,,ii #aahth ,,congress #b;d ,session ,s4 #eece ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #af1 #bjbd,mr4 ,marshall 7for himself and ,mr4 ,bennet7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend title ,,xxvii of the ,public ,health ,service ,act1 the ,employee ,retirement ,income ,security ,act of #aigd1 and the ,internal ,revenue ,code of #aihf to increase penalties for group health plans and health insurance issuers for practices that violate balance billing requirements1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,no ,surprises ,act ,enforcement ,act4 #b4 ,increasing penalties for group health plans and health insurance issuers for practices that violate balance billing requirements 7a7 ,,phsa ,section #bgbc7;b77#b77;,c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bb7;b77#b77;,c77 is amended-- 7#a7 in clause 7i71 by inserting 7or1 in the case of such a failure with respect to a provision specified in clause 7iv71 #aj1jjj per failure7 after #ajj2 and 7#b7 by adding at the end the following new clause3 7iv7 ,provisions specified ,for purposes of clause 7i71 the provisions specified in this clause are the following3 7,i7 ,subparagraphs 7,a7 and 7,b7 of section #bgii;,a-#a7;a77#a74 7,,ii7 ,clauses 7i71 7ii71 7iii71 and 7v7 of section #bgii;,a-#a7;a77#a77;,c74 7,,iii7 ,subparagraphs 7,a71 7,b71 and 7,e7 of section #bgii;,a-#a7;b77#a74 7,,iv7 ,paragraphs 7#a7 and 7#b7 of section #bgii;,a-#b7;a74 4 7b7 ,,erisa ,section #ejb of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaca7 is amended-- 7#a7 in subsection 7a77#f71 by striking or 7#i7 and inserting 7#i71 or 7#ab72 7#b7 in subsection 7b77#c7-- 7,a7 by inserting 1 7c77#ab71 after subsections 7c77#i72 and 7,b7 by inserting or 7c77#ab7 after under subsection 7c77#i72 and 7#c7 in subsection 7c71 by adding at the end the following new paragraph3 7#ab7 ,the ,secretary may assess a civil penalty against any group health plan or health insurance issuer offering group health insurance coverage of not more than #aj1jjj for each violation for each individual with respect to which such plan or coverage fails to comply with one of the following provisions3 7,a7 ,subparagraphs 7,a7 and 7,b7 of section #gaf7;a77#a74 7,b7 ,clauses 7i71 7ii71 7iii71 and 7v7 of section #gaf7;a77#a77;,c74 7,c7 ,subparagraphs 7,a71 7,b71 and 7,e7 of section #gaf7;b77#a74 7,d7 ,paragraphs 7#a7 and 7#b7 of section #gag7;a74 4 7c7 ,,irc ,section #dihj;,d7b7 of the ,internal ,revenue ,code of #aihf is amended-- 7#a7 in paragraph 7#a71 by inserting 7or1 in the case of such a failure with respect to a provision specified in paragraph 7#d71 #aj1jjj per failure7 after #ajj2 and 7#b7 by adding at the end the following new paragraph3 7#d7 ,provisions specified ,for purposes of paragraph 7#a71 the provisions specified in this paragraph are the following3 7,a7 ,subparagraphs 7,a7 and 7,b7 of section #ihaf7;a77#a74 7,b7 ,clauses 7i71 7ii71 7iii71 and 7v7 of section #ihaf7;a77#a77;,c74 7,c7 ,subparagraphs 7,a71 7,b71 and 7,e7 of section #ihaf7;b77#a74 7,d7 ,paragraphs 7#a7 and 7#b7 of section #ihag7;a74 4 #c4 ,additional penalties for late payment or non-payment after ,,idr entity payment determination 7a7 ,,phsa 7#a7 ,emergency and nonemergency services ,section #bgii;,a-#a7;c77#f7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aaa7;c77#f77 is amended-- 7,a7 in the paragraph heading1 by inserting 2 penalty for late payment or non-payment after payment2 7,b7 by striking ,the total plan and inserting the following3 7,a7 ,timing of payment ,the total plan 2 and 7,c7 by adding at the end the following new subparagraphs3 7,b7 ,notification ,in the case of a plan or coverage required to make a payment pursuant to a determination described in subparagraph 7,a71 such plan or coverage shall submit to the ,secretary a notification of such payment as of the date such payment is made in a manner specified by the ,secretary4 7,c7 ,penalty for late payment or non-payment 7i7 ,in general ,in the case of a plan or coverage that has not made the required payment described in subparagraph 7,a7 with respect to an item or service in the time period described in such subparagraph1 in addition to making such payment1 such plan or coverage shall also pay to the nonparticipating provider or facility an amount that is three times the difference between-- 7,i7 the initial payment 7or1 in