,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #cbha  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #ae1 #bjbc ,mrs4 
,rodg]s ( ,wa%+ton 7= h]self & ,mr4     
,pallone7 introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,en]gy &     
,comm]ce  ,a ,,bill  ,to promote        
hospital & insur] price transp>5cy4  #a4
 ,%ort title ,?is ,act may be cit$ z !  
,transp>5t ,prices ,requir$ to ,in=m    
,consum] & ,employ]s ,act or !          
,transp>5t ,,price ,act4  #b4 ,price    
transp>5cy requirem5ts  7a7 ,9 g5]al    
,section #bgah7;e7 ( ! ,public ,heal?   
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#ah7;e77 is am5d$--  7#a7 by    
/rik+ ,ea* hospital & ins]t+ ! foll[+3  
7#a7 ,9 g5]al ,ea* hospital  2  7#b7 by 
ins]t+ 1 )\t subscription & free ( *>ge1
 9 a s+le ma*9e-readable file1 aft] a   
li/2  7#c7 by ins]t+ & a li/1 9 pla9    
language & )\t subscription & free (    
*>ge1 9 a consum]-fri5dly =mat1 ( !     
hospital's /&>d *>ges = z _m ( ! #gj    
,c5t]s = ,m$ic>e  ,m$icaid              

,s]vices-specifi$ %oppable s]vices t are
 provid$ by ! hospital1 & z _m          
additional hospital-select$ %oppable    
s]vices 7or all su* additional s]vices1 
if su* hospital provides few] ?an #cjj  
%oppable s]vices7 z may be necess>y = a 
comb9$ total ( at lea/ #cjj %oppable    
s]vices aft] ,social ,security ,act2 &  
7#d7 by add+ at ! end ! foll[+3 ,su*    
li/s %all be updat$ n less frequ5tly ?an
 annually4 ,beg9n+ ,janu>y #a1 #bjbd1   
ea* hospital %all include 9 its li/s (  
/&>d *>ges1 along ) su* additional      
in=mation z ! ,secret>y may require )   
respect to su* *>ges = purposes (       
promot+ public aw>5ess ( hospital pric+ 
9 advance ( receiv+ a hospital item or  
s]vice1 ! foll[+3  7,a7 ,a pla9 language
 description ( ea* item or s]vice       
includ$ on su* li/1 includ+1 z          
applicable1 ! ,heal?c>e ,common         
,proc$ure ,cod+ ,sy/em 7,,hcpcs7 code1 !
 ,diagnosis ,relat$ ,gr\p 7,,drg71 !    
,national ,drug ,code 7,,ndc71 or o!r   
pay] id5tifi] us$ or approv$ by ! ,c5t]s

 = ,m$ic>e  ,m$icaid ,s]vices = su* item
 or s]vice4  7,b7 ,! gross *>ge1        
express$ z a doll> am\nt1 = ea* su* item
 or s]vice1 :5 provid$ 91 z applicable1 
! hospital inpati5t sett+ & outpati5t   
dep>tm5t sett+4  7,c7 ,any curr5t       
pay]-specific negotiat$ *>ges1 cle>ly   
associat$ ) ! "n ( ! ?ird p>ty pay] &   
plan & express$ z a doll> am\nt1 t      
applies to ea* su* item or s]vice :5    
provid$ 91 z applicable1 ! hospital     
inpati5t sett+ & outpati5t dep>tm5t     
sett+4  7,d7 ,! de-id5tifi$ maximum &   
m9imum negotiat$ *>ges = ea* su* item or
 s]vice4  7,e7 ,! disc\nt$ ca% price1   
express$ z a doll> am\nt1 = ea* su* item
 or s]vice :5 provid$ 91 z applicable1 !
 hospital inpati5t sett+ & outpati5t    
dep>tm5t sett+4 ,if ! disc\nt$ ca% price
 is a p]c5tage ( ano!r value provid$1 ! 
calculat$ value mu/ be ent]$ z a doll>  
am\nt4 ,if ! disc\nt$ ca% price equates 
to ! gross *>ge1 ! gross *>ge %all be   
re-ent]$ to indicate t no ca% disc\nt is
 available4  7#b7 ,deem$ compliance )   

