,,ii #aaf? ,,congress #a/ ,session ,s4 #aeca ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,may #af1 #bjai ,mr4 ,cassidy 7= himself1 ,mr4 ,b5net1 ,mr4 ,"y1 ,ms4 ,hassan1 ,ms4 ,murk[ski1 ,mr4 ,c>p]1 ,mr4 ,sullivan1 ,mr4 ,br[n1 ,mr4 ,cram]1 ,mr4 ,c>d91 ,mr4 ,k5n$y1 & ,mr4 ,casey7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ,a ,,bill ,to am5d ! ,public ,heal? ,s]vice ,act to provide protections = heal? insurance consum]s f surprise bill+4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,/opp+ ,! ,outrage\s ,practice ( ,surprise ,m$ical ,bills ,act ( #bjai or ! ,,/op ,surprise ,m$ical ,bills ,act ( #bjai4 #b4 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,consum]s frequ5tly /ruggle to det]m9e :5 & h[ mu* !y w pay = a m$ical s]vice or proc$ure4 ,a majority ( consum]s say heal? c>e provid]s r>ely1 if ev]1 discuss co/s ( recomm5d$ treatm5ts & :e!r ^! treatm5ts are cov]$ by heal? insurance4 ,almo/ #gj p]c5t ( pati5ts :o receive bills f out-(-network provid]s did n realize ! provid] 0 out-(-network at ! "t ( treatm5t4 ,pati5ts us+ 9-network facilities /ill receive claims f out-(- network provid]s at high rates1 ov] #ae p]c5t ( inpati5t admissions & #e p]c5t ( outpati5t s]vice days4 ,ev5 :5 pati5ts try to s*$ule an 9-network proc$ure at an 9-network hospital & try to ensure t all provid]s :o adm9i/] treatm5t w be 9-network1 !y may be s5t a balance bill by an out-(-network provid] aft] receiv+ c>e4 ,if provid]s accept$ ! same heal? plans z ! facilities at :i* !y practice & adm9i/] c>e1 out-(-network surprise m$ical bills w\ld n be a complication = consum]s s*$ul+ elective proc$ures4 7#b7 ,surprise m$ical bills affect a sizeable portion ( ! insur$ population4 ,approximately #cj p]c5t ( individuals cov]$ by private heal? insurance h receiv$ a surprise m$ical bill )9 ! pa/ ye>4 ,almo/ #bj p]c5t ( inpati5t admissions by enrollees 9 l>ge employ] plans include at lea/ #a claim f an out-(-network provid]1 :ile #h p]c5t ( outpati5t s]vice days include an out-(-network claim4 7#c7 ,surprise m$ical bills are an issue ( p>ticul> conc]n to consum]s4 ,a majority ( ,am]icans feel t s(t5+ ! impact ( surprise m$ical bills %\ld be a priority = ! curr5t ,congress4 ,eighty-six p]c5t ( ,am]icans ?9k x is important to protect individuals f surprise m$ical bills4 7#d7 ,surprise m$ical bills = em]g5cy c>e are frequ5tly unavoidable due to ! em]g5t & s]i\s nature ( ! pati5t's condition at ! "t ( treatm5t4 ,"o 9 #e cases ( inpati5t hospital admissions t orig9ate )9 ! em]g5cy dep>tm5t result 9 a surprise m$ical bill4 ,= inpati5t admissions1 ^? t include an em]g5cy room claim are mu* m likely to include a claim f an out-(-network provid] ?an admissions )\t an em]g5cy room claim4 ,?is is true :e!r or n enrollees use 9-network facilities4 ,mo/ cases ( surprise m$ical bill+ occur :5 privately insur$ individuals involunt>ily see out-(-network provid]s dur+ m$ical em]g5cies4 7#e7 ,! f9ancial implications ( surprise m$ical bills c be deva/at+ = ,am]ican consum]s & c prev5t !m f seek+ timely foll[-up c>e or f access+ necess>y s]vices4 ,approximately #bj p]c5t ( insur$ ,am]icans /ruggle to pay _! m$ical bills4 ,almo/ a ?ird ( consum]s :o report !y are /ruggl+ to pay a m$ical bill also report ?is bill 0 due to *>ges f an out-(-network provid] t 7 n cov]$ or 7 only p>tially cov]$ by _! insur]4 ,consum]s ) out/&+ m$ical bills report delay+ or