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[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2328 Reported in House (RH)]

<DOC>

                                                 Union Calendar No. 587
116th CONGRESS
  2d Session
                                H. R. 2328

                      [Report No. 116-332, Part I]

To reauthorize and extend funding for community health centers and the 
                     National Health Service Corps.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             April 15, 2019

Mr. O'Halleran (for himself and Ms. Stefanik) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

                            December 9, 2019

       Reported with amendments and referred to the Committee on 
 Transportation and Infrastructure for a period ending not later than 
 January 29, 2020, for consideration of such provisions of the bill as 
fall within the jurisdiction of that committee pursuant to clause 1(r) 
                               of rule X
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

                            January 29, 2020

Referral to the Committee on Transportation and Infrastructure extended 
          for a period ending not later than February 19, 2020

                           February 19, 2020

Referral to the Committee on Transportation and Infrastructure extended 
           for a period ending not later than April 23, 2020

                             April 23, 2020

Referral to the Committee on Transportation and Infrastructure extended 
            for a period ending not later than July 31, 2020

                             July 31, 2020

Referral to the Committee on Transportation and Infrastructure extended 
         for a period ending not later than September 21, 2020

                           September 21, 2020

Referral to the Committee on Transportation and Infrastructure extended 
          for a period ending not later than November 20, 2020

                           November 17, 2020

Referral to the Committee on Transportation and Infrastructure extended 
          for a period ending not later than December 31, 2020

                           December 31, 2020

  Additional sponsors: Mr. Swalwell of California, Mr. Espaillat, Ms. 
 Gabbard, Ms. Omar, Ms. McCollum, Mr. Smith of Washington, Mr. Khanna, 
  Mr. Cohen, Mr. Grijalva, Mr. Courtney, Mrs. Hartzler, Ms. Mucarsel-
    Powell, Ms. Jayapal, Ms. Kuster of New Hampshire, Mrs. Davis of 
    California, Mr. Rush, Mr. Lipinski, Mr. Engel, Mr. Schiff, Mr. 
 Cicilline, Mr. Serrano, Mr. Larsen of Washington, Mr. Krishnamoorthi, 
   Mr. Peters, Ms. Lee of California, Mr. Kilmer, Mr. Schrader, Mr. 
  Turner, Mr. King of New York, Mr. Yarmuth, Mr. Vela, Mr. Heck, Mr. 
LaMalfa, Mr. Young, Mr. Delgado, Mr. Tipton, Ms. Johnson of Texas, Mr. 
  Hastings, Mr. Sires, Ms. Blunt Rochester, Mr. Bergman, Mrs. Watson 
  Coleman, Mr. Johnson of Georgia, Mr. Cole, Mr. Gomez, Ms. Kelly of 
 Illinois, Miss Rice of New York, Mr. Zeldin, Mr. Newhouse, Mr. Rodney 
Davis of Illinois, Ms. Clarke of New York, Mr. DeFazio, Mr. Nadler, Mr. 
 Meeks, Mr. Stivers, Mrs. Carolyn B. Maloney of New York, Mr. Rose of 
New York, Mr. Lamborn, Mr. Balderson, Mr. Fleischmann, Mr. Gallego, Ms. 
Schakowsky, Mr. Welch, Mrs. Lowey, Ms. Ocasio-Cortez, Mr. Sean Patrick 
 Maloney of New York, Ms. Bass, Mr. Norman, Mr. Takano, Mr. Lujan, Mr. 
    Raskin, Ms. Judy Chu of California, Mr. Levin of Michigan, Mrs. 
 Dingell, Ms. Pingree, Mr. Ted Lieu of California, Ms. Torres Small of 
 New Mexico, Mr. DeSaulnier, Mr. Katko, Mr. Sablan, Ms. Roybal-Allard, 
Mr. Bishop of Utah, Mr. Griffith, Mrs. Radewagen, Mr. Bost, Mr. Walden, 
 Mr. Stanton, Mr. Correa, Ms. Lofgren, Mr. Curtis, Mr. Lowenthal, Ms. 
  Slotkin, Ms. Finkenauer, Mr. Foster, Mr. Langevin, Mrs. Bustos, Ms. 
   Kaptur, Mr. Stewart, Mr. Huffman, Mr. Schneider, Mr. McAdams, Ms. 
 Velazquez, Ms. Jackson Lee, Mr. Soto, Mr. Cooper, Mr. Austin Scott of 
  Georgia, Ms. Underwood, Mr. Brindisi, Mr. Stauber, Mr. Cleaver, Mr. 
 Peterson, Mr. McNerney, Mr. Keating, Ms. Spanberger, Mr. Perlmutter, 
   Mr. Aguilar, Mr. Cox of California, Mr. Harder of California, Ms. 
 Kendra S. Horn of Oklahoma, Mr. Price of North Carolina, Mrs. Miller, 
Mr. Van Drew, Mr. Fitzpatrick, Mr. Cisneros, Mr. Larson of Connecticut, 
                      Mrs. Demings, and Mrs. Hayes

                           December 31, 2020

Committee on Transportation and Infrastructure discharged; committed to 
the Committee of the Whole House on the State of the Union and ordered 
                             to be printed
 [For text of introduced bill, see copy of bill as introduced on April 
                               15, 2019]

_______________________________________________________________________

                                 A BILL

 
To reauthorize and extend funding for community health centers and the 
                     National Health Service Corps.

 

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Reauthorizing and 
Extending America's Community Health Act'' or the ``REACH Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

                    TITLE I--PUBLIC HEALTH EXTENDERS

Sec. 101. Extension for community health centers, the National Health 
                            Service Corps, and teaching health centers 
                            that operate GME programs.
Sec. 102. Extension for special diabetes programs.
Sec. 103. Extension of Personal Responsibility Education Program.
Sec. 104. Extension of sexual risk avoidance education program.

                      TITLE II--MEDICARE EXTENDERS

Sec. 201. Extension of the work geographic index floor under the 
                            Medicare program.
Sec. 202. Extension of funding outreach and assistance for low-income 
                            programs.
Sec. 203. Extension of funding for quality measure endorsement, input, 
                            and selection under the Medicare program.
Sec. 204. Extension of the Independence at Home Medical Practice 
                            Demonstration Program under the Medicare 
                            program.
Sec. 205. Extension of appropriations and transfers to the Patient-
                            Centered Outcomes Research Trust Fund; 
                            extension of certain health insurance fees.
Sec. 206. Transitional coverage and retroactive Medicare part D 
                            coverage for certain low-income 
                            beneficiaries.
Sec. 207. Health Equity and Access for Returning Troops and 
                            Servicemembers Act of 2019.
Sec. 208. Exclusion of complex rehabilitative manual wheelchairs from 
                            Medicare competitive acquisition program; 
                            Non-application of Medicare fee-schedule 
                            adjustments for certain wheelchair 
                            accessories and cushions.

                     TITLE III--MEDICAID PROVISIONS

Sec. 301. Modification of reductions in Medicaid DSH allotments.
Sec. 302. Public availability of hospital upper payment limit 
                            demonstrations.
Sec. 303. Report by Comptroller General.
Sec. 304. Sense of Congress regarding the need to develop a more 
                            permanent legislative solution to provide 
                            the territories with a reliable and 
                            consistent source of Federal funding under 
                            the Medicaid program.

                       TITLE IV--NO SURPRISES ACT

Sec. 401. Short title.
Sec. 402. Preventing surprise medical bills.
Sec. 403. Government Accountability Office study on profit- and 
                            revenue-sharing in health care.
Sec. 404. State All Payer Claims Databases.
Sec. 405. Air ambulance cost data reporting program.
Sec. 406. Report by Secretary of Labor.
Sec. 407. Billing statute of limitations.
Sec. 408. GAO report on impact of surprise billing provisions.
Sec. 409. Report by the Secretary of Health and Human Services.

            TITLE V--TERRITORIES HEALTH CARE IMPROVEMENT ACT

Sec. 501. Short title.
Sec. 502. Medicaid payments for Puerto Rico and the other territories 
                            for certain fiscal years.
Sec. 503. Application of certain requirements under Medicaid program to 
                            certain territories.
Sec. 504. Additional program integrity requirements.

                    TITLE I--PUBLIC HEALTH EXTENDERS

SEC. 101. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH 
              SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE 
              GME PROGRAMS.

