,i  #aag? ,,congress  #b;d ,session  ,h4
 ,r4 #hhia  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,septemb] #ai1        
#bjbb,ms4 ,sn*ez 7= h]self1 ,ms4 ,moore 
( ,wiscons91 & ,mrs4 ,mill] ( ,we/      
,virg9ia7 introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,en]gy &     
,comm]ce1 & 9 addition to ! ,committees 
on ,education & ,labor1 & ,ways &       
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d ! ,public ,heal?      
,s]vice ,act1 ! ,employee ,retirem5t    
,income ,security ,act ( #aigd1 & !     
,int]nal ,rev5ue ,code ( #aihf to       
require gr\p heal? plans & heal?        
insurance issu]s (f]+ gr\p or individual
 heal? insurance cov]age to provide     
cov]age = =5sic m$ical exams ) no co/   
%>+1 & = o!r purposes4  #a4 ,%ort title 
,?is ,act may be cit$ z ! ,no ,surprises
 = ,survivors ,act ( #bjbb4  #b4        
,requir+ cov]age ( =5sic m$ical exams ) 

no co/ %>+  7a7 ,,phsa ,"p ,d ( title   
,,xxvii ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #cjj;gg-#aaa et seq47 is 
am5d$-- 7#a7 9 section                  
#bgii;,a-#a7;a77#c77;,c77ii71 by ins]t+ 
=5sic m$ical exams 7z def9$ 9 section   
#bgii;,a-#aa7;d77 furni%$ on or aft]    
,janu>y #a1 #bjbe & aft] %all include2 &
  7#b7 by add+ at ! end ! foll[+ new    
section3  #bgii;,a-#aa4 ,requir$ cov]age
 ( =5sic m$ical exams ) no co/ %>+  7a7 
,9 g5]al ,except z provid$ 9 subsection 
7b71 a gr\p heal? plan & a heal?        
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age %all provide    
cov]age = & %all n impose any co/ %>+   
requirem5ts = a =5sic m$ical exam 7z    
def9$ 9 subsection 7d77 furni%$ by a    
sexual assault =5sic exam9] 7z def9$ =  
purposes ( section #cjd ( ! ,,dna       
,sexual ,assault ,ju/ice ,act ( #bjjd71 
a sexual assault nurse exam9] 7z s      
def9$71 or any o!r provid] specifi$ by !
 ,secret>y1 reg>dless ( :e!r su* =5sic  
exam9]1 nurse exam9]1 or o!r provid] has

 9 effect a contractual relation%ip )   
su* plan or cov]age = ! furni%+ ( su*   
exam or item or s]vice4  7b7            
,nonapplication to c]ta9 =5sic m$ical   
exams o!rwise cov]$  7#a7 ,9 g5]al ,!   
provisions ( subsection 7a7 %all n apply
 ) respect to a =5sic m$ical exam       
furni%$ 9 a ,/ate = :i* su* ,/ate is    
responsible = incurr+ ! full            
out-(-pocket co/s "u section #bjaj ( !  
,omnibus ,crime ,control & ,safe ,/reets
 ,act ( #aifh4  7#b7 ,notification ,9 ! 
case t a gr\p heal? plan or heal?       
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age receives a claim
 = a =5sic m$ical exam to :i* !         
provisions ( subsection 7a7 w\ld apply b
 = application ( p>agraph 7#a7 & su*    
plan or issu] d5ies su* claim or imposes
 co/ %>+ on su* claim1 su* plan or issu]
 %all-- 7,a7 at ! "t ( su* d5ial or     
imposition1 notify ! individual )       
respect to :om su* exam 0 furni%$ ( !   
mann] 9 :i* su* individual may seek     
reimbursem5t = su* exam 7or = ! am\nt ( 

