I 

118TH CONGRESS 

2D SESSION H. R. 9572 

To amend title XXVII of the Public Health Service Act, the Employee 

Retirement Income Security Act of 1974, and the Internal Revenue 

Code of 1986 to increase penalties for group health plans and health 

insurance issuers for practices that violate balance billing requirements, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 12, 2024 

Mr. MURPHY (for himself, Mr. RUIZ, Mr. JOYCE of Pennsylvania, Ms. 

SCHRIER, and Mr. PANETTA) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to 

the Committees on Ways and Means, and Education and the Workforce, 

for a period to be subsequently determined by the Speaker, in each case 

for consideration of such provisions as fall within the jurisdiction of the 

committee concerned 

A BILL 

To amend title XXVII of the Public Health Service Act, 

the Employee Retirement Income Security Act of 1974, 

and the Internal Revenue Code of 1986 to increase penalties for group health plans and health insurance issuers 

for practices that violate balance billing requirements, 

and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Enhanced Enforce3 ment of Health Coverage Act’’. 

4 SEC. 2. INCREASING PENALTIES FOR GROUP HEALTH 

5 PLANS AND HEALTH INSURANCE ISSUERS 

6 FOR PRACTICES THAT VIOLATE BALANCE 

7 BILLING REQUIREMENTS. 

8 (a) PHSA.—Section 2723(b)(2)(C) of the Public 

9 Health Service Act (42 U.S.C. 300gg–22(b)(2)(C)) is 

10 amended— 

11 (1) in clause (i), by inserting ‘‘(or, in the case 

12 of such a failure with respect to a provision specified 

13 in clause (iv), $10,000 per failure)’’ after ‘‘$100’’; 

14 and 

15 (2) by adding at the end the following new 

16 clause: 

17 ‘‘(iv) PROVISIONS SPECIFIED.—For 

18 purposes of clause (i), the provisions speci19 fied in this clause are the following: 

20 ‘‘(I) Subparagraphs (A) and (B) 

21 of section 2799A–1(a)(1). 

22 ‘‘(II) Clauses (i), (ii), (iii), and 

23 (v) of section 2799A–1(a)(1)(C). 

24 ‘‘(III) Subparagraphs (A), (B), 

25 and (E) of section 2799A–1(b)(1). 


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1 ‘‘(IV) Paragraphs (1) and (2) of 

2 section 2799A–2(a).’’. 

3 (b) ERISA.—Section 502 of the Employee Retire4 ment Income Security Act of 1974 (29 U.S.C. 1131) is 

5 amended— 

6 (1) in subsection (a)(6), by striking ‘‘or (9)’’ 

7 and inserting ‘‘(9), or (12)’’; 

8 (2) in subsection (b)(3)— 

9 (A) by inserting ‘‘, (c)(12),’’ after ‘‘sub10 sections (c)(9)’’; and 

11 (B) by inserting ‘‘or (c)(12)’’ after ‘‘under 

12 subsection (c)(9)’’; and 

13 (3) in subsection (c), by adding at the end the 

14 following new paragraph: 

15 ‘‘(12) The Secretary may assess a civil penalty 

16 against any group health plan or health insurance issuer 

17 offering group health insurance coverage of not more than 

18 $10,000 for each violation for each individual with respect 

19 to which such plan or coverage fails to comply with one 

20 of the following provisions: 

21 ‘‘(A) Subparagraphs (A) and (B) of section 

22 716(a)(1). 

23 ‘‘(B) Clauses (i), (ii), (iii), and (v) of section 

24 716(a)(1)(C). 


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1 ‘‘(C) Subparagraphs (A), (B), and (E) of sec2 tion 716(b)(1). 

3 ‘‘(D) Paragraphs (1) and (2) of section 

4 717(a).’’. 

5 (c) IRC.—Section 4980D(b) of the Internal Revenue 

6 Code of 1986 is amended— 

7 (1) in paragraph (1), by inserting ‘‘(or, in the 

8 case of such a failure with respect to a provision 

9 specified in paragraph (4), $10,000 per failure)’’ 

10 after ‘‘$100’’; and 

11 (2) by adding at the end the following new 

12 paragraph: 

13 ‘‘(4) PROVISIONS SPECIFIED.—For purposes of 

14 paragraph (1), the provisions specified in this para15 graph are the following: 

16 ‘‘(A) Subparagraphs (A) and (B) of section 

17 9816(a)(1). 

18 ‘‘(B) Clauses (i), (ii), (iii), and (v) of sec19 tion 9816(a)(1)(C). 

20 ‘‘(C) Subparagraphs (A), (B), and (E) of 

21 section 9816(b)(1). 

