,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #dhci  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #bd1 #bjbc,mrs4 
,/eel introduc$ ! foll[+ bill2 :i* 0    
ref]r$ to ! ,committee on ,ways &       
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = 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 title      
,,xviii ( ! ,social ,security ,act to   
require c]ta9 facilities "u ! ,m$ic>e   
program to disclose c]ta9 in=mation     
relat+ to *>ges & prices4  #a4 ,%ort    
title ,?is ,act may be cit$ z !         
,hospital & ,,asc ,price ,transp>5cy    
,act ( #bjbc4  #b4 ,requir+ c]ta9       
facilities "u ! ,m$ic>e program to      
disclose c]ta9 in=mation relat+ to *>ges
 & prices  7a7 ,9 g5]al ,"p ,e ( title  
,,xviii ( ! ,social ,security ,act 7#db 
,u4,s4,c4 #aciex et seq47 is am5d$ by   
add+ at ! end ! foll[+ new section3     
#ahii;,c4 ,price transp>5cy requirem5ts 

7a7 ,price transp>5cy requirem5ts =     
specifi$ hospitals  7#a7 ,9 g5]al       
,beg9n+ ,janu>y #a1 #bjbf1 ea* specifi$ 
hospital 7z def9$ 9 p>agraph 7#f77 t    
receives paym5t "u ?is title = furni%+  
items & s]vices %all comply ) ! price   
transp>5cy requirem5t describ$ 9        
p>agraph 7#b74  7#b7 ,requirem5t        
describ$  7,a7 ,9 g5]al ,= purposes (   
p>agraph 7#a71 ! price transp>5cy       
requirem5t describ$ 9 ?is p>agraph is1 )
 respect to a specifi$ hospital1 t su*  
hospital1 9 accordance ) a me?od & =mat 
e/abli%$ by ! ,secret>y "u subp>agraph  
7,c71 compile & make public 7)\t        
subscription & free ( *>ge7 = ea* ye>-- 
7i7 "o or m li/s1 9 a =mat specifi$ by !
 ,secret>y 7:i* may be a ma*9e-readable 
=mat71 ( ! hospital's /&>d *>ges        
7includ+ ! in=mation describ$ 9         
subp>agraph 7,b77 = ea* item & s]vice   
furni%$ by su* hospital2 &  7ii7        
in=mation 9 a consum]-fri5dly =mat 7z   
specifi$ by ! ,secret>y7-- 7,i7 on !    
hospital's prices 7includ+ ! in=mation  

describ$ 9 subp>agraph 7,b77 = z _m ( ! 
,c5t]s = ,m$ic>e  ,m$icaid              
,s]vices-specifi$ %oppable s]vices t are
 furni%$ by ! hospital1 & z _m          
additional hospital-select$ %oppable    
s]vices 7or all su* additional s]vices1 
if su* hospital furni%es few] ?an #cjj  
%oppable s]vices7 z may be necess>y = a 
comb9$ total ( at lea/ #cjj %oppable    
s]vices2 &  7,,ii7 t includes1 ) respect
 to ea* ,c5t]s = ,m$ic>e  ,m$icaid      
,s]vices-specifi$ %oppable s]vice t is n
 furni%$ by ! hospital1 an indication t 
su* s]vice is n s furni%$4  7,b7        
,in=mation describ$ ,= purposes (       
subp>agraph 7,a71 ! in=mation describ$ 9
 ?is subp>agraph is1 ) respect to /&>d  
*>ges & prices 7z applicable7 made      
public by a specifi$ hospital1 ! foll[+3
 7i7 ,a description ( ea* item or       
s]vice1 accompani$ by1 z applicable1 !  
,heal?c>e ,common ,proc$ure ,cod+ ,sy/em
 code1 ! diagnosis-relat$ gr\p1 !       
national drug code1 or o!r id5tifi] us$ 
or approv$ by ! ,c5t]s = ,m$ic>e        

