,,ii #aafth ,,congress #b;d ,session ,s4 #dahe ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #b1 #bjbj,mr4 ,wicker introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to establish an independent dispute resolution process for surprise air ambulance bills1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,end ,surprise ,medical ,bills for ,air ,ambulances ,act of #bjbj4 #b4 ,ending surprise air ambulance bills ,part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is amended by inserting after section #bgai;,a the following3 #bgai;,b4 ,air ,ambulance ,surprise ,medical ,bill ,dispute ,resolution 7a7 ,establishment of independent dispute resolution process 7#a7 ,establishment ,not later than #cj days after the date of enactment of this section1 the ,secretary1 in consultation with the ,secretary of ,transportation1 shall establish an independent dispute resolution process for resolving balance bills between a health plan or a health insurance issuer offering health insurance coverage 7in this section collectively referred to as a health insurance issuer7 and an out-of-network air ambulance providers in accordance with this section 7referred to in this section as the ,,idr process74 7#b7 ,independent dispute resolution entity ,under the ,,idr process1 the ,secretary in coordination with the ,secretary of ,transportation1 shall establish a list of qualified entities to serve as ,independent ,dispute ,resolution ,entities4 ,in establishing this list of qualified entities1 the ,secretary shall require that the qualified entities have arbitrators who have-- 7,a7 a minimum of #aj years of experience in health care litigation but whom have not represented a health insurance issuer or an air ambulance provider in the preceding #e years2 or 7,b7 a minimum of #ae years of experience in providing mediation and arbitration services4 7#c7 ,arbitration parameters ,the ,,idr process shall require an arbitrator to do the following3 7,a7 ,render a written decision resolving all disputes that designates #a party as the prevailing party4 7,b7 ,use the following factors in determining the reasonable value of the services provided3 7i7 ,the nature of the services provided and equipment used1 including the care capability and scope of practice of the out-of-network air ambulance provider4 7ii7 ,a comprehensive accounting of the out-of-network air ambulance provider's costs1 payor mix1 revenue mix1 and other economic factors of the out-of-network air ambulance provider's service4 7iii7 ,amounts paid 7in- and out-of-network7 to the out-of-network provider4 7iv7 ,amounts paid 7in- and out-of-network7 to similar out-of-network air ambulance providers in the same geographic region if such data is available4 7v7 ,information provided by ,federal data collection and reporting requirements1 when available4 7vi7 ,if available for the geographic area in which the flight took place1 the median in-network rate4 7,c7 ,not take into consideration bill charges when considering the amount to award4 7#d7 ,process requirements ,the ,,idr process shall require an arbitrator and parties adhere to the following process and timelines3 7,a7 ,the parties shall submit written submissions to the arbitrator on or before the #cjth day after initiating the ,,idr process4 7,b7 ,the arbitrator's decision shall include written findings and be issued within #de days after receipt of the parties' written submissions4 7,c7 ,any amount awarded by the arbitrator shall be paid within #bj days of the arbitrator's final decision4 7,d7 ,all proceedings and the arbitrator's decisions made under the ,,idr process shall be confidential in nature and not subject to any disclosure requirements4 7,e7 ,the nonprevailing party shall be responsible for paying all fees charged by the arbitrator4 7#e7 ,other considerations ,the ,,idr process shall allow the arbitrator in making the arbitrator's final decision to take into consideration the number of previous instances in which the parties involved have had to undergo the ,,idr process4 7b7 ,independent dispute resolution process 7#a7 ,in general ,when an out-of-network air ambulance provider bills a health insurance issuer for an air ambulance service provided to a participant1 beneficiary1 or enrollee of the issuer1 the health insurance issuer shall pay the billed amount or determine that the health insurance issuer considers some or all of the claim to be disputed within #cj days from receipt of the bill4 ,if a claim is disputed1 the health insurance issuer shall notify-- 7,a7 the out-of-network air ambulance provider in writing within #cj days of receipt of the bill why the claim is disputed 7in this subsection referred to as the notice of dispute72 and 7,b7 the patient who received the out-of-network air ambulance transport that the bill is disputed1 that the health insurance issuer1 and not the patient1 is responsible for the disputed bill1 and that the disputed bill will be resolved through the ,,idr process4 7#b7 ,resolution process ,the health insurance issuer and the out-of-network air ambulance provider have #ij days from the date on which the provider receives a notice of dispute from the issuer to come to a settlement agreement for the disputed bill4 7#c7 ,arbitrator selection ,if the health insurance issuer and the air ambulance provider do not come to an agreement under paragraph 7#b7 within such #ij-;day period1 the issuer and provider shall enter into the ,,idr process with an ,independent ,dispute ,resolution ,entity selected at random from the list established under subsection 7a77#b74 ,within #e business days of being selected1 the ,independent ,dispute ,resolution ,entity shall assign an arbitrator to make a determination in the matter4 7c7 ,effect of determination ,a final determination of the arbitrator assigned under subparagraph 7b77#c7 shall be binding on the issuer and provider4 7d7 ,privacy laws ,an arbitrator shall comply with all applicable ,federal and ,state privacy laws in conducting an ,,idr process under this section4 7e7 ,public availability ,the amount determined with respect to any claim by an arbitrator conducting an ,,idr process under this section shall be confidential1 except that an arbitrator may access the amounts determined in any previous claims involving the health insurance issuer or the out-of-network air ambulance provider that was resolved through the ,,idr process4 7f7 ,air ambulance enforcement ,the ,secretary of ,transportation shall require all air ambulance providers to participate in good faith in the ,,idr process4 ,if an air ambulance provider fails to abide by the timelines established in this section during the ,,idr process1 the ,secretary of ,transportation shall issue a fine of #bj1jjj against the air ambulance provider unless the provider's failure to abide by the timelines is attributable to the actions or inactions of the health insurance issuer4 7g7 ,insurers enforcement ,the ,secretary shall require all health insurance issuers to participate in good faith in the ,,idr process4 ,if an insurer fails to abide by the timelines established in this section during the ,,idr process1 the ,secretary shall issue a fine of #bj1jjj against the health insurance issuer unless the issuer's failure to abide by the timelines is attributable to the actions or inactions of the air ambulance provider4 7h7 ,reevaluation ,not later than #c years after the establishment of the ,,idr process1 the ,secretary and the ,secretary of ,transportation jointly shall-- 7#a7 conduct an evaluation of the process2 and 7#b7 based on the results of such evaluation1 determine whether to continue or terminate the ,,idr process 7after resolution of all disputed claims that are pending on the date the determination to terminate the process is made74 7i7 ,definition ,for purposes of this section1 the term air ambulance service means medical transport by helicopter or airplane for patients4 4