22 ‘‘(D) Paragraphs (1) and (2) of section 

23 9817(a).’’. 


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1 SEC. 3. ADDITIONAL PENALTIES FOR LATE PAYMENT OR 

2 NON-PAYMENT AFTER IDR ENTITY PAYMENT 

3 DETERMINATION. 

4 (a) PHSA.— 

5 (1) EMERGENCY AND NONEMERGENCY SERV6 ICES.—Section 2799A–1(c)(6) of the Public Health 

7 Service Act (42 U.S.C. 300gg–111(c)(6)) is amend8 ed— 

9 (A) in the paragraph heading, by inserting 

10 ‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY11 MENT’’ after ‘‘PAYMENT’’; 

12 (B) by striking ‘‘The total plan’’ and in13 serting the following: 

14 ‘‘(A) TIMING OF PAYMENT.—The total 

15 plan’’; and 

16 (C) by adding at the end the following new 

17 subparagraphs: 

18 ‘‘(B) NOTIFICATION.—In the case of a 

19 plan or coverage required to make a payment 

20 pursuant to a determination described in sub21 paragraph (A), such plan or coverage shall sub22 mit to the Secretary a notification of such pay23 ment as of the date such payment is made in 

24 a manner specified by the Secretary. 

25 ‘‘(C) PENALTY FOR LATE PAYMENT OR

26 NON-PAYMENT.— 


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1 ‘‘(i) IN GENERAL.—In the case of a 

2 plan or coverage that has not made the re3 quired payment described in subparagraph 

4 (A) with respect to an item or service in 

5 the time period described in such subpara6 graph, in addition to making such pay7 ment, such plan or coverage shall also pay 

8 to the nonparticipating provider or facility 

9 an amount that is three times the dif10 ference between— 

11 ‘‘(I) the initial payment (or, in 

12 the case of a notice of denial of pay13 ment, $0) described in subsection 

14 (a)(1)(C)(iv)(I) or (b)(1)(C), as appli15 cable; and 

16 ‘‘(II) the out-of-network rate (as 

17 defined in subsection (a)(3)(K)) for 

18 such item or service (less any cost 

19 sharing required to be paid by the in20 dividual receiving such item or serv21 ice). 

22 ‘‘(ii) INTEREST.—Such late payment 

23 or non-payment (as applicable) shall also 

24 be subject to interest in a manner specified 

25 by the Secretary.’’. 


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1 (2) AIR AMBULANCE SERVICES.—Section 

2 2799A–2(b)(6) of the Public Health Service Act (42 

3 U.S.C. 300gg–112(b)(6)) is amended— 

4 (A) in the paragraph heading, by inserting 

5 ‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY6 MENT’’ after ‘‘PAYMENT’’; 

7 (B) by striking ‘‘The total plan’’ and in8 serting the following: 

9 ‘‘(A) TIMING OF PAYMENT.—The total 

10 plan’’; and 

11 (C) by adding at the end the following new 

12 subparagraphs: 

13 ‘‘(B) NOTIFICATION.—In the case of a 

14 plan or coverage required to make a payment 

15 pursuant to a determination described in sub16 paragraph (A), such plan or coverage shall sub17 mit to the Secretary a notification of such pay18 ment as of the date such payment is made in 

19 a manner specified by the Secretary. 

20 ‘‘(C) PENALTY FOR LATE PAYMENT OR

21 NON-PAYMENT.— 

22 ‘‘(i) IN GENERAL.—In the case of a 

23 plan or coverage that has not made the re24 quired payment described in subparagraph 

25 (A) with respect to an item or service in 


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1 the time period described in such subpara2 graph, in addition to making such pay3 ment, such plan or coverage shall also pay 

4 to the nonparticipating provider an amount 

5 that is three times the difference be6 tween— 

7 ‘‘(I) the initial payment (or, in 

8 the case of a notice of denial of pay9 ment, $0) described in subsection 

10 (a)(3)(A); and 

11 ‘‘(II) the out-of-network rate (as 

12 defined in section 2799–1(a)(3)(K)) 

13 for such item or service (less any cost 

14 sharing required to be paid by the in15 dividual receiving such item or serv16 ice). 

17 ‘‘(ii) INTEREST.—Such late payment 

18 or non-payment (as applicable) shall also 

19 be subject to interest in a manner specified 

20 by the Secretary.’’. 

21 (b) ERISA.— 

22 (1) EMERGENCY AND NONEMERGENCY SERV23 ICES.—Section 716(c)(6) of the Employee Retire24 ment Income Security Act of 1974 (29 U.S.C. 

