,,ii #aaf? ,,congress #b;d ,session ,s4 #dahe ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,july #b1 #bjbj,mr4 ,wick] introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ,a ,,bill ,to e/abli% an indep5d5t dispute resolution process = surprise air ambulance bills1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,end ,surprise ,m$ical ,bills = ,air ,ambulances ,act ( #bjbj4 #b4 ,end+ surprise air ambulance bills ,"p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is am5d$ by ins]t+ aft] section #bgai;,a ! foll[+3 #bgai;,b4 ,air ,ambulance ,surprise ,m$ical ,bill ,dispute ,resolution 7a7 ,e/abli%m5t ( indep5d5t dispute resolution process 7#a7 ,e/abli%m5t ,n lat] ?an #cj days aft] ! date ( enactm5t ( ?is section1 ! ,secret>y1 9 consultation ) ! ,secret>y ( ,transportation1 %all e/abli% an indep5d5t dispute resolution process = resolv+ balance bills betwe5 a heal? plan or a heal? insurance issu] (f]+ heal? insurance cov]age 79 ?is section collectively ref]r$ to z a heal? insurance issu]7 & an out-(-network air ambulance provid]s 9 accordance ) ?is section 7ref]r$ to 9 ?is section z ! ,,idr process74 7#b7 ,indep5d5t dispute resolution entity ,"u ! ,,idr process1 ! ,secret>y 9 coord9ation ) ! ,secret>y ( ,transportation1 %all e/abli% a li/ ( qualifi$ entities to s]ve z ,indep5d5t ,dispute ,resolution ,entities4 ,9 e/abli%+ ?is li/ ( qualifi$ entities1 ! ,secret>y %all require t ! qualifi$ entities h arbitrators :o h-- 7,a7 a m9imum ( #aj ye>s ( exp]i5ce 9 heal? c>e litigation b :om h n repres5t$ a heal? insurance issu] or an air ambulance provid] 9 ! prec$+ #e ye>s2 or 7,b7 a m9imum ( #ae ye>s ( exp]i5ce 9 provid+ m$iation & arbitration s]vices4 7#c7 ,arbitration p>amet]s ,! ,,idr process %all require an arbitrator to d ! foll[+3 7,a7 ,r5d] a writt5 decision resolv+ all disputes t designates #a p>ty z ! prevail+ p>ty4 7,b7 ,use ! foll[+ factors 9 det]m9+ ! reasonable value ( ! s]vices provid$3 7i7 ,! nature ( ! s]vices provid$ & equipm5t us$1 includ+ ! c>e capability & scope ( practice ( ! out-(-network air ambulance provid]4 7ii7 ,a compreh5sive acc\nt+ ( ! out-(-network air ambulance provid]'s co/s1 payor mix1 rev5ue mix1 & o!r economic factors ( ! out-(-network air ambulance provid]'s s]vice4 7iii7 ,am\nts paid 79- & out-(-network7 to ! out-(-network provid]4 7iv7 ,am\nts paid 79- & out-(-network7 to simil> out-(-network air ambulance provid]s 9 ! same geographic region if su* data is available4 7v7 ,in=mation provid$ by ,f$]al data collection & report+ requirem5ts1 :5 available4 7vi7 ,if available = ! geographic area 9 :i* ! flight took place1 ! m$ian 9-network rate4 7,c7 ,n take into consid]ation bill *>ges :5 consid]+ ! am\nt to aw>d4 7#d7 ,process requirem5ts ,! ,,idr process %all require an arbitrator & p>ties adh]e to ! foll[+ process & timel9es3 7,a7 ,! p>ties %all submit writt5 submissions to ! arbitrator on or be=e ! #cj? day aft] initiat+ ! ,,idr process4 7,b7 ,! arbitrator's decision %all include writt5 f9d+s & be issu$ )9 #de days aft] receipt ( ! p>ties' writt5 submissions4 7,c7 ,any am\nt aw>d$ by ! arbitrator %all be paid )9 #bj days ( ! arbitrator's f9al decision4 7,d7 ,all proce$+s & ! arbitrator's decisions made "u ! ,,idr process %all be confid5tial 9 nature & n subject to any disclosure requirem5ts4 7,e7 ,! nonprevail+ p>ty %all be responsible = pay+ all fees *>g$ by ! arbitrator4 7#e7 ,o!r consid]ations ,! ,,idr process %all all[ ! arbitrator 9 mak+ ! arbitrator's f9al decision to take