skipp+ ne$$ heal? c>e at rates #b to #c times high] ?an consum]s )\t out/&+ bills4 ,ov] #fj p]c5t ( consum]s ) out/&+ m$ical bills report difficulties pay+ o!r bills 7includ+ necessities su* z food1 heat1 or h\s+ co/s7 z a result ( _! m$ical bills4 #c4 ,prohibition on surprise balance bill+ & indep5d5t dispute resolution ) respect to out-(-network heal? c>e s]vices 7a7 ,9 g5]al ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is am5d$ by add+ at ! end ! foll[+3 #bgbi;,a4 ,g5]al prohibition on surprise balance bill+ 7a7 ,surprise m$ical bill ,9 ?is title1 ! t]m surprise m$ical bill means a balance bill1 z describ$ 9 subsection 7b71 t an enrollee receives = s]vices provid$ to ! enrollee :]e su* s]vices 7-- 7#a7 em]g5cy s]vices provid$ by an out-(-network heal? c>e pr(essional or at an out-(-network facility2 7#b7 heal? c>e s]vices t 7 provid$-- 7,a7 at an 9-network facility 7includ+ ! use ( equipm5t1 devices1 telem$ic9e s]vices1 or o!r treatm5ts or s]vices72 & 7,b7 by an out-(-network heal? c>e pr(essional2 or 7#c7 additional heal? c>e s]vices requir$ 9 ! case ( an enrollee :o initially ent]s a hospital ?r\gh ! em]g5cy room = em]g5cy s]vices1 & !n receives nonem]g5cy s]vices f an out-(-network heal? c>e pr(essional or at an out-(-network hospital or facility aft] ! enrollee has be5 /abiliz$ 7z def9$ 9 section #bgai;,a7b77#b77;,c771 z det]m9$ by ! treat+ physician4 ,p>agraph 7#c7 %all n apply 9 ! case ( an enrollee :o is /abiliz$ & able to travel 9 nonm$ical transport1 & ! enrollee 7or designee ( ! enrollee :]e ! enrollee is n able to compreh5d ! in=mation to be provid$ or make relat$ decisions7 has be5 provid$ ) cle>1 writt5 notification t ! pr(essional or facility is an out-(-network heal? c>e pr(essional or facility1 has be5 giv5 a co/ e/imate = s]vices provid$ by ! out-(-network pr(essional or facility1 & has assum$1 9 writ+1 full responsibility = out-(-pocket co/s associat$ ) su* out-(-network c>e4 7b7 ,balance bill ,9 subsection 7a71 ! t]m balance bill ref]s to a claim = paym5t = s]vices provid$ to an enrollee t is 9 an am\nt equal to ! diff]5ce betwe5 ! actual am\nt *>g$ ) respect to s]vices or c>e describ$ 9 subsection 7a7 & ! expect$ 9-network co/-%>+ requir$ by ! enrollee "u ! plan or cov]age involv$4 7c7 ,prohibition on balance bill+ 7#a7 ,prohibition 7,a7 ,9 g5]al ,a gr\p heal? plan1 a heal? insurance issu] 9 connection ) gr\p or individual heal? insurance cov]age1 or a heal? c>e provid] %all n engage 9 balance bill+ practices prohibit$ "u ?is section4 7,b7 ,application ( provisions ,subp>agraph 7,a7 %all apply-- 7i7 to all s]vices provid$ at hospitals1 em]g5cy rooms1 ,/ate-accr$it$ free-/&+ em]g5cy dep>tm5ts1 hospital outpati5t dep>tm5ts1 & ambulatory surg]y c5t]s2 & 7ii7 ) respect to subsection 7a77#b71 to ! heal? c>e provid]'s (fices & relat$ s]vices 7includ+ laboratory & imag+ s]vices ord]$ by an 9-network provid] & provid$ by an out-(-network provid] or laboratory74 7#b7 ,enrollee liability ,) respect to ! s]vices & c>e describ$ 9 subsection 7a71 an enrollee %all only be liable = ! 9-network co/-%>+ am\nt provid$ = 9 _! plan or cov]age4 ,= purposes ( ?is section1 su* paym5ts by ! enrollee %all c\nt t[>d ! 