    (a) Community Health Centers.--Section 10503(b)(1)(F) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(1)(F)) 
is amended by striking ``fiscal year 2019'' and inserting ``each of 
fiscal years 2019 through 2023''.
    (b) National Health Service Corps.--Section 10503(b)(2)(F) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(2)(F)) 
is amended by striking ``2018 and 2019'' and inserting ``2019 through 
2023''.
    (c) Teaching Health Centers That Operate Graduate Medical Education 
Programs.--Section 340H(g)(1) of the Public Health Service Act (42 
U.S.C. 256h(g)(1)) is amended by striking ``2018 and 2019'' and 
inserting ``2019 through 2023''.
    (d) Application.--Amounts appropriated for a program pursuant to 
the amendments made by subsection (a), (b), or (c) for fiscal years 
2020 through 2023 are subject to the requirements and limitations of 
the most recently enacted regular or full-year continuing 
appropriations Act or resolution (as of the date of obligation of 
current funds) applicable to the respective program.

SEC. 102. EXTENSION FOR SPECIAL DIABETES PROGRAMS.

    (a) Reauthorization of Special Diabetes Programs for Type I 
Diabetes.--Section 330B(b)(2)(D) of the Public Health Service Act (42 
U.S.C. 254c-2(b)(2)(D)) is amended by striking ``each of fiscal years 
2018 and 2019'' and inserting ``fiscal years 2019 through 2023''.
    (b) Reauthorization of Special Diabetes Programs for Indians for 
Diabetes Services.--Section 330C(c)(2)(D) of the Public Health Service 
Act (42 U.S.C. 254c-3(c)(2)(D)) is amended by striking ``fiscal years 
2018 and 2019'' and inserting ``fiscal years 2019 through 2023''.

SEC. 103. EXTENSION OF PERSONAL RESPONSIBILITY EDUCATION PROGRAM.

    Section 513 of the Social Security Act (42 U.S.C. 713) is amended--
            (1) in paragraphs (1)(A) and (4)(A) of subsection (a), by 
        striking ``2019'' and inserting ``2023'' each place it appears;
            (2) in subsection (a)(4)(B)(i), by striking ``2019'' and 
        inserting ``2023''; and
            (3) in subsection (f), by striking ``2019'' and inserting 
        ``2023''.

SEC. 104. EXTENSION OF SEXUAL RISK AVOIDANCE EDUCATION PROGRAM.

    Section 510 of the Social Security Act (42 U.S.C. 710) is amended 
by striking ``fiscal years 2018 and 2019'' each place it appears in 
subsections (a)(1), (a)(2)(A), (f)(1) and (f)(2) and inserting ``fiscal 
years 2019 through 2023''.

                      TITLE II--MEDICARE EXTENDERS

SEC. 201. EXTENSION OF THE WORK GEOGRAPHIC INDEX FLOOR UNDER THE 
              MEDICARE PROGRAM.

    Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``2020'' and inserting ``2023''.

SEC. 202. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR LOW-INCOME 
              PROGRAMS.

    (a) Additional Funding for State Health Insurance Programs.--
Subsection (a)(1)(B) of section 119 of the Medicare Improvements for 
Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note), as amended 
by section 3306 of the Patient Protection and Affordable Care Act 
(Public Law 111-148), section 610 of the American Taxpayer Relief Act 
of 2012 (Public Law 112-240), section 1110 of the Pathway for SGR 
Reform Act of 2013 (Public Law 113-67), section 110 of the Protecting 
Access to Medicare Act of 2014 (Public Law 113-93), section 208 of the 
Medicare Access and CHIP Reauthorization Act of 2015 (Public Law 114-
10), and section 50207 of the Bipartisan Budget Act of 2018 (Public Law 
115-123), is amended--
            (1) in clause (vii), by striking ``and'' at the end;
            (2) in clause (viii), by striking ``and'' at the end;
            (3) in clause (ix), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (ix) the following new 
        clause:
                            ``(x) for each of fiscal years 2020 through 
                        2022, of $15,000,000.''.
    (b) Additional Funding for Area Agencies on Aging.--Subsection 
(b)(1)(B) of such section 119, as so amended, is amended--
            (1) in clause (vii), by striking ``and'' at the end;
            (2) in clause (viii), by striking ``and'' at the end;
            (3) in clause (ix), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (ix) the following new 
        clause:
                            ``(x) for each of fiscal years 2020 through 
                        2022, of $15,000,000.''.
    (c) Additional Funding for Aging and Disability Resource Centers.--
Subsection (c)(1)(B) of such section 119, as so amended, is amended--
            (1) in clause (vii), by striking ``and'' at the end;
            (2) in clause (viii), by striking ``and'' at the end;
            (3) in clause (ix), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (ix) the following new 
        clause:
                            ``(x) for each of fiscal years 2020 through 
                        2022, of $5,000,000.''.
    (d) Additional Funding for Contract With the National Center for 
Benefits and Outreach Enrollment.--Subsection (d)(2) of such section 
119, as so amended, is amended--
            (1) in clause (vii), by striking ``and'' at the end;
            (2) in clause (viii), by striking ``and'' at the end;
            (3) in clause (ix), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (ix) the following new 
        clause:
                            ``(x) for each of fiscal years 2020 through 
                        2022, of $15,000,000.''.

SEC. 203. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSEMENT, INPUT, 
              AND SELECTION UNDER THE MEDICARE PROGRAM.

    (a) In General.--Section 1890(d)(2) of the Social Security Act (42 
U.S.C. 1395aaa(d)(2)) is amended--
            (1) by striking ``and $7,500,000'' and inserting 
        ``$7,500,000''; and
            (2) by striking ``and 2019.'' and inserting ``and 2019, and 
        $30,000,000 for each of fiscal years 2020 through 2022.''.
    (b) Input for Removal of Measures.--Section 1890(b) of the Social 
Security Act (42 U.S.C. 1395aaa(b)) is amended by inserting after 
paragraph (3) the following:
            ``(4) Removal of measures.--The entity may, through the 
        multistakeholder groups convened under paragraph (7)(A), 
        provide input to the Secretary on quality and efficiency 
        measures described in paragraph (7)(B) that could be considered 
        for removal.''.
    (c) Prioritization of Measure Endorsement.--Section 1890(b) of the 
Social Security Act (42 U.S.C. 1395aaa(b)), as amended by subsection 
(b), is further amended by adding at the end the following:
            ``(9) Prioritization of measure endorsement.--The entity--
                    ``(A) during the period beginning on the date of 
                the enactment of this paragraph and ending on December 
                31, 2023, shall prioritize the endorsement of measures 
                relating to maternal morbidity and mortality by the 
                entity with a contract under subsection (a) in 
                connection with endorsement of measures described in 
                paragraph (2); and
                    ``(B) on and after January 1, 2024, may prioritize 
                the endorsement of such measures by such entity.''.

SEC. 204. EXTENSION OF THE INDEPENDENCE AT HOME MEDICAL PRACTICE 
              DEMONSTRATION PROGRAM UNDER THE MEDICARE PROGRAM.

    (a) In General.--Section 1866E(e)(1) of the Social Security Act (42 
U.S.C. 1395cc-5(e)(1)) is amended by striking ``7-year'' and inserting 
``10-year''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as if included in the enactment of Public Law 111-148.

SEC. 205. EXTENSION OF APPROPRIATIONS AND TRANSFERS TO THE PATIENT-
              CENTERED OUTCOMES RESEARCH TRUST FUND; EXTENSION OF 
              CERTAIN HEALTH INSURANCE FEES.

    (a) In General.--
            (1) Internal revenue code.--Section 9511 of the Internal 
        Revenue Code of 1986 is amended--
                    (A) in subsection (b)(1)(E), by striking ``2014'' 
                and all that follows through ``2019'' and inserting 
                ``2014 through 2022'';
                    (B) in subsection (d)(2)(A), by striking ``2019'' 
                and inserting ``2022''; and
                    (C) in subsection (f), by striking ``2019'' and 
                inserting ``2022''.
            (2) Title xi.--Section 1183(a)(2) of the Social Security 
        Act (42 U.S.C. 1320e-2(a)(2)) is amended by striking ``2014'' 
        and all that follows through ``2019'' and inserting ``2014 
        through 2022''.
    (b) Extension of Certain Health Insurance Fees.--
            (1) Health insurance policies.--Section 4375(e) of the 
        Internal Revenue Code of 1986 is amended by striking ``2019'' 
        and inserting ``2022''.
            (2) Self-insured health plans.--Section 4376(e) of the 
        Internal Revenue Code of 1986 is amended by striking ``2019'' 
        and inserting ``2022''.

SEC. 206. TRANSITIONAL COVERAGE AND RETROACTIVE MEDICARE PART D 
              COVERAGE FOR CERTAIN LOW-INCOME BENEFICIARIES.

