,,ii  #aah? ,,congress  #a/ ,session    
,s4 #cedh  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #ad1 #bjbc,mr4
 ,braun 7= himself1 ,mr4 ,s&]s1 ,ms4    
,smi?1 & ,mr4 ,hick5loop]7 introduc$ !  
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,heal?1 ,education1  
,labor1 & ,p5sions  ,a ,,bill  ,to am5d 
! ,public ,heal? ,s]vice ,act to provide
 = hospital & insur] price transp>5cy4  
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,heal? ,c>e ,prices ,reveal$ &        
,in=mation to ,consum]s ,expla9$        
,transp>5cy ,act or ! ,heal? ,c>e       
,,price ,transp>5cy ,act #b4j4  #b4     
,/r5g!n+ hospital 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$ to read z foll[s3  7e7 ,/&>d      
hospital *>ges  7#a7 ,9 g5]al  7,a7     
,disclosure ( /&>d *>ges ,= purposes (  
p>agraph 7#a71 ! price transp>5cy       
requirem5t describ$ 9 ?is p>agraph is1 )
 respect to a 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* mon?-- 7i7 all ( ! 
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$ic>e amp2 ,m$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]vices   
?r\gh ,decemb] #ca1 #bjbd1 aft] :i* !   
hospital's prices %all include all      
%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%$4 
7,b7 ,/&>d *>ges describ$ ,= purposes ( 
subp>agraph 7,a71 ! in=mation describ$ 9
 ?is subp>agraph is1 ) respect to /&>d  
*>ges & prices1 z applicable1 made      
public by a hospital1 ! foll[+3 7i7 ,a  
pla9 language description ( ea* item or 
s]vice1 accompani$ by any applicable    
bill+ codes1 includ+ modifi]s1 us+      
commonly recogniz$ bill+ code sets1     
includ+ ! ,curr5t ,proc$ural ,t]m9ology 
code1 ! ,heal?c>e ,common ,proc$ure     
,cod+ ,sy/em code1 ! diagnosis-relat$   
gr\p1 ! ,national ,drug ,code1 & o!r    
nationally recogniz$ id5tifi]4  7ii7 ,! 
gross *>ge1 z applicable1 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 z applicable1   
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 
! m9imum ca% price accept$ by ! hospital
 f self-pay individuals = su* item or   
s]vice1 express$ z a doll> am\nt1 z well
 z1 ) respect to prices made public     
pursuant to subp>agraph 7,a77ii71 a l9k 
to a consum]-fri5dly docum5t t cle>ly   
expla9s ! hospital's *>ity c>e policy74 
,! hospital %all accept ! disc\nt$ ca%  
price z paym5t 9 full f any pati5t t    
*ooses to pay 9 ca% )\t reg>d to !      
pati5t's cov]age4  7iv7 ,! pay]-specific
 negotiat$ *>ges1 express$ z a doll>    
am\nt & cle>ly associat$ ) ! "n ( !     
applicable ?ird p>ty pay] & "n ( ea*    
plan1 t apply to ea* su* item or s]vice 
:5 provid$ 91 z applicable1 ! inpati5t  
sett+ & outpati5t dep>tm5t sett+4 ,if ! 
*>ges are bas$ on an algori?m1 p]c5tage 
( ano!r am\nt1 or o!r =mula or crit]ia1 
! hospital also %all disclose su*       
algori?m1 p]c5tage1 =mula1 or crit]ia z 
set =? 9 its contract & any o!r t]ms1   
s*$ules1 exhibits1 data1 or o!r         
in=mation ref]5c$ 9 any su* contract z  

%all be requir$ to det]m9e & disclose ! 
negotiat$ *>ge4  7v7 ,! de-id5tifi$     
maximum & m9imum negotiat$ *>ges1 z     
applicable1 = ea* su* item or s]vice1   
express$ z a non-z]o doll> am\nt4  7vi7 
,any o!r additional in=mation !         
,secret>y may require = ! purpose (     
improv+ ! accuracy (1 or enabl+ consum]s
 to easily und]/& & comp>e1 /&>d *>ges &
 prices = an item or s]vice1 except     
in=mation t is duplicative ( any o!r    
report+ requirem5t "u ?is subsection4 ,9
 ! case ( /&>d *>ges & prices = an item 
or s]vice includ$ z "p ( a bundl$1 p]   
diem1 episodic1 or o!r simil>           
arrangem5t1 ! in=mation describ$ 9 ?is  
subp>agraph %all be made available z    
det]m9$ appropriate by ! ,secret>y4     
7,c7 ,uni=m me?od & =mat ,n lat] ?an    
,janu>y #a1 #bjbe1 ! ,secret>y %all     
e/abli% a /&>d1 uni=m me?od & =mat =    
hospitals to use 9 compil+ & mak+ public
 /&>d *>ges pursuant to subp>agraph     
7,a77i7 & a /&>d1 uni=m me?od & =mat =  
su* hospitals to use 9 compil+ & mak+   

public prices pursuant to subp>agraph   
7,a77ii74 ,su* me?ods & =mats-- 7i7     
%all1 9 ! case ( su* me?od & =mat = mak+
 public /&>d *>ges pursuant to          
subp>agraph 7,a77i71 ensure t su* *>ges 
are made available 9 a ma*9e-readable   
spread%eet =mat2  7ii7 may be simil> to 
any template made available by ! ,c5t]s 
= ,m$ic>e  ,m$icaid ,s]vices z ( ! date 
( ! enactm5t ( ?is subp>agraph2  7iii7  
%all meet su* /&>ds z det]m9$           
appropriate by ! ,secret>y 9 ord] to    
ensure ! accessibility & usability ( su*
 *>ges & prices2 &  7iv7 %all be updat$ 
z det]m9$ appropriate by ! ,secret>y1 9 
consultation ) /akehold]s4  7#b7 ,no    
deem$ compliance ,! availability ( a    
price e/imator tool %all n be consid]$  
to deem compliance ) or o!rwise vitiate 
! requirem5ts ( p>agraph 7#b77;,a77ii7  
or any o!r requirem5ts ( ?is section4   
,fur!rmore1 ! use ( an e/imator tool    
%all n be us$ = purposes ( compliance ) 
any provisions 9 ?is ,section4  7#c7    
,monitor+ compliance ,! ,secret>y %all1 