su* co/ %>+ s impos$1 z applicable7 f ! 
,/ate 9 :i* su* exam 0 furni%$2 &  7,b7 
aft] receiv+ au?orization f su*         
individual1 notify ! appropriate ,/ate  
ag5cy ( ! ,/ate 9 :i* su* exam 0 furni%$
 ( su* claim4  7c7 ,application (       
surprise bill+ provisions  7#a7 ,9 g5]al
 ,! provisions ( sections #bgii;,a-#a & 
#bgii;,b-#a1 #gaf ( ! ,employee         
,retirem5t ,income ,security ,act (     
#aigd1 & #ihaf ( ! ,int]nal ,rev5ue     
,code ( #aihf %all apply to a =5sic     
m$ical exam = :i* a gr\p heal? plan or  
heal? insurance issu] (f]+ gr\p or      
individual heal? insurance cov]age is   
responsible = provid+ cov]age at no co/ 
%>+ "u ?is section furni%$ to an        
enrollee ( su* plan or gr\p or          
individual heal? insurance cov]age by a 
provid] t does n h 9 effect a           
contractual relation%ip describ$ 9      
subsection 7a7 ) su* plan or cov]age 7z 
applicable7 = furni%+ su* exam z if su* 
exam 0 an em]g5cy s]vice furni%$ by a   
nonp>ticipat+ provid] 9 an em]g5cy      

dep>tm5t ( a hospital4  7#b7 ,def9itions
 ,9 ?is subsection1 ! t]ms em]g5cy      
s]vice & nonp>ticipat+ provid] h !      
mean+s giv5 su* t]ms 9 subp>agraphs     
7,c77i7 & 7,g71 respectively1 ( sections
 #bgii;,a-#a7;a77#c71 #gaf7;a77#c7 ( !  
,employee ,retirem5t ,income ,security  
,act ( #aigd1 & section #ihaf7;a77#c7 ( 
! ,int]nal ,rev5ue ,code ( #aihf4  7d7  
,def9ition ,= purposes ( ?is section1 ! 
t]m =5sic m$ical exam means1 ) respect  
to an individual-- 7#a7 an exam9ation = 
physical trauma2  7#b7 a det]m9ation (  
p5etration or =ce2  7#c7 an int]view (  
su* individual2 &  7#d7 ! collection &  
evaluation ( evid5ce f su* individual4  
4  7b7 ,,erisa  7#a7 ,9 g5]al ,subp>t ,b
 ( "p #g ( subtitle ,b ( title ,i ( !   
,employee ,retirem5t ,income ,security  
,act ( #aigd is am5d$-- 7,a7 9 section  
#gaf7;a77#c77;,c77ii71 by ins]t+ =5sic  
m$ical exams 7z def9$ 9 section         
#gbf7;d77 furni%$ on or aft] ,janu>y #a1
 #bjbe & aft] %all include2 &  7,b7 by  
add+ at ! end ! foll[+ new section3     

#gbf4 ,requir$ cov]age ( =5sic m$ical   
exams ) no co/ %>+  7a7 ,9 g5]al ,except
 z provid$ 9 subsection 7b71 a gr\p     
heal? plan & a heal? insurance issu]    
(f]+ gr\p heal? insurance cov]age %all  
provide cov]age = & %all n impose any   
co/ %>+ requirem5ts = a =5sic m$ical    
exam 7z def9$ 9 subsection 7d77 furni%$ 
by a sexual assault =5sic exam9] 7z     
def9$ = purposes ( section #cjd ( !     
,,dna ,sexual ,assault ,ju/ice ,act (   
#bjjd71 a sexual assault nurse exam9] 7z
 s def9$71 or any o!r provid] specifi$  
by ! ,secret>y1 reg>dless ( :e!r su*    
=5sic exam9]1 nurse exam9]1 or o!r      
provid] has 9 effect a contractual      
relation%ip ) su* plan or cov]age = !   
furni%+ ( su* exam or item or s]vice4   
7b7 ,nonapplication to c]ta9 =5sic      
m$ical exams o!rwise cov]$  7#a7 ,9     
g5]al ,! provisions ( subsection 7a7    
%all n apply ) respect to a =5sic m$ical
 exam furni%$ 9 a ,/ate = :i* su* ,/ate 
is responsible = incurr+ ! full         
out-(-pocket co/s "u section #bjaj ( !  