9-network d$uctible "u ! plan or cov]age z well z t[>d ! enrollee's out-(-pocket maximum limitation4 7#c7 ,p5alty ,violations ( ?is section %all subject ! violator to a civil monet>y p5alty z provid$ = 9 ?is title4 ,su* provisions %all n apply to a heal? c>e provid]1 gr\p heal? plan1 or heal? insurance issu] t unkn[+ly balance bills an enrollee & reimburses su* enrollee )9 #cj cal5d> days ( su* bill+4 #bgbi;,b4 ,out-(-network bill+ 7a7 ,prohibition 7#a7 ,9 g5]al ,an enrollee may n be bill$ 9 excess ( ! 9-network co/-%>+ am\nt = s]vices or c>e provid$ "u section #bgbi;,a 7a surprise m$ical bill situation74 7#b7 ,automatic paym5t 7,a7 ,9 g5]al ,a gr\p heal? plan1 or heal? insurance issu] 9 connection ) gr\p or individual heal? insurance cov]age1 %all pay ! m$ian 9-network rate "u ! plan or cov]age1 less ! applicable enrollee 9-network co/-%>+1 directly to ! heal? c>e provid] z provid$ = 9 ?is section4 7,b7 ,reque/ = alt]native rate ,^u paym5t "u subp>agraph 7,a71 ! plan or issu] %all provide to ! heal? c>e provid] in=mation ab\t h[ ! provid] may initiate indep5d5t dispute resolution "u su* subsection ) respect to su* paym5t4 ,! plan1 issu]1 or provid] may negotiate an alt]native am\nt or initiate indep5d5t dispute resolution "u subsection 7b7 dur+ ! #cj-;day p]iod beg9n+ on ! date on :i* ! automatic paym5t is made "u ?is subsection4 7b7 ,e/abli%m5t ( ,,idr process2 c]tification ( entities 7#a7 ,e/abli%m5t ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 ! ,secret>y1 9 consultation ) ! ,secret>y ( ,labor1 %all e/abli% a process = resolv+ paym5t disputes betwe5 gr\p heal? plans1 or heal? insurance issu]s (f]+ heal? insurance cov]age 9 ! gr\p m>ket1 & out-(-network heal? c>e provid]s 9 surprise m$ical bill situations 9 accordance ) ?is section 7ref]r$ to 9 ?is section z ! ,,idr process74 7#b7 ,c]tification ( entities ,an entity wi%+ to p>ticipate 9 ! ,,idr process "u ?is subsection %all reque/ c]tification f ! ,secret>y4 ,! ,secret>y1 9 consultation ) ! ,secret>y ( ,labor1 %all det]m9e eligibility ( applicant entities1 tak+ into consid]ation :e!r ! entity is unbias$ & unaffiliat$ ) heal? plans & provid]s & free ( conflicts ( int]e/1 9 accordance ) ! ,secret>y's rulemak+ on det]m9+ crit]ia = conflicts ( int]e/4 7#c7 ,,idr entity ,"u ! process e/abli%$ "u p>agraph 7#a71 ! p>ties 9 ! indep5d5t dispute resolution process %all jo9tly agree ^u an indep5d5t dispute resolution entity4 ,9 ! ev5t t p>ties _c agree1 "o w be select$ at r&om jo9tly by ! ,dep>tm5t ( ,heal? & ,human ,s]vices & ! ,dep>tm5t ( ,labor4 7c7 ,applicable claims 7#a7 ,9 g5]al ,! ,,idr process %all be ) respect to "o or m ,curr5t ,proc$ural ,t]m9ology 7,,cpt7 codes4 7#b7 ,bat*+ ( claims ,heal? c>e facilities & provid]s & gr\p heal? plans or heal? insurance issu]s may bat* claims if su* claims-- 7,a7 involve id5tical plan or issu] & provid] or facility p>ties2 7,b7 involve claims ) ! same or relat$ curr5t proc$ural t]m9ology codes relevant to a p>ticul> proc$ure2 & 7,c7 involve claims t occur )9 #cj days ( ea* o!r4 7d7 ,indep5d5t dispute resolution process 7#a7 ,tim+ ,an indep5d5t dispute resolution entity t receives a reque/ "u ?is section %all1 n lat] ?an #cj days aft] receiv+ su* reque/1 det]m9e ! am\nt ! gr\p heal? plan1 or heal? insurance issu] (f]+ heal? insurance cov]age 9 ! gr\p m>ket1 is requir$ to pay ! out-(-network heal? c>e provid]4 ,su* am\nt %all be-- 7,a7 ! am\nt det]m9$ by ! p>ties ?r\gh a settlem5t "u p>agraph 7#b72 or 7,b7 ! am\nt det]m9$ reasonable by ! entity 9 accordance ) p>agraph 7#c74 7#b7 ,settlem5t 7,a7 ,9 g5]al ,if ! indep5d5t dispute