,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #cghd  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #af1 #bjai,mr4  
,neguse introduc$ ! foll[+ bill2 :i* 0  
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce  ,a ,,bill  ,to am5d title     
,,xxvii ( ! ,public ,heal? ,s]vice ,act 
& title ,,xi ( ! ,social ,security ,act 
to prohibit surprise bill+ ) respect to 
air ambulance s]vices4  #a4 ,%ort title 
,?is ,act may be cit$ z ! ,air          
,ambulance ,af=dability ,act ( #bjai4   
#b4 ,prohibit+ surprise bill+ ) respect 
to air ambulance s]vices  7a7 ,air      
ambulance s]vices  7#a7 ,9 g5]al        
,section #bgai;,a ( ! ,public ,heal?    
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#ai;a7 is am5d$ by add+ at ! end
 ! foll[+ new subsections3  7e7 ,air    
ambulance s]vices  7#a7 ,9 g5]al        
,subject to p>agraph 7#b71 9 ! case (   
air ambulance s]vices furni%$ to a      
p>ticipant1 b5efici>y1 or enrollee ( a  
heal? plan 7z def9$ 9 p>agraph          
7#c77;,a77 by a nonp>ticipat+ provid] 7z

 def9$ 9 p>agraph 7#c77;,c771 ! plan--  
7,a7 %all n impose on su* p>ticipant1   
b5efici>y1 or enrollee a co/-%>+ am\nt  
7express$ z a copaym5t am\nt or         
co9surance rate7 = su* s]vices s furni%$
 t is great] ?an ! co/-%>+ am\nt t w\ld 
apply "u su* plan _h su* s]vices be5    
furni%$ by a p>ticipat+ provid]2  7,b7  
%all calculate su* co/-%>+ am\nt z if ! 
negotiat$ rate t w\ld h be5 *>g$ by su* 
p>ticipat+ provid] = su* s]vices 7 equal
 to ! am\nt det]m9$ 9 accordance )      
subsection 7f7 = su* s]vices 7or1 9 !   
case ( su* s]vices furni%$ 9 a ,/ate    
describ$ 9 p>agraph 7#c77;,e77i71 !     
am\nt det]m9$ by su* ,/ate = su* s]vices
 9 accordance ) ! me?od describ$ 9 su*  
p>agraph72  7,c7 %all pay to su* provid]
 furni%+ su* s]vices to su* p>ticipant1 
b5efici>y1 or enrollee ! am\nt by :i* ! 
recogniz$ am\nt 7z def9$ 9 p>agraph     
7#c77;,e77 = su* s]vices exce$s !       
co/-%>+ am\nt impos$ = su* s]vices 7z   
det]m9$ 9 accordance ) subp>agraphs 7,a7
 & 7,b772 &  7,d7 %all c\nt t[>d any    

d$uctible or out-(-pocket maximums      
appli$ "u ! plan any co/-%>+ paym5ts    
made by ! p>ticipant1 b5efici>y1 or     
enrollee ) respect to su* s]vices s     
furni%$ 9 ! same mann] z if su* co/-%>+ 
paym5ts 7 ) respect to s]vices furni%$  
by a p>ticipat+ provid]4  7#b7          
,exception = c]ta9 s]vices ,! provisions
 ( p>agraph 7#a7 %all n apply 9 ! case (
 air ambulance s]vices t-- 7,a7 are n   
furni%$ ) respect to an individual ) an 
em]g5cy m$ical condition 7z def9$ 9     
subsection 7b77#b77;,a772 &  7,b7 are   
furni%$ by a provid] t is 9 compliance )
 ! requirem5t ( section #aabh;,a7t77#c7 
( ! ,social ,security ,act ) respect to 
su* s]vices4  7#c7 ,def9itions ,9 ?is   
subsection & subsection 7f73 7,a7 ,heal?
 plan ,! t]m heal? plan means a gr\p    
heal? plan & heal? insurance cov]age    
(f]$ by a hea? insurance issu] 9 ! gr\p 
or individual m>ket4  7,b7 ,provid] ,!  
t]m provid] means a provid] ( s]vices or
 a suppli] 7z su* t]ms are def9$ 9      
section #ahfa ( ! ,social ,security     