%oppable s]vices requirem5t = c]ta9 ye>s
 ,) respect to a ye> be=e #bjbe1 a      
hospital %all be deem$ to meet !        
requirem5t ( p>agraph 7#a7 t su*        
hospital make available a li/ ( /&>d    
*>ges = %oppable s]vices if ! hospital  
ma9ta9s an int]net-bas$ price e/imator  
tool t meets ! foll[+ requirem5ts3  7,a7
 ,! tool provides e/imates = z _m ( !   
#gj ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices 
specifi$ %oppable s]vices t are provid$ 
by ! hospital1 & z _m additional        
hospital-select$ %oppable s]vices 7or   
all su* additional s]vices1 if su*      
hospital provides few] ?an #cjj %oppable
 s]vices7 z may be necess>y = a comb9$  
total ( at lea/ #cjj %oppable s]vices4  
7,b7 ,! tool all[s heal? c>e consum]s   
to1 at ! "t !y use ! tool1 obta9 an     
e/imate ( ! am\nt !y w be obligat$ to   
pay ! hospital = ! %oppable s]vice4     
7,c7 ,! tool is prom95tly display$ on ! 
hospital's website & easily accessible  
to ! public1 )\t subscription1 fee1 or  
hav+ to submit p]sonal id5tify+         

in=mation1 & se>*able by s]vice         
description1 bill+ code1 & pay]4  ,!    
,secret>y may n deem ! e/abli%m5t ( an  
int]net-bas$ price e/imator tool t meets
 ! requirem5ts ( ?is p>agraph to        
con/itute compliance ) ! requirem5t (   
p>agraph 7#a7 t su* hospital make       
available a li/ ( /&>d *>ges = %oppable 
s]vices = #bjbe or a subsequ5t ye>4     
7#c7 ,uni=m me?od & =mat ,n lat] ?an    
,janu>y #a1 #bjbe1 ! ,secret>y %all     
implem5t a /&>d1 uni=m me?od & =mat =   
hospitals to use 9 ord] to satisfy !    
requirem5ts ( ?is subsection = disclos+ 
directly to ! public *>ge & price       
in=mation4 ,su* me?od & =mat may be     
simil> to any template e/abli%$ by !    
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices z ( 
! date ( ! enactm5t ( ?is p>agraph =    
report+ su* in=mation "u ?is subsection 
& %all meet su* /&>ds z det]m9$         
appropriate by ! ,secret>y4  7#d7       
,monitor+ ( pric+ in=mation ,!          
,secret>y1 9 consultation ) ! ,inspector
 ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human 

,s]vices1 %all1 ?r\gh notice & comm5t   
rulemak+1 e/abli% a process to regul>ly 
monitor ! accuracy & validity ( pric+   
in=mation display$ by ea* hospital      
pursuant to p>agraph 7#a74  7#e7        
,def9itions ,not)/&+ any o!r provision (
 law1 = ! purpose ( p>agraphs 7#a7 &    
7#b73  7,a7 ,de-id5tifi$ maximum        
negotiat$ *>ge ,! t]m de-id5tifi$       
maximum negotiat$ *>ge means ! highe/   
*>ge t a hospital has negotiat$ ) all   
?ird p>ty pay]s = an item or s]vice4    
7,b7 ,de-id5tifi$ m9imum negotiat$ *>ge 
,! t]m de-id5tifi$ m9imum negotiat$ *>ge
 means ! l[e/ *>ge t a hospital has     
negotiat$ ) all ?ird p>ty pay]s = an    
item or s]vice4  7,c7 ,disc\nt$ ca%     
price ,! t]m disc\nt$ ca% price means ! 
*>ge t applies to an individual :o pays 
ca%1 or ca% equival5t1 = a hospital item
 or s]vice4 ,hospitals t d n (f]        
self-pay disc\nts may display !         
hospital's undisc\nt$ gross *>ges z f\nd
 9 ! hospital *>gema/]4  7,d7 ,gross    
*>ge ,! t]m gross *>ge means ! *>ge = an