resolution entity det]m9es1 bas$ on ! am\nts indicat$ 9 ! reque/ "u ?is section1 t a settlem5t betwe5 ! gr\p heal? plan1 or heal? insurance issu] (f]+ heal? insurance cov]age 9 ! gr\p m>ket1 & ! out-(-network heal? c>e provid] is likely1 ! indep5d5t dispute resolution entity may direct ! p>ties to attempt1 = a p]iod n to exce$ #aj days1 a good fai? negotiation = a settlem5t4 7,b7 ,tim+ ,! p]iod = a settlem5t describ$ 9 subp>agraph 7,a7 %all accrue t[>ds ! #cj-;day p]iod requir$ "u p>agraph 7#a74 7#c7 ,det]m9ation ( am\nt 7,a7 ,f9al (f]s ,9 ! abs5ce ( a settlem5t "u p>agraph 7#b71 ! gr\p heal? plan1 or heal? insurance issu] (f]+ heal? insurance cov]age 9 ! gr\p m>ket1 & ! out-(-network heal? c>e provid] %all ea* submit to ! indep5d5t dispute resolution entity _! f9al (f]4 ,su* entity %all det]m9e :i* ( ! #b am\nts is m reasonable bas$ on ! factors describ$ 9 subp>agraph 7,d74 7,b7 ,f9al decisions ,! am\nt t is det]m9$ to be ! m reasonable am\nt "u subp>agraph 7,a7 %all be ! f9al decision ( ! indep5d5t dispute resolution entity z to ! am\nt ! gr\p heal? plan1 or heal? insurance issu] (f]+ heal? insurance cov]age 9 ! gr\p m>ket1 is requir$ to pay ! out-(-network heal? c>e provid]4 7,c7 ,s]vice units ,a f9al det]m9ation "u subp>agraph 7,b7 may include ! resolution ( disputes = multiple items or s]vices1 if su* det]m9ation is 9 reg>d to items or s]vices t are eligible = indep5d5t dispute resolution "u subsection 7c77#b74 7,d7 ,factors ,9 det]m9+ :i* f9al (f] to select z ! m reasonable am\nt "u subp>agraph 7,a71 ! indep5d5t dispute resolution entity %all consid] relevant factors includ+-- 7i7 comm]cially reasonable rates = comp>able s]vices or items 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 ( ! out-(-network heal? c>e provid]2 7,,ii7 ! circum/ances & complexity ( ! p>ticul> dispute1 includ+ ! "t & place ( ! s]vice2 7,,iii7 ! m>ket %>e held by ! out-(-network heal? c>e provid] or t ( ! plan or issu]2 7,,iv7 demon/ration ( good fai? ef=ts 7or lack ( good fai? ef=ts7 made by ! out-(-network provid] or ! plan to contract & prior negotiat$ rates1 if applicable2 & 7,v7 o!r relevant economic aspects ( provid] reimbursem5t = ! same specialty )9 ! same geographic area4 7,e7 ,effect ( det]m9ation ,a f9al det]m9ation ( an indep5d5t dispute resolution entity "u subp>agraph 7,b7-- 7i7 %all be b9d+2 & 7ii7 %all n be subject to judicial review1 except 9 cases comp>able to ^? describ$ 9 section #aj7;a7 ( title #i1 ,unit$ ,/ates ,code1 z det]m9$ by ! ,secret>y 9 consultation ) ! ,secret>y ( ,labor1 & cases 9 :i* in=mation submitt$ by "o p>ty 0 det]m9$ to be fraudul5t4 7#d7 ,privacy laws ,an indep5d5t dispute resolution entity %all1 9 conduct+ an indep5d5t dispute resolution process "u ?is subsection1 comply ) all applicable ,f$]al & ,/ate privacy laws4 7#e7 ,public availability ,! reasonable am\nt det]m9$ by an indep5d5t dispute resolution entity "u ?is subsection ) respect to any claim %all n be confid5tial1 except t in=mation submitt$ to ! indep5d5t dispute entity %all be kept confid5tial4 ,indep5d5t dispute entities may consid] pa/ decisions aw>d$ by indep5d5t dispute entities dur+ ! indep5d5t dispute resolution process4 7#f7 ,co/s ( indep5d5t dispute resolution process ,! nonprevail+ p>ty %all be responsible = pay+ all fees *>g$ by ! indep5d5t dispute resolution entity4 ,if ! p>ties rea* a settlem5t prior to completion ( ! indep5d5t dispute resolution process1 ! co/s ( ! indep5d5t dispute resolution process %all be divid$ equally betwe5 ! p>ties4 7#g7 ,paym5t ,gr\p heal? plans & heal? insurance issu]s ) respect to gr\p heal? cov]age %all pay directly to ! heal? c>e provid] am\nts det]m9$ by ! indep5d5t dispute resolution entity )9 #cj days ( ! date on :i* ! entity makes a det]m9ation ) respect to su* am\nt4 ,a plan or issu] t fails to comply ) ?is p>agraph %all be subject to ! p5alties describ$ 9 section #bgbi;,a7c77#c74 4 7b7 ,em]g5cy s]vices ,section #bgai;,a7b77#a77;,c77ii77,,ii7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ai;a7b77#a77;,c77ii77,,ii77 is am5d$ by ins]t+ 1 d$uctible am\nt1 aft] copaym5t am\nt4 #d4 ,notification ( new insurance products to 9-network provid]s ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et seq471 z am5d$ by section #c1 is fur!r am5d$ by add+ at ! end ! foll[+3 #bgbi;,c4 ,notification ( new insurance products to 9-network provid]s ,if a heal? c>e provid] has a contract to provide 9-network s]vices to enrollees 9 a gr\p heal? plan or heal? insurance cov]age (f]$ by a heal? insurance issu]1 ! plan or issu] %all notify ! 9-network provid] )9 #g days ( (f]+ any new insurance product = :i* ! 9-network provid] w\ld be eligible to enroll z an 9-network provid]4 4 #e4 ,transp>5cy reg>d+ 9-network & out-(-network d$uctibles ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et seq471 z am5d$ by section #d1 is fur!r am5d$ by add+ at ! end ! foll[+3 #bgbi;,d4 ,transp>5cy reg>d+ 9-network & out-(-network d$uctibles 7a7 ,9 g5]al ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age & provid+ or cov]+ any b5efit ) respect to items or s]vices %all include1 9 cle> writ+1 on any plan or insurance id5tification c>d issu$ to enrollees 9 ! plan or cov]age ! am\nt ( ! 9-network & out-(-network d$uctibles & ! out-(-pocket maximum limitation t apply to su* plan or cov]age4 7b7 ,guidance ,! ,secret>y1 9 consultation ) ! ,secret>y ( ,labor1 %all issue guidance to implem5t subsection 7a74 4 #f4 ,ensur+ enrollee access to co/-%>+ in=mation 7a7 ,9 g5]al ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq471 z am5d$ by section #e1 is fur!r am5d$ by add+ at ! end ! foll[+3 #bgbi;,e4 ,provision ( co/-%>+ in=mation 7a7 ,co/-,%>+ disclosure = m$ical s]vices 7#a7 ,provid] disclosures ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all n contract ) a heal? c>e provid] ) respect to ! plan or cov]age unless ! provid] agrees to provide an enrollee 9 ! plan or cov]age1 at ! "t ( s*$ul+ an elective heal? c>e s]vice1 or n lat] ?an #dh h\rs ( ! enrollee reque/+ su* in=mation1 ! expect$ enrollee co/-%>+ = ! provision ( a p>ticul> heal? c>e s]vice involv$ 7includ+ any s]vice t is reasonably expect$ to be provid$ 9 conjunction ) su* specific s]vice1 su* z expect$ co/-%>+ ( laboratory s]vices74 7#b7 ,insur] disclosures ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all provide an enrollee 9 ! plan or cov]age ) a good fai? e/imate ( ! enrollee's co/-%>+ 7includ+ d$uctibles1 copaym5ts1 & co9surance7 = :i* ! enrollee w\ld be responsible = pay+ ) respect to a specific elective heal? c>e s]vice 7includ+ any s]vice t is reasonably expect$ to be provid$ 9 conjunction ) su* specific s]vice su* z expect$ co/-%>+ ( laboratory s]vices71 n lat] ?an #dh h\rs aft] receiv+ a reque/ = su* in=mation by an enrollee4 7b7 ,electronically