,omnibus ,crime ,control & ,safe ,/reets
 ,act ( #aifh4  7#b7 ,notification ,9 ! 
case t a gr\p heal? plan or heal?       
insurance issu] (f]+ gr\p heal?         
insurance cov]age receives a claim = a  
=5sic m$ical exam to :i* ! provisions ( 
subsection 7a7 w\ld apply b =           
application ( p>agraph 7#a7 & su* plan  
or issu] d5ies su* claim or imposes co/ 
%>+ on su* claim1 su* plan or issu]     
%all-- 7,a7 at ! "t ( su* d5ial or      
imposition1 notify ! individual )       
respect to :om su* exam 0 furni%$ ( !   
mann] 9 :i* su* individual may seek     
reimbursem5t = su* exam 7or = ! am\nt ( 
su* co/ %>+ s impos$1 z applicable7 f ! 
,/ate 9 :i* su* exam 0 furni%$2 &  7,b7 
aft] receiv+ au?orization f su*         
individual1 notify ! appropriate ,/ate  
ag5cy ( ! ,/ate 9 :i* su* exam 0 furni%$
 ( su* claim4  7c7 ,application (       
surprise bill+ provisions  7#a7 ,9 g5]al
 ,! provisions ( sections #bgii;,a-#a & 
#bgii;,b-#a ( ! ,public ,heal? ,s]vice  
,act1 #gaf1 & #ihaf ( ! ,int]nal ,rev5ue

 ,code ( #aihf %all apply to a =5sic    
m$ical exam = :i* a gr\p heal? plan or  
heal? insurance issu] (f]+ gr\p heal?   
insurance cov]age is responsible =      
provid+ cov]age at no co/ %>+ "u ?is    
section furni%$ to a p>ticipant or      
b5efici>y ( su* plan or gr\p heal?      
insurance cov]age by a provid] t does n 
h 9 effect a contractual relation%ip    
describ$ 9 subsection 7a7 ) su* plan or 
cov]age 7z applicable7 = furni%+ su*    
exam z if su* exam 0 an em]g5cy s]vices 
furni%$ by a nonp>ticipat+ provid] 9 an 
em]g5cy dep>tm5t ( a hospital4  7#b7    
,def9itions ,9 ?is subsection1 ! t]ms   
em]g5cy s]vice & nonp>ticipat+ provid] h
 ! mean+s giv5 su* t]ms 9 subp>agraphs  
7,c77i7 & 7,g71 respectively1 ( sections
 #bgii;,a-#a7;a77#c7 ( ! ,public ,heal? 
,s]vice ,act1 #gaf7;a77#c71 & section   
#ihaf7;a77#c7 ( ! ,int]nal ,rev5ue ,code
 ( #aihf4  7d7 ,def9ition ,= purposes ( 
?is section1 ! t]m =5sic m$ical exam    
means1 ) respect to an individual-- 7#a7
 an exam9ation = physical trauma2  7#b7 

a det]m9ation ( p5etration or =ce2  7#c7
 an int]view ( su* individual2 &  7#d7 !
 collection & evaluation ( evid5ce f su*
 individual4  4  7#b7 ,te*nical am5dm5t 
,! table ( cont5ts 9 section #a ( su*   
,act is am5d$ by ins]t+ aft] ! item     
relat+ to section #gbe ! foll[+ new     
item3  ,sec4 #gbf4 ,requir$ cov]age (   
=5sic m$ical exams ) no co/ %>+4  4  7c7
 ,,irc  7#a7 ,9 g5]al ,sub*apt] ,b (    
*apt] #ajj ( ! ,int]nal ,rev5ue ,code ( 
#aihf is am5d$-- 7,a7 9 section         
#ihaf7;a77#c77;,c77ii71 by ins]t+ =5sic 
m$ical exams 7z def9$ 9 section         
#ihbf7;d77 furni%$ on or aft] ,janu>y   
#a1 #bjbe & aft] %all include2 &  7,b7  
by add+ at ! end ! foll[+ new section3  
#ihbf4 ,requir$ cov]age ( =5sic m$ical  
exams ) no co/ %>+  7a7 ,9 g5]al ,except
 z provid$ 9 subsection 7b71 a gr\p     
heal? plan %all provide cov]age = & %all
 n impose any co/ %>+ requirem5ts = a   
=5sic m$ical exam 7z def9$ 9 subsection 
7d77 furni%$ by a sexual assault =5sic  
exam9] 7z def9$ = purposes ( section    