 individual item or s]vice t is reflect$
 on a hospital's *>gema/]1 abs5t any    
disc\nts4  7,e7 ,pay]-specific negotiat$
 *>ge ,! t]m pay]-specific negotiat$    
*>ge means ! *>ge t a hospital has      
negotiat$ ) a ?ird p>ty pay] = an item  
or s]vice4  7,f7 ,%oppable s]vice ,! t]m
 %oppable s]vice means a s]vice t c be  
s*$ul$ by a heal? c>e consum] 9 advance4
  7,g7 ,?ird p>ty pay] ,! t]m ?ird p>ty 
pay] means an entity t is1 by /atute1   
contract1 or agreem5t1 legally          
responsible = paym5t ( a claim = a heal?
 c>e item or s]vice4  7#f7 ,en=cem5t    
7,a7 ,9 g5]al ,subject to subp>agraph   
7,c71 9 ! case ( a hospital t fails to  
comply ) ?is subsection--  7i7 !        
,secret>y %all notify su* hospital ( su*
 failure n lat] ?an #cj days aft] ! date
 on :i* ! ,secret>y det]m9es su* failure
 exi/s2 &  7ii7 n lat] ?an #de days aft]
 ! date ( su* notification1 ! hospital  
%all complete a corrective action plan  
to comply ) su* requirem5ts4  7,b7      
,civil monet>y p5alty  7i7 ,9 g5]al ,9  

addition to any o!r en=cem5t actions or 
p5alties t may apply "u subsection      
7b77#c7 or ano!r provision ( law1 a     
hospital t has receiv$ a notification "u
 subp>agraph 7,a77i7 & fails to satisfy 
! requirem5t "u subp>agraph 7,a77ii7 or 
o!rwise comply ) ! requirem5ts ( ?is    
subsection by ! date t is #ij days aft] 
su* notification %all be subject to a   
civil monet>y p5alty ( an am\nt-- 7,i7 9
 ! case ! hospital provides n m ?an #cj 
b$s 7z det]m9$ "u section               
#ahj4ij7;c77#b77;ii77,d7 ( title #de1   
,code ( ,f$]al ,regulations1 z 9 effect 
on ! date ( ! enactm5t ( ?is p>agraph71 
n to exce$ #cjj p] day t ! violation is 
ongo+ z det]m9$ by ! ,secret>y2 &       
7,,ii7 9 ! case ! hospital provides m   
?an #cj b$s 7z s det]m9$71 equal to--   
7aa7 subject to item 7bb71 #aj p] b$ p] 
day t ! violation is ongo+ z det]m9$ by 
! ,secret>y1 b = violations occurr+ be=e
 ,janu>y #a1 #bjbd1 n to exce$ #e1ejj p]
 ea* su* day2 or  7bb7 9 ! case su*     
hospital has fail$ to satisfy !         

requirem5t "u subp>agraph 7,a77ii7 or   
o!rwise comply ) ! requirem5ts ( ?is    
subsection = any cont9u\s #a-ye> p]iod  
beg9n+ on or aft] ,janu>y #a1 #bjbd1 & !
 am\nt o!rwise impos$ "u item 7aa7 = su*
 failure = su* p]iod w\ld be less ?an   
#e1jjj1jjj1 an am\nt n less ?an         
#e1jjj1jjj4  7ii7 ,increase au?ority ,9 
apply+ ?is subp>agraph ) respect to     
violations occurr+ 9 #bjbe or a         
subsequ5t ye>1 ! ,secret>y may ?r\gh    
notice & comm5t rulemak+ increase any   
doll> am\nt appli$ "u ?is subp>agraph by
 an am\nt specifi$ by ! ,secret>y4      
7iii7 ,application ( c]ta9 provisions ,!
 provisions ( section #aabh;,a ( !      
,social ,security ,act 7o!r ?an         
subsections 7a7 & 7b7 ( su* section7    
%all apply to a civil monet>y p5alty    
impos$ "u clause 7i7 9 ! same mann] z   
su* provisions apply to a civil monet>y 
p5alty impos$ "u subsection 7a7 ( su*   
section4  7,c7 ,option to =go notice (  
noncompliance ,9 ! case t ! ,secret>y   
det]m9es t a hospital has fail$ to      