available price in=mation ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all provide to enrollees ! out-(-pocket co/s & b5efits in=mation at all sites ( c>e & = all provid]s includ$ 9 ! plan network4 ,su* in=mation %all be made available to enrollees ?r\gh an int]net website or an application4 ,in=mation ab\t ! availability ( su* price in=mation ?r\gh su* means %all be provid$ to ea* enrollee ^u enrollm5t1 or r5ewal1 9 ! heal? plan or heal? insurance cov]age4 4 7b7 ,effective dates 7#a7 ,co/-%>+ disclosures ,subsection 7a77#a7 ( section #bgbi;,e ( ! ,public ,heal? ,s]vice ,act1 z add$ by subsection 7a71 %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbj4 7#b7 ,availability ( in=mation ,subsection 7b7 ( section #bgbi;,e ( ! ,public ,heal? ,s]vice ,act1 z add$ by subsection 7a71 %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjba4 #g4 ,m$ical loss ratio ,section #bgah7;a77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ah7;a77#a77 is am5d$ by ins]t+ be=e ! p]iod ! foll[+3 7includ+1 9 ! case ( gr\p heal? plans1 ! am\nt ( indep5d5t dispute process exp5ses incurr$ by ! plan74 #h4 ,transp>5cy requirem5ts on hospitals ,section #bgah ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ah7 is am5d$ by add+ at ! end ! foll[+3 7f7 ,transp>5cy requirem5ts on hospitals 7#a7 ,requirem5ts = hospitals & physician gr\ps ,ea* hospital op]at+ )9 ! ,unit$ ,/ates %all = ea* ye> disclose on its int]net website & 9 pr9t$ mat]ials1 any f9ancial relation%ip or pr(it-%>+ agreem5t ! hospital ma9ta9s ) a physician gr\p4 7#b7 ,requir$ in=mation 7,a7 ,9 g5]al ,ea* hospital op]at+ )9 ! ,unit$ ,/ates %all include ancill>y s]vices provid$ by individuals su* z phlebotomi/s1 laboratory te*nicians1 & e*oc>diogram te*nicians )9 ea* hospital bill t is provid$ to pati5ts4 7,b7 ,/udy ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all conduct a /udy on ! feasibility ( hospitals & hospital-bas$ provid] gr\ps provid+ to pati5ts a s+le1 unifi$ bill = all s]vices provid$ )9 an episode ( c>e4 4 #i4 ,transp>5cy requirem5ts on insurance 7a7 ,gr\p heal? plan report+ ,"p ,c ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia et seq47 is am5d$ by add+ at ! end ! foll[+3 #bgie4 ,transp>5cy requirem5ts = gr\p heal? plans 7a7 ,9 g5]al ,ea* gr\p heal? plan & heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all annually report to ! ,secret>y ( ,heal? & ,human ,s]vices & ! ,secret>y ( ,labor1 ) respect to ! applicable plan or cov]age = ! applicable plan ye>-- 7#a7 ! total claims t 7 submitt$ by 9-network heal? c>e provid]s ) respect to enrollees "u ! plan or cov]age1 & ! numb] ( su* claims t 7 paid & ! numb] ( su* claims t 7 d5i$2 7#b7 ! total claims t 7 submitt$ by out-(-network heal? c>e provid]s ) respect to enrollees "u ! plan or cov]age1 & ! numb] ( su* claims t 7 paid & ! numb] ( su* claims t 7 d5i$2 7#c7 ) respect to ea* out-(-network claim1 ! out-(-pocket co/s1 includ+ applicable co/-%>+ am\nts1 to ! enrollee = ! s]vices1 & ! diff]5ce betwe5 ! bill$ *>ge & ! am\nt ! plan pays1 adju/$ by any balance bill+ limitation ?r\gh ,/ate & ,f$]al regulatory & /atutory requirem5ts t might apply2 7#d7 ! numb] ( out-(-network claims report$ "u p>agraph 7#b7 t are = em]g5cy s]vices2 & 7#e7 ! numb] ( out-(-network claims report$ "u p>agraph 7#b7 t relate to c>e at 9-network hospitals or facilities provid$ by out-(-network provid]s4 7b7 ,cl>ification ,! in=mation requir$ to be submitt$ "u ?is section %all be 9 addition to ! in=mation requir$ to be submitt$ "u section #bgae;,a4 4 #aj4 ,applicability to ,/ates ) surprise bill+ laws 7a7 ,g5]al application 7#a7 ,9 g5]al ,no?