,m$icaid ,s]vices4  7ii7 ,! gross *>ge1 
express$ z a doll> am\nt1 = ea* su* item
 or s]vice1 :5 provid$ 91 z applicable1 
! inpati5t sett+ & outpati5t dep>tm5t   
sett+4  7iii7 ,! disc\nt$ ca% price1    
express$ z a doll> am\nt1 = ea* su* item
 or s]vice :5 provid$ 91 z applicable1 !
 inpati5t sett+ & outpati5t dep>tm5t    
sett+ 7or1 9 ! case no disc\nt$ ca%     
price is available = an item or s]vice1 
! gross *>ge = su* item or s]vice74     
7iv7 ,any o!r in=mation ! ,secret>y may 
require = purposes ( promot+ public     
aw>5ess ( specifi$ hospital /&>d *>ges  
or prices 9 advance ( receiv+ an item or
 s]vice f su* a hospital1 except        
in=mation t is duplicative ( any o!r    
report+ requirem5t "u ?is section4 ,su* 
in=mation may include any curr5t        
pay]-specific negotiat$ rates1 cle>ly   
associat$ ) ! "n ( ! ?ird p>ty pay] &   
plan & express$ z a doll> am\nt1 t apply
 to ea* su* item or s]vice :5 provid$ 91
 z applicable1 ! inpati5t sett+ &       
outpati5t dep>tm5t sett+4  7,c7 ,me?od &

 =mat ,n lat] ?an ,janu>y #a1 #bjbf1 !  
,secret>y %all e/abli% "o or m me?ods & 
=mats = specifi$ facilities to use 9    
compil+ & mak+ public /&>d *>ges &      
prices 7z applicable7 pursuant to       
subp>agraph 7,a74 ,any su* me?od &      
=mat-- 7i7 may be simil> to any template
 made available by ! ,c5t]s = ,m$ic>e   
,m$icaid ,s]vices z ( ! date ( !        
enactm5t ( ?is subp>agraph2  7ii7 %all  
meet su* /&>ds z det]m9$ appropriate by 
! ,secret>y 9 ord] to ensure !          
accessibility & usability ( su* *>ges & 
prices2 &  7iii7 %all be updat$ z       
det]m9$ appropriate by ! ,secret>y1 9   
consultation ) /akehold]s4  7#c7 ,deem$ 
compliance ) %oppable s]vices requirem5t
 = hospitals ) a price e/imator tool    
7,a7 ,9 g5]al ,) respect to ea* ye>     
until ! effective date ( regulations    
implem5t+ ! provisions ( sections       
#bgii;,a-#a7;f7 & #bgii;,b-#f ( !       
,public ,heal? ,s]vice ,act 7relat+ to  
advanc$ explanations ( b5efits71 includ+
 regulations on e/abli%+ data transf]   

/&>ds to effectuate su* provisions1 a   
specifi$ hospital %all be deem$ to h    
compli$ ) ! requirem5t describ$ 9       
p>agraph 7#b77;,a77ii7 7relat+ to       
%oppable s]vices7 if su* hospital       
ma9ta9s a price e/imator tool describ$ 9
 subp>agraph 7,b74  7,b7 ,price e/imator
 tool describ$ ,= purposes ( subp>agraph
 7,a71 ! price e/imator tool describ$ 9 
?is subp>agraph is1 ) respect to a      
specifi$ hospital1 a tool t meets !     
foll[+ requirem5ts3 7i7 ,su* tool all[s 
an individual to imm$iately obta9 a     
price e/imate 7tak+ into acc\nt :e!r su*
 individual is cov]$ "u any plan1       
cov]age1 or program describ$ 9 clause   
7iv77,,iii77 & ! disc\nt$ ca% price *>g$
 by a specifi$ hospital1 = ea* ,c5t]s = 
,m$ic>e  ,m$icaid ,s]vices-specifi$     
%oppable s]vice t is furni%$ by su*     
hospital1 & = ea* additional %oppable   
s]vice z su* hospital may select1 su* t 
price e/imates are available ?r\gh su*  
tool = at lea/ #cjj %oppable s]vices 7or
 = all su* s]vices1 if su* hospital     