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* hospital's compliance ) ?is
 subsection is review$ n less frequ5tly 
?an once e ye>4  7#d7 ,atte/ation ,a    
s5ior (ficial f ea* hospital 7! ,*ief   
,executive ,(fic]1 ,*ief ,f9ancial      
,(fic]1 or an (ficial ( equival5t       
s5iority7 %all atte/ to ! accuracy &    
complet5ess ( ! disclosures made 9      
accordance ) ! hospital price transp>5cy
 requirem5ts set =? 9 ?is regulation4   
,su* atte/ation %all be deem$ to be     
mat]ial to paym5t f ! ,f$]al ,gov]nm5t  
to ! hospital4  7#e7 ,en=cem5t  7,a7 ,9 
g5]al ,9 ! case ( a hospital t fails to 
comply ) ! requirem5ts ( ?is subsection1
 n lat] ?an #cj days aft] ! date on :i* 
! ,secret>y det]m9es su* failure exi/s1 
! ,secret>y %all submit to su* hospital 
a notification ( su* det]m9ation1 :i*   
%all include a reque/ = 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 hospital t has      
receiv$ a reque/ = a corrective action  
plan "u subp>agraph 7,a7 & fails to     
comply ) ! requirem5ts ( ?is subsection 
by ! date t is #de days aft] su* reque/ 
is made %all be subject to a civil      
monet>y p5alty ( an am\nt specifi$ by ! 
,secret>y = ea* day 7beg9n+ ) ! day on  
:i* ! ,secret>y fir/ det]m9$ t su*      
hospital 0 n comply+ ) su* requirem5ts7 
dur+ :i* su* failure 0 ongo+4 ,su* am\nt
 %all n exce$-- 7,i7 9 ! case ( a       
hospital ) #cj or few] b$s1 #cjj p] day2
  7,,ii7 9 ! case ( a hospital ) m ?an  
#cj b$s b few] ?an #aja b$s1 #aj p] b$  
p] day 7or1 9 ! case ( su* a hospital t 
has be5 noncompliant ) su* requirem5ts =
 a #a-ye> p]iod or long]1 beg9n+ ) !    
fir/ day foll[+ su* #a-ye> p]iod1 #ab4ej
 p] b$ p] day72  7,,iii7 9 ! case ( a   
hospital ) m ?an #ajj b$s b few] ?an    
#cja b$s1 #ae p] b$ p] day 7or1 9 ! case

 ( su* a hospital t has be5 noncompliant
 ) su* requirem5ts = a #a-ye> p]iod or  
long]1 beg9n+ ) ! fir/ day foll[+ su*   
#a-ye> p]iod1 #ag4ej p] b$ p] day72     
7,,iv7 9 ! case ( a hospital ) m ?an    
#cjj b$s b few] ?an #eja b$s1 #bj p] b$ 
p] day 7or1 9 ! case ( su* a hospital t 
has be5 noncompliant ) su* requirem5ts =
 a #a-ye> p]iod or long]1 beg9n+ ) !    
fir/ day foll[+ su* #a-ye> p]iod1 #be p]
 b$ p] day72 &  7,v7 9 ! case ( a       
hospital ) m ?an #ejj b$s1 #be p] b$ p] 
day 7or1 9 ! case ( su* a hospital t has
 be5 noncompliant ) su* requirem5ts = a 
#a-ye> p]iod or long]1 beg9n+ ) ! fir/  
day foll[+ su* #a-ye> p]iod1 #ce p] b$  
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-- 7,i7
 ! limitation on ! p] day am\nt ( any   
p5alty applicable to a hospital "u      
clause 7i77,i72  7,,ii7 ! limitations on
 ! p] b$ p] day am\nt ( any p5alty      

applicable "u any ( subclauses 7,,ii7   
?r\gh 7,v7 ( clause 7i72 &  7,,iii7 !   
limitation on ! increase ( any p5alty   
appli$ "u clause 7iii7 pursuant to !    
am\nts specifi$ 9 subclause 7,,ii7 ( su*
 clause4  7iii7 ,p]si/5t noncompliance  
7,i7 ,9 g5]al ,9 ! case ( a hospital 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 ! am\nt specifi$ 9       
subclause 7,,ii7 ) respect to su*       
hospital & may require su* hospital to  
complete su* additional corrective      
actions plans z ! ,secret>y may specify4
  7,,ii7 ,specifi$ am\nt ,= purposes (  
subclause 7,i71 ! am\nt specifi$ 9 ?is  
subclause is1 ) respect to a hospital-- 
7aa7 ) m ?an #cj b$s b few] ?an #aja    
b$s1 an am\nt t is n less ?an #ejj1jjj &
 n m ?an #a1jjj1jjj2  7bb7 ) m ?an #ajj 
b$s b few] ?an #cja b$s1 an am\nt t is  
great] ?an #a1jjj1jjj & n m ?an         

#b1jjj1jjj2  7cc7 ) m ?an #cjj b$s b    
few] ?an #eja b$s1 an am\nt t is great] 
?an #b1jjj1jjj & n m ?an #d1jjj1jjj2 &  
7dd7 ) m ?an #ejj b$s1 & am\nt t is n   
less ?an #e1jjj1jjj & n m ?an           
#aj1jjj1jjj4  7iv7 ,provision ( te*nical
 assi/ance ,! ,secret>y may1 to ! ext5t 
practicable1 provide te*nical assi/ance 
relat+ to compliance ) ! provisions (   
?is section to hospitals reque/+ su*    
assi/ance4  7v7 ,application ( c]ta9    
provisions ,! provisions ( section      
#aabh;,a 7o!r ?an subsections 7a7 & 7b7 
( su* section7 %all apply to a civil    
monet>y p5alty impos$ "u ?is subp>agraph
 9 ! same mann] z su* provisions apply  
to a civil monet>y p5alty impos$ "u     
subsection 7a7 ( su* section4  7,c7 ,no 
waiv] ,! ,secret>y %all n grant or ext5d
 any waiv]1 delay1 toll+1 or o!r        
mitigation ( a civil monet>y p5alty =   
violation ( ?is subsection4  7#f7       
,def9itions ,= purposes ( ?is           
subsection3 7,a7 ,disc\nt$ ca% price ,! 
t]m disc\nt$ ca% price means ! m9imum   

*>ge t ! hospital accepts f an          
individual :o pays ca%1 or ca%          
equival5t1 = a hospital-furni%$ item or 
s]vice4  7,b7 ,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,c7     
,hospital ,! t]m hospital means a       
hospital 7z def9$ 9 section #ahfa7;e7 ( 
! ,social ,security ,act71 a critical   
access hospital 7z def9$ 9 section      
#ahfa7mmm77#a7 ( ! ,social ,security    
,act71 or a rural em]g5cy hospital 7z   
def9$ 9 section #ahfa7kkk7 ( ! ,social  
,security ,act71 toge!r ) any p>5t1     
subsidi>y1 or o!r affiliat$ provid] or  
suppli] ( heal? c>e items & s]vices )\t 
reg>d to :e!r su* p>5t1 subsidi>y1 or   
o!r affiliat$ provid] or suppli] op]ates
 "u sep>ate lic5sure1 c]tification1 or  
designation4  7,d7 ,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,e7 ,%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,f7 ,?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 ,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 ( !   
regulations codifi$ at "p #ahj ( title  
#de1 ,code ( ,f$]al ,regulations1 be=e  
,janu>y #a1 #bjbe4  7c7 ,cont9u$        
applicability ( /ate law ,! provisions (
 ?is ,act %all n sup]s$e any provision (
 ,/ate law t e/abli%es1 implem5ts1 or   
cont9ues 9 effect any requirem5t or     
prohibition relat$ to heal? c>e price   
transp>5cy1 except to ! ext5t t su*     
requirem5t or prohibition prev5ts !     

