,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #hfa  ,,in ,,the ,,house ,,of   
,,representatives  ,january #cj1        
#bjai,mr4 ,doggett 7for himself1 ,mr4   
,cartwright1 ,ms4 ,judy ,chu of         
,california1 ,mr4 ,cicilline1 ,mr4      
,cohen1 ,mr4 ,courtney1 ,mr4 ,danny ,k4 
,davis of ,illinois1 ,ms4 ,de,lauro1    
,mr4 ,grijalva1 ,ms4 ,hill of           
,california1 ,ms4 ,jayapal1 ,ms4        
,kaptur1 ,ms4 ,kelly of ,illinois1 ,mr4 
,khanna1 ,ms4 ,kuster of ,new           
,hampshire1 ,ms4 ,lee of ,california1   
,mr4 ,lewis1 ,ms4 ,moore1 ,ms4 ,norton1 
,ms4 ,pingree1 ,mr4 ,pocan1 ,ms4        
,velzquez1 ,ms4 ,schakowsky1 ,mr4       
,lipinski1 ,ms4 ,de,gette1 ,mr4         
,espaillat1 ,mr4 ,welch1 ,ms4 ,porter1  
and ,mr4 ,langevin7 introduced the      
following bill2 which was referred to   
the ,committee on ,ways and ,means1 and 
in addition to the ,committee on ,energy
 and ,commerce1 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 title ,,xviii of   
the ,social ,security ,act to prevent   
surprise billing practices1 and for     
other purposes4  #a4 ,short title ,this 
,act may be cited as the ,end ,surprise 
,billing ,act of #bjai4  #b4 ,preventing
 surprise billing practices  7a7        
,condition of participation in ,medicare
 ,section #ahff of the ,social ,security
 ,act 7#db ,u4,s4,c4 #acie;cc7 is       
amended--  7#a7 in subsection 7a77#a7-- 
7,a7 in subparagraph 7,x71 by striking  
and at the end2  7,b7 in subparagraph   
7,y71 by striking at the end the period 
and inserting 1 and2 and  7,c7 by       
inserting after such subparagraph 7,y7  
the following new subparagraph3  7,z7 in
 the case of a hospital or critical     
access hospital1 to adopt and enforce a 
policy to ensure compliance with the    
requirements of paragraphs 7#a7 and 7#d7
 of subsection 7l7 and to meet the      
requirements of such paragraphs         

7relating to the prevention of surprise 
billing practices74  2 and  7#b7 by     
adding at the end the following new     
subsection3  7l7 ,requirement for       
purposes of preventing surprise billing 
7#a7 ,in general ,for purposes of       
subsection 7a77#a77,z71 the requirements
 described in this paragraph are1 with  
respect to a hospital or critical access
 hospital1 in the case of an individual 
with health benefits coverage1 including
 benefits under a group health plan or  
health insurance coverage offered in the
 group or individual market 7as such    
terms are defined in section #bgia of   
the ,public ,health ,service ,act7 or   
under this title1 title ,,xix1 title    
,,xxi1 or another government-sponsored  
health plan or program1 who seeks to be 
furnished items or services or is to be 
furnished items or services by the      
hospital or critical access hospital    
7including by a provider of services or 
supplier that furnishes items or        
services at the hospital or critical    

access hospital71 that the hospital or  
critical access hospital-- 7,a7 7i7     
provides to the individual 7or to a     
representative of the individual71 on   
the date on which the individual makes  
an appointment to be furnished such     
items or services1 if applicable1 and on
 the date on which the individual is    
furnished such items and services1 a    
written notice specified by the         
,secretary through rulemaking that--    
7,i7 contains the information required  
under paragraph 7#b72 and  7,,ii7 is    
signed and dated by the individual2 and 
7ii7 retains a copy of each such notice 
for a period specified through          
rulemaking by the ,secretary2 and  7,b7 
in the case that such hospital or       
critical access hospital 7or provider of
 services or supplier furnishing        
services at such hospital or critical   
access hospital7 is not within the      
health care provider network or         
otherwise a participating provider of   
services or supplier with respect to    

such health benefits coverage of such   
individual1 obtains from the individual 
the consent described in paragraph 7#c74
  7#b7 ,information included in notice  
,the notice described in paragraph      
7#a77;,a7 shall include1 with respect to
 an individual with health benefits     
coverage described in paragraph 7#a7 who
 seeks to be furnished items or services
 or is to be furnished items or services
 by a hospital or critical access       
hospital 7including by a provider of    
services or supplier that furnishes     
items or services at the hospital or    
critical access hospital71 a            
notification of each of the following3  
7,a7 ,whether the hospital or critical  
access hospital is not within the health
 care provider network or otherwise a   
participating provider of services or   
supplier with respect to such health    
benefits coverage of such individual4   
7,b7 ,if the hospital or critical access
 hospital is not within such network or 
otherwise such a participating provider 