furni%es few] ?an #cjj %oppable         
s]vices74  7ii7 ,su* tool all[s an      
individual to obta9 su* an e/imate by   
bill+ code & by s]vice description4     
7iii7 ,su* tool is prom95tly display$ on
 ! public int]net website ( su*         
hospital4  7iv7 ,su* tool does n require
 an individual seek+ su* an e/imate to  
create an acc\nt or o!rwise input       
p]sonal in=mation1 except t su* tool may
 require t su* individual provide       
in=mation specifi$ by ! ,secret>y1 :i*  
may include ! foll[+3 7,i7 ,! "n ( su*  
individual4  7,,ii7 ,! date ( bir? ( su*
 individual4  7,,iii7 ,9 ! case su*     
individual is cov]$ "u a gr\p heal?     
plan1 gr\p or individual heal? insurance
 cov]age1 a ,f$]al heal? c>e program1 or
 ! program e/abli%$ "u *apt] #hi ( title
 #e1 ,unit$ ,/ates ,code1 an id5tify+   
numb] assign$ by su* plan1 cov]age1 or  
program to su* individual4  7,,iv7 ,9 ! 
case ( an individual describ$ 9         
subclause 7,,iii71 an indication z to   
:e!r su* individual is ! prim>y insur$  

individual "u su* plan1 cov]age1 or     
program 7&1 if su* individual is n !    
prim>y insur$ individual1 a description 
( ! individual's relation%ip to su*     
prim>y insur$ individual74  7,v7 ,any   
o!r in=mation specifi$ by ! ,secret>y4  
7v7 ,su* tool conta9s a /atem5t confirm+
 ! accuracy & complet5ess ( in=mation   
pres5t$ ?r\gh su* tool z ( ! date su*   
reque/ is made4  7vi7 ,su* tool meets   
any o!r requirem5t specifi$ by !        
,secret>y4  7#d7 ,monitor+ compliance ,!
 ,secret>y %all1 ?r\gh notice & comm5t  
rulemak+ & 9 consultation ) ! ,inspector
 ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human 
,s]vices1 e/abli% a process to monitor  
compliance ) ?is subsection4 ,su*       
process %all ensure t ea* specifi$      
hospital's compliance ) ?is subsection  
is review$ n less frequ5tly ?an once e  
#c ye>s4  7#e7 ,en=cem5t  7,a7 ,9 g5]al 
,9 ! case ( a specifi$ hospital t fails 
to comply ) ! requirem5ts ( ?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 ^u  
reque/ ( ! ,secret>y1 ! hospital %all   
submit to ! ,secret>y1 n lat] ?an #de   
days aft] ! date ( su* reque/1 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 ano!r provision ( law1 a specifi$   
hospital t has receiv$ a notification "u
 subp>agraph 7,a77i7 & fails to comply )
 ! requirem5ts ( ?is section by ! date t
 is #ij days aft] su* notification 7or1 
9 ! case ( su* a hospital t has submitt$
 a corrective action plan describ$ 9    
subp>agraph 7,a77ii7 9 response to a    
reque/ s describ$1 by ! date t is #ij   
days aft] ! ,secret>y id5tifies !       
failure ( su* hospital to satisfactorily
 complete su* corrective action plan7   
%all be subject to a civil monet>y      
p5alty ( an am\nt specifi$ by !         
,secret>y = ea* subsequ5t day dur+ :i*  
su* failure is ongo+4 ,su* am\nt %all n 

exce$-- 7,i7 9 ! case ( a specifi$      
hospital t is a hospital or critical    
access hospital ) #cj or few] b$s1 #cjj 
p] day2 &  7,,ii7 9 ! case ( any        
specifi$ hospital & except z provid$ 9  
clause 7iii71 #b1jjj1jjj = a #a-ye>     
p]iod4  7ii7 ,increase au?ority ,9      
apply+ ?is subp>agraph ) respect to     
violations occurr+ 9 #bjbg or a         
subsequ5t ye>1 ! ,secret>y may ?r\gh    
notice & comm5t rulemak+ increase-- 7,i7
 ! limitation on ! p] day am\nt ( any   
p5alty applicable to a specifi$ hospital
 t is a hospital or critical access     
hospital ) #cj or few] b$s "u clause    
7i72  7,,ii7 ! limitation on ! am\nt (  
any p5alty applicable = a #a-ye> p]iod  
"u su* clause2 &  7,,iii7 ! limitation  
on ! increase ( any p5alty appli$ "u    
clause 7iii74  7iii7 ,p]si/5t           
noncompliance ,9 ! case ( a specifi$    
hospital 7o!r ?an a specifi$ hospital t 
is a hospital or critical access        
hospital ) #cj or few] b$s7 t !         
,secret>y has det]m9$ to be kn[+ly &    