the case of a notice of denial of payment1 #j7 described in subsection 7a77#a77;,c77iv77,i7 or 7b77#a77;,c71 as applicable2 and 7,,ii7 the out-of-network rate 7as defined in subsection 7a77#c77,k77 for such item or service 7less any cost sharing required to be paid by the individual receiving such item or service74 7ii7 ,interest ,such late payment or non-payment 7as applicable7 shall also be subject to interest in a manner specified by the ,secretary4 4 7#b7 ,air ambulance services ,section #bgii;,a-#b7;b77#f7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aab7;b77#f77 is amended-- 7,a7 in the paragraph heading1 by inserting 2 penalty for late payment or non-payment after payment2 7,b7 by striking ,the total plan and inserting the following3 7,a7 ,timing of payment ,the total plan 2 and 7,c7 by adding at the end the following new subparagraphs3 7,b7 ,notification ,in the case of a plan or coverage required to make a payment pursuant to a determination described in subparagraph 7,a71 such plan or coverage shall submit to the ,secretary a notification of such payment as of the date such payment is made in a manner specified by the ,secretary4 7,c7 ,penalty for late payment or non-payment 7i7 ,in general ,in the case of a plan or coverage that has not made the required payment described in subparagraph 7,a7 with respect to an item or service in the time period described in such subparagraph1 in addition to making such payment1 such plan or coverage shall also pay to the nonparticipating provider an amount that is three times the difference between-- 7,i7 the initial payment 7or1 in the case of a notice of denial of payment1 #j7 described in subsection 7a77#c77;,a72 and 7,,ii7 the out-of-network rate 7as defined in section #bgii-a7;a77#c77,k77 for such item or service 7less any cost sharing required to be paid by the individual receiving such item or service74 7ii7 ,interest ,such late payment or non-payment 7as applicable7 shall also be subject to interest in a manner specified by the ,secretary4 4 7b7 ,,erisa 7#a7 ,emergency and nonemergency services ,section #gaf7;c77#f7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;e7c77#f77 is amended-- 7,a7 in the paragraph heading1 by inserting 2 penalty for late payment or non-payment after payment2 7,b7 by striking ,the total plan and inserting the following3 7,a7 ,timing of payment ,the total plan 2 and 7,c7 by adding at the end the following new subparagraphs3 7,b7 ,notification ,in the case of a plan or coverage required to make a payment pursuant to a determination described in subparagraph 7,a71 such plan or coverage shall submit to the ,secretary a notification of such payment as of the date such payment is made in a manner specified by the ,secretary4 7,c7 ,penalty for late payment or non-payment 7i7 ,in general ,in the case of a plan or coverage that has not made the required payment described in subparagraph 7,a7 with respect to an item or service in the time period described in such subparagraph1 in addition to making such payment1 such plan or coverage shall also pay to the nonparticipating provider or facility an amount that is three times the difference between-- 7,i7 the initial payment 7or1 in the case of a notice of denial of payment1 #j7 described in subsection 7a77#a77;,c77iv77,i7 or 7b77#a77;,c71 as applicable2 and 7,,ii7 the out-of-network rate 7as defined in subsection 7a77#c77,k77 for such item or service 7less any cost sharing required to be paid by the individual receiving such item or service74 7ii7 ,interest ,such late payment or non-payment 7as applicable7 shall also be subject to interest in a manner specified by the ,secretary4 4 7#b7 ,air ambulance services ,section #gag7;b77#f7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;f7b77#f77 is amended-- 7,a7 in the paragraph heading1 by inserting 2 penalty for late payment or non-payment after payment2 7,b7 by striking ,the total plan and inserting the following3 7,a7 ,timing of payment ,the total plan 2 and 7,c7 by adding at the end the following new subparagraphs3 7,b7 ,notification ,in the case of a plan or coverage required to make a payment pursuant to a determination described in subparagraph 7,a71 such plan or coverage shall submit to the ,secretary a notification of such payment as of the date such payment is made in a manner specified by the ,secretary4 7,c7 ,penalty