or supplier1 the estimated amount that  
the hospital or critical access hospital
 will charge the individual for such    
items and services in excess of any cost
 sharing obligations that the individual
 would otherwise have under such health 
benefits coverage for such items and    
services if the hospital or critical    
access hospital were within such network
 or otherwise participating in such     
coverage4  7,c7 ,whether any of the     
providers of services or suppliers      
furnishing items or services at the     
hospital or critical access hospital who
 will furnish the items or services to  
the individual are not within the health
 care provider network or otherwise a   
participating provider of services or   
supplier with respect to such health    
benefits coverage of such individual4   
7,d7 ,if any of such providers of       
services or suppliers are not within    
such network or otherwise such a        
participating provider or supplier1 the 
estimated amount that such providers of 

services or suppliers will charge the   
individual for such items and services  
in excess of any cost sharing           
obligations that the individual would   
otherwise have for such items and       
services if the providers of services or
 suppliers were within the such network 
or otherwise participating in such      
coverage4  7#c7 ,consent described ,for 
purposes of paragraph 7#a77;,b71 the    
consent described in this paragraph1    
with respect to an individual with      
health benefits coverage described in   
paragraph 7#a7 who is to be furnished   
items or services by a hospital or      
critical access hospital 7or provider of
 services or supplier furnishing        
services at such hospital or critical   
access hospital7 that is not within the 
health care provider network or         
otherwise a participating provider of   
services or supplier with respect to    
such health benefits coverage of such   
individual1 is a document specified by  
the ,secretary through rulemaking that  

is signed by the individual 7or by a    
representative of the individual7 not   
less than #bd hours prior to the        
individual being furnished such items or
 services by such hospital1 critical    
access hospital1 provider of services1  
or supplier1 respectively1 and that--   
7,a7 acknowledges that the individual   
has been-- 7i7 provided with a written  
estimate of the charge that the         
individual will be assessed for the     
items or services anticipated to be     
furnished to the individual by the      
hospital1 critical access hospital1     
provider of services1 or supplier that  
is not within such network or otherwise 
such a participating provider of        
services or supplier2 and  7ii7 informed
 that the payment of such charge by the 
individual will not accrue toward any   
limitation that the health benefits     
coverage places upon the annual         
out-of-pocket expenses to be paid by the
 individual or upon the in-network      
deductible to be paid by the individual2

 and  7,b7 documents the consent of the 
individual to--  7i7 be furnished with  
such items or services by such hospital1
 critical access hospital1 provider of  
services1 or supplier1 as applicable2   
and  7ii7 in the case that the          
individual is so furnished such items or
 services1 be charged an amount         
approximate to the estimated charge     
described in subparagraph 7,a77i7 with  
respect to such items or services4  7#d7
 ,limitations on payment by individual  
,for purposes of subsection 7a77#a77,z71
 the requirements under this paragraph  
are the following3 7,a7 ,in case of     
noncompliance by hospitals and critical 
access hospitals ,in the case of an     
individual with health benefits coverage
 described in paragraph 7#a7 who is     
furnished items or services by a        
hospital or critical access hospital 7or
 provider of services or supplier       
furnishing services at such hospital or 
critical access hospital7 that is not   
within the health care provider network 

or otherwise a participating provider of
 services or supplier with respect to   
such health benefits coverage of such   
individual1 if the hospital or critical 
access hospital does not comply with the
 requirements of paragraph 7#a7 with    
respect to the furnishing of such items 
or services to such individual1 the     
hospital or critical access hospital    
7or1 as applicable1 the provider of     
services or supplier furnishing such    
items or services to such individual7   
may not charge the individual more than 
the amount that the individual would    
have been required to pay in cost       
sharing if such items or services had   
been furnished by a hospital or critical
 access hospital1 as applicable 7or by a
 provider of services or supplier1 as   
applicable7 that is within such network 
or that is otherwise such a             
participating provider of services or   
supplier4  7,b7 ,in case of same-day    
emergency services ,in the case of an   
individual with health benefits coverage

 described in paragraph 7#a7 who is     
furnished items or services by a        
hospital or critical access hospital 7or
 provider of services or supplier       
furnishing services at such hospital or 
critical access hospital7 that is not   
within the health care provider network 
or otherwise a participating provider of
 services or supplier with respect to   
such health benefits coverage of such   
individual on the same date on which the
 individual makes an appointment for    
such items or services 7or otherwise    
presents at the hospital or critical    
access hospital for such services such  
as in the case of items and services    
furnished with respect to an emergency  
medical condition1 as defined in section
 #ahfg7;e771 the hospital or critical   
access hospital 7or1 as applicable1 the 
provider of services or supplier        
furnishing such items or services to    
such individual7 may not charge the     
individual more than the amount that the
 individual would have been required to 

pay in cost sharing if such items or    
services had been furnished by a        
hospital or critical access hospital1 as
 applicable 7or by a provider of        
services or supplier1 as applicable7    
that is within such network or that is  
otherwise such a participating provider 
of services or supplier4  4  7b7        
,effective date ,the amendments made by 
subsection 7a7 shall apply with respect 
to agreements under section             
#ahff7;a77#a7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #acie;cc7a77#a77    
that are filed with the ,secretary of   
,health and ,human ,services on a date  
that is not less than #ab months after  
the date of the enactment of this ,act4