willfully noncompliant ) ! provisions ( 
?is subsection two or m times dur+ a    
#a-ye> p]iod1 ! ,secret>y may increase  
any p5alty o!rwise applicable "u ?is    
subp>agraph by n m ?an #a1jjj1jjj & may 
require su* hospital to complete su*    
additional corrective actions plans z ! 
,secret>y may specify4  7iv7            
,application ( c]ta9 provisions ,!      
provisions ( section #aabh;,a 7o!r ?an  
subsections 7a7 & 7b7 ( su* section7    
%all apply to a civil monet>y p5alty    
impos$ "u ?is subp>agraph 9 ! same mann]
 z su* provisions apply to a civil      
monet>y p5alty impos$ "u subsection 7a7 
( su* section4  7v7 ,au?ority to waive  
or r$uce p5alty ,! ,secret>y may waive  
or r$uce any p5alty o!rwise applicable )
 respect to a specifi$ hospital "u ?is  
subp>agraph if ! ,secret>y det]m9es t   
imposition ( su* p5alty w\ld result 9 a 
significant h>d%ip = su* hospital 7su* z
 9 ! case ( a hospital locat$ 9 a rural 
or und]s]v$ area :]e imposition ( su*   
p5alty may result 91 or contribute to1 a

 lack ( access to c>e = individuals 9   
su* area74  7,c7 ,publication ( hospital
 price transp>5cy in=mation ,beg9n+ on  
,janu>y #a1 #bjbf1 ! ,secret>y %all make
 publicly available on ! public website 
( ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices 
in=mation ) respect to compliance ) !   
requirem5ts ( ?is subsection & en=cem5t 
activities und]tak5 by ! ,secret>y "u   
?is subsection4 ,su* in=mation %all be  
updat$ n less ?an annually & include1 ) 
respect to ea* ye>-- 7i7 ! numb] (      
reviews ( compliance ) ?is subsection   
und]tak5 by ! ,secret>y2  7ii7 ! numb] (
 notifications describ$ 9 subp>agraph   
7,a77i7 s5t by ! ,secret>y2  7iii7 !    
id5tify ( ea* specifi$ hospital t 0 s5t 
su* a notification & a description ( !  
nature ( su* hospital's noncompliance ) 
?is subsection2  7iv7 ! am\nt ( any     
civil monet>y p5alty impos$ on su*      
hospital "u subp>agraph 7,b72  7v7 :e!r 
su* hospital subsequ5tly came into      
compliance ) ?is subsection2 &  7vi7 any
 o!r in=mation z det]m9$ by ! ,secret>y4

  7#f7 ,def9itions ,= purposes ( ?is    
subsection3 7,a7 ,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 specifi$            
hospital-furni%$ item or s]vice4  7,b7  
,f$]al heal? c>e program ,! t]m ,f$]al  
heal? c>e program has ! mean+ giv5 su*  
t]m 9 section #aabh;,b4  7,c7 ,gross    
*>ge ,! t]m gross *>ge means ! *>ge = an
 individual item or s]vice t is reflect$
 on a specifi$ hospital's *>gema/]1     
abs5t any disc\nts4  7,d7 ,gr\p heal?   
plan2 gr\p heal? insurance cov]age2     
individual heal? insurance cov]age ,!   
t]ms gr\p heal? plan1 gr\p heal?        
insurance cov]age1 & individual heal?   
insurance cov]age h ! mean+ giv5 su*    
t]ms 9 section #bgia ( ! ,public ,heal? 
,s]vice ,act4  7,e7 ,pay]-specific      
negotiat$ *>ge ,! t]m pay]-specific     
negotiat$ *>ge means ! *>ge t a specifi$
 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 advance & includes all    
ancill>y items & s]vices cu/om>ily      
furni%$ z "p ( su* s]vice4  7,g7        
,specifi$ hospital ,! t]m specifi$      
hospital means a hospital 7z def9$ 9    
section #ahfa7;e771 a critical access   
hospital 7z def9$ 9 section             
#ahfa7mmm77#a771 or a rural em]g5cy     
hospital 7z def9$ 9 section #ahfa7kkk774
  7,h7 ,?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  7b7 ,price        
transp>5cy requirem5ts = ambulatory     
surgical c5t]s  7#a7 ,9 g5]al ,beg9n+   
,janu>y #a1 #bjbh1 ea* ambulatory       
surgical c5t] t receives paym5t "u ?is  
title = furni%+ items & s]vices %all    
comply ) ! price transp>5cy requirem5t  
describ$ 9 p>agraph 7#b74  7#b7         
,requirem5t describ$  7,a7 ,9 g5]al ,=  
purposes ( p>agraph 7#a71 ! price       
transp>5cy requirem5t describ$ 9 ?is    