for late payment or non-payment 7i7 ,in general ,in the case of a plan or coverage that has not made the required payment described in subparagraph 7,a7 with respect to an item or service in the time period described in such subparagraph1 in addition to making such payment1 such plan or coverage shall also pay to the nonparticipating provider an amount that is three times the difference between-- 7,i7 the initial payment 7or1 in the case of a notice of denial of payment1 #j7 described in subsection 7a77#c77;,a72 and 7,,ii7 the out-of-network rate 7as defined in section #gaf7;a77#c77,k77 for such item or service 7less any cost sharing required to be paid by the individual receiving such item or service74 7ii7 ,interest ,such late payment or non-payment 7as applicable7 shall also be subject to interest in a manner specified by the ,secretary4 4 7c7 ,,irc 7#a7 ,emergency and nonemergency services ,section #ihaf7;c77#f7 of the ,internal ,revenue ,code of #aihf is amended-- 7,a7 in the paragraph heading1 by inserting 2 penalty for late payment or non-payment after payment2 7,b7 by striking ,the total plan and inserting the following3 7,a7 ,timing of payment ,the total plan 2 and 7,c7 by adding at the end the following new subparagraphs3 7,b7 ,notification ,in the case of a plan required to make a payment pursuant to a determination described in subparagraph 7,a71 such plan shall submit to the ,secretary a notification of such payment as of the date such payment is made in a manner specified by the ,secretary4 7,c7 ,penalty for late payment or non-payment 7i7 ,in general ,in the case of a plan that has not made the required payment described in subparagraph 7,a7 with respect to an item or service in the time period described in such subparagraph1 in addition to making such payment1 such plan shall also pay to the nonparticipating provider or facility an amount that is three times the difference between-- 7,i7 the initial payment 7or1 in the case of a notice of denial of payment1 #j7 described in subsection 7a77#a77;,c77iv77,i7 or 7b77#a77;,c71 as applicable2 and 7,,ii7 the out-of-network rate 7as defined in subsection 7a77#c77,k77 for such item or service 7less any cost sharing required to be paid by the individual receiving such item or service74 7ii7 ,interest ,such late payment or non-payment 7as applicable7 shall also be subject to interest in a manner specified by the ,secretary4 4 7#b7 ,air ambulance services ,section #ihag7;b77#f7 of the ,internal ,revenue ,code of #aihf is amended-- 7,a7 in the paragraph heading1 by inserting 2 penalty for late payment or non-payment after payment2 7,b7 by striking ,the total plan and inserting the following3 7,a7 ,timing of payment ,the total plan 2 and 7,c7 by adding at the end the following new subparagraphs3 7,b7 ,notification ,in the case of a plan required to make a payment pursuant to a determination described in subparagraph 7,a71 such plan shall submit to the ,secretary a notification of such payment as of the date such payment is made in a manner specified by the ,secretary4 7,c7 ,penalty for late payment or non-payment 7i7 ,in general ,in the case of a plan that has not made the required payment described in subparagraph 7,a7 with respect to an item or service in the time period described in such subparagraph1 in addition to making such payment1 such plan shall also pay to the nonparticipating provider an amount that is three times the difference between-- 7,i7 the initial payment 7or1 in the case of a notice of denial of payment1 #j7 described in subsection 7a77#c77;,a72 and 7,,ii7 the out-of-network rate 7as defined in section #ihaf7;a77#c77,k77 for such item or service 7less any cost sharing required to be paid by the individual receiving such item or service74 7ii7 ,interest ,such late payment or non-payment 7as applicable7 shall also be subject to interest in a manner specified by the ,secretary4 4 #d4 ,transparency reporting requirements 7a7 ,,phsa ,section #bgii;,a-#a7;a77#b77;,a77iii7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aaa7;a77#b77;,a77iii77 is amended to read as follows3 7iii7 ,reporting 7,i7 ,initial reporting ,beginning for #bjbb and ending on ,december #ca of the calendar year in which the ,no ,surprises ,act ,enforcement ,act is enacted1 the ,secretary shall annually submit to ,congress a report on the number of plans and