comply ) ?is subsection & fur!r det]m9es
 t su* hospital has made no ef=t to     
comply ) su* subsection1 ! ,secret>y may
 elect to reque/ a corrective action    
plan f su* hospital  4  7b7 ,publication
 ( li/ ( hospitals  7#a7 ,li/ (         
hospitals ,beg9n+ n lat] ?an #ij days   
aft] ! date ( enactm5t ( ?is ,act1 !    
,secret>y ( ,heal? & ,human ,s]vices    
7ref]r$ to 9 ?is section z ! ,secret>y7 
%all e/abli% & ma9ta9 a publicly        
available li/ on ! website ( ! ,c5t]s = 
,m$ic>e  ,m$icaid ,s]vices ( ea*        
hospital ) respect to :i* ! ,secret>y   
has conduct$ a review ( su* hospital's  
compliance ) ! provisions ( section     
#bgah7;e7 ( ! ,public ,heal? ,s]vice    
,act 7#db ,u4,s4,c4 #cjj;gg-#ah7;e774   
,su* li/ %all include1 ) respect to ea* 
su* hospital t 0 noncompliant ) su*     
provisions1 a specification z to :e!r   
su* hospital-- 7,a7 has be5 issu$ a     
civil monet>y p5alty2  7,b7 has receiv$ 
a w>n+ notice2 or  7,c7 has submitt$ a  
corrective action plan4  7#b7 ,additions

 & updates ,9 ! case ( a hospital n     
includ$ on ! li/ describ$ 9 p>agraph    
7#a7 z ( ! date ( ! e/abli%m5t ( su* li/
 & t is subject to a review ( su*       
hospital's compliance ) ! provisions    
describ$ 9 su* p>agraph aft] su* date1 !
 ,secret>y %all add su* hospital to su* 
li/1 along ) ! specifications describ$ 9
 su* p>agraph1 n lat] ?an #a bus9ess day
 aft] su* review occurs4 ,! ,secret>y   
%all update su* specifications ) respect
 to any hospital includ$ on su* li/--   
7,a7 n lat] ?an #a bus9ess day aft] any 
subsequ5t review ( su* hospital's       
compliance ) su* provisions2 &  7,b7 n  
lat] ?an #a bus9ess day aft] any p5alty1
 notice1 or reque/ describ$ 9 p>agraph  
7#a7 is made ) respect to su* hospital4 
7#c7 ,,foia reque/s ,any p5alty1 notice1
 or reque/ describ$ 9 p>agraph 7#a7 %all
 be subject to public disclosure1 9 full
 & )\t r$action1 "u section #eeb ( title
 #ba1 ,unit$ ,/ates ,code1 not)/&+ any  
exemptions or exclusions o!rwise        
available "u su* section #eeb4  7#d7    

,reports to ,congress ,n lat] ?an #a ye>
 aft] ! date ( enactm5t ( ?is ,act & ea*
 ye> !reaft]1 ! ,secret>y ( ,heal? &    
,human ,s]vices %all submit to          
,congress1 & make publicly available1 a 
report t conta9s in=mation reg>d+       
compla9ts ( alleg$ violations ( law &   
en=cem5t activities by ! ,secret>y "u ! 
hospital price transp>5cy rule implem5t+
 section #bgah7;e7 ( ! ,public ,heal?   
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#ah7;e774 ,su* report %all be   
made available to ! public on ! website 
( ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices4
 ,ea* su* report %all include1 ) respect
 to ! ye> involv$-- 7,a7 ! numb] (      
compliance & en=cem5t inquiries op5$ by 
! ,secret>y pursuant to su* section2    
7,b7 ! numb] ( notices ( noncompliance  
issu$ by ! ,secret>y bas$ on su*        
inquiries2  7,c7 ! id5tity ( ea*        
hospital entity t receiv$ a notice (    
noncompliance & ! nature ( ! failure    
giv+ rise to ! ,secret>y's det]m9ation (
 noncompliance2  7,d7 ! am\nt ( civil   

monet>y p5alty assess$ aga9/ ! hospital 
entity2  7,e7 :e!r ! hospital entity    
subsequ5tly correct$ ! noncompliance2 & 
7,f7 an analysis ( factors contribut+ to
 increas+ heal? c>e co/s4  7#e7 ,,gao   
report ,n lat] ?an #a ye> aft] ! date ( 
enactm5t ( ?is ,act1 ! ,comptroll]      
,g5]al ( ! ,unit$ ,/ates %all submit to 
! ,committee on ,en]gy & ,comm]ce ( !   
,h\se ( ,repres5tatives & ! ,committee  
on ,heal?1 ,education1 ,labor1 &        
,p5sions ( ! ,s5ate a report on !       
compliance & en=cem5t ) ! hospital price
 transp>5cy rule implem5t+ section      
#bgah7;e7 ( ! ,public ,heal? ,s]vice    
,act 7#db ,u4,s4,c4 #cjj;gg-#ah7;e774 ,!
 report %all include recomm5dations     
relat$ to--  7,a7 improv+ price         
transp>5cy to pati5ts1 employ]s1 & !    
public2 &  7,b7 increas$ civil monet>y  
p5alty am\nts to ensure compliance4     
7#f7 ,reque/ = in=mation ,n lat] ?an    
,janu>y #a1 #bjbe1 ! ,secret>y ( ,heal? 
& ,human ,s]vices %all issue a public   
reque/ = in=mation z to ! be/ me?od     