application ( a requirem5t or           
prohibition ( ?is ,act4  #c4 ,increas+  
price transp>5cy ( cl9ical diagno/ic    
laboratory te/s "u ! m$ic>e program     
,section #bgah ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ah7
 is am5d$ by add+ at ! end ! foll[+3    
7f7 ,cl9ical diagno/ic laboratory price 
transp>5cy  7#a7 ,9 g5]al ,beg9n+       
,janu>y #a1 #bjbe1 any applicable       
laboratory t receives paym5t f a gr\p   
heal? plan or heal? insurance issu] =   
furni%+ any specifi$ cl9ical diagno/ic  
laboratory te/ %all-- 7,a7 make publicly
 available on an int]net website !      
in=mation describ$ 9 p>agraph 7#b7 )    
respect to ea* su* specifi$ cl9ical     
diagno/ic laboratory te/ t su*          
laboratory s furni%es2 &  7,b7 ensure t 
su* in=mation is updat$ n less frequ5tly
 ?an annually4  7#b7 ,in=mation describ$
 ,= purposes ( p>agraph 7#a71 !         
in=mation describ$ 9 ?is p>agraph is1 ) 
respect to an applicable laboratory & a 
specifi$ cl9ical diagno/ic laboratory   

te/1 ! foll[+3 7,a7 ,a pla9 language    
description ( ea* item or s]vice1       
accompani$ by any applicable bill+      
codes1 includ+ modifi]s1 us+ commonly   
recogniz$ bill+ code sets1 includ+ !    
,curr5t ,proc$ural ,t]m9ology code1 !   
,heal?c>e ,common ,proc$ure ,cod+ ,sy/em
 code1 ! diagnosis-relat$ gr\p1 !       
,national ,drug ,code1 & o!r nationally 
recogniz$ id5tifi]4  7,b7 ,! gross *>ge1
 z applicable1 express$ z a doll> am\nt1
 = ea* su* item or s]vice4  7,c7 ,!     
disc\nt$ ca% price1 z applicable1       
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
 ! m9imum ca% price accept$ by !        
laboratory f self-pay individuals = su* 
item or s]vice :5 provid$ 9 su* sett+s =
 ! previ\s ?ree ye>s1 express$ z a doll>
 am\nt1 z well z1 ) respect to prices   
made public pursuant to subp>agraph     
7,a77ii71 a l9k to a consum]-fri5dly    
docum5t t cle>ly expla9s ! laboratory's 
*>ity c>e policy74 ,! laboratory %all   

accept ! disc\nt$ ca% price z paym5t 9  
full f any pati5t t *ooses to pay 9 ca% 
)\t reg>d to ! pati5t's cov]age4  7,d7  
,! pay]-specific negotiat$ *>ges1       
express$ z a doll> am\nt & cle>ly       
associat$ ) ! "n ( ! applicable ?ird    
p>ty pay] & "n ( ea* plan1 t apply to   
ea* su* item or s]vice :5 provid$ 91 z  
applicable1 ! inpati5t sett+ & outpati5t
 dep>tm5t sett+4 ,if ! *>ges are bas$ on
 an algori?m1 p]c5tage ( ano!r am\nt1 or
 o!r =mula or crit]ia1 ! cl9ical        
diagno/ic laboratory also %all disclose 
su* algori?m1 p]c5tage1 =mula1 or       
crit]ia z set =? 9 its contract & any   
o!r t]ms1 s*$ules1 exhibits1 data1 or   
o!r in=mation ref]5c$ 9 any su* contract
 z %all be requir$ to det]m9e & disclose
 ! negotiat$ *>ge4  7,e7 ,! de-id5tifi$ 
maximum & m9imum negotiat$ *>ges1 z     
applicable1 = ea* su* item or s]vice1   
express$ z a non-z]o doll> am\nt4  7,f7 
,any o!r additional in=mation !         
,secret>y may require = ! purpose (     
improv+ ! accuracy (1 or enabl+ consum]s

 to easily und]/& & comp>e1 /&>d *>ges &
 prices = an item or s]vice1 except     
in=mation t is duplicative ( any o!r    
report+ requirem5t "u ?is subsection4 ,9
 ! case ( /&>d *>ges & prices = an item 
or s]vice includ$ z "p ( a bundl$1 p]   
diem1 episodic1 or o!r simil>           
arrangem5t1 ! in=mation describ$ 9 ?is  
subp>agraph %all be made available z    
det]m9$ appropriate by ! ,secret>y4     
7#c7 ,uni=m me?od & =mat ,n lat] ?an    
,janu>y #a1 #bjbe1 ! ,secret>y %all     
e/abli% a /&>d1 uni=m me?od & =mat =    
applicable laboratories to use 9 compil+
 & mak+ public in=mation pursuant to    
p>agraph 7#a74 ,su* me?od & =mat-- 7,a7 
%all include a ma*9e-readable spread%eet
 =mat conta9+ ! in=mation describ$ 9    
p>agraph 7#b7 = all items & s]vices     
furni%$ by ea* laboratory2  7,b7 may be 
simil> to any template made available by
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices  
7z describ$ 9 subsection 7e772  7,c7    
%all meet su* /&>ds z det]m9$           
appropriate by ! ,secret>y 9 ord] to    

ensure ! accessibility & usability ( su*
 in=mation2 &  7,d7 %all be updat$ z    
det]m9$ appropriate by ! ,secret>y1 9   
consultation ) /akehold]s4  7#d7        
,inclusion ( ancill>y s]vices ,any price
 or rate = a specifi$ cl9ical diagno/ic 
laboratory te/ available to be furni%$  
by an applicable laboratory made        
publicly available 9 accordance )       
p>agraph 7#a7 %all include ! price or   
rate 7z applicable7 = any ancill>y item 
or s]vice 7su* z specim5 collection     
s]vices7 t w\ld normally be furni%$ by  
su* laboratory z "p ( su* te/1 z        
specifi$ by ! ,secret>y4  7#e7 ,en=cem5t
  7,a7 ,9 g5]al ,9 ! case t ! ,secret>y 
det]m9es t an applicable laboratory is n
 9 compliance ) p>agraph 7#a7-- 7i7 n   
lat] ?an #cj days aft] su* det]m9ation1 
! ,secret>y %all notify su* laboratory (
 su* det]m9ation2 &  7ii7 if su*        
laboratory cont9ues to fail to comply ) 
su* p>agraph aft] ! date t is #ij days  
aft] su* notification is s5t1 !         
,secret>y may impose a civil monet>y    

p5alty 9 an am\nt n to exce$ #cjj = ea* 
7beg9n+ ) ! day on :i* ! ,secret>y fir/ 
det]m9$ t su* laboratory 0 fail+ to     
comply ) su* p>agraph7 dur+ :i* su*     
failure is ongo+4  7,b7 ,increase       
au?ority ,9 apply+ ?is p>agraph )       
respect to violations occurr+ 9 #bjbe or
 a subsequ5t ye>1 ! ,secret>y may ?r\gh 
notice & comm5t rulemak+ increase ! p]  
day limitation on civil monet>y p5alties
 "u subp>agraph 7,a77ii74  7,c7         
,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 ?is p>agraph 9 ! same mann] z 
su* provisions apply to a civil monet>y 
p5alty impos$ "u subsection 7a7 ( su*   
section4  7#f7 ,provision ( te*nical    
assi/ance ,! ,secret>y %all1 to ! ext5t 
practicable1 provide te*nical assi/ance 
relat+ to compliance ) ! provisions (   
?is subsection to applicable            
laboratories reque/+ su* assi/ance4     