25 1185e(c)(6)) is amended— 


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1 (A) in the paragraph heading, by inserting 

2 ‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY3 MENT’’ after ‘‘PAYMENT’’; 

4 (B) by striking ‘‘The total plan’’ and in5 serting the following: 

6 ‘‘(A) TIMING OF PAYMENT.—The total 

7 plan’’; and 

8 (C) by adding at the end the following new 

9 subparagraphs: 

10 ‘‘(B) NOTIFICATION.—In the case of a 

11 plan or coverage required to make a payment 

12 pursuant to a determination described in sub13 paragraph (A), such plan or coverage shall sub14 mit to the Secretary a notification of such pay15 ment as of the date such payment is made in 

16 a manner specified by the Secretary. 

17 ‘‘(C) PENALTY FOR LATE PAYMENT OR

18 NON-PAYMENT.— 

19 ‘‘(i) IN GENERAL.—In the case of a 

20 plan or coverage that has not made the re21 quired payment described in subparagraph 

22 (A) with respect to an item or service in 

23 the time period described in such subpara24 graph, in addition to making such pay25 ment, such plan or coverage shall also pay 


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1 to the nonparticipating provider or facility 

2 an amount that is three times the dif3 ference between— 

4 ‘‘(I) the initial payment (or, in 

5 the case of a notice of denial of pay6 ment, $0) described in subsection 

7 (a)(1)(C)(iv)(I) or (b)(1)(C), as appli8 cable; and 

9 ‘‘(II) the out-of-network rate (as 

10 defined in subsection (a)(3)(K)) for 

11 such item or service (less any cost 

12 sharing required to be paid by the in13 dividual receiving such item or serv14 ice). 

15 ‘‘(ii) INTEREST.—Such late payment 

16 or non-payment (as applicable) shall also 

17 be subject to interest in a manner specified 

18 by the Secretary.’’. 

19 (2) AIR AMBULANCE SERVICES.—Section 

20 717(b)(6) of the Employee Retirement Income Secu21 rity Act of 1974 (29 U.S.C. 1185f(b)(6)) is amend22 ed— 

23 (A) in the paragraph heading, by inserting 

24 ‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY25 MENT’’ after ‘‘PAYMENT’’; 


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1 (B) by striking ‘‘The total plan’’ and in2 serting the following: 

3 ‘‘(A) TIMING OF PAYMENT.—The total 

4 plan’’; and 

5 (C) by adding at the end the following new 

6 subparagraphs: 

7 ‘‘(B) NOTIFICATION.—In the case of a 

8 plan or coverage required to make a payment 

9 pursuant to a determination described in sub10 paragraph (A), such plan or coverage shall sub11 mit to the Secretary a notification of such pay12 ment as of the date such payment is made in 

13 a manner specified by the Secretary. 

14 ‘‘(C) PENALTY FOR LATE PAYMENT OR

15 NON-PAYMENT.— 

16 ‘‘(i) IN GENERAL.—In the case of a 

17 plan or coverage that has not made the re18 quired payment described in subparagraph 

19 (A) with respect to an item or service in 

20 the time period described in such subpara21 graph, in addition to making such pay22 ment, such plan or coverage shall also pay 

23 to the nonparticipating provider an amount 

24 that is three times the difference be25 tween— 


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1 ‘‘(I) the initial payment (or, in 

2 the case of a notice of denial of pay3 ment, $0) described in subsection 

4 (a)(3)(A); and 

5 ‘‘(II) the out-of-network rate (as 

6 defined in section 716(a)(3)(K)) for 

7 such item or service (less any cost 

8 sharing required to be paid by the in9 dividual receiving such item or serv10 ice). 

11 ‘‘(ii) INTEREST.—Such late payment 

12 or non-payment (as applicable) shall also 

13 be subject to interest in a manner specified 

14 by the Secretary.’’. 

15 (c) IRC.— 

16 (1) EMERGENCY AND NONEMERGENCY SERV17 ICES.—Section 9816(c)(6) of the Internal Revenue 

18 Code of 1986 is amended— 

19 (A) in the paragraph heading, by inserting 

20 ‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY21 MENT’’ after ‘‘PAYMENT’’; 

22 (B) by striking ‘‘The total plan’’ and in23 serting the following: 

24 ‘‘(A) TIMING OF PAYMENT.—The total 

25 plan’’; and 


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1 (C) by adding at the end the following new 

2 subparagraphs: 

3 ‘‘(B) NOTIFICATION.—In the case of a 

4 plan required to make a payment pursuant to 

5 a determination described in subparagraph (A), 

6 such plan shall submit to the Secretary a notifi7 cation of such payment as of the date such pay8 ment is made in a manner specified by the Sec9 retary. 