,act74  7,c7 ,nonp>ticipat+ provid] ,!  
t]m nonp>ticipat+ provid] means1 )      
respect to air ambulance s]vices & a    
gr\p heal? plan or heal? insurance      
cov]age (f]$ by a heal? insurance issu]1
 a provid] or suppli] ( su* s]vices t is
 lic5s$ by ! ,/ate involv$ to furni% su*
 s]vices & t does n h a contractual     
relation%ip ) ! plan or cov]age =       
furni%+ su* s]vices4  7,d7 ,p>ticipat+  
provid] ,! t]m p>ticipat+ provid] means1
 ) respect to air ambulance s]vices & a 
gr\p heal? plan or heal? insurance      
cov]age (f]$ by a heal? insurance issu]1
 a provid] or suppli] ( su* s]vices t is
 lic5s$ by ! ,/ate involv$ to furni% su*
 s]vices & t has a contractual          
relation%ip ) ! plan or cov]age =       
s]vices4  7,e7 ,recogniz$ am\nt ,! t]m  
recogniz$ am\nt means1 ) respect to air 
ambulance s]vices-- 7i7 9 ! case ( su*  
s]vices furni%$ 9 a ,/ate t has 9 effect
 a ,/ate law t provides = a me?od =     
det]m9+ ! am\nt ( paym5t t is requir$ to
 be cov]$ by a heal? plan or heal?      

insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age regulat$ by su* 
,/ate 9 ! case ( a p>ticipant1          
b5efici>y1 or enrollee cov]$ "u su* plan
 or cov]age & receiv+ su* s]vices f a   
nonp>ticipat+ provid]1 n m ?an ! am\nt  
det]m9$ 9 accordance ) su* law plus !   
co/-%>+ am\nt impos$ = su* s]vices 7z   
det]m9$ 9 accordance ) p>agraph 7#a772  
or  7ii7 9 ! case ( su* s]vices furni%$ 
9 a ,/ate t does n h 9 effect su* a law1
 an am\nt det]m9$ 9 accordance ) !      
indep5d5t dispute resolution process    
e/abli%$ "u subsection 7f74  7f7        
,indep5d5t dispute resolution process   
7#a7 ,e/abli%m5t  7,a7 ,9 g5]al ,n lat] 
?an #a ye> aft] ! date ( ! enactm5t (   
?is subsection1 ! ,secret>y1 9          
consultation ) ! ,secret>y ( ,labor1    
%all e/abli% by regulation an indep5d5t 
dispute resolution process 7ref]r$ to 9 
?is subsection z ! ,,idr process7 "u :i*
 entities c]tifi$ "u p>agraph 7#b7 79   
?is subsection ref]r$ to z c]tifi$ ,,idr
 entities7 resolve specifi$ claims (    

nonp>ticipat+ provid]s or heal? plans1  
tak+ into acc\nt ! factors describ$ 9   
subp>agraph 7,c74 ,su* process %all     
prohibit su* an entity f p>ticipat+ 9 ! 
resolution ( su* a claim if su* entity  
has a conflict ( int]e/ ) respect to su*
 provid]1 facility1 or ! heal? plan     
involv$4  7,b7 ,specifi$ claim ,=       
purposes ( subp>agraph 7,a71 ! t]m      
specifi$ claim means a claim by a       
nonp>ticipat+ provid] or heal? plan t1 )
 respect to air ambulance s]vices       
furni%$ by su* provid] = :i* a heal?    
plan is requir$ to make paym5t pursuant 
to subsection 7e77#a71 is made "u !     
,,idr process n lat] ?an #cj days aft] !
 s]vices are furni%$4  7,c7 ,factors ,! 
factors describ$ 9 ?is subp>agraph      
include-- 7i7 comm]cially reasonable    
rates = comp>able s]vices furni%$ 9 !   
same geographic area 7:i* %all take into
 consid]ation 9-network rates = t       
geographic area & n *>ges72 &  7ii7 o!r 
factors t may be submitt$ at !          
discretion ( ei!r p>ty1 :i* may         