7#g7 ,def9itions ,9 ?is subsection3 7,a7
 ,applicable laboratory ,! t]m          
applicable laboratory has ! mean+ giv5  
su* t]m 9 section #dad4ejb1 ( title #db1
 ,code ( ,f$]al ,regulations 7or a      
successor regulation71 except t su* t]m 
does n include a laboratory ) respect to
 :i* /&>d *>ges & prices = specifi$     
cl9ical diagno/ic laboratory te/s       
furni%$ by su* laboratory are made      
available by a hospital pursuant to     
subsection 7e74  7,b7 ,disc\nt$ ca%     
price ,! t]m disc\nt$ ca% price means ! 
*>ge t applies to an individual :o pays 
ca%1 or ca% equival5t1 = an item or     
s]vice4  7,c7 ,gross *>ge ,! t]m gross  
*>ge means ! *>ge = an individual item  
or s]vice t is reflect$ on an applicable
 laboratory's *>gema/]1 abs5t any       
disc\nts4  7,d7 ,pay]-specific negotiat$
 *>ge ,! t]m pay]-specific negotiat$    
*>ge means ! *>ge t an applicable       
laboratory has negotiat$ ) a ?ird p>ty  
pay] = an item or s]vice4  7,e7         
,specifi$ cl9ical diagno/ic laboratory  

te/ ,! t]m specifi$ cl9ical diagno/ic   
laboratory te/ means a cl9ical diagno/ic
 laboratory te/ t is includ$ on ! li/ ( 
%oppable s]vices specifi$ by ! ,c5t]s = 
,m$ic>e  ,m$icaid ,s]vices 7z describ$ 9
 subsection 7e771 o!r ?an su* a te/ t is
 only available to be furni%$ by a s+le 
provid] ( s]vices or suppli]4  7,f7     
,?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  #d4 ,imag+     
transp>5cy ,section #bgah ( ! ,public   
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#ah71 z am5d$ by section #c1 is 
fur!r am5d$ by add+ at ! end ! foll[+3  
7g7 ,imag+ s]vices price transp>5cy     
7#a7 ,9 g5]al ,beg9n+ ,janu>y #a1 #bjbe1
 ea* provid] ( s]vices & suppli] t      
receives paym5t f a gr\p heal? plan or  
heal? insurance issu] = furni%+ a       
specifi$ imag+ s]vice1 o!r ?an su* a    
provid] or suppli] ) respect to :i* /&>d
 *>ges & prices = su* s]vices furni%$ by

 su* provid] or suppli] are made        
available by a hospital pursuant to     
subsection 7e71 %all-- 7,a7 make        
publicly available 79 accordance )      
p>agraph 7#c77 on an int]net website !  
in=mation describ$ 9 p>agraph 7#b7 )    
respect to ea* su* s]vice t su* provid] 
( s]vices or suppli] furni%es2 &  7,b7  
ensure t su* in=mation is updat$ n less 
frequ5tly ?an annually4  7#b7 ,in=mation
 describ$ ,= purposes ( p>agraph 7#a71 !
 in=mation describ$ 9 ?is p>agraph is1 )
 respect to a provid] ( s]vices or      
suppli] & a specifi$ imag+ s]vice1 !    
foll[+3 7,a7 ,a pla9 language           
description ( ea* item or s]vice1       
accompani$ by any applicable bill+      
codes1 includ+ modifi]s1 us+ commonly   
recogniz$ bill+ code sets1 includ+ !    
,curr5t ,proc$ural ,t]m9ology code1 !   
,heal?c>e ,common ,proc$ure ,cod+ ,sy/em
 code1 ! diagnosis-relat$ gr\p1 !       
,national ,drug ,code1 & o!r nationally 
recogniz$ id5tifi]4  7,b7 ,! gross *>ge1
 z applicable1 express$ z a doll> am\nt1

 = ea* su* item or s]vice4  7,c7 ,!     
disc\nt$ ca% price1 z applicable1       
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
 ! m9imum ca% price accept$ by ! provid]
 ( s]vices or suppli] f self-pay        
individuals = su* item or s]vice :5     
provid$ 9 su* sett+s = ! previ\s ?ree   
ye>s1 express$ z a doll> am\nt1 z well  
z1 ) respect to prices made public      
pursuant to subp>agraph 7,a77ii71 a l9k 
to a consum]-fri5dly docum5t t cle>ly   
expla9s ! provid] ( s]vices or suppli]'s
 *>ity c>e policy74 ,! provid] ( s]vices
 or suppli] %all accept ! disc\nt$ ca%  
price z paym5t 9 full f any pati5t t    
*ooses to pay 9 ca% )\t reg>d to !      
pati5t's cov]age4  7,d7 ,! pay]-specific
 negotiat$ *>ges1 express$ z a doll>    
am\nt & cle>ly associat$ ) ! "n ( !     
applicable ?ird p>ty pay] & "n ( ea*    
plan1 t apply to ea* su* item or s]vice 
:5 provid$ 91 z applicable1 ! inpati5t  
sett+ & outpati5t dep>tm5t sett+4 ,if ! 

*>ges are bas$ on an algori?m1 p]c5tage 
( ano!r am\nt1 or o!r =mula or crit]ia1 
! provid] or suppli] also %all disclose 
su* algori?m1 p]c5tage1 =mula1 or       
crit]ia z set =? 9 its contract & any   
o!r t]ms1 s*$ules1 exhibits1 data1 or   
o!r in=mation ref]5c$ 9 any su* contract
 z %all be requir$ to det]m9e & disclose
 ! negotiat$ *>ge4  7,e7 ,! de-id5tifi$ 
maximum & m9imum negotiat$ *>ges1 z     
applicable1 = ea* su* item or s]vice1   
express$ z a non-z]o doll> am\nt4  7,f7 
,any o!r additional in=mation !         
,secret>y may require = ! purpose (     
improv+ ! accuracy (1 or enabl+ consum]s
 to easily und]/& & comp>e1 /&>d *>ges &
 prices = an item or s]vice1 except     
in=mation t is duplicative ( any o!r    
report+ requirem5t "u ?is subsection4 ,9
 ! case ( /&>d *>ges & prices = an item 
or s]vice includ$ z "p ( a bundl$1 p]   
diem1 episodic1 or o!r simil>           
arrangem5t1 ! in=mation describ$ 9 ?is  
subp>agraph %all be made available z    
det]m9$ appropriate by ! ,secret>y4     

7#c7 ,uni=m me?od & =mat ,n lat] ?an    
,janu>y #a1 #bjbe1 ! ,secret>y %all     
e/abli% a /&>d1 uni=m me?od & =mat =    
provid]s ( s]vices & suppli]s to use 9  
mak+ public in=mation describ$ 9        
p>agraph 7#b74 ,any su* me?od & =mat--  
7,a7 %all include a ma*9e-readable      
spread%eet =mat conta9+ ! in=mation     
describ$ 9 p>agraph 7#b7 = all items &  
s]vices furni%$ by ea* provid] ( s]vices
 & suppli] describ$ 9 p>agraph 7#a72    
7,b7 may be simil> to any template made 
available by ! ,c5t]s = ,m$ic>e         
,m$icaid ,s]vices 7z describ$ 9         
subsection 7e772  7,c7 %all meet su*    
/&>ds z det]m9$ appropriate by !        
,secret>y 9 ord] to ensure !            
accessibility & usability ( su*         
in=mation2 &  7,d7 %all be updat$ z     
det]m9$ appropriate by ! ,secret>y1 9   
consultation ) /akehold]s4  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  7#e7 ,en=cem5t  7,a7 
,9 g5]al ,9 ! case t ! ,secret>y        
det]m9es t a provid] ( s]vices or       
suppli] is n 9 compliance ) p>agraph    
7#a7-- 7i7 n lat] ?an #cj days aft] su* 
det]m9ation1 ! ,secret>y %all notify su*
 provid] or suppli] ( su* det]m9ation2  
7ii7 ^u reque/ ( ! ,secret>y1 su*       
provid] or suppli] %all submit to !     
,secret>y1 n lat] ?an #de days aft] !   
date ( su* reque/1 a corrective action  
plan to comply ) su* p>agraph2 &  7iii7 
if su* provid] or suppli] cont9ues to   
fail to comply ) su* p>agraph aft] !    
date t is #ij days aft] su* notification
 is s5t 7or1 9 ! case ( su* a provid] or
 suppli] t has submitt$ a corrective    
action plan describ$ 9 clause 7ii7 9    
response to a reque/ s describ$1 aft] ! 
date t is #ij days aft] su* submission71
 ! ,secret>y may impose a civil monet>y 
p5alty 9 an am\nt n to exce$ #cjj = ea* 
day 7beg9n+ ) ! day on :i* ! ,secret>y  
fir/ det]m9$ t su* provid] or suppli] 0 