subsection is1 ) respect to an          
ambulatory surgical c5t]1 t su* surgical
 c5t] 9 accordance ) a me?od & =mat     
e/abli%$ by ! ,secret>y "u subp>agraph  
7,c771 compile & make public 7)\t       
subscription & free ( *>ge71 = ea* ye>--
 7i7 "o or m li/s1 9 a =mat specifi$ by 
! ,secret>y1 ( ! surgical c5t]'s /&>d   
*>ges 7includ+ ! in=mation describ$ 9   
subp>agraph 7,b77 = ea* item & s]vice   
furni%$ by ! surgical c5t]2  7ii7       
in=mation on ! surgical c5t]'s prices   
7includ+ ! in=mation describ$ 9         
subp>agraph 7,b77 = z _m ( ! ,c5t]s =   
,m$ic>e  ,m$icaid ,s]vices-specifi$     
%oppable s]vices t are furni%$ by !     
surgical c5t]1 & z _m additional        
surgical c5t]-select$ %oppable s]vices  
7or all su* additional s]vices1 if su*  
surgical c5t] furni%es few] ?an #cjj    
%oppable s]vices7 z may be necess>y = a 
comb9$ total ( at lea/ #cjj %oppable    
s]vices2  7iii7 ) respect to ea* ,c5t]s 
= ,m$ic>e  ,m$icaid ,s]vices-specifi$   
%oppable s]vice t is n furni%$ by !     

ambulatory surgical c5t]1 an indication 
t su* s]vice is n s furni%$2 &  7iv7 any
 additional in=mation specifi$ by !     
,secret>y4  7,b7 ,in=mation describ$ ,= 
purposes ( subp>agraph 7,a71 ! in=mation
 describ$ 9 ?is subp>agraph is1 )       
respect to /&>d *>ges & prices 7z       
applicable7 made public by a specifi$   
surgical c5t]1 ! foll[+3 7i7 ,a         
description ( ea* item or s]vice1       
accompani$ by1 z applicable1 ! ,heal?c>e
 ,common ,proc$ure ,cod+ ,sy/em code1 ! 
diagnosis-relat$ gr\p1 ! national drug  
code1 or o!r id5tifi] us$ or approv$ by 
! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices4  
7ii7 ,! gross *>ge1 express$ z a doll>  
am\nt1 = ea* su* item or s]vice4  7iii7 
,! disc\nt$ ca% price1 express$ z a     
doll> am\nt1 = ea* su* item or s]vice   
7or1 9 ! case no disc\nt$ ca% price is  
available = an item or s]vice1 ! m$ian  
price *>g$ by su* ambulatory surgical   
c5t] = su* item or s]vice = ! previ\s   
?ree ye>s1 express$ z a doll> am\nt74   
7iv7 ,any o!r in=mation ! ,secret>y may 

require t is n duplicative ( any o!r    
report+ requirem5t "u ?is subsection =  
purposes ( promot+ public aw>5ess (     
ambulatory surgical c5t] prices 9       
advance ( receiv+ an item or s]vice f   
su* an ambulatory surgical c5t]1 :i* may
 include any curr5t pay]-specific       
negotiat$ rates1 cle>ly associat$ ) ! "n
 ( ! ?ird p>ty pay] & plan & express$ z 
a doll> am\nt1 t applies to ea* su* item
 or s]vice4  7,c7 ,me?od & =mat ,n lat] 
?an ,janu>y #a1 #bjbh1 ! ,secret>y %all 
e/abli% "o or m me?ods & =mats =        
ambulatory surgical c5t]s to use 9 mak+ 
public /&>d *>ges & prices 7z           
applicable7 pursuant to subp>agraph     
7,a74 ,any su* me?od & =mat-- 7i7 may be
 simil> to any template made available  
by ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices
 z ( ! date ( ! enactm5t ( ?is p>agraph2
  7ii7 %all meet su* /&>ds z det]m9$    
appropriate by ! ,secret>y 9 ord] to    
ensure ! accessibility & usability ( su*
 *>ges & prices2 &  7iii7 %all be updat$
 z det]m9$ appropriate by ! ,secret>y1 9

