,,ii #aaf? ,,congress #a/ ,session ,s4 #abff ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,may #a1 #bjai,mr4 ,scott ( ,florida introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ,a ,,bill ,to am5d ! ,employee ,retirem5t ,income ,security ,act ( #aigd to protect pati5ts f surprise m$ical bills4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,protect+ ,pati5ts f ,surprise ,m$ical ,bills ,act4 #b4 ,prohibition on surprise m$ical bill+ ,subp>t ,b ( "p #g ( title ,i ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aahe et seq47 is am5d$ by add+ at ! end ! foll[+3 #gaf4 ,prohibition on surprise m$ical bill+ 7a7 ,def9itions ,9 ?is section3 7#a7 ,balance bill ,! t]m balance bill means ! collection or attempt$ collection f a p>ticipant or b5efici>y ( any am\nt 9 excess ( ! applicable copaym5ts1 co9surance1 or d$uctible = s]vices cov]$ "u ! p>ticipant or b5efici>y's gr\p heal? plan4 7#b7 ,em]g5cy m$ical condition ,! t]m em]g5cy m$ical condition means ! condition describ$ 9 section #bgai;,a7b77#b77;,a7 ( ! ,public ,heal? ,s]vice ,act4 7#c7 ,em]g5cy s]vices ,! t]m em]g5cy s]vices means ! s]vices describ$ 9 section #bgai;,a7b77#b77;,b7 ( ! ,public ,heal? ,s]vice ,act4 7#d7 ,em]g5cy s]vices provid] ,! t]m em]g5cy s]vices provid] means a facility or facility-bas$ provid] t bills a p>ticipant or b5efici>y = em]g5cy s]vices4 7#e7 ,facility ,! t]m facility means an entity provid+ heal? c>e s]vices1 z lic5s$ or au?oriz$ by a ,/ate4 7#f7 ,facility-bas$ provid] ,! t]m facility-bas$ provid] means a physician1 heal? c>e pr(essional1 or entity t has ent]$ into an agreem5t ) a facility to provide heal? c>e s]vices to pati5ts ( t facility4 7b7 ,em]g5cy s]vices 7#a7 ,prohibition on balance bill+ ,a self-insur$ gr\p heal? plan %all be solely liable = mak+ paym5ts to an em]g5cy s]vices provid] = em]g5cy s]vices cov]$ "u ! plan t are provid$ to a p>ticipant or b5efici>y1 & su* p>ticipant or b5efici>y %all n be liable to ! em]g5cy s]vices provid] = any am\nt = su* s]vices o!r ?an ! applicable copaym5t1 co9surance1 or d$uctible am\nt requir$ "u ! plan = cov]$ em]g5cy s]vices4 ,em]g5cy s]vice provid]s %all n balance bill a p>ticipant or b5efici>y "u a self-insur$ gr\p heal? plan = any cov]$ em]g5cy s]vices provid$ to su* p>ticipant or b5efici>y4 7#b7 ,co/ %>+ limitation & prior au?orization ,if a self-insur$ gr\p heal? plan provides cov]age = any b5efits ) respect to em]g5cy s]vices1 su* cov]age %all be 9 accordance ) ! provisions ( section #bgai;,a7b7 ( ! ,public ,heal? ,s]vice ,act &-- 7,a7 if su* s]vices are provid$ by an out-(-network provid]1 ! co/-%>+ requirem5ts 7includ+ any d$uctible am\nt & ! out-(-pocket limit7 applicable to su* s]vices %all be ! same z ! co/-%>+ requirem5t t w\ld apply if su* s]vices 7 provid$ by an 9-network provid]2 7,b7 prior au?orization %all n be requir$ = pre-hospital transport or treatm5t2 & 7,c7 paym5t by ! plan %all be made directly to ! em]g5cy s]vices provid]4 7c7 ,cov]$ non-,em]g5cy s]vices ,facility-bas$ provid]s %all n balance bill a pati5t = cov]$ non-em]g5cy s]vices if ! s]vices are provid$ at an 9-network facility & ! p>ticipant or b5efici>y did n h ! ability or opportunity to select to receive su* s]vices f an 9-network provid]4 7d7 ,reimbursem5ts = out-(-,network paym5ts ,a self-insur$ gr\p heal? plan %all reimburse a heal? c>e provid] = out-(-network em]g5cy & non-em]g5cy s]vices describ$ 9 subsections 7b7 & 7c7 bas$ on "o ( ! foll[+ paym5t me?odologies3 7#a7 ,! am\nt ( ! claim made by ! provid] = su* s]vices4 7#b7 ,! usual & cu/om>y am\nt *>g$ by ! provid] = simil> s]vices 9 ! community :]e ! s]vices 7 provid$4 7#c7 ,! am\nt mutually agre$ to by ! plan & ! provid] dur+ ! #fj-;day p]iod aft] ! date on :i* ! claim is submitt$4 7e7 ,volunt>y b9d+ arbitration 7#a7 ,9 g5]al ,if a self-insur$ gr\p heal? plan & heal? c>e provid] are unable to resolve a dispute ) respect to bill+ = s]vices describ$ 9 subsection 7b7 or 7c71 su* provid] may volunt>ily initiate b9d+ arbitration ) su* plan "u ?is subsection4 ,! ,secret>y %all e/abli% by rule me?ods ( aggregation = claim disputes submitt$ to volunt>y b9d+ arbitration "u ?is subsection4 7#b7 ,arbitration organizations 7,a7 ,9 g5]al ,! ,secret>y %all ent] into contracts ) outside organizations to conduct timely1 volunt>y b9d+ arbitration proce$+s "u ?is subsection4 ,to be eligible = su* a contract1 an organization %all h at lea/ #e ye>s ( exp]i5ce s]v+ z a neutral p>ty 9 complex dispute resolution proce$+s4 7,b7 ,limitation ,an organization %all n be eligible to ent] into a contract "u subp>agraph 7,a7 if ! organization has be5 employ$ by1 consult$ =1 or o!rwise _h a bus9ess relation%ip 7o!r ?an ! receipt ( arbitration fees7 ) a heal? plan1 heal? insurance issu]1 facility1 or heal? c>e pr(essional dur+ ! #c-ye> p]iod imm$iately prec$+ ! effective date ( ! contract ) ! ,secret>y or dur+ ! t]m ( su* contract4 7,c7 ,arbitrator ,an arbitrator may n be assign$ by an organization to resolve a dispute "u ?is p>agraph if ! arbitrator has be5 employ$ by1 consult$ =1 or o!rwise _h a bus9ess relation%ip 7o!r ?an ! receipt ( arbitration fees7 ) a heal? plan1 heal? insurance issu]1 facility1 or heal? c>e pr(essional dur+ ! #c-ye> p]iod imm$iately prec$+ ! reque/ = arbitration4 7#c7 ,eligibility ,to be eligible = volunt>y b9d+ arbitration "u ?is subsection ! claim involv$ %all-- 7,a7 9 ! case ( a claim relat+ to facility heal? c>e s]vices1 be n less ?an #c1jjj2 & 7,b7 9 ! case ( a claim relat+ to pr(essional s]vices1 be n less ?an #ejj4 ,su* am\nts %all be adju/$ by ! ,secret>y ea* ye> by ! p]c5tage increase 9 ! consum] price index4 7#d7 ,proc$ures ,! foll[+ proc$ures %all apply dur+ a volunt>y arbitration proce$+ "u ?is subsection3 7,a7 ,! plan or provid] involv$ may make an (f] to settle ! disput$ claim4 ,! p>ty to :om su* an (f] is direct$ %all respond to su* (f] )9 #ae days aft] receipt ( ! (f]4 7,b7 ,if ! p>ty receiv+ an (f] to settle "u p>agraph 7,a7 does n accept su* (f]1 & ! arbitrator issues a f9al ord] ) respect to ! disput$ claim t is m ?an #ij p]c5t or less ?an #aaj p]c5t ( ! (f] am\nt1 ! p>ty receiv+ ! (f] is deem$ a non-prevail+ p>ty = purpose ( p>agraph 7#e74 7,c7 ,a f9al ord] "u ?is p>agraph is subject to judicial review "u ?is ,act4 7,d7 ,all p>ties to a dispute t is subject to arbitration "u ?is subsection may agree to settle claim at any "t1 = any am\nt1 reg>dless ( :e!r an (f] to settle 0 made or reject$4 7#e7 ,review co/s 7,a7 ,9 g5]al ,! entity t does n prevail "u an arbitrator's f9al ord] "u volunt>y b9d+ arbitration "u ?is subsection %all pay ! review co/s4 7,b7 ,apportionm5t ( co/s ,9 ! case t bo? p>ties to volunt>y b9d+ arbitration "u ?is subsection prevail 9 "p1 ! review co/s %all be apportion$ among ! p>ties 9 proportion to ! f9al judgm5t4 ,! apportionm5t %all be bas$ on ! disput$ claim am\nt4 7,c7 ,failure to pay ,if a p>ty to volunt>y b9d+ arbitration "u ?is subsection fails to pay any am\nt ( ! ord]$ review co/s )9 #ce days aft] ! arbitrator's f9al ord]1 ! p>ty %all be subject to a p5alty ( #ejj = ea* day t su* am\nt is n paid4 7f7 ,network transp>5cy ,a self-insur$ gr\p heal? plan %all-- 7#a7 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 publi% on _! ,int]net website a li/ ( network provid]s1 & update su* li/ on a mon?ly basis2 & 7#b7 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 & annually !reaft]1 provide an annual notification to p>ticipants & b5efici>ies conc]n+ ! pot5tial = balance bill+ :5 us+ out-(-network provid]s4 4