fail+ to comply ) su* p>agraph7 dur+ :i*
 su* failure to comply or failure to    
submit is ongo+4  7,b7 ,increase        
au?ority ,9 apply+ ?is p>agraph )       
respect to violations occurr+ 9 #bjbg or
 a subsequ5t ye>1 ! ,secret>y may ?r\gh 
notice & comm5t rulemak+ increase !     
am\nt ( ! civil monet>y p5alty "u       
subp>agraph 7,a77iii74  7,c7            
,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 ?is p>agraph 9 ! same mann] z 
su* provisions apply to a civil monet>y 
p5alty impos$ "u subsection 7a7 ( su*   
section4  7,d7 ,no au?ority to waive or 
r$uce p5alty ,! ,secret>y %all n grant  
or ext5d any waiv]1 delay1 toll+1 or o!r
 mitigation ( a civil monet>y p5alty =  
violation ( ?is subsection4  7,e7       
,provision ( te*nical assi/ance ,!      
,secret>y %all1 to ! ext5t practicable1 
provide te*nical assi/ance relat+ to    

compliance ) ! provisions ( ?is         
subsection to provid]s ( s]vices &      
suppli]s reque/+ su* assi/ance4  7,f7   
,cl>ification ( nonapplicability ( o!r  
en=cem5t provisions ,not)/&+ any o!r    
provision ( ?is title1 ?is p>agraph %all
 be ! sole means ( en=c+ ! provisions ( 
?is subsection4  7#f7 ,specifi$ imag+   
s]vice def9$ ! t]m specifi$ imag+ s]vice
 means an imag+ s]vice t is a ,c5t]s =  
,m$ic>e  ,m$icaid ,s]vices-specifi$     
%oppable s]vice 7z describ$ 9 subsection
 7e774  4  #e4 ,ambulatory surgical c5t]
 price transp>5cy requirem5ts ,section  
#bgah ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #cjj;gg-#ah71 z am5d$ by 
section #d1 is fur!r am5d$ by add+ at ! 
end ! foll[+3  7h7 ,ambulatory surg]y   
c5t] transp>5cy  7#a7 ,9 g5]al ,beg9n+  
,janu>y #a1 #bjbe1 ea* specifi$         
ambulatory surgical c5t] t receives     
paym5t f a gr\p heal? plan or heal?     
insurance issu] = 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 a specifi$  
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 ma*9e-readable   
=mat specifi$ by ! ,secret>y1 ( !       
ambulatory surgical c5t]'s /&>d *>ges   
7includ+ ! in=mation describ$ 9         
subp>agraph 7,b77 = ea* item & s]vice   
furni%$ by su* surgical c5t]2  7ii7     
in=mation 9 a consum]-fri5dly =mat 7z   
specifi$ by ! ,secret>y7 on ! ambulatory
 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      
includ$ on ! li/ describ$ 9 subsection  
7e7 t are furni%$ by su* surgical c5t]1 
& z _m additional ambulatory 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 7z describ$ 9 clause    
7ii77 t is n furni%$ by ! ambulatory    
surgical c5t]1 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 & prices1 z 
applicable1 made public by a specifi$   
ambulatory surgical c5t]1 ! foll[+3 7i7 
,a description ( ea* item or s]vice1    
accompani$ by1 z applicable1 ! ,heal?c>e
 ,common ,proc$ure ,cod+ ,sy/em code1 ! 
national drug code1 or o!r id5tifi] us$ 
or approv$ by ! ,c5t]s = ,m$ic>e amp2   
,m$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 ! m9imum ca% price      
accept$ by ! specifi$ ambulatory        
surgical c5t] f self-pay individuals =  
su* item or s]vice :5 provid$ 9 su*     
sett+s = ! previ\s ?ree ye>s1 express$ z
 a doll> am\nt1 z well z1 ) respect to  
prices made public pursuant to          
subp>agraph 7,a77ii71 a l9k to a        
consum]-fri5dly docum5t t cle>ly expla9s
 ! provid] ( s]vices or suppli]'s *>ity 
c>e policy74 ,! specifi$ ambulatory     
surgical c5t] %all accept ! disc\nt$ ca%
 price z paym5t 9 full f any pati5t t   
*ooses to pay 9 ca% )\t reg>d to !      
pati5t's cov]age4  7iv7 ,! pay]-specific
 negotiat$ *>ges1 express$ z a doll>    
am\nt & cle>ly associat$ ) ! "n ( !     
applicable ?ird p>ty pay] & "n ( ea*    
plan1 t apply to ea* su* item or s]vice 
:5 provid$ 91 z applicable1 ! inpati5t  
sett+ & outpati5t dep>tm5t sett+4 ,if ! 
*>ges are bas$ on an algori?m1 p]c5tage 
( ano!r am\nt1 or o!r =mula or crit]ia1 
! ambulatory surgical c5t] also %all    

disclose su* algori?m1 p]c5tage1 =mula1 
or crit]ia z set =? 9 its contract & any
 o!r t]ms1 s*$ules1 exhibits1 data1 or  
o!r in=mation ref]5c$ 9 any su* contract
 z %all be requir$ to det]m9e & disclose
 ! negotiat$ *>ge4  7v7 ,! de-id5tifi$  
maximum & m9imum negotiat$ *>ges1 z     
applicable1 = ea* su* item or s]vice1   
express$ z a non-z]o doll> am\nt4  7vi7 
,any o!r additional in=mation !         
,secret>y may require = ! purpose (     
improv+ ! accuracy (1 or enabl+ consum]s
 to easily und]/& & comp>e1 /&>d *>ges &
 prices = an item or s]vice1 except     
in=mation t is duplicative ( any o!r    
report+ requirem5t "u ?is subsection4   
7,c7 ,uni=m me?od & =mat ,n lat] ?an    
,janu>y #a1 #bjbe1 ! ,secret>y %all     
e/abli% a /&>d1 uni=m me?od & =mat =    
specifi$ ambulatory surgical c5t]s to   
use 9 mak+ public /&>d *>ges pursuant to
 subp>agraph 7,a77i7 & a /&>d1 uni=m    
me?od & =mat = su* c5t]s to use 9 mak+  
public prices pursuant to subp>agraph   
7,a77ii74 ,any su* me?od & =mat-- 7i7   