?r\gh :i* hospitals may be requir$ to   
publi% quality data 7su* z data requir$ 
to be report$ "u ! ,m$ic>e ,hospital    
,comp>e program7 alongside data requir$ 
to be report$ "u section #bgah7;e7 ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#ah7;e774  #c4        
,/r5g!n+ heal? insurance transp>5cy     
requirem5ts  7a7 ,transp>5cy 9 cov]age  
,section #acaa7;e77#c77;,c7 ( ! ,pati5t 
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca7;e77#c77;,c77 is       
am5d$--  7#a7 by /rik+ ,! ,ex*ange &    
ins]t+ ! foll[+3  7i7 ,9 g5]al ,!       
,ex*ange  2  7#b7 9 clause 7i71 z ins]t$
 by p>agraph 7#a7-- 7,a7 by /rik+       
p>ticipat+ provid] & ins]t+ provid]2    
7,b7 by ins]t+ %all include ! in=mation 
specifi$ 9 clause 7ii7 & aft] su*       
in=mation2  7,c7 by /rik+ an ,int]net   
website & ins]t+ a self-s]vice tool t   
meets ! requirem5ts ( clause 7iii72 &   
7,d7 by /rik+ & su* o!r & all t foll[s  
?r\gh ! p]iod & ins]t+ or1 at ! option  
su* individual1 ?r\gh a pap] or phone   

disclosure 7z select$ by su* individual 
& provid$ at no co/ to su* individual7 t
 meets su* requirem5ts z ! ,secret>y may
 specify42 &  7#c7 by add+ at ! end !   
foll[+ new clauses3  7ii7 ,specifi$     
in=mation ,= purposes ( clause 7i71 !   
in=mation specifi$ 9 ?is clause is1 )   
respect to an item or s]vice = :i*      
b5efits are available "u a heal? plan   
furni%$ by a heal? c>e provid]1 !       
foll[+3 7,i7 ,if su* provid] is a       
p>ticipat+ provid] ) respect to su* item
 or s]vice1 ! 9-network rate 7z def9$ 9 
subp>agraph 7,f77 = su* item or s]vice4 
7,,ii7 ,if su* provid] is n describ$ 9  
subclause 7,i71 ! maximum all[$ am\nt = 
su* item or s]vice4  7,,iii7 ,! am\nt ( 
co/ %>+ 7includ+ d$uctibles1 copaym5ts1 
& co9surance7 t ! individual w incur =  
su* item or s]vice 7:i*1 9 ! case su*   
item or s]vice is to be furni%$ by a    
provid] describ$ 9 subclause 7,,ii71    
%all be calculat$ us+ ! maximum am\nt   
describ$ 9 su* subclause74  7,,iv7 ,!   
am\nt ! individual has already          

accumulat$ ) respect to any d$uctible or
 out ( pocket maximum "u ! plan 7brok5  
d[n1 9 ! case sep>ate d$uctibles or     
maximums apply to sep>ate individuals   
enroll$ 9 ! plan1 by su* sep>ate        
d$uctibles or maximums1 9 addition to   
any cumulative d$uctible or maximum74   
7,v7 ,9 ! case su* plan imposes any     
frequ5cy or volume limitations ) respect
 to su* item or s]vice 7exclud+ m$ical  
necessity det]m9ations71 ! am\nt t su*  
individual has accru$ t[>ds su*         
limitation ) respect to su* item or     
s]vice4  7,,vi7 ,any prior au?orization1
 concurr5t review1 /ep !rapy1 fail fir/1
 or simil> requirem5ts applicable to    
cov]age ( su* item or s]vice "u su*     
plan4  7iii7 ,self-s]vice tool ,=       
purposes ( clause 7i71 a self-s]vice    
tool e/abli%$ by a heal? plan meets !   
requirem5ts ( ?is clause if su* tool--  
7,i7 is bas$ on an ,int]net website2    
7,,ii7 provides = real-"t responses to  
reque/s describ$ 9 su* clause2  7,,iii7 
is updat$ 9 a mann] su* t in=mation     