include-- 7,i7 ! level ( tra9+1         
education1 exp]i5ce1 & quality &        
outcomes measurem5ts ( ! provid]2       
7,,ii7 ! circum/ances & complexity ( !  
p>ticul> dispute1 includ+ ! "t & place (
 ! s]vice2  7,,iii7 ! m>ket %>e held by 
! provid] or t ( ! plan2  7,,iv7        
demon/ration ( good fai? ef=ts 7or lack 
( good fai? ef=ts7 made by ! provid] or 
! plan to contract = negotiat$ rates1 if
 applicable2 &  7,v7 o!r relevant       
economic aspects ( provid] reimbursem5t 
= ! same specialty )9 ! same geographic 
area4  7#b7 ,c]tification ( entities    
7,a7 ,process ( c]tification ,z "p ( !  
regulation describ$ 9 p>agraph 7#a71 !  
,secret>y1 9 consultation ) ! ,secret>y 
( ,labor1 %all e/abli% a c]tification   
process "u :i* eligible entities may be 
c]tifi$ to c>ry out ! ,,idr process4    
7,b7 ,eligibility ,= purposes (         
subp>agraph 7,a71 an eligible entity is 
an entity t is a nongov]nm5tal entity   
7su* z ! ,am]ican ,arbitration          
,association74  7#c7 ,selection (       

c]tifi$ ,,idr entity = a specifi$ claim 
,) respect to ! resolution ( a specifi$ 
claim "u ! ,,idr process1 ! heal? plan &
 ! nonp>ticipat+ provid] involv$ %all   
agree on a c]tifi$ ,,idr entity to      
resolve su* claim4 ,9 ! case t su* plan 
& su* provid] _c s agree1 su* an entity 
%all be select$ by ! ,secret>y at r&om4 
7#d7 ,paym5t det]m9ation  7,a7 ,tim+ ,a 
c]tifi$ ,,idr entity t receives a reque/
 f a nonp>ticipat+ provid] or heal? plan
 "u ?is subsection %all1 n lat] ?an #cj 
days aft] receiv+ su* reque/1 det]m9e ! 
am\nt ! heal? plan is requir$ to pay su*
 provid] or facility = s]vices describ$ 
9 p>agraph 7#a71 9 accordance )         
subp>agraph 7,c71 9 ! case t a settlem5t
 describ$ 9 subp>agraph 7,b7 is n rea*$4
  7,b7 ,settlem5t  7i7 ,9 g5]al ,if su* 
entity det]m9es t a settlem5t betwe5 !  
heal? plan & ! provid] is likely1 !     
entity may direct ! p>ties to attempt1 =
 a p]iod n to exce$ #aj days1 a good    
fai? negotiation = a settlem5t4  7ii7   
,tim+ ,! p]iod = a settlem5t describ$ 9 

clause 7i7 %all accrue t[>ds ! #cj-;day 
p]iod requir$ "u subp>agraph 7,a74  7,c7
 ,det]m9ation ( am\nt  7i7 ,decisions ,!
 heal? plan & ! nonp>ticipat+ provid]   
%all ea* submit to ! c]tifi$ ,,idr      
entity a f9al (f] ( paym5t ) respect to 
s]vices :i* are ! subject ( ! specifi$  
claim4 ,su* entity %all select ! (f] t  
su* entity det]m9es is ! mo/ reasonable 
bas$ on ! factors describ$ 9 p>agraph   
7#a77;,c74  7ii7 ,effect ( decision ,a  
decision ( a c]tifi$ ,,idr entity "u    
clause 7ii7-- 7,i7 %all be b9d+2 &      
7,,ii7 %all n be subject to judicial    
review1 except 9 a case describ$ 9 any (
 p>agraphs 7#a7 ?r\gh 7#d7 ( section    
#aj7;a7 ( title #i1 ,unit$ ,/ates ,code1
 z det]m9$ by ! ,secret>y 9 consultation
 ) ! ,secret>y ( ,labor4  7iii7 ,co/s ( 
indep5d5t dispute resolution process ,! 
p>ty ^: calculation is n *os5 "u        
subp>agraph 7,b77ii7 %all be responsible
 = pay+ all fees *>g$ by ! c]tifi$ ,,idr
 entity4 ,if ! p>ties rea* a settlem5t  
prior to completion ( ! ,,idr process1 !