%all1 9 ! case ( su* *>ges made public  
by an ambulatory surgical c5t]1 ensure t
 su* *>ges are made available 9 a       
ma*9e-readable =mat2  7ii7 may be simil>
 to any template made available by !    
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices 7z  
describ$ 9 subsection 7e772  7iii7 %all 
meet su* /&>ds z det]m9$ appropriate by 
! ,secret>y 9 ord] to ensure !          
accessibility & usability ( su* *>ges & 
prices2 &  7iv7 %all be updat$ z det]m9$
 appropriate by ! ,secret>y1 9          
consultation ) /akehold]s4  7#c7 ,no    
deem$ compliance ,! availability ( a    
price e/imator tool %all n be consid]$  
to deem compliance ) or o!rwise vitiate 
! requirem5ts ( ?is subsection 7aa74    
,fur!rmore1 ! use ( an e/imator tool    
%all n be us$ = purposes ( compliance ) 
any provisions 9 ?is subsection4  7#d7  
,monitor+ compliance ,! ,secret>y %all1 
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$ ambulatory        
surgical c5t]'s compliance ) ?is        
subsection is review$ n less frequ5tly  
?an once e ye>4  7#e7 ,en=cem5t  7,a7 ,9
 g5]al ,9 ! case ( a specifi$ 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 ,a  
specifi$ 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* day 7beg9n+ ) ! day on  
:i* ! ,secret>y fir/ det]m9$ t su*      
hospital 0 n comply+ ) su* requirem5ts7 
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 a specifi$         
ambulatory surgical c5t] "u clause 7i74 
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 ?is subp>agraph 9 ! same mann]
 z su* provisions apply to a civil      
monet>y p5alty impos$ "u subsection 7a7 
( su* section4  7iv7 ,no au?ority to    

waive or r$uce p5alty ,! ,secret>y %all 
n grant or ext5d any waiv]1 delay1      
toll+1 or o!r mitigation ( a civil      
monet>y p5alty = violation ( ?is        
subsection4  7#f7 ,provision ( te*nical 
assi/ance ,! ,secret>y %all1 to ! ext5t 
practicable1 provide te*nical assi/ance 
relat+ to compliance ) ! provisions (   
?is subsection to specifi$ ambulatory   
surgical c5t]s reque/+ su* assi/ance4   
7#g7 ,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 ,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,c7 ,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,d7      
,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,e7 ,%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,f7 ,specifi$ ambulatory surgical c5t] 
,! t]m specifi$ ambulatory surgical c5t]
 means an ambulatory surgical c5t] )    
respect to :i* a hospital 7or any p]son 
) an own]%ip or control int]e/ 7z def9$ 
9 section #aabd7;a77#c7 ( ! ,social     
,security ,act7 9 a hospital7 is a p]son
 ) an own]%ip or control int]e/ 7z s    
def9$74  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  #f4 ,/r5g!n+   
heal? cov]age 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 b5efits available "u a heal? 

plan = an item or s]vice 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]vice2 & 
7,,vi7 holds a memb] h>mless = ! am\nt (
 any diff]5ce 9 excess ( ! am\nt ( !    
individual's responsibility g5]at$ by ! 
self-s]vice tool & ! am\nt ultimately   
bill$ or *>g$ to ! individual4  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
 mon? !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* plan 7express$ z a     
doll> am\nt71 includ+ prescription      
drugs1 id5tifi$ by ,,cpt1 ,,hcpcs1      
,,drg1 ,,ndc1 or o!r applicable         
nationally recogniz$ id5tifi]1 includ+  
any applicable code modifi]s1 &         
accompani$ by a brief description ( !   
item or s]vice1 ! 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] t has submitt$ no claims =  
su* item or s]vice to su* plan4  7,,ii7 
,) respect to ea* drug 7id5tifi$ by     
,national ,drug ,code1 ,j-code1 or o!r  
commonly recogniz$ bill+ code us$ =     
drugs7 = :i* b5efits are available "u   
su* plan3 7aa7 ,! 9-network rate        
7express$ z a doll> am\nt71 includ+ !   
individual & total am\nts = any bundl$  

rates1 9 effect z ( ! fir/ day ( ! mon? 
9 :i* su* in=mation is made public ) ea*
 provid] t is a p>ticipat+ provid] )    
respect to su* drug4  7bb7 ,! hi/orical 
net price paid by su* plan 7net (       
rebates1 disc\nts1 & price concessions7 
7express$ z a doll> am\nt7 = 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] 
t has submitt$ no claims = su* drug to  
su* plan4  7,,iii7 ,) respect to ea*    
item or s]vice = :i* b5efits are        
available "u su* plan 7express$ z a     
doll> am\nt71 id5tifi$ by ,,cpt1 ,,drg1 
,,hcpcs1 ,,ndc1 or o!r applicable       
nationally recogniz$ id5tifi]1 includ+  
any applicable code modifi]s1 &         
accompani$ by a brief description ( !   
item or s]vice1 ! am\nt bill$ or *>g$ by
 ! provid]1 & ! am\nt all[$ by ! plan1 =

 ea* su* item or s]vice furni%$ dur+ !  
#ij-;day p]iod beg9n+ #ahj days be=e su*
 date ( submission by ea* 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* no 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 z foll[s3 7,i7 ,in=mation %all
 be conta9$ 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+1 9 consultation ) !      
,secret>ies ( ,labor & ! ,treasury to   
apply comp>able requirem5ts to gr\p     
heal? plans & to entities provid+ b5efit
 managem5t or o!r ?ird-p>ty adm9i/ration
 s]vices on a contractual basis ) a gr\p

 heal? plan4  7,,ii7 ,requirem5ts       
specifi$ by ! ,secret>y ?r\gh rulemak+  
%all ensure t3 7aa7 ,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$5tials4  7bb7 ,! rates1  
am\nts1 & prices to be disclos$ include 
contractual t]ms conta9+ calculation    
=mulae1 pric+ me?odologies1 & o!r       
in=mation necess>y to det]m9e ! doll>   
value ( reimbursem5t4  7cc7 ,ea* su*    
file includes ea* ( ! foll[+ data       
elem5ts3 7,,aa7 ,a num]ical id5tifi] = !
 gr\p heal? plan &_/or heal? insurance  
issu] 7su* z a ,heal? ,insurance        
,ov]sight ,sy/em id5tifi]74 7,,bb7 ,a   
pla9-language description ( ! item or   
s]vice 7includ+1 = drugs1 ! propriet>y &
 nonpropriet>y "n assign$74 7,,cc7 ,!   
bill+ code1 includ+ any applicable      
modifi]s1 associat$ ) su* item or       

s]vice1 includ+ ! ,heal?c>e ,common     
,proc$ure ,cod+ ,sy/em code1            
diagnosis-relat$ gr\p1 national drug    
code1 or o!r commonly recogniz$ code    
set4 7,,dd7 ,! place ( s]vice code4     
7,,ee7 ,! ,national ,provid] ,id5tifi]  
or provid] ,tax ,id5tification ,numb]4  
7,,iii7 ,! rate & paym5t in=mation      
disclos$ "u subclauses 7,i7 ?r\gh       
7,,iii7 ( clause 7ii7 %all be sep>ately 
del9eat$ = ea* item or s]vice1 reg>dless
 ( :e!r su* item or s]vice is reimburs$ 
z a "p ( a bundle1 episode1 or o!r gr\p+
 ( items & s]vices4  7,,iv7 ,an (fic] or
 executive ( compet5t au?ority %all     
atte/ to ! accuracy & complet5ess (     
in=mation submitt$ & made available "u  
?is subp>agraph4 ,su* atte/ation %all be
 deem$ mat]ial to paym5ts f ! ,f$]al    
,gov]nm5t receiv$ by ! gr\p heal? plan  
or heal? insurance issu]4  7,v7         
,regulations promulgat$ pursuant to ?is 
section %all provide t3 7aa7 ,!         
,secret>y %all audit ! ?ree             
ma*9e-readable files requir$ by         

