the same or related current procedural terminology codes relevant to a particular procedure2 and 7cc7 involve claims that occur within #fj days of each other4 7,c7 ,independent dispute resolution process 7i7 ,timing ,in the case of an ,,idr entity that receives a request under this paragraph1 with respect to a payment amount to be paid by a health plan to a nonparticipating provider-- 7,i7 the plan and provider may1 during the #cj-;day period following the date of receipt of such request1 submit any information or supporting documentation to the ,,idr entity2 and 7,,ii7 the ,,idr entity shall1 not later than #fj days after receiving such request1 determine such amount4 7ii7 ,determination of amount 7,i7 ,in general ,the amount determined by the ,,idr entity under clause 7i71 with respect to a payment amount to be paid by a health plan to a nonparticipating provider for an item or service shall be-- 7aa7 the initial charge for the item or service made by the provider or the commercially reasonable rate paid by the plan for the item or service under subsections 7b77#a77;,c77iii7 or 7e77#a77;,b71 respectively1 whichever is determined reasonable by the entity based on the factors described in subclause 7,,iii72 or 7bb7 in the case neither such charge or such rate is determined by the entity to be reasonable1 the final offer submitted under subclause 7,,ii7 that is determined more reasonable in accordance with such subclause4 7,,ii7 ,final offers ,for purposes of subclause 7,i77bb71 the health plan and the nonparticipating provider party to the independent dispute resolution under this paragraph shall each submit to the ,,idr entity their final offer for an amount for the payment that is subject to the dispute not later than #cj days after the ,,idr entity determines under such subclause that neither the charge or rate described in subclause 7,i77aa7 were reasonable4 ,not later than #fj days after such date of such determination1 such entity shall determine which of the #b final offers is more reasonable based on the factors described in subclause 7,,iii74 7,,iii7 ,factors ,for purposes of subclauses 7,i7 and 7,,ii71 the factors described in this subclause include1 as relevant-- 7aa7 commercially reasonable rates for comparable services or items in the same geographic area 7which shall take into consideration in-network rates for that geographic area and not charges72 7bb7 the usual and customary cost of the item or service involved1 determined as the #hjth percentile of charges for comparable items and services for the specialty involved in the geographical area in which the item or service was furnished1 as determined through reference to a medical claims database2 7cc7 other factors that may be submitted at the discretion of either party1 which may include-- 7dd7 the level of training1 education1 experience1 and quality and outcomes measurements of the nonparticipating provider2 7ee7 the circumstances and complexity of the particular dispute1 including the time and place of the service2 7ff7 the provider's quality and outcome metrics2 7gg7 the provider's usual charge for comparable services with regard to patients in health care plans in which the provider is not participating2 7hh7 the individual patient characteristics2 and 7ii7 other relevant economic and clinical factors4 7,,iv7 ,final decisions ,the amount that is determined to be the more reasonable amount under item 7aa7 or 7bb7 of subclause 7,i71 as applicable1 shall be the final decision of the ,,idr entity as to the amount the health plan is required to pay the provider4 7,v7 ,effect of determination ,a final determination of an ,,idr entity under subclause 7,,iv7-- 7aa7 shall be binding2 and 7bb7 shall not be subject to judicial review1 except in cases comparable to those described in section #aj7;a7 of title #i1 ,united ,states ,code1 as determined by the ,secretary in consultation with the ,secretary of ,labor1 and cases in which information submitted by one party was determined to be fraudulent4 7iii7 ,privacy laws ,an ,,idr entity shall1 in conducting an independent dispute resolution process under this paragraph1 comply with all applicable ,federal and ,state privacy laws4 7iv7 ,public availability ,the reasonable amount determined by an ,,idr entity under this paragraph with respect to any claim shall not be confidential1 except that information submitted to the ,,idr entity shall be kept confidential4 ,,idr entities may consider past decisions awarded by independent dispute entities during the independent dispute resolution process4 7v7 ,costs of independent dispute resolution process ,the nonprevailing party shall be responsible for paying all fees charged by the ,,idr entity4 ,if the parties reach a settlement prior to completion of the ,,idr process1 the costs of the independent dispute resolution process shall be divided equally between the parties4 7vi7 ,payment ,any difference between-- 7,i7 the amount determined to be paid by one party of the dispute resolution to another pursuant to this paragraph2 and 7,,ii7 the amounts already paid under subsection 7b7 or 7e7 before entering into the process under this paragraph1 shall be paid not later than #ae days after the date on which the entity makes a determination with respect to such amount4 7,d7 ,publication ,the ,secretary shall publish aggregated results of the independent dispute resolution by geographic region in order to give more guidance to providers and health plans4 4 7d7 ,preventing certain cases of balance billing ,section #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7 is amended by adding at the end the following new subsections3 7t7 7#a7 ,subject to paragraph 7#c71 in the case of an individual with benefits under a health plan or health insurance coverage offered in the group or individual market 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-- 7,a7 if the emergency department of a hospital holds the individual 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 section #bgai;,a7b77#a77;,c77ii7 of