into consid]ation ! numb] ( previ\s in/ances 9 :i* ! p>ties involv$ h _h to und]go ! ,,idr process4 7b7 ,indep5d5t dispute resolution process 7#a7 ,9 g5]al ,:5 an out-(-network air ambulance provid] bills a heal? insurance issu] = an air ambulance s]vice provid$ to a p>ticipant1 b5efici>y1 or enrollee ( ! issu]1 ! heal? insurance issu] %all pay ! bill$ am\nt or det]m9e t ! heal? insurance issu] consid]s "s or all ( ! claim to be disput$ )9 #cj days f receipt ( ! bill4 ,if a claim is disput$1 ! heal? insurance issu] %all notify-- 7,a7 ! out-(-network air ambulance provid] 9 writ+ )9 #cj days ( receipt ( ! bill :y ! claim is disput$ 79 ?is subsection ref]r$ to z ! notice ( dispute72 & 7,b7 ! pati5t :o receiv$ ! out-(-network air ambulance transport t ! bill is disput$1 t ! heal? insurance issu]1 & n ! pati5t1 is responsible = ! disput$ bill1 & t ! disput$ bill w be resolv$ ?r\gh ! ,,idr process4 7#b7 ,resolution process ,! heal? insurance issu] & ! out-(-network air ambulance provid] h #ij days f ! date on :i* ! provid] receives a notice ( dispute f ! issu] to come to a settlem5t agreem5t = ! disput$ bill4 7#c7 ,arbitrator selection ,if ! heal? insurance issu] & ! air ambulance provid] d n come to an agreem5t "u p>agraph 7#b7 )9 su* #ij-;day p]iod1 ! issu] & provid] %all ent] into ! ,,idr process ) an ,indep5d5t ,dispute ,resolution ,entity select$ at r&om f ! li/ e/abli%$ "u subsection 7a77#b74 ,)9 #e bus9ess days ( be+ select$1 ! ,indep5d5t ,dispute ,resolution ,entity %all assign an arbitrator to make a det]m9ation 9 ! matt]4 7c7 ,effect ( det]m9ation ,a f9al det]m9ation ( ! arbitrator assign$ "u subp>agraph 7b77#c7 %all be b9d+ on ! issu] & provid]4 7d7 ,privacy laws ,an arbitrator %all comply ) all applicable ,f$]al & ,/ate privacy laws 9 conduct+ an ,,idr process "u ?is section4 7e7 ,public availability ,! am\nt det]m9$ ) respect to any claim by an arbitrator conduct+ an ,,idr process "u ?is section %all be confid5tial1 except t an arbitrator may access ! am\nts det]m9$ 9 any previ\s claims involv+ ! heal? insurance issu] or ! out-(-network air ambulance provid] t 0 resolv$ ?r\gh ! ,,idr process4 7f7 ,air ambulance en=cem5t ,! ,secret>y ( ,transportation %all require all air ambulance provid]s to p>ticipate 9 good fai? 9 ! ,,idr process4 ,if an air ambulance provid] fails to abide by ! timel9es e/abli%$ 9 ?is section dur+ ! ,,idr process1 ! ,secret>y ( ,transportation %all issue a f9e ( #bj1jjj aga9/ ! air ambulance provid] unless ! provid]'s failure to abide by ! timel9es is attributable to ! actions or inactions ( ! heal? insurance issu]4 7g7 ,insur]s en=cem5t ,! ,secret>y %all require all heal? insurance issu]s to p>ticipate 9 good fai? 9 ! ,,idr process4 ,if an insur] fails to abide by ! timel9es e/abli%$ 9 ?is section dur+ ! ,,idr process1 ! ,secret>y %all issue a f9e ( #bj1jjj aga9/ ! heal? insurance issu] unless ! issu]'s failure to abide by ! timel9es is attributable to ! actions or inactions ( ! air ambulance provid]4 7h7 ,reevaluation ,n lat] ?an #c ye>s aft] ! e/abli%m5t ( ! ,,idr process1 ! ,secret>y & ! ,secret>y ( ,transportation jo9tly %all-- 7#a7 conduct an evaluation ( ! process2 & 7#b7 bas$ on ! results ( su* evaluation1 det]m9e :e!r to cont9ue or t]m9ate ! ,,idr process 7aft] resolution ( all disput$ claims t are p5d+ on ! date ! det]m9ation to t]m9ate ! process is made74 7i7 ,def9ition ,= purposes ( ?is section1 ! t]m air ambulance s]vice means m$ical transport by helicopt] or airplane = pati5ts4 4