subp>agraph 7,e77ii7 po/$ by no few] ?an
 #bj gr\p heal? plans or heal? insurance
 issu]s4  7bb7 ,! ,secret>y ( ,labor    
%all audit ! ?ree ma*9e-readable files  
requir$ by subp>agraph 7,e77ii7 po/$ by 
no few] ?an #bjj gr\p heal? plans or    
s]vice provid]s furni%+ ?ird-p>ty       
adm9i/rator s]vices to a gr\p heal?     
plan4  7cc7 ,f9d+s1 conclusions1 &      
en=cem5t actions tak5 bas$ on audits ( !
 ma*9e-readable files %all be report$   
annually to ,congress no lat] ?an ,july 
#a ( ! cal5d> ye> dur+ :i* ! files 7    
audit$4 ,su* report to ,congress %all be
 accessible to ! public4  7iv7 ,us]     
guide ,ea* heal? plan %all make         
available to ! public in/ructions writt5
 9 pla9 language expla9+ h[ individuals 
may se>* = in=mation describ$ 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 ,if ! rate is bas$  
on an algori?m1 p]c5tage ( ano!r am\nt1 
or o!r =mula or crit]ia1 ! heal? plan   
also %all disclose su* algori?m1        
p]c5tage1 =mula1 or crit]ia z set =? 9  
its contract & any o!r t]ms1 s*$ules1   
exhibits1 data1 or o!r in=mation ref]5c$
 9 any su* contract z %all be requir$ to
 det]m9e & disclose ! negotiat$ rate4   
7,g7 ,applicability to acc\ntable c>e   
organizations ,an applicable ,,aco      
p>ticipat+ 9 ! ,m$ic>e ,%>$ ,sav+s      
,program1 z def9$ 9 ,section #ahii ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acie;jjj71 %all be subject to !        
requirem5ts ( ?is p>agraph z if su*     
applicable ,,aco is a gr\p heal? plan or
 heal? insurance issu]4  7,h7 ,en=cem5t 
,ea* ye>1 ! ,secret>y %all audit ! ?ree 

ma*9e-readable files requir$ by         
subp>agraph 7,e77ii7 po/$ by no few] ?an
 #bj gr\p heal? plans or heal? insurance
 issu]s4  4  7c7 ,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$4 ,reg4 #gbaeh7 be=e ,janu>y #a1     
#bjbe4  #g4 ,increas+ gr\p heal? plan   
access to heal? data  7a7 ,gr\p heal?   
plan access to in=mation  7#a7 ,9 g5]al 
,p>agraph 7#b7 ( section #djh7;b7 ( !   
,employee ,retirem5t ,income ,security  
,act ( #aigd 7 #bi ,u4,s4,c4 #aajh7;b77 
is am5d$ by add+ at ! end ! foll[+ new  
subp>agraphs3  7,c7 ,no contract or     
arrangem5t = s]vices betwe5 a gr\p heal?
 plan & any o!r entity1 includ+ a heal? 

c>e provid] 7includ+ a heal? c>e        
facility71 network or association (     
provid]s1 s]vice provid] (f]+ access to 
a network ( provid]s1 ?ird-p>ty         
adm9i/rator1 or ph>macy b5efit manag]   
7collectively1 ,cov]$ ,s]vice           
,provid]s71 is reasonable )9 ! mean+ (  
?is p>agraph unless su* contract or     
arrangem5t-- 7i7 all[s ! responsible    
gr\p heal? plan access to all claims &  
enc\nt] in=mation1 & any docum5tation   
support+ claim paym5ts1 includ+1 b n    
limit$ to1 m$ical records & policy      
docum5ts1 or data describ$ 9 section    
#gbd7;a77#a77;,b7 to-- 7,i7 enable su*  
entity to comply ) ! t]ms ( ! plan & any
 applicable law2 &  7,,ii7 det]m9e !    
accuracy or reasonabl5ess ( paym5t2 &   
7ii7 does n-- 7,i7 unreasonably limit or
 delay access to su* in=mation or data2 
7,,ii7 limit ! volume ( claims & enc\nt]
 in=mation or data t ! gr\p heal? plan  
may access dur+ an audit2  7,,iii7 limit
 ! disclosure ( pric+ t]ms = value-bas$ 
paym5t arrangem5ts or capitat$ paym5t   

arrangem5ts1 includ+-- 7aa7 paym5t      
calculations & =mulas2  7bb7 quality    
measures2  7cc7 contract t]ms2  7dd7    
paym5t am\nts2  7ee7 measurem5t p]iods =
 all inc5tives2 &  7ff7 o!r paym5t      
me?odologies us$ by an entity1 includ+ a
 heal? c>e provid] 7includ+ a heal? c>e 
facility71 network or association (     
provid]s1 s]vice provid] (f]+ access to 
a network ( provid]s1 ?ird-p>ty         
adm9i/rator1 or ph>macy b5efit manag]2  
7,,iv7 limit ! disclosure ( ov]paym5ts &
 ov]paym5t recov]y t]ms2  7,v7 limit !  
"r ( ! gr\p heal? plan to select an     
auditor or def9e audit scope or         
frequ5cy2  7,,vi7 o!rwise limit or      
unduly delay ! gr\p heal? plan f access+
 claims & enc\nt] in=mation or data 9 a 
daily bat*4  7,,vii7 limit ! disclosure 
( fees *>g$ to ! gr\p heal? plan relat$ 
to plan adm9i/ration & claims process+1 
includ+ r5egotiation fees1 access fees1 
repric+ fees1 or enhanc$ review fees2   
7,,viii7 limit ! "r ( ! gr\p heal? plan 
to reque/ action on any suspect claim   

paym5ts2 or  7,,ix7 limit public        
disclosure ( de-id5tifi$ or aggregate   
in=mation4  7,d7 ,privacy requirem5ts   
,cov]$ ,s]vice ,provid]s %all provide   
in=mation "u ?is p>agraph 9 a mann]     
consi/5t ) ! privacy & security         
regulations promulgat$ "u ! ,heal?      
,insurance ,portability & ,acc\ntability
 ,act 7,,hipaa74 ,?is subp>agraph %all n
 be read to abridge or limit !          
disclosure requirem5ts "u ?is p>agraph  
or to impose additional privacy or      
security requirem5ts on ,cov]$ ,s]vice  
,provid]s or plan sponsors4  7,e7       
,disclosure & r$isclosure2 limitation to
 bus9ess associates ,a gr\p heal? plan  
receiv+ in=mation or data "u ?is        
p>agraph may disclose su* in=mation only
 to ! entity f :i* ! in=mation or data 0
 receiv$1 ! gr\p heal? plan or plan     
sponsor to :i* ! in=mation or data      
p]ta9s1 or to t entity's bus9ess        
associates z def9$ 9 section #afj4ajc ( 
title #de1 ,code ( ,f$]al ,regulations1 
or z o!rwise p]mitt$ by ! ,,hipaa       

