,,ii #aafth ,,congress #ast ,session ,s4 #abff ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #a1 #bjai,mr4 ,scott of ,florida introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,employee ,retirement ,income ,security ,act of #aigd to protect patients from surprise medical bills4 #a4 ,short title ,this ,act may be cited as the ,protecting ,patients from ,surprise ,medical ,bills ,act4 #b4 ,prohibition on surprise medical billing ,subpart ,b of part #g of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe et seq47 is amended by adding at the end the following3 #gaf4 ,prohibition on surprise medical billing 7a7 ,definitions ,in this section3 7#a7 ,balance bill ,the term balance bill means the collection or attempted collection from a participant or beneficiary of any amount in excess of the applicable copayments1 coinsurance1 or deductible for services covered under the participant or beneficiary's group health plan4 7#b7 ,emergency medical condition ,the term emergency medical condition means the condition described in section #bgai;,a7b77#b77;,a7 of the ,public ,health ,service ,act4 7#c7 ,emergency services ,the term emergency services means the services described in section #bgai;,a7b77#b77;,b7 of the ,public ,health ,service ,act4 7#d7 ,emergency services provider ,the term emergency services provider means a facility or facility-based provider that bills a participant or beneficiary for emergency services4 7#e7 ,facility ,the term facility means an entity providing health care services1 as licensed or authorized by a ,state4 7#f7 ,facility-based provider ,the term facility-based provider means a physician1 health care professional1 or entity that has entered into an agreement with a facility to provide health care services to patients of that facility4 7b7 ,emergency services 7#a7 ,prohibition on balance billing ,a self-insured group health plan shall be solely liable for making payments to an emergency services provider for emergency services covered under the plan that are provided to a participant or beneficiary1 and such participant or beneficiary shall not be liable to the emergency services provider for any amount for such services other than the applicable copayment1 coinsurance1 or deductible amount required under the plan for covered emergency services4 ,emergency service providers shall not balance bill a participant or beneficiary under a self-insured group health plan for any covered emergency services provided to such participant or beneficiary4 7#b7 ,cost sharing limitation and prior authorization ,if a self-insured group health plan provides coverage for any benefits with respect to emergency services1 such coverage shall be in accordance with the provisions of section #bgai;,a7b7 of the ,public ,health ,service ,act and-- 7,a7 if such services are provided by an out-of-network provider1 the cost-sharing requirements 7including any deductible amount and the out-of-pocket limit7 applicable to such services shall be the same as the cost-sharing requirement that would apply if such services were provided by an in-network provider2 7,b7 prior authorization shall not be required for pre-hospital transport or treatment2 and 7,c7 payment by the plan shall be made directly to the emergency services provider4 7c7 ,covered non-,emergency services ,facility-based providers shall not balance bill a patient for covered non-emergency services if the services are provided at an in-network facility and the participant or beneficiary did not have the ability or opportunity to select to receive such services from an in-network provider4 7d7 ,reimbursements for out-of-,network payments ,a self-insured group health plan shall reimburse a health care provider for out-of-network emergency and non-emergency services described in subsections 7b7 and 7c7 based on one of the following payment methodologies3 7#a7 ,the amount of the claim made by the provider for such services4 7#b7 ,the usual and customary amount charged by the provider for similar services in the community where the services were provided4 7#c7 ,the amount mutually agreed to by the plan and the provider during the #fj-;day period after the date on which the claim is submitted4 7e7 ,voluntary binding arbitration 7#a7 ,in general ,if a self-insured group health plan and health care provider are unable to resolve a dispute with respect to billing for services described in subsection 7b7 or 7c71 such provider may voluntarily initiate binding arbitration with such plan under this subsection4 ,the ,secretary shall establish by rule methods of aggregation for claim disputes submitted to voluntary binding arbitration under this subsection4 7#b7 ,arbitration organizations 7,a7 ,in general ,the ,secretary shall enter into contracts with outside organizations to conduct timely1 voluntary binding arbitration proceedings under this subsection4 ,to be eligible for such a contract1 an organization shall have at least #e years of experience serving as a neutral party in complex dispute resolution proceedings4 7,b7 ,limitation ,an organization shall not be eligible to enter into a contract under subparagraph 7,a7 if the organization has been employed by1 consulted for1 or otherwise had a business relationship 7other than the receipt of arbitration fees7 with a health plan1 health insurance issuer1 facility1 or health care professional during the #c-year period immediately preceding the effective date of the contract with the ,secretary or during the term of such contract4 7,c7 ,arbitrator ,an arbitrator may not be assigned by an organization to resolve a dispute under this paragraph if the arbitrator has been employed by1 consulted for1 or otherwise had a business relationship 7other than the receipt of arbitration fees7 with a health plan1 health insurance issuer1 facility1 or health care professional during the #c-year period immediately preceding the request for arbitration4 7#c7 ,eligibility ,to be eligible for voluntary binding arbitration under this subsection the claim involved shall-- 7,a7 in the case of a claim relating to facility health care services1 be not less than #c1jjj2 and 7,b7 in the case of a claim relating to professional services1 be not less than #ejj4 ,such amounts shall be adjusted by the ,secretary each year by the percentage increase in the consumer price index4 7#d7 ,procedures ,the following procedures shall apply during a voluntary arbitration proceeding under this subsection3 7,a7 ,the plan or provider involved may make an offer to settle the disputed claim4 ,the party to whom such an offer is directed shall respond to such offer within #ae days after receipt of the offer4 7,b7 ,if the party receiving an offer to settle under paragraph 7,a7 does not accept such offer1 and the arbitrator issues a final order with respect to the disputed claim that is more than #ij percent or less than #aaj percent of the offer amount1 the party receiving the offer is deemed a non-prevailing party for purpose of paragraph 7#e74 7,c7 ,a final order under this paragraph is subject to judicial review under this ,act4 7,d7 ,all parties to a dispute that is subject to arbitration under this subsection may agree to settle claim at any time1 for any amount1 regardless of whether an offer to settle was made or rejected4 7#e7 ,review costs 7,a7 ,in general ,the entity that does not prevail under an arbitrator's final order under voluntary binding arbitration under this subsection shall pay the review costs4 7,b7 ,apportionment of costs ,in the case that both parties to voluntary binding arbitration under this subsection prevail in part1 the review costs shall be apportioned among the parties in proportion to the final judgment4 ,the apportionment shall be based on the disputed claim amount4 7,c7 ,failure to pay ,if a party to voluntary binding arbitration under this subsection fails to pay any amount of the ordered review costs within #ce days after the arbitrator's final order1 the party shall be subject to a penalty of #ejj for each day that such amount is not paid4 7f7 ,network transparency ,a self-insured group health plan shall-- 7#a7 not later than #a year after the date of enactment of this section1 publish on their ,internet website a list of network providers1 and update such list on a monthly basis2 and 7#b7 not later than #a year after the date of enactment of this section1 and annually thereafter1 provide an annual notification to participants and beneficiaries concerning the potential for balance billing when using out-of-network providers4 4