 co/s ( su* process %all be divid$      
equally betwe5 ! p>ties1 unless ! p>ties
 o!rwise agree4  7iv7 ,paym5t ,n lat]   
?an #cj days aft] a decision describ$ 9 
clause 7i7 is made1 ! heal? plan %all   
pay to ! provid] or suppli] ( ! s]vices 
) respect to :i* ! specifi$ claim is    
made ! am\nt det]m9$ "u ?is subsection4 
7v7 ,public availability ,! c]tifi$     
,,idr entity %all make ea* f9al (f]     
select$ "u clause 7i7 available to !    
public4 ,any in=mation submitt$ to !    
entity by ! heal? plan1 provid]1 or     
facility1 o!r ?an su* f9al (f]1 may n be
 disclos$ by ! entity4  4  7#b7         
,effective date ,! am5dm5ts made by ?is 
subsection %all apply ) respect to plan 
ye>s beg9n+ on or aft] ,janu>y #a1      
#bjba4  7b7 ,prev5t+ c]ta9 cases (      
balance bill+ ,section #aabh;,a ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a-#g;a7 is am5d$ by add+ at ! end 
! foll[+ new subsections3  7t7  7#a7    
,subject to p>agraph 7#b71 9 ! case ( an
 individual ) b5efits "u a heal? plan or

 heal? insurance cov]age (f]$ 9 ! gr\p  
or individual m>ket :o is furni%$ on or 
aft] ,janu>y #a1 #bjba1 air ambulance   
s]vices by a nonp>ticipat+ provid] 7z   
def9$ 9 section #bgai;,a7e77#c7 ( !     
,public ,heal? ,s]vice ,act71 if su*    
provid] holds ! individual liable = a   
paym5t am\nt = su* s]vices s furni%$ t  
is m ?an ! co/-%>+ am\nt = su* s]vices  
7z det]m9$ 9 accordance ) section       
#bgai;,a7e77#a7 ( ! ,public ,heal?      
,s]vice ,act71 su* provid] %all be      
subject1 9 addition to any o!r p5alties 
t may be prescrib$ by law1 to a civil   
money p5alty ( n m ?an an am\nt det]m9$ 
appropriate by ! ,secret>y = ea*        
specifi$ claim4  7#b7 ,p>agraph 7#a7    
%all n apply to a nonp>ticipat+ provid]1
 ) respect to air ambulance s]vices     
furni%$ by ! provid] to a p>ticipant1   
b5efici>y1 or enrollee ( a heal? plan or
 heal? insurance cov]age (f]$ by a heal?
 insurance issu]1 if--  7,a7 su* s]vices
 are n furni%$ ) respect to an          
individual ) an em]g5cy m$ical condition

 7z def9$ 9 section #bgai;,a7e77#c7 ( ! 
,public ,heal? ,s]vice ,act72 &  7,b7 ! 
provid] is 9 compliance ) ! requirem5t (
 p>agraph 7#c74  7#c7 7,a7 ,= purposes (
 p>agraph 7#b7 & section #bgai;,a7e77#b7
 ( ! ,public ,heal? ,s]vice ,act1 a     
nonp>ticipat+ provid] is 9 compliance ) 
?is p>agraph1 ) respect to air ambulance
 s]vices furni%$ by ! provid] to a      
p>ticipant1 b5efici>y1 or enrollee ( a  
heal? plan or heal? insurance cov]age   
(f]$ by a heal? insurance issu]1 if !   
provid]--  7i7  7,i7 provides to !      
p>ticipant1 b5efici>y1 or enrollee 7or  
to a repres5tative ( ! p>ticipant1      
b5efici>y1 or enrollee71 on ! date on   
:i* ! p>ticipant1 b5efici>y1 or enrollee
 s*$ules su* s]vices1 if applicable1 &  
on ! date on :i* ! individual is furni%$
 su* s]vices--  7aa7 an oral explanation
 ( ! writt5 notice describ$ 9 item 7bb7 
& su* docum5tation ( ! provision ( su*  
explanation1 z ! ,secret>y det]m9es     
appropriate2 &  7bb7 a writt5 notice    
specifi$1 n lat] ?an ,july #a1 #bjbj1 by