    Section 1860D-14 of the Social Security Act (42 U.S.C. 1395w-114) 
is amended--
            (1) by redesignating subsection (e) as subsection (f); and
            (2) by adding after subsection (d) the following new 
        subsection:
    ``(e) Limited Income Newly Eligible Transition Program.--
            ``(1) In general.--Beginning not later than January 1, 
        2021, the Secretary shall carry out a program to provide 
        transitional coverage for covered part D drugs for LI NET 
        eligible individuals in accordance with this subsection.
            ``(2) LI net eligible individual defined.--For purposes of 
        this subsection, the term `LI NET eligible individual' means a 
        part D eligible individual who--
                    ``(A) meets the requirements of clauses (ii) and 
                (iii) of subsection (a)(3)(A); and
                    ``(B) has not yet enrolled in a prescription drug 
                plan or an MA-PD plan, or, who has so enrolled, but 
                with respect to whom coverage under such plan has not 
                yet taken effect.
            ``(3) Transitional coverage.--For purposes of this 
        subsection, the term `transitional coverage' means, with 
        respect to an LI NET eligible individual--
                    ``(A) immediate access to covered part D drugs at 
                the point of sale during the period that begins on the 
                first day of the month such individual is determined to 
                meet the requirements of clauses (ii) and (iii) of 
                subsection (a)(3)(A) and ends on the date that coverage 
                under a prescription drug plan or MA-PD plan takes 
                effect with respect to such individual; and
                    ``(B) in the case of an LI NET eligible individual 
                who is a full-benefit dual eligible individual (as 
                defined in section 1935(c)(6)) or a recipient of 
                supplemental security income benefits under title XVI, 
                retroactive coverage (in the form of reimbursement of 
                the amounts that would have been paid under this part 
                had such individual been enrolled in a prescription 
                drug plan or MA-PD plan) of covered part D drugs 
                purchased by such individual during the period that 
                begins on the date that is the later of--
                            ``(i) the date that such individual was 
                        first eligible for a low-income subsidy under 
                        this part; or
                            ``(ii) the date that is 36 months prior to 
                        the date such individual enrolls in a 
                        prescription drug plan or MA-PD plan,
                and ends on the date that coverage under such plan 
                takes effect.
            ``(4) Program administration.--
                    ``(A) Single point of contact.--The Secretary 
                shall, to the extent feasible, administer the program 
                under this subsection through a contract with a single 
                program administrator.
                    ``(B) Benefit design.--The Secretary shall ensure 
                that the transitional coverage provided to LI NET 
                eligible individuals under this subsection--
                            ``(i) provides access to all covered part D 
                        drugs under an open formulary;
                            ``(ii) permits all pharmacies determined by 
                        the Secretary to be in good standing to process 
                        claims under the program;
                            ``(iii) is consistent with such 
                        requirements as the Secretary considers 
                        necessary to improve patient safety and ensure 
                        appropriate dispensing of medication; and
                            ``(iv) meets such other requirements as the 
                        Secretary may establish.
            ``(5) Relationship to other provisions of this title; 
        waiver authority.--
                    ``(A) In general.--The following provisions shall 
                not apply with respect to the program under this 
                subsection:
                            ``(i) Paragraphs (1) and (3)(B) of section 
                        1860D-4(a) (relating to dissemination of 
                        general information; availability of 
                        information on changes in formulary through the 
                        internet).
                            ``(ii) Subparagraphs (A) and (B) of section 
                        1860D-4(b)(3) (relating to requirements on 
                        development and application of formularies; 
                        formulary development).
                            ``(iii) Paragraphs (1)(C) and (2) of 
                        section 1860D-4(c) (relating to medication 
                        therapy management program).
                    ``(B) Waiver authority.--The Secretary may waive 
                such other requirements of titles XI and this title as 
                may be necessary to carry out the purposes of the 
                program established under this subsection.''.

SEC. 207. HEALTH EQUITY AND ACCESS FOR RETURNING TROOPS AND 
              SERVICEMEMBERS ACT OF 2019.

    (a) Modification of Requirement for Certain Former Members of the 
Armed Forces to Enroll in Medicare Part B to Be Eligible for TRICARE 
for Life.--
            (1) TRICARE eligibility.--
                    (A) In general.--Subsection (d) of section 1086 of 
                title 10, United States Code, is amended by adding at 
                the end the following new paragraph:
    ``(6)(A) The requirement in paragraph (2)(A) to enroll in the 
supplementary medical insurance program under part B of title XVIII of 
the Social Security Act (42 U.S.C. 1395j et seq.) shall not apply to a 
person described in subparagraph (B) during any month in which such 
person is not entitled to a benefit described in subparagraph (A) of 
section 226(b)(2) of the Social Security Act (42 U.S.C. 426(b)(2)) if 
such person has received the counseling and information under 
subparagraph (C).
    ``(B) A person described in this subparagraph is a person--
            ``(i) who is under 65 years of age;
            ``(ii) who is entitled to hospital insurance benefits under 
        part A of title XVIII of the Social Security Act pursuant to 
        subparagraph (A) or (C) of section 226(b)(2) of such Act (42 
        U.S.C. 426(b)(2));
            ``(iii) whose entitlement to a benefit described in 
        subparagraph (A) of such section has terminated due to 
        performance of substantial gainful activity; and
            ``(iv) who is retired under chapter 61 of this title.
    ``(C) The Secretary of Defense shall coordinate with the Secretary 
of Health and Human Services and the Commissioner of Social Security to 
notify persons described in subparagraph (B) of, and provide 
information and counseling regarding, the effects of not enrolling in 
the supplementary medical insurance program under part B of title XVIII 
of the Social Security Act (42 U.S.C. 1395j et seq.), as described in 
subparagraph (A).''.
                    (B) Conforming amendment.--Paragraph (2)(A) of such 
                subsection is amended by striking ``is enrolled'' and 
                inserting ``except as provided by paragraph (6), is 
                enrolled''.
                    (C) Identification of persons.--Section 1110a of 
                such title is amended by adding at the end the 
                following new subsection:
    ``(c) Certain Individuals Not Required To Enroll in Medicare Part 
B.--In carrying out subsection (a), the Secretary of Defense shall 
coordinate with the Secretary of Health and Human Services and the 
Commissioner of Social Security to--
            ``(1) identify persons described in subparagraph (B) of 
        section 1086(d)(6) of this title; and
            ``(2) provide information and counseling pursuant to 
        subparagraph (C) of such section.''.
            (2) Non-application of medicare part b late enrollment 
        penalty.--Section 1839(b) of the Social Security Act (42 U.S.C. 
        1395r(b)) is amended, in the second sentence, by inserting ``or 
        months for which the individual can demonstrate that the 
        individual is an individual described in paragraph (6)(B) of 
        section 1086(d) of title 10, United States Code, who is 
        enrolled in the TRICARE program pursuant to such section'' 
        after ``an individual described in section 1837(k)(3)''.
            (3) Report.--Not later than October 1, 2024, the Secretary 
        of Defense, the Secretary of Health and Human Services, and the 
        Commissioner of Social Security shall jointly submit to the 
        Committees on Armed Services of the House of Representatives 
        and the Senate, the Committee on Ways and Means and the 
        Committee on Energy and Commerce of the House of 
        Representatives, and the Committee on Finance of the Senate a 
        report on the implementation of section 1086(d)(6) of title 10, 
        United States Code, as added by paragraph (1). Such report 
        shall include, with respect to the period covered by the 
        report--
                    (A) the number of individuals enrolled in TRICARE 
                for Life who are not enrolled in the supplementary 
                medical insurance program under part B of title XVIII 
                of the Social Security Act (42 U.S.C. 1395j et seq.) by 
                reason of such section 1086(d)(6); and
                    (B) the number of individuals who--
                            (i) are retired from the Armed Forces under 
                        chapter 61 of title 10, United States Code;
                            (ii) are entitled to hospital insurance 
                        benefits under part A of title XVIII of the 
                        Social Security Act pursuant to receiving 
                        benefits for 24 months as described in 
                        subparagraph (A) or (C) of section 226(b)(2) of 
                        such Act (42 U.S.C. 426(b)(2)); and
                            (iii) because of such entitlement, are no 
                        longer enrolled in TRICARE Standard, TRICARE 
                        Prime, TRICARE Extra, or TRICARE Select under 
                        chapter 55 of title 10, United States Code.
            (4) Deposit of savings into medicare improvement fund.--
        Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
        1395iii(b)(1)) is amended by striking ``during and after fiscal 
        year 2021, $0'' and inserting ``during and after fiscal year 
        2024, $5,000,000''.
            (5) Application.--The amendments made by paragraphs (1) and 
        (2) shall apply with respect to a person who, on or after 
        October 1, 2023, is a person described in section 1086(d)(6)(B) 
        of title 10, United States Code, as added by paragraph (1).
    (b) Coverage of Certain DNA Specimen Provenance Assay Tests Under 
Medicare.--
            (1) Benefit.--
                    (A) Coverage.--Section 1861 of the Social Security 
                Act (42 U.S.C. 1395x) is amended--
                            (i) in subsection (s)(2)--
                                    (I) in subparagraph (GG), by 
                                striking ``and'' at the end;
                                    (II) in subparagraph (HH), by 
                                striking the period and inserting ``; 
                                and''; and
                                    (III) by adding at the end the 
                                following new subparagraph:
            ``(II) a prostate cancer DNA Specimen Provenance Assay test 
        (DSPA test) (as defined in subsection (kkk));''; and
                            (ii) by adding at the end the following new 
                        subsection:
    ``(kkk) Prostate Cancer DNA Specimen Provenance Assay Test.--The 
term `prostate cancer DNA Specimen Provenance Assay Test' (DSPA test) 
means a test that, after a determination of cancer in one or more 
prostate biopsy specimens obtained from an individual, assesses the 
identity of the DNA in such specimens by comparing such DNA with the 
DNA that was separately taken from such individual at the time of the 
biopsy.''.
                    (B) Exclusion from coverage.--Section 1862(a)(1) of 
                the Social Security Act (42 U.S.C. 1395y(a)(1)) is 
                amended--
                            (i) in subparagraph (O), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (P), by striking the 
                        semicolon at the end and inserting ``, and''; 
                        and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(Q) in the case of a prostate cancer DNA Specimen 
        Provenance Assay test (DSPA test) (as defined in section 
        1861(kkk)), unless such test is furnished on or after January 
        1, 2021, and before January 1, 2026, and such test is ordered 
        by the physician who furnished the prostate cancer biopsy that 
        obtained the specimen tested;''.
            (2) Payment amount and related requirements.--Section 1834 
        of the Social Security Act (42 U.S.C. 1395m) is amended by 
        adding at the end the following new subsection:
    ``(x) Prostate Cancer DNA Specimen Provenance Assay Tests.--
            ``(1) Payment for covered tests.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                payment amount for a prostate cancer DNA Specimen 
                Provenance Assay test (DSPA test) (as defined in 
                section 1861(kkk)) shall be $200. Such payment shall be 
                payment for all of the specimens obtained from the 
                biopsy furnished to an individual that are tested.
                    ``(B) Limitation.--Payment for a DSPA test under 
                subparagraph (A) may only be made on an assignment-
                related basis.
                    ``(C) Prohibition on separate payment.--No separate 
                payment shall be made for obtaining DNA that was 
                separately taken from an individual at the time of a 
                biopsy described in subparagraph (A).
            ``(2) HCPCS code and modifier assignment.--
                    ``(A) In general.--The Secretary shall assign one 
                or more HCPCS codes to a prostate cancer DNA Specimen 
                Provenance Assay test and may use a modifier to 
                facilitate making payment under this section for such 
                test.
                    ``(B) Identification of dna match on claim.--The 
                Secretary shall require an indication on a claim for a 
                prostate cancer DNA Specimen Provenance Assay test of 
                whether the DNA of the prostate biopsy specimens match 
                the DNA of the individual diagnosed with prostate 
                cancer. Such indication may be made through use of a 
                HCPCS code, a modifier, or other means, as determined 
                appropriate by the Secretary.
            ``(3) DNA match review.--
                    ``(A) In general.--The Secretary shall review at 
                least three years of claims under part B for prostate 
                cancer DNA Specimen Provenance Assay tests to identify 
                whether the DNA of the prostate biopsy specimens match 
                the DNA of the individuals diagnosed with prostate 
                cancer.
                    ``(B) Posting on internet website.--Not later than 
                July 1, 2023, the Secretary shall post on the internet 
                website of the Centers for Medicare & Medicaid Services 
                the findings of the review conducted under subparagraph 
                (A).''.
            (3) Cost-sharing.--Section 1833(a)(1) of the Social 
        Security Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and (CC)'' and inserting 
                ``(CC)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (DD) with respect to a prostate 
                cancer DNA Specimen Provenance Assay test (DSPA test) 
                (as defined in section 1861(kkk)), the amount paid 
                shall be an amount equal to 80 percent of the lesser of 
                the actual charge for the test or the amount specified 
                under section 1834(x)''.