 consultation ) /akehold]s4  7#c7 ,deem$
 compliance ) %oppable s]vices          
requirem5t = ambulatory surgical c5t]s )
 a price e/imator tool  7,a7 ,9 g5]al   
,an ambulatory surgical c5t] %all be    
deem$ to h compli$ ) ! requirem5t       
describ$ 9 subsection 7b77#a77;,b7      
7relat+ to %oppable s]vices7 if su*     
surgical c5t] ma9ta9s a price e/imator  
tool describ$ 9 subp>agraph 7,b74  7,b7 
,price e/imator tool describ$ ,=        
purposes ( subp>agraph 7,a71 ! price    
e/imator tool describ$ 9 ?is subp>agraph
 is1 ) respect to an ambulatory surgical
 c5t]1 a tool t meets ! foll[+          
requirem5ts3 7i7 ,su* tool all[s an     
individual to imm$iately obta9 a price  
e/imate 7tak+ into acc\nt :e!r su*      
individual is cov]$ "u any plan1        
cov]age1 or program describ$ 9          
subp>agraph 7,c77iii77 = ea* ,c5t]s =   
,m$ic>e  ,m$icaid ,s]vices-specifi$     
%oppable s]vice t is furni%$ by !       
surgical c5t]1 & = ea* additional       
%oppable s]vice z su* surgical c5t] may 

select su* t price e/imates are         
available ?r\gh su* tool = at lea/ #cjj 
%oppable s]vices 7or = all su* s]vices1 
if su* surgical c5t] furni%es few] ?an  
#cjj %oppable s]vices74  7ii7 ,su* tool 
all[s an individual to obta9 su* an     
e/imate by bill+ code & by s]vice       
description4  7iii7 ,su* tool is        
prom95tly display$ on ! public int]net  
website ( su* ambulatory surgical c5t]4 
7iv7 ,su* tool does n require an        
individual seek+ su* an e/imate to      
create an acc\nt or o!rwise input       
p]sonal in=mation1 except t su* tool may
 require t su* individual provide       
in=mation specifi$ by ! ,secret>y1 :i*  
may include ! foll[+3 7,i7 ,! "n ( su*  
individual4  7,,ii7 ,! date ( bir? ( su*
 individual4  7,,iii7 ,9 ! case su*     
individual is cov]$ "u a gr\p heal?     
plan1 gr\p or individual heal? insurance
 cov]age1 a ,f$]al heal? c>e program1 or
 ! program e/abli%$ "u *apt] #hi ( title
 #e1 ,unit$ ,/ates ,code1 an id5tify+   
numb] assign$ by su* plan1 cov]age1 or  

program to su* individual4  7,,iv7 ,9 ! 
case ( an individual describ$ 9 clause  
7iii71 an indication z to :e!r su*      
individual is ! prim>y insur$ individual
 "u su* plan1 cov]age1 or program 7&1 if
 su* individual is n ! prim>y insur$    
individual1 a description ( !           
individual's relation%ip to su* prim>y  
insur$ individual74  7,v7 ,any o!r      
in=mation specifi$ by ! ,secret>y4  7v7 
,su* tool conta9s a /atem5t confirm+ !  
accuracy & complet5ess ( in=mation      
pres5t$ ?r\gh su* tool z ( ! date su*   
reque/ is made4  7vi7 ,su* tool meets   
any o!r requirem5t specifi$ by !        
,secret>y4  7#d7 ,monitor+ compliance ,!
 ,secret>y %all1 ?r\gh notice & comm5t  
rulemak+ & 9 consultation ) ! ,inspector
 ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human 
,s]vices1 e/abli% a process to monitor  
compliance ) ?is subsection4 ,su*       
process %all ensure t ea* ambulatory    
surgical c5t]'s compliance ) ?is        
subsection is review$ n less frequ5tly  
?an once e #c ye>s4  7#e7 ,en=cem5t     