+ 9 ?is ,act1 or ! am5dm5ts made by ?is ,act1 %all be con/ru$ to prohibit a ,/ate f enact+ pati5t protections t are great] ?an ^? provid$ = 9 su* am5dm5ts4 7#b7 ,application to all plans ,9 ! case ( a gr\p heal? plan1 individual heal? plan1 & non-,f$]al gov]nm5tal heal? plan (f]$ 9 a ,/ate t has n enact$ a law to det]m9e ! paym5t resolution betwe5 enrollees & heal? c>e facilities or pr(essionals relat+ to surprise m$ical bills1 ! proc$ures applicable to self-insur$ gr\p heal? plans = ! resolution ( surprise m$ical bills "u ?is ,act 7includ+ ! am5dm5ts made by ?is ,act71 %all apply to det]m9e comp5sation ) respect to a surprise m$ical bill1 until su* "t z ! ,/ate enacts a law provid+ = su* a resolution me?odology4 7b7 ,provisions applicable to ,,erisa ,section #gae ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aahe;d7 is am5d$ by add+ at ! end ! foll[+3 7c7 ,prohibitions on balance bill+ 7#a7 ,fully insur$ plans ,9 ! case ( a fully insur$ gr\p heal? plan-- 7,a7 a ,/ate may e/abli% proc$ures = det]m9+ ! appropriate comp5sation applicable to surprise m$ical bills betwe5 a p>ticipant or b5efici>y & a heal? c>e facility or pr(essional s long z ! me?odology us$ relies on ! def9ition ( surprise m$ical bill & ! prohibitions conta9$ 9 section #bgbi;,a ( ! ,public ,heal? ,s]vice ,act2 & 7,b7 a ,/ate may enact laws relat+ to rate-sett+1 indep5d5t dispute resolution1 an 9-network gu>antee1 or an alt]native me?odology t complies ) p>agraph 7#a74 7#b7 ,self-insur$ plans ,9 ! case ( a self-insur$ gr\p heal? plan1 ! resolution me?odology provid$ = "u section #bgbi;,a ( ! ,public ,heal? ,s]vice ,act1 %all be us$ to det]m9e comp5sation ) respect to a surprise m$ical bill4 4 7c7 ,,fehbp ,9 ! case ( a heal? plan "u *apt] #hi ( title #e1 ,unit$ ,/ates ,code1 ! resolution me?odology provid$ = "u ?is ,act 7includ+ ! am5dm5ts made by ?is ,act71 %all be us$ to det]m9e comp5sation ) respect to a surprise m$ical bill4 #aa4 ,balance bill+ /udy 7a7 ,9 g5]al ,n lat] ?an #c ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 9 consultation ) ! ,secret>y ( ,labor1 %all conduct a /udy ( ! effects ( ?is ,act 7includ+ ! am5dm5ts made by ?is ,act71 & submit to ,congress a report on ! f9d+s ( su* /udy1 :i* %all include in=mation & analysis on-- 7#a7 ! f9ancial impact on pati5t responsibility = heal? c>e sp5d+ & ov]all heal? c>e sp5d+2 7#b7 ! incid5ce & preval5ce ( ! deliv]y ( out-(-network heal? c>e s]vices2 7#c7 ! adequacy ( provid] networks (f]$ by heal? plans & heal? insurance issu]s 7z su* t]ms are def9$ 9 section #bgia ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia772 7#d7 ! impact ( connect+ reimbursem5t to diff]5t claims databases2 7#e7 ! numb] ( bills t g to ! indep5d5t dispute resolution process2 & 7#f7 ! adm9i/rative co/ ( ! indep5d5t dispute resolution process & e/imat$ impact on heal? insurance premiums & d$uctibles4 7b7 ,in=mation requirem5ts ,! in=mation provid$ 9 ! report "u subsection 7a7 %all be-- 7#a7 disaggregat$ by ,/ate & accord+ to ! fully insur$ & ! self-insur$ m>kets2 & 7#b7 ) respect to p>agraphs 7#a7 ?r\gh 7#c7 ( su* subsection1 made available to ! public electronically 9 a se>*able database4