provid$ ?r\gh su* tool is timely &      
accurate2  7,,iv7 all[s su* a reque/ to 
be made ) respect to an item or s]vice  
furni%$ by--  7aa7 a specific provid] t 
is a p>ticipat+ provid] ) respect to su*
 item or s]vice2  7bb7 all provid]s t   
are p>ticipat+ provid]s ) respect to su*
 plan & su* item or s]vice2 or  7cc7 a  
provid] t is n describ$ 9 item 7bb72 &  
7,v7 provides t su* a reque/ may be made
 ) respect to an item or s]vice ?r\gh   
use ( ! bill+ code = su* item or s]vice 
or ?r\gh use ( a descriptive t]m = su*  
item or s]vice4  ,! ,secret>y may       
require su* tool1 z a condition (       
comply+ ) subclause 7,v71 to l9k        
multiple bill+ codes to a s+le          
descriptive t]m if ! ,secret>y det]m9es 
t ! bill+ codes to be s l9k$ correspond 
to items & s]vices4  4  7b7 ,disclosure 
( additional in=mation ,section         
#acaa7;e77#c7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjca7;e77#c77 is am5d$ by add+ at !   
end ! foll[+ new subp>agraphs3  7,e7    

,rate & paym5t in=mation  7i7 ,9 g5]al  
,n lat] ?an ,janu>y #a1 #bjbe1 & e #c   
mon?s !reaft]1 ea* heal? plan %all      
submit to ! ,ex*ange1 ! ,secret>y1 !    
,/ate insurance commission]1 & make     
available to ! public1 ! rate & paym5t  
in=mation describ$ 9 clause 7ii7 9      
accordance ) clause 7iii74  7ii7 ,rate &
 paym5t in=mation describ$ ,= purposes (
 clause 7i71 ! rate & paym5t in=mation  
describ$ 9 ?is clause is1 ) respect to a
 heal? plan1 ! foll[+3 7,i7 ,) respect  
to ea* item or s]vice = :i* b5efits are 
available "u su* plan1 ! 9-network rate 
9 effect z ( ! date ( ! submission ( su*
 in=mation ) ea* provid] 7id5tifi$ by   
national provid] id5tifi]7 t is a       
p>ticipat+ provid] ) respect to su* item
 or s]vice1 o!r ?an su* a rate 9 effect 
) a provid] t1 dur+ ! #a-ye> p]iod end+ 
on su* date1 submitt$ few] ?an #aj      
claims = su* item or s]vice to su* plan4
  7,,ii7 ,) respect to ea* drug         
7id5tifi$ by national drug code7 = :i*  
b5efits are available "u su* plan1 !    

av]age am\nt paid by su* plan 7net (    
rebates1 disc\nts1 & price concessions7 
= su* drug disp5s$ or adm9i/]$ dur+ !   
#ij-;day p]iod beg9n+ #ahj days be=e su*
 date ( submission to ea* provid] t 0 a 
p>ticipat+ provid] ) respect to su*     
drug1 brok5 d[n by ea* su* provid]      
7id5tifi$ by national provid] id5tifi]71
 o!r ?an su* an am\nt paid to a provid] 
t1 dur+ su* p]iod1 submitt$ few] ?an #bj
 claims = su* drug to su* plan4  7,,iii7
 ,) respect to ea* item or s]vice = :i* 
b5efits are available "u su* plan1 !    
am\nt bill$1 & ! am\nt all[$ by ! plan1 
= ea* su* item or s]vice furni%$ dur+ ! 
#ij-;day p]iod specifi$ 9 subclause     
7,,ii7 by a provid] t 0 n a p>ticipat+  
provid] ) respect to su* item or s]vice1
 brok5 d[n by ea* su* provid] 7id5tifi$ 
by national provid] id5tifi]71 o!r ?an  
items & s]vices ) respect to :i* few]   
?an #bj claims = su* item or s]vice 7   
submitt$ to su* plan dur+ su* p]iod4    
7iii7 ,mann] ( submission ,rate & paym5t
 in=mation requir$ to be submitt$ & made