SEC. 208. EXCLUSION OF COMPLEX REHABILITATIVE MANUAL WHEELCHAIRS FROM 
              MEDICARE COMPETITIVE ACQUISITION PROGRAM; NON-APPLICATION 
              OF MEDICARE FEE-SCHEDULE ADJUSTMENTS FOR CERTAIN 
              WHEELCHAIR ACCESSORIES AND CUSHIONS.

    (a) Exclusion of Complex Rehabilitative Manual Wheelchairs From 
Competitive Acquisition Program.--Section 1847(a)(2)(A) of the Social 
Security Act (42 U.S.C. 1395w-3(a)(2)(A)) is amended--
            (1) by inserting ``, complex rehabilitative manual 
        wheelchairs (as determined by the Secretary), and certain 
        manual wheelchairs (identified, as of October 1, 2018, by HCPCS 
        codes E1235, E1236, E1237, E1238, and K0008 or any successor to 
        such codes)'' after ``group 3 or higher''; and
            (2) by striking ``such wheelchairs'' and inserting ``such 
        complex rehabilitative power wheelchairs, complex 
        rehabilitative manual wheelchairs, and certain manual 
        wheelchairs''.
    (b) Non-Application of Medicare Fee Schedule Adjustments for 
Wheelchair Accessories and Seat and Back Cushions When Furnished in 
Connection With Complex Rehabilitative Manual Wheelchairs.--
            (1) In general.--Notwithstanding any other provision of 
        law, the Secretary of Health and Human Services shall not, 
        during the period beginning on January 1, 2020, and ending on 
        December 31, 2020, use information on the payment determined 
        under the competitive acquisition programs under section 1847 
        of the Social Security Act (42 U.S.C. 1395w-3) to adjust the 
        payment amount that would otherwise be recognized under section 
        1834(a)(1)(B)(ii) of such Act (42 U.S.C. 1395m(a)(1)(B)(ii)) 
        for wheelchair accessories (including seating systems) and seat 
        and back cushions when furnished in connection with complex 
        rehabilitative manual wheelchairs (as determined by the 
        Secretary), and certain manual wheelchairs (identified, as of 
        October 1, 2018, by HCPCS codes E1235, E1236, E1237, E1238, and 
        K0008 or any successor to such codes).
            (2) Implementation.--Notwithstanding any other provision of 
        law, the Secretary may implement this subsection by program 
        instruction or otherwise.

                     TITLE III--MEDICAID PROVISIONS

SEC. 301. MODIFICATION OF REDUCTIONS IN MEDICAID DSH ALLOTMENTS.

    Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 1396r-
4(f)(7)(A)) is amended--
            (1) in clause (i), in the matter preceding subclause (I), 
        by striking ``2020'' and inserting ``2022''; and
            (2) in clause (ii)--
                    (A) in subclause (I), by striking ``2020'' and 
                inserting ``2022''; and
                    (B) in subclause (II), by striking ``for each of 
                fiscal years 2021 through 2025'' and inserting ``for 
                each of fiscal years 2023 through 2025''.

SEC. 302. PUBLIC AVAILABILITY OF HOSPITAL UPPER PAYMENT LIMIT 
              DEMONSTRATIONS.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by adding at the end the following new subsection:
    ``(bb) Public Availability of Hospital Upper Payment Limit 
Demonstrations.--The Secretary shall make publicly available upper 
payment limit demonstrations for hospital services that a State submits 
with respect to a fiscal year of the State (beginning with State fiscal 
year 2022) to the Administrator of the Centers for Medicare & Medicaid 
Services.''.

SEC. 303. REPORT BY COMPTROLLER GENERAL.

    Not later than the date that is 21 months after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall identify and report to Congress policy considerations for 
legislative action with respect to establishing an equitable formula 
for determining disproportionate share hospital allotments for States 
under section 1923 of the Social Security Act (42 U.S.C. 1396r-4) that 
takes into account the following factors:
            (1) The level of uncompensated care costs of hospitals in a 
        State.
            (2) Expenditures of a State with respect to hospitals, 
        including payment adjustments made under such section 1923 to 
        disproportionate share hospitals (as defined under the State 
        plan under title XIX of such Act (42 U.S.C. 1396 et seq.) 
        pursuant to subsection (a)(1)(A) of such section 1923), upper 
        payment limit supplemental payments, and other related payments 
        that hospitals may receive from the State.
            (3) State policy decisions that may affect the level of 
        uncompensated care costs of hospitals in a State.

SEC. 304. SENSE OF CONGRESS REGARDING THE NEED TO DEVELOP A MORE 
              PERMANENT LEGISLATIVE SOLUTION TO PROVIDE THE TERRITORIES 
              WITH A RELIABLE AND CONSISTENT SOURCE OF FEDERAL FUNDING 
              UNDER THE MEDICAID PROGRAM.