 ! ,secret>y ?r\gh rulemak+ t-- 7,,aa7  
conta9s ! in=mation requir$ "u          
subp>agraph 7,b72 & 7,,bb7 is sign$ &   
dat$ by ! p>ticipant1 b5efici>y1 or     
enrollee2 &  7,,ii7 reta9s1 = a p]iod   
specifi$ ?r\gh rulemak+ by ! ,secret>y1 
a copy ( ! docum5tation describ$ 9      
subclause 7,i77aa7 & ! writt5 notice    
describ$ 9 subclause 7,i77bb72 &  7ii7  
obta9s f ! p>ticipant1 b5efici>y1 or    
enrollee 7or repres5tative7 ! cons5t    
describ$ 9 subp>agraph 7,c74  7,b7 ,=   
purposes ( subp>agraph 7,a77i71 !       
in=mation describ$ 9 ?is subp>agraph1 ) 
respect to a nonp>ticipat+ provid] & a  
p>ticipant1 b5efici>y1 or enrollee ( a  
heal? plan or heal? insurance cov]age   
(f]$ by a heal? insurance issu]1 is a   
notification ( ea* ( ! foll[+3  7i7 ,t !
 heal? c>e provid] is a nonp>ticipat+   
provid] ) respect to ! gr\p heal? plan  
or heal? insurance cov]age4  7ii7 ,!    
e/imat$ am\nt t su* provid] w *>ge !    
p>ticipant1 b5efici>y1 or enrollee = su*
 s]vices involv$4  7,c7 ,= purposes (   

subp>agraph 7,a77ii71 ! cons5t describ$ 
9 ?is subp>agraph1 ) respect to a       
p>ticipant1 b5efici>y1 or enrollee ( a  
gr\p heal? plan or heal? insurance      
cov]age (f]$ by a heal? insurance issu]1
 :o is to be furni%$ air ambulance      
s]vices by a nonp>ticipat+ provid]1 is a
 docum5t specifi$ by ! ,secret>y ?r\gh  
rulemak+ t--  7i7 is sign$ by !         
p>ticipant1 b5efici>y1 or enrollee 7or  
by a repres5tative ( ! p>ticipant1      
b5efici>y1 or enrollee7 n less ?an #bd  
h\rs prior to ! p>ticipant1 b5efici>y1  
or enrollee be+ furni%$ su* s]vices by  
su* provid]2  7ii7 ackn[l$ges t !       
p>ticipant1 b5efici>y1 or enrollee has  
be5-- 7,i7 provid$ ) a writt5 e/imate & 
an oral explanation ( ! *>ge t !        
p>ticipant1 b5efici>y1 or enrollee w be 
assess$ = ! s]vices anticipat$ to be    
furni%$ to ! p>ticipant1 b5efici>y1 or  
enrollee by su* nonp>ticipat+ provid]2 &
  7,,ii7 in=m$ t ! paym5t ( su* *>ge by 
! p>ticipant1 b5efici>y1 or enrollee w n
 accrue t[>d meet+ any limitation t !   

gr\p heal? plan or heal? insurance      
cov]age places on co/-%>+2 &  7iii7     
docum5ts ! cons5t ( ! p>ticipant1       
b5efici>y1 or enrollee to-- 7,i7 be     
furni%$ ) su* s]vices by su*            
nonp>ticipat+ provid]2 &  7,,ii7 9 !    
case t ! individual is s furni%$ su*    
s]vices1 be *>g$ an am\nt t may be      
great] ?an ! am\nt t w\ld o!rwise be    
*ang$ ! individual if furni%$ by a      
p>ticipat+ provid] 7z def9$ 9 section   
#bgai;,a7e77#c7 ( ! ,public ,heal?      
,s]vice ,act7 ) respect to su* s]vices &
 plan or cov]age4  7#d7 ,! provisions ( 
subsections 7c71 7d71 7e71 7g71 7h71    
7k71 & 7l7 %all apply to a civil money  
p5alty or assessm5t "u p>agraph 7#a7 9 !
 same mann] z su* provisions apply to a 
p5alty1 assessm5t1 or proce$+ "u        
subsection 7a74  7#e7 ,9 ?is subsection1
 ! t]ms gr\p heal? plan1 heal? insurance
 issu]1 & heal? insurance cov]age h !   
mean+s giv5 su* t]ms1 respectively1 9   
section #bgia ( ! ,public ,heal? ,s]vice
 ,act  4