 available "u ?is subp>agraph %all be s 
submitt$ & s made available 9 #c sep>ate
 ma*9e-readable files correspond+ to !  
in=mation describ$ 9 ea* ( subclauses   
7,i7 ?r\gh 7,,iii7 ( clause 7ii7 t meet 
su* requirem5ts z specifi$ by !         
,secret>y ?r\gh rulemak+4 ,su*          
requirem5ts %all ensure t su* files are 
limit$ to an appropriate size1 are made 
available 9 a widely-available =mat t   
all[s = in=mation conta9$ 9 su* files to
 be comp>$ across heal? plans1 & are    
accessible to individuals at no co/ &   
)\t ! ne$ to e/abli% a us] acc\nt or    
provid] o!r cr$5tials4  7iv7 ,us] guide 
,ea* heal? plan %all make available to !
 public in/ructions writt5 9 pla9       
language expla9+ h[ individuals may se>*
 = in=mation describ$ 9 clause 7ii7 9   
files submitt$ 9 accordance ) clause    
7iii74  7,f7 ,def9itions ,9 ?is         
p>agraph3 7i7 ,p>ticipat+ provid] ,! t]m
 p>ticipat+ provid] has ! mean+ giv5 su*
 t]m 9 section #bgii;,a-#a ( ! ,public  
,heal? ,s]vice ,act4  7ii7 ,9-network   

rate ,! t]m 9-network rate means1 )     
respect to a heal? plan & an item or    
s]vice furni%$ by a provid] t is a      
p>ticipat+ provid] ) respect to su* plan
 & item or s]vice1 ! contract$ rate 9   
effect betwe5 su* plan & su* provid] =  
su* item or s]vice4  4  7c7 ,reports    
7#a7 ,compliance ,n lat] ?an ,janu>y #a1
 #bjbe1 ! ,comptroll] ,g5]al ( ! ,unit$ 
,/ates %all submit to ,congress a report
 conta9+--  7,a7 an analysis ( heal?    
plan compliance ) ! am5dm5ts made by ?is
 section2  7,b7 an analysis ( en=cem5t (
 su* am5dm5ts by ! ,secret>ies ( ,heal? 
& ,human ,s]vices1 ,labor1 & !          
,treasury2  7,c7 recomm5dations relat+  
to improv+ su* en=cem5t2 &  7,d7        
recomm5dations relat+ to improv+ public 
disclosure1 & public aw>5ess1 (         
in=mation requir$ to be made available  
by su* plans pursuant to su* am5dm5ts4  
7#b7 ,prices ,n lat] ?an ,janu>y #a1    
#bjbh1 ! ,comptroll] ,g5]al ( ! ,unit$  
,/ates %all submit to ,congress a report
 conta9+ an assessm5t ( diff]5ces 9     

negotiat$ prices 7& any tr5ds 9 su*     
prices7 9 ! private m>ket betwe5-- 7,a7 
rural & urban areas2  7,b7 ! individual1
 small gr\p1 & l>ge gr\p m>kets2  7,c7  
consolidat$ & nonconsolidat$ heal? c>e  
provid] areas 7z specifi$ by !          
,secret>y72  7,d7 nonpr(it & =-pr(it    
hospitals2  7,e7 nonpr(it & =-pr(it     
insur]s2 &  7,f7 insur]s s]v+ local or  
regional areas & insur]s s]v+ multi/ate 
or national areas4  7d7 ,effective date 
7#a7 ,9 g5]al ,! am5dm5ts made by       
subsection 7a7 %all apply beg9n+ ,janu>y
 #a1 #bjbe4  7#b7 ,cont9u$ applicability
 ( rules = previ\s ye>s ,no?+ 9 !       
am5dm5ts made by ?is section may be     
con/ru$ z affect+ ! applicability ( !   
rule entitl$ ,transp>5cy 9 ,cov]age     
publi%$ by ! ,dep>tm5t ( ! ,treasury1 ! 
,dep>tm5t ( ,labor1 & ! ,dep>tm5t (     
,heal? & ,human ,s]vices on ,novemb]    
#ab1 #bjbj 7#he ,f$4 ,reg4 #gbaeh71 be=e
 ,janu>y #a1 #bjbe4