    It is the sense of Congress that--
            (1) the territories of American Samoa, the Commonwealth of 
        the Northern Mariana Islands, Guam, Puerto Rico, and the United 
        States Virgin Islands are currently subject to Federal funding 
        caps for their Medicaid programs;
            (2) as a result of these Federal funding caps, which have 
        not been adjusted over time, the territories continue to 
        struggle in managing their Medicaid programs, including 
        planning for their respective financial obligations and 
        managing health care services for low-income adults, children, 
        pregnant women, elderly adults, and persons with disabilities;
            (3) to address this disparate funding treatment and to 
        provide the territories with some measure of relief, Congress 
        has had to enact legislation six times in the last 15 years, 
        including multiple temporary increases in the Federal funding 
        caps, higher Federal medical assistance percentage rates, and 
        billions of dollars in supplemental block grants;
            (4) the supplemental funding provided to the territories 
        under title V with respect to their Medicaid programs continues 
        Congress' commitment to ensuring the sustainability of these 
        critically important programs and the people these programs 
        serve; and
            (5) a more permanent legislative solution must be developed 
        in order to provide the territories with a reliable and 
        consistent source of Federal funding under their Medicaid 
        programs so that the territories can continue to meet the 
        health care needs of vulnerable populations.

                       TITLE IV--NO SURPRISES ACT

SEC. 401. SHORT TITLE.

    This title may be cited as the ``No Surprises Act''.

SEC. 402. PREVENTING SURPRISE MEDICAL BILLS.