7,a7 ,9 g5]al ,9 ! case ( an ambulatory 
surgical c5t] t fails to comply ) !     
requirem5ts ( ?is subsection-- 7i7 !    
,secret>y %all notify su* ambulatory    
surgical c5t] ( su* failure n lat] ?an  
#cj days aft] ! date on :i* ! ,secret>y 
det]m9es su* failure exi/s2 &  7ii7 ^u  
reque/ ( ! ,secret>y1 ! ambulatory      
surgical c5t] %all submit to !          
,secret>y1 n lat] ?an #de days aft] !   
date ( su* reque/1 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 ano!r provision 
( law1 an ambulatory surgical c5t] t has
 receiv$ a notification "u subp>agraph  
7,a77i7 & fails to comply ) !           
requirem5ts ( ?is subsection by ! date t
 is #ij days aft] su* notification 7or1 
9 ! case ( an ambulatory surgical c5t] t
 has submitt$ a corrective action plan  
describ$ 9 subp>agraph 7,a77ii7 9       
response to a reque/ s describ$1 by !   
date t is #ij days aft] su* submission7 

%all be subject to a civil monet>y      
p5alty ( an am\nt specifi$ by !         
,secret>y = ea* subsequ5t day dur+ :i*  
su* failure is ongo+ 7n to exce$ #cjj p]
 day74  7ii7 ,increase au?ority ,9      
apply+ ?is subp>agraph ) respect to     
violations occurr+ 9 #bjbg or a         
subsequ5t ye>1 ! ,secret>y may ?r\gh    
notice & comm5t rulemak+ increase !     
limitation on ! p] day am\nt ( any      
p5alty applicable to an ambulatory      
surgical c5t] "u clause 7i74  7iii7     
,application ( c]ta9 provisions ,!      
provisions ( section #aabh;,a 7o!r ?an  
subsections 7a7 & 7b7 ( su* section7    
%all apply to a civil monet>y p5alty    
impos$ "u ?is subp>agraph 9 ! same mann]
 z su* provisions apply to a civil      
monet>y p5alty impos$ "u subsection 7a7 
( su* section4  7iv7 ,au?ority to waive 
or r$uce p5alty ,! ,secret>y may waive  
or r$uce any p5alty o!rwise applicable )
 respect to an ambulatory surgical c5t] 
"u ?is subp>agraph if ! ,secret>y       
det]m9es t imposition ( su* p5alty w\ld 

result 9 a significant h>d%ip = su*     
ambulatory surgical c5t] 7su* z 9 ! case
 ( an ambulatory surgical c5t] locat$ 9 
a rural or und]s]v$ area :]e imposition 
( su* p5alty may result 91 or contribute
 to1 a lack ( access to c>e =           
individuals 9 su* area74  7#f7          
,def9itions ,= purposes ( ?is section3  
7,a7 ,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 item or s]vice furni%$ by
 an ambulatory surgical c5t]4  7,b7     
,f$]al heal? c>e program ,! t]m ,f$]al  
heal? c>e program has ! mean+ giv5 su*  
t]m 9 section #aabh;,b4  7,c7 ,gross    
*>ge ,! t]m gross *>ge means ! *>ge = an
 individual item or s]vice t is reflect$
 on a specifi$ surgical c5t]'s *>gema/]1
 abs5t any disc\nts4  7,d7 ,gr\p heal?  
plan2 gr\p heal? insurance cov]age2     
individual heal? insurance cov]age ,!   
t]ms gr\p heal? plan1 gr\p heal?        
insurance cov]age1 & individual heal?   
insurance cov]age h ! mean+ giv5 su*    

t]ms 9 section #bgia ( ! ,public ,heal? 
,s]vice ,act4  7,e7 ,pay]-specific      
negotiat$ *>ge ,! t]m pay]-specific     
negotiat$ *>ge means ! *>ge t a specifi$
 surgical c5t] 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 advance & includes all    
ancill>y items & s]vices cu/om>ily      
furni%$ z "p ( su* s]vice4  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  
4  7b7 ,publication ( hospital          
compliance ) price transp>5cy           
requirem5ts ,section #ahhf ( ! ,social  
,security ,act 7#db ,u4,s4,c4 #acieww7  
is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7u7 ,publication (         
compliance ) price transp>5cy           
requirem5ts  7#a7 ,9 g5]al ,beg9n+      
,janu>y #a1 #bjbf1 ! ,secret>y %all1 =  
ea* hospital ) respect to :i* !         