,privacy ,rule 7#de ,,cfr p>ts #afj &   
#afd1 subp>ts ,a & ,e74  7,f7 ,data     
/&>ds ,in=mation made available "u ?is  
section %all con=m to ! foll[+ /&>ds3   
7i7 ,in/itutional1 pr(essional1 & d5tal 
claims receiv$ f a heal?c>e provid] %all
 be made available to ! gr\p heal? plan 
z ,,asc ,x#ab,n #hcg files4 ,! files    
%all be unmodifi$ copies ( ! files s5t f
 ! provid]4 ,9 ! ev5t t pap] claims are 
s5t by ! provid]1 !y %all be conv]t$ to 
! ,,asc ,x#ab,n #hcg electronic =mat4   
,files %all be accessible to ! plan at  
no co/ to ! gr\p heal? plan4  7ii7 ,all 
claim paym5t 7or ,,eft1 electronic funds
 transf]7 & electronic remittance advice
 7,,era7 notices s5t by a ,cov]$ ,s]vice
 ,provid] %all be made available to !   
gr\p heal? plan z ,,asc ,x#ab,n #hce    
files4 ,! files %all be unmodifi$ copies
 ( ! files s5t by ! ,cov]$ ,s]vice      
,provid] to ! heal?c>e provid]4 ,files  
%all be accessible at no co/ to ! gr\p  
heal? plan4  7iii7 ,! contractual t]ms  
conta9+ calculation =mulae1 pric+       

me?odologies1 & o!r in=mation us$ to    
det]m9e ! doll> value ( reimbursem5t4   
7iv7 ,all non-claim co/s %all be itemiz$
 & made available to ! gr\p heal? plan 9
 real "t ?r\gh a web-bas$ portal1 ?r\gh 
an ,,api1 & ?r\gh a d[nloadable ,,csv   
file4  4  7#b7 ,civil en=cem5t  7,a7 ,9 
g5]al ,subsection 7c7 ( section #ejb (  
su* ,act 7#bi ,u4,s4,c4 #aacb7 is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 
#8#87#ac7 ,9 ! case ( an agreem5t betwe5
 a gr\p heal? plan & a heal? c>e provid]
 7includ+ a heal? c>e facility71 network
 or association ( provid]s1 s]vice      
provid] (f]+ access to a network (      
provid]s1 ?ird-p>ty adm9i/rator1 or     
ph>macy b5efit manag]1 t violates !     
provisions ( section #gbd1 ! ,secret>y  
may assess a civil p5alty aga9/ su*     
provid]1 network or association1 s]vice 
provid] (f]+ access to a network (      
provid]s1 ?ird-p>ty adm9i/rator1 ph>macy
 b5efit manag]1 or o!r s]vice provid] 9 
! am\nt ( #aj1jjj = ea* day dur+ :i* su*
 violation cont9ues4 ,su* p5alty %all be

 9 addition to o!r p5alties z may be    
prescrib$ by law4  7,b7 ,con=m+ am5dm5t 
,p>agraph 7#f7 ( section #ejb7;a7 ( su* 
,act is am5d$ by /rik+ or 7#i7 & ins]t+ 
7#i71 or 7#ac7 4  7#c7 ,exi/+ provisions
 void ,section #daj ( su* ,act is am5d$ 
by add+ at ! end ! foll[+3  7c7 ,any    
provision 9 an agreem5t or in/rum5t %all
 be void z aga9/ public policy if su*   
provision-- 7#a7 unduly delays or limits
 a gr\p heal? plan f access+ ! claims & 
enc\nt] in=mation or data describ$ 9    
section #gbd7;a77#a77;,b72 or  7#b7     
violates ! requirem5ts ( section        
#djh7;b77#b77;,c74  4  7#d7 ,te*nical   
am5dm5t ,clause 7i7 ( section           
#djh7;b77#b77;,b7 ( su* ,act is am5d$ by
 /rik+ ?is clause & ins]t+ ?is p>agraph4
  7b7 ,updat$ atte/ation = price &      
quality in=mation ,section #gbd7;a77#c7 
( ! ,employee ,retirem5t ,income        
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#aahem7a77#c77 is am5d$ to read z       
foll[s3  7#c7 ,atte/ation  7,a7 ,9 g5]al
 ,subject to subp>agraph 7,c71 ! gr\p   

heal? plan or heal? insurance issu] (f]+
 gr\p heal? insurance cov]age %all      
annually submit to ! ,secret>y an       
atte/ation t su* plan or issu] ( su*    
cov]age is 9 compliance ) ! requirem5ts 
( ?is subsection4 ,su* atte/ation %all  
also include a /atem5t v]ify+ t-- 7i7 ! 
in=mation or data describ$ "u           
subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#a7
 is available ^u reque/ & provid$ to !  
gr\p heal? plan1 ! plan adm9i/rator1 or 
! issu] 9 a timely mann]2 &  7ii7 !re   
are no t]ms 9 ! agreem5t "u su* p>agraph
 7#a7 t directly or indirectly re/rict  
or unduly delay a gr\p heal? plan1 !    
plan adm9i/rator1 or ! issu] f audit+1  
review+1 or o!rwise access+ su*         
in=mation1 except z p]mitt$ "u section  
#djh7;b77#b77;,c74  7,b7 ,limitation on 
submission ,subject to clause 7ii71 a   
gr\p heal? plan or issu] (f]+ gr\p heal?
 insurance cov]age may n ent] into an   
agreem5t ) a ?ird-p>ty adm9i/rator or   
o!r s]vice provid] to submit !          
atte/ation requir$ "u subp>agraph 7,a74 

7,c7 ,exception ,9 ! case ( a gr\p heal?
 plan or issu] (f]+ gr\p heal? insurance
 cov]age t is unable to obta9 !         
in=mation or data ne$$ to submit !      
atte/ation requir$ "u subp>agraph 7,a71 
su* plan or issu] may submit a writt5   
/atem5t 9 lieu ( su* atte/ation t       
includes-- 7i7 an explanation ( :y su*  
plan or issu] 0 unsuccessful 9 obta9+   
su* in=mation or data1 includ+ :e!r su* 
plan or issu] 0 limit$ or prev5t$ f     
audit+1 review+1 or o!rwise access+ su* 
in=mation or data2  7ii7 a description (
 ! ef=ts made by ! gr\p heal? plan to   
remove any gag clause provisions f !    
agreem5t "u p>agraph 7#a72 &  7iii7 a   
description ( any response by !         
?ird-p>ty adm9i/rator or o!r s]vice     
provid] ) respect to ef=ts to comply ) !
 atte/ation requirem5t "u subp>agraph   
7,a74  4  7c7 ,effective date ,!        
am5dm5ts made by subsections 7a7 & 7b7  
%all apply ) respect to a plan beg9n+ ) 
! fir/ plan ye> t beg9s on or aft] !    
date t is #a ye> aft] ! date ( enactm5t 

( ?is ,act4  #h4 ,preemption only 9 ev5t
 ( conflict ,! provisions ( sections #b 
?r\gh #e ( ?is ,act 7includ+ ! am5dm5ts 
made by su* sections7 %all n sup]s$e any
 provision ( ,/ate law :i* e/abli%es1   
implem5ts1 or cont9ues 9 effect any     
requirem5t or prohibition relat$ to     
heal? c>e price transp>5cy1 except to ! 
ext5t t su* requirem5t or prohibition   
prev5ts ! application ( a requirem5t or 
prohibition ( su* sections 7or am5dm5t74
 ,no?+ 9 ?is section %all be con/ru$ to 
affect heal? plans e/abli%$ "u !        
,employee ,retirem5t ,income ,security  
,act ( #aigd4