10 ‘‘(C) PENALTY FOR LATE PAYMENT OR

11 NON-PAYMENT.— 

12 ‘‘(i) IN GENERAL.—In the case of a 

13 plan that has not made the required pay14 ment described in subparagraph (A) with 

15 respect to an item or service in the time 

16 period described in such subparagraph, in 

17 addition to making such payment, such 

18 plan shall also pay to the nonparticipating 

19 provider or facility an amount that is three 

20 times the difference between— 

21 ‘‘(I) the initial payment (or, in 

22 the case of a notice of denial of pay23 ment, $0) described in subsection 

24 (a)(1)(C)(iv)(I) or (b)(1)(C), as appli25 cable; and 


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1 ‘‘(II) the out-of-network rate (as 

2 defined in subsection (a)(3)(K)) for 

3 such item or service (less any cost 

4 sharing required to be paid by the in5 dividual receiving such item or serv6 ice). 

7 ‘‘(ii) INTEREST.—Such late payment 

8 or non-payment (as applicable) shall also 

9 be subject to interest in a manner specified 

10 by the Secretary.’’. 

11 (2) AIR AMBULANCE SERVICES.—Section 

12 9817(b)(6) of the Internal Revenue Code of 1986 is 

13 amended— 

14 (A) in the paragraph heading, by inserting 

15 ‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY16 MENT’’ after ‘‘PAYMENT’’; 

17 (B) by striking ‘‘The total plan’’ and in18 serting the following: 

19 ‘‘(A) TIMING OF PAYMENT.—The total 

20 plan’’; and 

21 (C) by adding at the end the following new 

22 subparagraphs: 

23 ‘‘(B) NOTIFICATION.—In the case of a 

24 plan required to make a payment pursuant to 

25 a determination described in subparagraph (A), 


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1 such plan shall submit to the Secretary a notifi2 cation of such payment as of the date such pay3 ment is made in a manner specified by the Sec4 retary. 

5 ‘‘(C) PENALTY FOR LATE PAYMENT OR

6 NON-PAYMENT.— 

7 ‘‘(i) IN GENERAL.—In the case of a 

8 plan that has not made the required pay9 ment described in subparagraph (A) with 

10 respect to an item or service in the time 

11 period described in such subparagraph, in 

12 addition to making such payment, such 

13 plan shall also pay to the nonparticipating 

14 provider an amount that is three times the 

15 difference between— 

16 ‘‘(I) the initial payment (or, in 

17 the case of a notice of denial of pay18 ment, $0) described in subsection 

19 (a)(3)(A); and 

20 ‘‘(II) the out-of-network rate (as 

21 defined in section 9816(a)(3)(K)) for 

22 such item or service (less any cost 

23 sharing required to be paid by the in24 dividual receiving such item or serv25 ice). 


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1 ‘‘(ii) INTEREST.—Such late payment 

2 or non-payment (as applicable) shall also 

3 be subject to interest in a manner specified 

4 by the Secretary.’’. 

5 SEC. 4. TRANSPARENCY REPORTING REQUIREMENTS. 

6 (a) PHSA.—Section 2799A–1(a)(2)(A)(iii) of the 

7 Public Health Service Act (42 U.S.C. 300gg– 

8 111(a)(2)(A)(iii)) is amended to read as follows: 

9 ‘‘(iii) REPORTING.— 

10 ‘‘(I) INITIAL REPORTING.—Be11 ginning for 2022 and ending on De12 cember 31 of the calendar year in 

13 which the Enhanced Enforcement of 

14 Health Coverage Act is enacted, the 

15 Secretary shall annually submit to 

16 Congress a report on the number of 

17 plans and issuers with respect to 

18 which audits were conducted during 

19 such year pursuant to this subpara20 graph. 

21 ‘‘(II) SUBSEQUENT REPORT22 ING.— 

23 ‘‘(aa) IN GENERAL.—With 

24 respect to the first calendar year 

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1 ment of the Enhanced Enforce2 ment of Health Coverage Act, 

3 not later than February 1 of 

4 such year, and every 6 months 

5 thereafter, the Secretary, in co6 ordination with the Secretary of 

7 Labor and the Secretary of the 

8 Treasury, shall submit to the 

9 Committee on Ways and Means, 

10 the Committee on Energy and 

11 Commerce, and the Committee 

12 on Education and the Workforce 

13 of the House of Representatives, 

14 and the Committee on Finance 

15 and the Committee on Health, 

16 Education, Labor and Pensions 

17 of the Senate, a report on any 

18 audits conducted pursuant to this 

19 subparagraph during the applica20 ble reporting period, and any en21 forcement actions taken during 