,secret>y has conduct$ a review ( su*   
hospital's compliance ) ! provisions (  
section #ahii;,c7a7 & f\nd su* hospital 
noncompliant ) su* provisions-- 7,a7    
indicate su* noncompliance on su*       
hospital's entry on ! ,hospital ,comp>e 
int]net website 7or a successor         
website72 &  7,b7 specify :e!r su*      
hospital-- 7i7 submitt$ a corrective    
action plan describ$ 9 subsection       
7a77#e77;,a77ii7 ( su* section 7&1 if s1
 ! date su* plan 0 receiv$ by !         
,secret>y72 or  7ii7 0 subject to a     
civil monet>y p5alty impos$ "u          
subsection 7a77#e7 ( su* section 7&1 if 
s1 ! date ( ! imposition ( su* p5alty & 
! am\nt ( su* p5alty74  7#b7 ,additions 
& updates ,! ,secret>y %all update any  
specification describ$ 9 subp>agraph    
7,a7 or 7,b7 ( p>agraph 7#a7 ) respect  
to su* hospital-- 7,a7 9 ! case ( !     
specification describ$ 9 su* p>agraph   
7#a77;,b77i71 z soon z practicable aft] 
s5d+ a notification describ$ 9 su*      
subp>agraph2 &  7,b7 9 ! case ( !       

specification describ$ 9 su* p>agraph   
7#a77;,b77ii71 z soon z practicable aft]
 ! imposition ( a civil monet>y p5alty  
describ$ 9 su* subp>agraph4  4  7c7     
,con=m+ am5dm5t ,section #bgah7;e7 ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#ah7;e77 is am5d$ by  
add+ at ! end ! foll[+ new s5t5ce3 ,!   
prec$+ s5t5ce %all n apply beg9n+       
,janu>y #a1 #bjbf44  7d7 ,fund+  7#a7 ,9
 g5]al ,9 addition to funds o!rwise     
available1 out ( any moneys 9 !         
,treasury n o!rwise appropriat$1 !re are
 appropriat$ #aj1jjj1jjj = fiscal ye>   
#bjbd1 to rema9 available until exp5d$1 
= purposes (-- 7,a7 implem5t+ ! am5dm5t 
made by ?is subsection 7a72 &  7,b7     
monitor+ ! compliance ( entities ) su*  
am5dm5t4  7#b7 ,report on exp5ditures ,n
 lat] ?an #e ye>s aft] ! date ( !       
enactm5t ( ?is ,act1 ! ,secret>y (      
,heal? & ,human ,s]vices %all submit to 
! ,committee on ,ways & ,means & !      
,committee on ,en]gy & ,comm]ce ( !     
,h\se ( ,repres5tatives & ! ,committee  

on ,f9ance ( ! ,s5ate a report t-- 7,a7 
describes activities und]tak5 fund$     
?r\gh funds made available "u p>agraph  
7#a71 includ+ a specification ( ! am\nt 
( su* funds exp5d$ = ea* su* activity2 &
  7,b7 id5tifies all entities ) :i* !   
,secret>y has ent]$ into contracts =    
purposes ( implem5t+ ! am5dm5t made by  
?is subsection 7a71 monitor+ compliance 
( entities ) su* am5dm5t1 or provid+    
te*nical assi/ance to entities to       
promote compliance ) su* am5dm5t4  7e7  
,implem5tation  7#a7 ,accessibility ,9  
implem5t+ section                       
#ahii;,c7a77#b77;,a77ii7 ( ! ,social    
,security ,act 7z add$ by subsection    
7a771 ! ,secret>y ( ,heal? & ,human     
,s]vices %all ?r\gh rulemak+ ensure t   
in=mation made available pursuant to su*
 am5dm5t by an entity is s made         
available 9 pla91 easily und]/&able     
language & t su* entity provides access 
to su* int]pretation s]vices1           
translations1 & o!r assi/ive s]vices to 
make su* in=mation accessible to        

individuals ) limit$ ,engli% pr(ici5cy &
 individuals ) disabilities4  7#b7      
,te*nical assi/ance ,! ,secret>y (      
,heal? & ,human ,s]vices %all1 to !     
ext5t practicable1 provide te*nical     
assi/ance to entities mak+ public /&>d  
*>ges & prices 7z applicable7 pursuant  
to ! am5dm5t made by subsection 7a74