    (a) Coverage of Emergency Services.--Section 2719A(b) of the Public 
Health Service Act (42 U.S.C. 300gg-19a(b)) is amended--
            (1) in paragraph (1)--
                    (A) in the matter preceding subparagraph (A)--
                            (i) by striking ``a group health plan, or a 
                        health insurance issuer offering group or 
                        individual health insurance issuer,'' and 
                        inserting ``a health plan (as defined in 
                        subsection (e)(2)(A))'';
                            (ii) by inserting ``or, for plan year 2021 
                        or a subsequent plan year, with respect to 
                        emergency services in an independent 
                        freestanding emergency department (as defined 
                        in paragraph (3)(D))'' after ``emergency 
                        department of a hospital'';
                            (iii) by striking ``the plan or issuer'' 
                        and inserting ``the plan''; and
                            (iv) by striking ``paragraph (2)(B)'' and 
                        inserting ``paragraph (3)(C)'';
                    (B) in subparagraph (B), by inserting ``or a 
                participating emergency facility, as applicable,'' 
                after ``participating provider''; and
                    (C) in subparagraph (C)--
                            (i) in the matter preceding clause (i), by 
                        inserting ``by a nonparticipating provider or a 
                        nonparticipating emergency facility'' after 
                        ``enrollee'';
                            (ii) by striking clause (i);
                            (iii) by striking ``(ii)(I) such services'' 
                        and inserting ``(i) such services'';
                            (iv) by striking ``where the provider of 
                        services does not have a contractual 
                        relationship with the plan for the providing of 
                        services'';
                            (v) by striking ``emergency department 
                        services received from providers who do have 
                        such a contractual relationship with the plan; 
                        and'' and inserting ``emergency services 
                        received from participating providers and 
                        participating emergency facilities with respect 
                        to such plan;'';
                            (vi) by striking ``(II) if such services'' 
                        and all that follows through ``were provided 
                        in-network;'' and inserting the following:
                            ``(ii) the cost-sharing requirement 
                        (expressed as a copayment amount or coinsurance 
                        rate) is not greater than the requirement that 
                        would apply if such services were provided by a 
                        participating provider or a participating 
                        emergency facility;''; and
                            (vii) by adding at the end the following 
                        new clauses:
                            ``(iii) such requirement is calculated as 
                        if the total amount that would have been 
                        charged for such services by such participating 
                        provider or participating emergency facility 
                        were equal to--
                                    ``(I) in the case of such services 
                                furnished in a State described in 
                                paragraph (3)(H)(ii), the median 
                                contracted rate (as defined in 
                                paragraph (3)(E)(i)) for such services; 
                                and
                                    ``(II) in the case of such services 
                                furnished in a State described in 
                                paragraph (3)(H)(i), the lesser of--
                                            ``(aa) the amount 
                                        determined by such State for 
                                        such services in accordance 
                                        with the method described in 
                                        such paragraph; and
                                            ``(bb) the median 
                                        contracted rate (as so defined) 
                                        for such services;
                            ``(iv) the health plan pays to such 
                        provider or facility, respectively, the amount 
                        by which the recognized amount (as defined in 
                        paragraph (3)(H)) for such services exceeds the 
                        cost-sharing amount for such services (as 
                        determined in accordance with clauses (ii) and 
                        (iii)); and
                            ``(v) any cost-sharing payments made by the 
                        participant, beneficiary, or enrollee with 
                        respect to such emergency services so furnished 
                        shall be counted toward any in-network 
                        deductible or out-of-pocket maximums applied 
                        under the plan (and such in-network deductible 
                        shall be applied) in the same manner as if such 
                        cost-sharing payments were with respect to 
                        emergency services furnished by a participating 
                        provider and a participating emergency 
                        facility; and'';
            (2) by redesignating paragraph (2) as paragraph (3);
            (3) by inserting after paragraph (1) the following new 
        paragraph:
            ``(2) Audit process for median contracted rates.--
                    ``(A) In general.--Not later than July 1, 2020, the 
                Secretary, in consultation with appropriate State 
                agencies, shall establish through rulemaking a process, 
                in accordance with subparagraph (B), under which health 
                plans are audited by such Secretaries to ensure that--
                            ``(i) such plans are in compliance with the 
                        requirement of applying a median contracted 
                        rate under this section; and
                            ``(ii) that such median contracted rate so 
                        applied satisfies the definition under 
                        paragraph (3)(E) with respect to the year 
                        involved, including with respect to a health 
                        plan described in clause (ii) of such 
                        paragraph.
                    ``(B) Audit samples.--Under the process established 
                pursuant to subparagraph (A), the Secretary--
                            ``(i) shall conduct audits described in 
                        such subparagraph, with respect to a year 
                        (beginning with 2021), of a sample with respect 
                        to such year of claims data from not more than 
                        25 health plans; and
                            ``(ii) may audit any health plan if the 
                        Secretary has received any complaint about such 
                        plan that involves the compliance of the plan 
                        with either of the requirements described in 
                        clauses (i) and (ii) of such subparagraph.''; 
                        and
            (4) in paragraph (3), as redesignated by paragraph (2) of 
        this subsection--
                    (A) in the matter preceding subparagraph (A), by 
                inserting ``and subsection (e)'' after ``this 
                subsection'';
                    (B) by redesignating subparagraphs (A) through (C) 
                as subparagraphs (B) through (D), respectively;
                    (C) by inserting before subparagraph (B), as 
                redesignated by subparagraph (B) of this paragraph, the 
                following new subparagraph:
                    ``(A) Emergency department of a hospital.--The term 
                `emergency department of a hospital' includes a 
                hospital outpatient department that provides emergency 
                services.'';
                    (D) by amending subparagraph (C), as redesignated 
                by subparagraph (B) of this paragraph, to read as 
                follows:
                    ``(C) Emergency services.--
                            ``(i) In general.--The term `emergency 
                        services', with respect to an emergency medical 
                        condition, means--
                                    ``(I) a medical screening 
                                examination (as required under section 
                                1867 of the Social Security Act, or as 
                                would be required under such section if 
                                such section applied to an independent 
                                freestanding emergency department) that 
                                is within the capability of the 
                                emergency department of a hospital or 
                                of an independent freestanding 
                                emergency department, as applicable, 
                                including ancillary services routinely 
                                available to the emergency department 
                                to evaluate such emergency medical 
                                condition; and
                                    ``(II) within the capabilities of 
                                the staff and facilities available at 
                                the hospital or the independent 
                                freestanding emergency department, as 
                                applicable, such further medical 
                                examination and treatment as are 
                                required under section 1867 of such 
                                Act, or as would be required under such 
                                section if such section applied to an 
                                independent freestanding emergency 
                                department, to stabilize the patient.
                            ``(ii) Inclusion of poststabilization 
                        services.--For purposes of this subsection and 
                        section 2799, in the case of an individual 
                        enrolled in a health plan who is furnished 
                        services described in clause (i) by a provider 
                        or facility to stabilize such individual with 
                        respect to an emergency medical condition, the 
                        term `emergency services' shall include such 
                        items and services in addition to those 
                        described in clause (i) that such a provider or 
                        facility determines are needed to be furnished 
                        (after such stabilization but during such visit 
                        in which such individual is so stabilized) to 
                        such individual, unless each of the following 
                        conditions are met:
                                    ``(I) Such a provider or facility 
                                determines such individual is able to 
                                travel using nonmedical transportation 
                                or nonemergency medical transportation.
                                    ``(II) Such provider furnishing 
                                such additional items and services is 
                                in compliance with section 2799A(d) 
                                with respect to such items and 
                                services.'';
                    (E) by redesignating subparagraph (D), as 
                redesignated by subparagraph (B) of this paragraph, as 
                subparagraph (I); and
                    (F) by inserting after subparagraph (C), as 
                redesignated by subparagraph (B) of this paragraph, the 
                following new subparagraphs:
                    ``(D) Independent freestanding emergency 
                department.--The term `independent freestanding 
                emergency department' means a facility that--
                            ``(i) is geographically separate and 
                        distinct and licensed separately from a 
                        hospital under applicable State law; and
                            ``(ii) provides emergency services.
                    ``(E) Median contracted rate.--
                            ``(i) In general.--The term `median 
                        contracted rate' means, with respect to an item 
                        or service and a health plan (as defined in 
                        subsection (e)(2)(A))--
                                    ``(I) for 2021, the median of the 
                                negotiated rates recognized by the 
                                sponsor or issuer of such plan 
                                (determined with respect to all such 
                                plans of such sponsor or such issuer 
                                that are within the same line of 
                                business) as the total maximum payment 
                                (including the cost-sharing amount 
                                imposed for such services (as 
                                determined in accordance with clauses 
                                (ii) and (iii) of paragraph (1)(C) or 
                                subparagraphs (A) and (B) of subsection 
                                (e)(1), as applicable) and the amount 
                                to be paid by the plan or issuer) under 
                                such plans in 2019 for the same or a 
                                similar item or service that is 
                                provided by a provider in the same or 
                                similar specialty and provided in the 
                                geographic region in which the item or 
                                service is furnished, consistent with 
                                the methodology established by the 
                                Secretary under section 402(e) of the 
                                No Surprises Act, increased by the 
                                percentage increase in the consumer 
                                price index for all urban consumers 
                                (United States city average) over 2019 
                                and 2020; and
                                    ``(II) for 2022 and each subsequent 
                                year, the median contracted rate 
                                determined under this clause for the 
                                previous year, increased by the 
                                percentage increase in the consumer 
                                price index for all urban consumers 
                                (United States city average) over such 
                                previous year.
                            ``(ii) Special rule.--The Secretary shall 
                        provide pursuant to rulemaking described in 
                        section 402(e) of the No Surprises Act that--
                                    ``(I) if the sponsor or issuer of a 
                                health plan does not have sufficient 
                                information to calculate a median 
                                contracted rate for an item or service 
                                or provider type, or amount of, claims 
                                for items or services (as determined by 
                                the Secretary) provided in a particular 
                                geographic area (other than in a case 
                                described in item (bb)), such sponsor 
                                or issuer shall demonstrate that such 
                                sponsor or issuer will use any database 
                                free of conflicts of interest that has 
                                sufficient information reflecting 
                                allowed amounts paid to a health care 
                                provider for relevant services provided 
                                in the applicable geographic region 
                                (such as State All Payer Claims 
                                Databases (as defined in section 404(d) 
                                of such Act)), and that such sponsor or 
                                issuer will use any such database to 
                                determine a median contracted rate and 
                                cover the cost of accessing any such 
                                database; and
                                    ``(II) in the case of a sponsor or 
                                issuer offering a health plan in a 
                                geographic region that did not offer 
                                any health plan in such region during 
                                2019, such sponsor or issuer shall use 
                                a methodology established by the 
                                Secretary for determining the median 
                                contracted rate for items and services 
                                covered by such plan for the first year 
                                in which such plan is offered in such 
                                region, and that, for each succeeding 
                                year, the median contracted rate for 
                                such items and services under such plan 
                                shall be the median contracted rate for 
                                such items and services under such plan 
                                for the previous year, increased by the 
                                percentage increase in the consumer 
                                price index for all urban consumers 
                                (United States city average) over such 
                                previous year.
                    ``(F) Nonparticipating emergency facility; 
                participating emergency facility.--
                            ``(i) Nonparticipating emergency 
                        facility.--The term `nonparticipating emergency 
                        facility' means, with respect to an item or 
                        service and a health plan, an emergency 
                        department of a hospital, or an independent 
                        freestanding emergency department, that does 
                        not have a contractual relationship with the 
                        plan (or, if applicable, issuer offering the 
                        plan) for furnishing such item or service under 
                        the plan.
                            ``(ii) Participating emergency facility.--
                        The term `participating emergency facility' 
                        means, with respect to an item or service and a 
                        health plan, an emergency department of a 
                        hospital, or an independent freestanding 
                        emergency department, that has a contractual 
                        relationship with the plan (or, if applicable, 
                        issuer offering the plan) for furnishing such 
                        item or service under the plan.
                    ``(G) Nonparticipating providers; participating 
                providers.--
                            ``(i) Nonparticipating provider.--The term 
                        `nonparticipating provider' means, with respect 
                        to an item or service and a health plan, a 
                        physician or other health care provider who is 
                        acting within the scope of practice of that 
                        provider's license or certification under 
                        applicable State law and who does not have a 
                        contractual relationship with the plan (or, if 
                        applicable, issuer offering the plan) for 
                        furnishing such item or service under the plan.
                            ``(ii) Participating provider.--The term 
                        `participating provider' means, with respect to 
                        an item or service and a health plan, a 
                        physician or other health care provider who is 
                        acting within the scope of practice of that 
                        provider's license or certification under 
                        applicable State law and who has a contractual 
                        relationship with the plan (or, if applicable, 
                        issuer offering the plan) for furnishing such 
                        item or service under the plan.
                    ``(H) Recognized amount.--The term `recognized 
                amount' means, with respect to an item or service--
                            ``(i) in the case of such item or service 
                        furnished in a State that has in effect a State 
                        law that provides for a method for determining 
                        the amount of payment that is required to be 
                        covered by a health plan regulated by such 
                        State in the case of a participant, 
                        beneficiary, or enrollee covered under such 
                        plan and receiving such item or service from a 
                        nonparticipating provider or facility, not more 
                        than the amount determined in accordance with 
                        such law plus the cost-sharing amount imposed 
                        under the plan for such item or service (as 
                        determined in accordance with clauses (ii) and 
                        (iii) of paragraph (1)(C) or subparagraphs (A) 
                        and (B) of subsection (e)(1), as applicable); 
                        or
                            ``(ii) in the case of such item or service 
                        furnished in a State that does not have in 
                        effect such a law, an amount that is at least 
                        the median contracted rate (as defined in 
                        subparagraph (E)(i) and determined in 
                        accordance with rulemaking described in section 
                        402(e) of the No Surprises Act) for such item 
                        or service.''.
    (b) Coverage of Non-emergency Services Performed by 
Nonparticipating Providers at Certain Participating Facilities; 
Independent Dispute Resolution Process.--Section 2719A of the Public 
Health Service Act (42 U.S.C. 300gg-19a) is amended by adding at the 
end the following new subsections:
    ``(e) Coverage of Non-emergency Services Performed by 
Nonparticipating Providers at Certain Participating Facilities.--
            ``(1) In general.--Subject to paragraph (3), in the case of 
        items or services (other than emergency services to which 
        subsection (b) applies) furnished to a participant, 
        beneficiary, or enrollee of a health plan (as defined in 
        paragraph (2)(A)) by a nonparticipating provider (as defined in 
        subsection (b)(3)(G)(i)) during a visit (as defined by the 
        Secretary in accordance with paragraph (2)(C)) at a 
        participating health care facility (as defined in paragraph 
        (2)(B)), with respect to such plan, the plan--
                    ``(A) shall not impose on such participant, 
                beneficiary, or enrollee a cost-sharing amount 
                (expressed as a copayment amount or coinsurance rate) 
                for such items and services so furnished that is 
                greater than the cost-sharing amount that would apply 
                under such plan had such items or services been 
                furnished by a participating provider (as defined in 
                subsection (b)(3)(G)(ii));
                    ``(B) shall calculate such cost-sharing amount as 
                if the amount that would have been charged for such 
                items and services by such participating provider were 
                equal to--
                            ``(i) in the case of such items and 
                        services furnished in a State described in 
                        subsection (b)(3)(H)(ii), the median contracted 
                        rate (as defined in subsection (b)(3)(E)(i)) 
                        for such items and services; and
                            ``(ii) in the case of such items and 
                        services furnished in a State described in 
                        subsection (b)(3)(H)(i), the lesser of--
                                    ``(I) the amount determined by such 
                                State for such items and services in 
                                accordance with the method described in 
                                such subsection; and
                                    ``(II) the median contracted rate 
                                (as so defined) for such items and 
                                services;
                    ``(C) shall pay to such provider furnishing such 
                items and services to such participant, beneficiary, or 
                enrollee the amount by which the recognized amount (as 
                defined in subsection (b)(3)(H)) for such items and 
                services exceeds the cost-sharing amount imposed under 
                the plan for such items and services (as determined in 
                accordance with subparagraphs (A) and (B)); and
                    ``(D) shall count toward any in-network deductible 
                or out-of-pocket maximums applied under the plan any 
                cost-sharing payments made by the participant, 
                beneficiary, or enrollee (and such in-network 
                deductible shall be applied) with respect to such items 
                and services so furnished in the same manner as if such 
                cost-sharing payments were with respect to items and 
                services furnished by a participating provider.
            ``(2) Definitions.--In this subsection and subsection (b):
                    ``(A) Health plan.--The term `health plan' means a 
                group health plan and health insurance coverage offered 
                by a heath insurance issuer in the group or individual 
                market and includes a grandfathered health plan (as 
                defined in section 1251(e) of the Patient Protection 
                and Affordable Care Act).
                    ``(B) Participating health care facility.--
                            ``(i) In general.--The term `participating 
                        health care facility' means, with respect to an 
                        item or service and a health plan, a health 
                        care facility described in clause (ii) that has 
                        a contractual relationship with the plan (or, 
                        if applicable, issuer offering the plan) for 
                        furnishing such item or service.
                            ``(ii) Health care facility described.--A 
                        health care facility described in this clause 
                        is each of the following:
                                    ``(I) A hospital (as defined in 
                                1861(e) of the Social Security Act).
                                    ``(II) A critical access hospital 
                                (as defined in section 1861(mm) of such 
                                Act).
                                    ``(III) An ambulatory surgical 
                                center (as defined in section 
                                1833(i)(1)(A) of such Act).
                                    ``(IV) A laboratory.
                                    ``(V) A radiology facility or 
                                imaging center.
                    ``(C) During a visit.--The term `during a visit' 
                shall, with respect to items and services furnished to 
                an individual at a participating health care facility, 
                include equipment and devices, telemedicine services, 
                imaging services, laboratory services, and such other 
                items and services as the Secretary may specify, 
                regardless of whether or not the provider furnishing 
                such items or services is at the facility.
            ``(3) Exception.--Paragraph (1) shall not apply to a health 
        plan in the case of items or services (other than emergency 
        services to which subsection (b) applies) furnished to a 
        participant, beneficiary, or enrollee of a health plan (as 
        defined in paragraph (2)(A)) by a nonparticipating provider (as 
        defined in subsection (b)(3)(G)(i)) during a visit (as defined 
        by the Secretary in accordance with paragraph (2)(C)) at a 
        participating health care facility (as defined in paragraph 
        (2)(B)) if such provider is in compliance with section 2799A(d) 
        with respect to such items and services.
    ``(f) Independent Dispute Resolution Process.--
            ``(1) Establishment.--
                    ``(A) In general.--Not later than 1 year after the 
                date of the enactment of this subsection, the 
                Secretary, in consultation with the Secretary of Labor, 
                shall establish by regulation an independent dispute 
                resolution process (referred to in this subsection as 
                the `IDR process') under which--
                            ``(i) a nonparticipating provider (as 
                        defined in subparagraph (G) of subsection 
                        (b)(3)), nonparticipating emergency facility 
                        (as defined in subparagraph (F) of such 
                        subsection), or health plan (as defined in 
                        subsection (e)(2)(A)) may submit a request for 
                        resolution by an entity certified under 
                        paragraph (2) (in this subsection referred to 
                        as a `certified IDR entity') of a specified 
                        claim; and
                            ``(ii) in the case a settlement described 
                        in subparagraph (B) of paragraph (4) is not 
                        reached with respect to such claim, such entity 
                        so resolves such claim in accordance with such 
                        paragraph.
                    ``(B) Definitions.--In this subsection:
                            ``(i) Specified claim.--
                                    ``(I) In general.--Subject to 
                                subclause (II), the term `specified 
                                claim' means a claim by a 
                                nonparticipating provider, a 
                                nonparticipating emergency facility, or 
                                a health plan with respect to 
                                qualifying items and services (as 
                                defined in clause (ii)) furnished by 
                                such provider or facility in a State 
                                described in subparagraph (H)(ii) of 
                                subsection (b)(3) for which a health 
                                plan is required to make payment 
                                pursuant to subsection (b)(1) or 
                                subsection (e)(1)--
                                            ``(aa) that such payment 
                                        should be increased or 
                                        decreased; and
                                            ``(bb) that is made not 
                                        later than--