the ,public ,health ,service ,act72 or 7,b7 if any health care provider holds such individual 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 section #bgai;,a7b77#a77;,c77ii7 of the ,public ,health ,service ,act71 the hospital1 emergency department or health care provider1 respectively1 shall be subject1 in addition to any other penalties that may be prescribed by law1 to a civil money penalty of not more than an amount determined appropriate by the ,secretary for each specified claim4 7#b7 ,the provisions of subsections 7c71 7d71 7e71 7g71 7h71 7k71 and 7l7 shall apply to a civil money penalty or assessment under paragraph 7#a7 or subsection 7u7 in the same manner as such provisions apply to a penalty1 assessment1 or proceeding under subsection 7a74 7#c7 ,paragraph 7#a7 shall not apply to an emergency department of a hospital or a provider1 with respect to items or services furnished to a participant1 beneficiary1 or enrollee of a health plan or health insurance coverage offered by a health insurance issuer1 if the emergency department of the hospital or the provider1 respectively1 reimburses such participant1 beneficiary1 or enrollee any amount for such an item or service that is more than the cost-sharing amount for such item or service 7as determined in accordance with section #bgai;,a7e77#a77;,a77 not later than #cj days after the date the emergency department of the hospital or provider1 respectively1 knew or should have known such excess payment was in violation of this subsection4 7#d7 ,in this subsection and subsection 7u73 7,a7 ,the terms emergency medical condition and emergency services have the meanings given such terms1 respectively1 in section #bgai;,a7b77#b7 of the ,public ,health ,service ,act4 7,b7 ,the terms group health plan1 health insurance issuer1 and health insurance coverage have the meanings given such terms1 respectively1 in section #bgia of the ,public ,health ,service ,act4 7u7 7#a7 ,subject to paragraph 7#b71 in the case of an individual with benefits under a health plan or health insurance coverage offered in the group or individual market who is furnished on or after ,january #a1 #bjba1 items or services 7other than emergency services to which subsection 7t7 applies7 during an episode of care 7as defined by the ,secretary7 at a participating health care facility by a nonparticipating provider 7including imaging or laboratory services so furnished by a nonparticipating provider when ordered by a participating provider or after-emergency care furnished by a nonparticipating provider in the case that the participant1 beneficiary1 or enrollee cannot travel without medical transport71 if such nonparticipating provider holds such individual liable for a payment amount for such an item or service furnished by such provider that is more than the cost-sharing amount for such item or service 7as determined in accordance with section #bgai;,a7e77#a77;,a7 of the ,public ,health ,service ,act71 such provider shall be subject1 in addition to any other penalties that may be prescribed by law1 to a civil money penalty of not more than an amount determined appropriate by the ,secretary for each specified claim4 7#b7 ,paragraph 7#a7 shall not apply to a nonparticipating provider1 with respect to items or services furnished by the provider to a participant1 beneficiary1 or enrollee of a health plan or health insurance coverage offered by a health insurance issuer1 if the provider reimburses such participant1 beneficiary1 or enrollee any amount for such an item or service that is more than the cost-sharing amount for such item or service 7as determined in accordance with section #bgai;,a7e77#a77;,a77 not later than #cj days after the date the provider knew or should have known such excess payment was in violation of this subsection4 7#c7 ,for purposes of this subsection1 the terms nonparticipating provider and participating health care facility have such meanings given such terms under subsections 7b77#b7 and 7e77#b71 respectively1 of section #bgai;,a of the ,public ,health ,service ,act4 4 7e7 ,effective date ,the amendments made by this section shall apply with respect to plan years beginning on or after ,january #a1 #bjba4 #c4 ,transparency regarding in-network and out-of-network deductibles 7a7 ,in general ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is amended by adding at the end the following3 #bgbi;,a4 ,transparency regarding in-network and out-of-network deductibles 7a7 ,in general ,a group health plan or a health insurance issuer offering group or individual health insurance coverage and providing or covering any benefit with respect to items or services shall include1 in clear writing1 on any plan or insurance identification card issued to enrollees in the plan or coverage the amount of the in-network and out-of-network deductibles and the out-of-pocket maximum limitation that apply to such plan or coverage4 7b7 ,guidance ,the ,secretary1 in consultation with the ,secretary of ,labor1 shall issue guidance to implement subsection 7a74 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply with respect to plan years beginning on or after the date that is one year after the date of the enactment of this ,act4 #d4 ,transparency for in-network patients ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq471 as amended by section #c1 is further amended by adding at the end the following3 #bgbi;,b4 ,transparency for in-network patients 7a7 ,standards ,not later than ,january #a1 #bjba1 the ,secretary shall1 through rulemaking1 establish transparency standards to provide better information to individuals who are enrolled in group health plans or health insurance coverage offered in the individual or group market 7as such terms are defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia77 about which health care providers are participating in the network of the plan or coverage in which such an individual is enrolled4 ,such standards shall at a minimum provide for the following3 7#a7 ,such plans and coverage offer