22 such period in accordance with 

23 the provisions of this part, in24 cluding— 


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1 ‘‘(AA) the total number 

2 of audits conducted under 

3 this subparagraph; 

4 ‘‘(BB) the number of 

5 audits conducted pursuant 

6 to clause (ii)(I); 

7 ‘‘(CC) the number of 

8 complaints submitted by 

9 providers and by partici10 pants, beneficiaries, and en11 rollees with respect to a vio12 lation of this part; 

13 ‘‘(DD) any enforcement 

14 actions taken as a result of 

15 a complaint submitted by a 

16 provider or by a participant, 

17 a beneficiary, or an enrollee, 

18 with respect to the provi19 sions of this part; 

20 ‘‘(EE) the total number 

21 of, and the aggregate dollar 

22 amount of, any civil mone23 tary penalties issued in ac24 cordance with this part; 


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1 ‘‘(FF) a summary of 

2 any non-monetary corrective 

3 action taken against a group 

4 health plan or health insur5 ance issuer offering group or 

6 individual health insurance 

7 coverage for a violation of 

8 this part; and 

9 ‘‘(GG) a description of 

10 the 3 most commonly re11 ported violations of this 

12 part. 

13 ‘‘(bb) APPLICABLE REPORT14 ING PERIOD.—For purposes of 

15 this subclause, the term ‘applica16 ble reporting period’ means the 6 

17 month period prior to each report 

18 submitted under item (aa).’’. 

19 (b) IRC.—Section 9816(a)(2)(A)(iii) of the Internal 

20 Revenue Code of 1986 is amended to read as follows: 

21 ‘‘(iii) REPORTING.— 

22 ‘‘(I) INITIAL REPORTING.—Be23 ginning for 2022 and ending on De24 cember 31 of the calendar year in 

25 which the Enhanced Enforcement of 


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1 Health Coverage Act is enacted, the 

2 Secretary shall annually submit to 

3 Congress a report on the number of 

4 plans with respect to which audits 

5 were conducted during such year pur6 suant to this subparagraph. 

7 ‘‘(II) SUBSEQUENT REPORT8 ING.— 

9 ‘‘(aa) IN GENERAL.—With 

10 respect to the first calendar year 

11 following the date of the enact12 ment of the Enhanced Enforce13 ment of Health Coverage Act, 

14 not later than February 1 of 

15 such year, and every 6 months 

16 thereafter, the Secretary, in co17 ordination with the Secretary of 

18 Labor and the Secretary of 

19 Health and Human Services, 

20 shall submit to the Committee on 

21 Ways and Means, the Committee 

22 on Energy and Commerce, and 

23 the Committee on Education and 

24 the Workforce of the House of 

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1 mittee on Finance and the Com2 mittee on Health, Education, 

3 Labor and Pensions of the Sen4 ate, a report on audits performed 

5 pursuant to this subparagraph 

6 during the applicable reporting 

7 period, and any enforcement ac8 tions taken during such period in 

9 accordance with the provisions of 

10 an applicable section, including— 

11 ‘‘(AA) the total number 

12 of audits conducted under 

13 this subparagraph; 

14 ‘‘(BB) the number of 

15 audits conducted pursuant 

16 to clause (ii)(I); 

17 ‘‘(CC) the number of 

18 complaints submitted by 

19 providers and by partici20 pants and beneficiaries with 

21 respect to a violation of an 

22 applicable section; 

23 ‘‘(DD) any enforcement 

24 actions taken pursuant to a 


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1 violation of an applicable 

2 section; 

3 ‘‘(EE) the total number 

4 of, and the aggregate dollar 

5 amount of, any civil mone6 tary penalties issued in ac7 cordance with an applicable 

8 section; 

9 ‘‘(FF) a summary of 

10 any non-monetary corrective 

11 action taken against a group 

12 health plan for a violation of 

13 an applicable section; and 

14 ‘‘(GG) a description of 

15 the 3 most commonly re16 ported violations of an appli17 cable section. 

18 ‘‘(bb) DEFINITIONS.—In 

19 this subclause: 

20 ‘‘(AA) APPLICABLE RE21 PORTING PERIOD.—The 

22 term ‘applicable reporting 

23 period’ means the 6 month 

24 period prior to each report 

25 submitted under item (aa). 


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1 ‘‘(BB) APPLICABLE

2 SECTION.—The term ‘appli3 cable section’ means this 

4 section and each of sections 

5 9817 through 9825.’’. 

Æ 


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