                                                    ``(AA) in the case 
                                                of such a claim filed 
                                                by such a provider or 
                                                facility, the date on 
                                                which the appeal with 
                                                respect to such items 
                                                and services described 
                                                in clause 
                                                (ii)(I)(aa)(AA) has 
                                                been resolved (or the 
                                                date that is 30 days 
                                                after such appeal is 
                                                filed, whichever is 
                                                earlier); or

                                                    ``(BB) in the case 
                                                of such a claim filed 
                                                by such plan, the date 
                                                on which the period 
                                                described in clause 
                                                (ii)(I)(bb)(BB) with 
                                                respect to such items 
                                                and services elapses.

                                    ``(II) Limitation on packaging of 
                                items and services in a specified 
                                claim.--The term `specified claim' 
                                shall not include, in the case such 
                                claim is made by such provider, 
                                facility, or plan with respect to 
                                multiple items and services, any claim 
                                with respect to items and services 
                                furnished by such provider or facility 
                                if--
                                            ``(aa) such items and 
                                        services were not furnished by 
                                        the same provider or facility;
                                            ``(bb) payment for such 
                                        items and services made 
                                        pursuant to subsection (b)(1) 
                                        or subsection (e)(1) was made 
                                        by multiple health plans;
                                            ``(cc) such items and 
                                        services are not related to the 
                                        treatment of the same 
                                        condition; or
                                            ``(dd) such items and 
                                        services were not furnished 
                                        within 30 days of the date of 
                                        the earliest item or service 
                                        furnished that is included in 
                                        such claim.
                            ``(ii) Qualifying items and services.--
                                    ``(I) In general.--Subject to 
                                subclause (II), the term `qualifying 
                                items and services' means--
                                            ``(aa) with respect to a 
                                        specified claim made by a 
                                        nonparticipating provider or 
                                        nonparticipating emergency 
                                        facility, items and services 
                                        furnished by such provider or 
                                        facility for which a health 
                                        plan is required to make 
                                        payment pursuant to subsection 
                                        (b)(1) or subsection (e)(1), 
                                        but only if--

                                                    ``(AA) such items 
                                                and services are 
                                                included in an appeal 
                                                filed under such plan's 
                                                internal appeals 
                                                process not later than 
                                                30 days after such 
                                                payment is received; 
                                                and

                                                    ``(BB) such appeal 
                                                under such plan's 
                                                internal appeals 
                                                process has been 
                                                resolved, or a 30-day 
                                                period has elapsed 
                                                since such appeal was 
                                                so filed; and

                                            ``(bb) with respect to a 
                                        specified claim made by a 
                                        health plan, items and services 
                                        furnished by such a provider or 
                                        facility for which such health 
                                        plan is required to make 
                                        payment pursuant to subsection 
                                        (b)(1) or subsection (e)(1), 
                                        but only if--

                                                    ``(AA) such plan 
                                                submits a notice to 
                                                such provider or 
                                                facility not later than 
                                                30 days after such 
                                                provider or facility 
                                                receives such payment 
                                                that such plan disputes 
                                                the amount of such 
                                                payment with respect to 
                                                such items and 
                                                services; and

                                                    ``(BB) a 30-day 
                                                period has elapsed 
                                                since the submission of 
                                                such notice.