issuers with respect to which audits were conducted during such year pursuant to this subparagraph4 7,,ii7 ,subsequent reporting 7aa7 ,in general ,with respect to the first calendar year following the date of the enactment of the ,no ,surprises ,act ,enforcement ,act1 not later than ,february #a of such year1 and every #f months thereafter1 the ,secretary1 in coordination with the ,secretary of ,labor and the ,secretary of the ,treasury1 shall submit to the ,committee on ,ways and ,means1 the ,committee on ,energy and ,commerce1 and the ,committee on ,education and the ,workforce of the ,house of ,representatives1 and the ,committee on ,finance and the ,committee on ,health1 ,education1 ,labor and ,pensions of the ,senate1 a report on any audits conducted pursuant to this subparagraph during the applicable reporting period1 and any enforcement actions taken during such period in accordance with the provisions of this part1 including-- 7,,aa7 the total number of audits conducted under this subparagraph2 7,,bb7 the number of audits conducted pursuant to clause 7ii77,i72 7,,cc7 the number of complaints submitted by providers and by participants1 beneficiaries1 and enrollees with respect to a violation of this part2 7,,dd7 any enforcement actions taken as a result of a complaint submitted by a provider or by a participant1 a beneficiary1 or an enrollee1 with respect to the provisions of this part2 7,,ee7 the total number of1 and the aggregate dollar amount of1 any civil monetary penalties issued in accordance with this part2 7,,ff7 a summary of any non-monetary corrective action taken against a group health plan or health insurance issuer offering group or individual health insurance coverage for a violation of this part2 and 7,,gg7 a description of the #c most commonly reported violations of this part4 7bb7 ,applicable reporting period ,for purposes of this subclause1 the term applicable reporting period means the #f month period prior to each report submitted under item 7aa74 4 7b7 ,,irc ,section #ihaf7;a77#b77;,a77iii7 of the ,internal ,revenue ,code of #aihf is amended to read as follows3 7iii7 ,reporting 7,i7 ,initial reporting ,beginning for #bjbb and ending on ,december #ca of the calendar year in which the ,no ,surprises ,act ,enforcement ,act is enacted1 the ,secretary shall annually submit to ,congress a report on the number of plans with respect to which audits were conducted during such year pursuant to this subparagraph4 7,,ii7 ,subsequent reporting 7aa7 ,in general ,with respect to the first calendar year following the date of the enactment of the ,no ,surprises ,act ,enforcement ,act1 not later than ,february #a of such year1 and every #f months thereafter1 the ,secretary1 in coordination with the ,secretary of ,labor and the ,secretary of ,health and ,human ,services1 shall submit to the ,committee on ,ways and ,means1 the ,committee on ,energy and ,commerce1 and the ,committee on ,education and the ,workforce of the ,house of ,representatives1 and the ,committee on ,finance and the ,committee on ,health1 ,education1 ,labor and ,pensions of the ,senate1 a report on audits performed pursuant to this subparagraph during the applicable reporting period1 and any enforcement actions taken during such period in accordance with the provisions of an applicable section1 including-- 7,,aa7 the total number of audits conducted under this subparagraph2 7,,bb7 the number of audits conducted pursuant to clause 7ii77,i72 7,,cc7 the number of complaints submitted by providers and by participants and beneficiaries with respect to a violation of an applicable section2 7,,dd7 any enforcement actions taken pursuant to a violation of an applicable section2 7,,ee7 the total number of1 and the aggregate dollar amount of1 any civil monetary penalties issued in accordance with an applicable section2 7,,ff7 a summary of any non-monetary corrective action taken against a group health plan for a violation of an applicable section2 and 7,,gg7 a description of the #c most commonly reported violations of an applicable section4 7bb7 ,definitions ,in this subclause3 7,,aa7 ,applicable reporting period ,the term applicable reporting period means the #f month period prior to each report submitted under item 7aa74 7,,bb7 ,applicable section ,the term applicable section means this section and each of sections #ihag through #ihbe4 4