#cjd ( ! ,,dna ,sexual ,assault ,ju/ice 
,act ( #bjjd71 a sexual assault nurse   
exam9] 7z s def9$71 or any o!r provid]  
specifi$ by ! ,secret>y1 reg>dless (    
:e!r su* =5sic exam9]1 nurse exam9]1 or 
o!r provid] has 9 effect a contractual  
relation%ip ) su* plan = ! furni%+ ( su*
 exam or item or s]vice4  7b7           
,nonapplication to c]ta9 =5sic m$ical   
exams o!rwise cov]$  7#a7 ,9 g5]al ,!   
provisions ( subsection 7a7 %all n apply
 ) respect to a =5sic m$ical exam       
furni%$ 9 a ,/ate = :i* su* ,/ate is    
responsible = incurr+ ! full            
out-(-pocket co/s "u section #bjaj ( !  
,omnibus ,crime ,control & ,safe ,/reets
 ,act ( #aifh4  7#b7 ,notification ,9 ! 
case t a gr\p heal? plan receives a     
claim = a =5sic m$ical exam to :i* !    
provisions ( subsection 7a7 w\ld apply b
 = application ( p>agraph 7#a7 & su*    
plan d5ies su* claim or imposes co/ %>+ 
on su* claim1 su* plan %all-- 7,a7 at ! 
"t ( su* d5ial or imposition1 notify !  
individual ) respect to :om su* exam 0  

furni%$ ( ! mann] 9 :i* su* individual  
may seek reimbursem5t = su* exam 7or = !
 am\nt ( su* co/ %>+ s impos$1 z        
applicable7 f ! ,/ate 9 :i* su* exam 0  
furni%$2 &  7,b7 aft] receiv+           
au?orization f su* individual1 notify ! 
appropriate ,/ate ag5cy ( ! ,/ate 9 :i* 
su* exam 0 furni%$ ( su* claim4  7c7    
,application ( surprise bill+ provisions
  7#a7 ,9 g5]al ,! provisions ( sections
 #bgii;,a-#a & #bgii;,b-#a ( ! ,public  
,heal? ,s]vice ,act1 #gaf ( ! ,employee 
,retirem5t ,income ,security ,act (     
#aigd1 & #ihaf %all apply to a =5sic    
m$ical exam = :i* a gr\p heal? plan is  
responsible = provid+ cov]age at no co/ 
%>+ "u ?is section furni%$ to an        
enrollee1 p>ticipant1 or b5efici>y ( su*
 plan by a provid] t does n h 9 effect a
 contractual relation%ip describ$ 9     
subsection 7a7 ) su* plan = furni%+ su* 
exam z if su* exam 0 an em]g5cy s]vice  
furni%$ by a nonp>ticipat+ provid] 9 an 
em]g5cy dep>tm5t ( a hospital4  7#b7    
,def9itions ,9 ?is subsection1 ! t]ms   

em]g5cy s]vice & nonp>ticipat+ provid] h
 ! mean+s giv5 su* t]ms 9 subp>agraphs  
7,c77i7 & 7,g71 respectively1 ( sections
 #bgii;,a-#a7;a77#c7 ( ! ,public ,heal? 
,s]vice ,act1 #gaf7;a77#c7 ( ! ,employee
 ,retirem5t ,income ,security ,act (    
#aigd1 & section #ihaf7;a77#c74  7d7    
,def9ition ,= purposes ( ?is section1 ! 
t]m =5sic m$ical exam means1 ) respect  
to an individual-- 7#a7 an exam9ation = 
physical trauma2  7#b7 a det]m9ation (  
p5etration or =ce2  7#c7 an int]view (  
su* individual2 &  7#d7 ! collection &  
evaluation ( evid5ce f su* individual4  
4  7#b7 ,te*nical am5dm5t ,! table (    
sections = su* sub*apt] is am5d$ by add+
 at ! end ! foll[+ new item3  ,sec4     
#ihbf4 ,requir$ cov]age ( =5sic m$ical  
exams ) no co/ %>+4  4  7d7 ,con=m+     
am5dm5t ,section #bbc7;c77#b7 ( !       
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,h7 ,safe h>bor = =5sic  
m$ical exams ,a plan %all n fail to be  
treat$ z a high d$uctible heal? plan by 

reason ( fail+ to h a d$uctible = any   
item or s]vice = :i* su* plan is requir$
 to provide cov]age at no co/ %>+ "u    
section #ihbf4  4  7e7 ,implem5tation ,!
 ,secret>ies ( ,labor1 ,heal? & ,human  
,s]vices1 & ! ,treasury may implem5t !  
am5dm5ts made by ?is section ?r\gh      
int]im f9al rules1 subregulatory        
guidance1 program in/ruction1 or        
o!rwise4  7f7 ,effective date ,!        
am5dm5ts made by subsections 7a7 ?r\gh  
7d7 %all apply ) respect to plan ye>s   
beg9n+ on or aft] ,janu>y #a1 #bjbe4