provider directories online and in print4 7#b7 ,annual audits of such provider directories1 as specified by the ,secretary4 7#c7 ,monthly updates of such online directories4 7b7 ,guidance ,beginning ,january #a1 #bjbb1 a group health plan or a health insurance issuer offering group or individual health insurance coverage shall be in compliance with the standards established pursuant to subsection 7a74 4 #e4 ,reporting requirements ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq471 as amended by sections #c and #d1 is further amended by adding at the end the following3 #bgbi;,c4 ,transparency requirements 7a7 ,in general ,each group health plan and health insurance issuer offering group or individual health insurance coverage shall annually report 7beginning for plan year #bjba7 to the ,secretary and the ,secretary of ,labor1 with respect to the applicable plan or coverage for the applicable plan year-- 7#a7 the total claims that were submitted by in-network health care providers with respect to enrollees under the plan or coverage1 and the number of such claims that were paid and the number of such claims that were denied2 7#b7 the total claims that were submitted by out-of-network health care providers with respect to enrollees under the plan or coverage1 and the number of such claims that were paid and the number of such claims that were denied2 7#c7 with respect to each out-of-network claim1 the out-of-pocket costs to the enrollee for the services2 7#d7 the number of out-of-network claims reported under paragraph 7#b7 that are for emergency services2 and 7#e7 the number of out-of-network claims reported under paragraph 7#b7 that relate to care at in-network hospitals or facilities provided by out-of-network providers4 7b7 ,clarification ,the information required to be submitted under this section shall be in addition to the information required to be submitted under section #bgae;,a4 4 #f4 ,billing statute of limitations ,notwithstanding any other provision of law1 a health care provider may not seek reimbursement from an individual for a service furnished by such provider to such individual more than a year after such date of service4 ,any provider 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 #g4 ,application 7a7 ,non-,application in cases of ,states with certain balance billing laws ,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 subsection3 7g7 ,in any case in which a ,state has in effect a law or regulation that prohibits balance billing or otherwise provides an alternate method for resolving a dispute between a health plan and provider for determining compensation for services described in subsections 7b71 7e71 or 7f71 the provisions of such law and not the provisions of this ,act shall apply to health plans 7except self-insured group health plans that are not subject to ,state insurance regulation71 health care providers1 and individuals in such ,state so long as such law does not require an individual to pay more in cost-sharing than the amount that would otherwise be required of such individual under this section4 4 7b7 ,application to ,,fehb 7#a7 ,in general ,section #hijb of title #e1 ,united ,states ,code1 is amended by adding at the end the following new subsection3 7p7 ,each contract under this chapter shall require the carrier to comply with requirements described in the provisions of subsections 7b71 7e71 and 7f7 of section #bgai;,a of the ,public ,health ,service ,act and sections #bgbi;,a and #bgbi;,b of such ,act in the same manner as those provisions apply to a groups health plan or health insurance issuer offering health insurance coverage1 as described in such sections4 4 7#b7 ,effective date ,the amendment made by this subsection shall apply with respect to contracts entered into or renewed for contract years beginning at least one year after the date of enactment of this ,act4 #h4 ,studies by ,secretaries of ,health and ,human ,services and of ,labor 7a7 ,impact study ,not later than #c years after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in consultation with the ,secretary of ,labor1 shall conduct a study of the effects of this ,act 7including the amendments made by this ,act71 and submit to ,congress 7and make public7 a report on the findings of such study1 which shall include information and analysis on-- 7#a7 the financial impact on patient responsibility for health care spending and overall health care spending2 7#b7 the incidence and prevalence of the delivery of unanticipated out-of-network health care services1 in the cases of emergency services and in the cases of care at in-network hospitals or facilities provided by out-of-network providers2 7#c7 the adequacy of provider networks offered by health plans and health insurance issuers 7as such terms are defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia772 7#d7 a comparison of the different claims databases used and the impact of using such databases on reimbursement rates2 7#e7 the number of bills that are settled through negotiations pursuant to subsection 7f77#b7 of section #bgai;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ai;a71 as added by section #b1 and the number of bills that go to the independent dispute resolution process under subsection 7f77#c7 of such section1 as so added2 7#f7 the administrative cost of such independent dispute resolution process2 and 7#g7 the estimated impact of such independent dispute resolution process on health insurance premiums and deductibles4 7b7 ,billing feasibility study ,not later than #c years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall conduct1 and submit to ,congress 7and make public71 a feasibility study on the provision of a single bill for all services provided for a single episode of care1 as defined by the ,secretary4 #i4 ,regulations ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,labor and the ,secretary of ,health and ,human ,services shall promulgate regulations pertaining to carry out the provisions 7including amendments made by7 this ,act4