                                    ``(II) Limitation.--The term 
                                `qualifying items and services' shall 
                                not include an item or service 
                                furnished in a geographic area during a 
                                year by such provider or facility for 
                                which a health plan is required to make 
                                payment pursuant to subsection (b)(1) 
                                or subsection (e)(1) if the median 
                                contracted rate (as defined in 
                                subsection (b)(3)(E)) under such plan 
                                for such year with respect to such item 
                                or service furnished by such a provider 
                                or such a facility in such area does 
                                not exceed--
                                            ``(aa) with respect to an 
                                        item or service furnished 
                                        during 2021, $1,250; and
                                            ``(bb) with respect to an 
                                        item or service furnished 
                                        during a subsequent year, the 
                                        amount specified under this 
                                        subclause for the previous 
                                        year, increased by the 
                                        percentage increase in the 
                                        consumer price index for all 
                                        urban consumers (United States 
                                        city average) over such 
                                        previous year.
            ``(2) Certification of entities.--
                    ``(A) Process of certification.--The process 
                described in paragraph (1) shall include a 
                certification process under which eligible entities may 
                be certified to carry out the IDR process.
                    ``(B) Eligibility.--
                            ``(i) In general.--For purposes of 
                        subparagraph (A), an eligible entity is an 
                        entity that is a nongovernmental entity that 
                        agrees to comply with the fee limitations 
                        described in clause (ii).
                            ``(ii) Fee limitation.--For purposes of 
                        clause (i), the fee limitations described in 
                        this clause are limitations established by the 
                        Secretary on the amount a certified IDR entity 
                        may charge a nonparticipating provider, 
                        nonparticipating emergency facility, or health 
                        plan for services furnished by such entity with 
                        respect to the resolution of a specified claim 
                        of such provider, facility, or plan under the 
                        process described in paragraph (1).
            ``(3) Selection of certified idr entity for a specified 
        claim.--With respect to the resolution of a specified claim 
        under the IDR process, the health plan and the nonparticipating 
        provider or the nonparticipating emergency facility (as 
        applicable) involved shall agree on a certified IDR entity to 
        resolve such claim. In the case that such plan and such 
        provider or facility (as applicable) cannot so agree, such an 
        entity shall be selected by the Secretary at random.
            ``(4) Payment determination.--
                    ``(A) Timing.--A certified IDR entity selected 
                under paragraph (3) by a health plan and a 
                nonparticipating provider or a nonparticipating 
                emergency facility (as applicable) with respect to a 
                specified claim shall, subject to subparagraph (B), not 
                later than 30 days after being so selected, determine 
                the total reimbursement that should have been made for 
                items and services included in such claim in accordance 
                with subparagraph (C).
                    ``(B) Settlement.--
                            ``(i) In general.--If such entity 
                        determines that a settlement between the health 
                        plan and the provider or facility is likely 
                        with respect to a specified claim, the entity 
                        may direct the parties to attempt, for a period 
                        not to exceed 10 days, a good faith negotiation 
                        for a settlement of such claim.
                            ``(ii) Timing.--The period for a settlement 
                        described in clause (i) shall accrue towards 
                        the 30-day period described in subparagraph 
                        (A).
                    ``(C) Determination of amount.--
                            ``(i) In general.--The health plan and the 
                        nonparticipating provider or nonparticipating 
                        emergency facility (as applicable) shall, with 
                        respect to a specified claim, each submit to 
                        the certified IDR entity a final offer of 
                        payment or reimbursement (as applicable) with 
                        respect to items and services which are the 
                        subject of the specified claim. Such entity 
                        shall determine which such offer is the most 
                        reasonable in accordance with clause (ii).
                            ``(ii) Considerations in determination.--
                                    ``(I) In general.--In determining 
                                which final offer is the most 
                                reasonable under clause (i), the 
                                certified IDR entity shall consider--
                                            ``(aa) the median 
                                        contracted rates (as defined in 
                                        subsection (b)(3)(E)) for items 
                                        or services that are comparable 
                                        to the items and services 
                                        included in the specified claim 
                                        and that are furnished in the 
                                        same geographic area (as 
                                        defined by the Secretary for 
                                        purposes of such subsection) as 
                                        such items and services (not 
                                        including any facility fees 
                                        with respect to such rates); 
                                        and
                                            ``(bb) the circumstances 
                                        described in subclause (II), if 
                                        any information with respect to 
                                        such circumstances is submitted 
                                        by either party.
                                    ``(II) Additional circumstances.--
                                For purposes of subclause (I)(bb), the 
                                circumstances described in this 
                                subclause are, with respect to items 
                                and services included in the specified 
                                claim of a nonparticipating provider, 
                                nonparticipating emergency facility, or 
                                health plan, the following:
                                            ``(aa) The level of 
                                        training, education, 
                                        experience, and quality and 
                                        outcomes measurements of the 
                                        provider or facility that 
                                        furnished such items and 
                                        services.
                                            ``(bb) Any other 
                                        extenuating circumstances with 
                                        respect to the furnishing of 
                                        such items and services that 
                                        relate to the acuity of the 
                                        individual receiving such items 
                                        and services or the complexity 
                                        of furnishing such items and 
                                        services to such individual.
                                    ``(III) Prohibition on 
                                consideration of billed charges.--In 
                                determining which final offer is the 
                                most reasonable under clause (i) with 
                                respect to items and services furnished 
                                by a provider or facility and included 
                                in a specified claim, the certified IDR 
                                entity may not consider the amount that 
                                would have been billed by such provider 
                                or facility with respect to such items 
                                and services had the provisions of 
                                section 2799 or 2799A (as applicable) 
                                not applied.
                            ``(iii) Effect of determination.--A 
                        determination of a certified IDR entity under 
                        clause (i)--
                                    ``(I) shall be binding; and
                                    ``(II) shall not be subject to 
                                judicial review, except in a case 
                                described in any of paragraphs (1) 
                                through (4) of section 10(a) of title 
                                9, United States Code.
                            ``(iv) Costs of independent dispute 
                        resolution process.--In the case of a specified 
                        claim made by a nonparticipating provider, 
                        nonparticipating emergency facility, or health 
                        plan and submitted to a certified IDR entity--
                                    ``(I) if such entity makes a 
                                determination with respect to such 
                                claim under clause (i), the party whose 
                                offer is not chosen under such clause 
                                shall be responsible for paying all 
                                fees charged by such entity; and
                                    ``(II) if the parties reach a 
                                settlement with respect to such claim 
                                prior to such a determination, such 
                                fees shall be divided equally between 
                                the parties, unless the parties 
                                otherwise agree.
                            ``(v) Payment.--Not later than 30 days 
                        after a determination described in clause (i) 
                        is made with respect to a specified claim of a 
                        nonparticipating provider, nonparticipating 
                        emergency facility, or health plan--
                                    ``(I) in the case that such 
                                determination finds that the amount 
                                paid with respect to such specified 
                                claim by the health plan should have 
                                been greater than the amount so paid, 
                                such plan shall pay directly to the 
                                provider or facility (as applicable) 
                                the difference between the amount so 
                                paid and the amount so determined; and
                                    ``(II) in the case that such 
                                determination finds that the amount 
                                paid with respect to such specified 
                                claim by the health plan should have 
                                been less than the amount so paid, the 
                                provider or facility (as applicable) 
                                shall pay directly to the plan the 
                                difference between the amount so paid 
                                and the amount so determined.
            ``(5) Publication of information relating to disputes.--
                    ``(A) In general.--For 2021 and each subsequent 
                year, the Secretary and the Secretary of Labor shall 
                publish on the public website of the Department of 
                Health and Human Services and the Department of Labor, 
                respectively--
                            ``(i) the number of specified claims filed 
                        during such year;
                            ``(ii) the number of such claims with 
                        respect to which a final determination was made 
                        under paragraph (4)(C)(i); and
                            ``(iii) the information described in 
                        subparagraph (B) with respect to each specified 
                        claim with respect to which such a decision was 
                        so made.
                    ``(B) Information with respect to specified 
                claims.--For purposes of subparagraph (A), the 
                information described in this subparagraph is, with 
                respect to a specified claim of a nonparticiapting 
                provider, nonparticipating emergency facility, or 
                health plan--
                            ``(i) a description of each item and 
                        service included in such claim;
                            ``(ii) the amount of the offer submitted 
                        under paragraph (4)(C)(i) by the health plan 
                        and by the nonparticipating provider or 
                        nonparticipating emergency facility (as 
                        applicable);
                            ``(iii) whether the offer selected by the 
                        certified IDR entity under such paragraph was 
                        the offer submitted by such plan or by such 
                        provider or facility (as applicable) and the 
                        amount of such offer so selected; and
                            ``(iv) the category and practice specialty 
                        of each such provider or facility involved in 
                        furnishing such items and services.
                    ``(C) Confidentiality of parties.--None of the 
                information published under this paragraph may specify 
                the identity of a health plan, provider, facility, or 
                individual with respect to a specified claim.''.
    (c) Provider Directory Requirements; Disclosure on Patient 
Protections.--Section 2719A of the Public Health Service Act, as 
amended by subsection (b), is further amended by adding at the end the 
following new subsections:
    ``(g) Provider Directory Information Requirements.--
            ``(1) In general.--Not later than 1 year after the date of 
        the enactment of this subsection, each group health plan and 
        health insurance issuer offering group or individual health 
        insurance coverage shall--
                    ``(A) establish the verification process described 
                in paragraph (2);
                    ``(B) establish the response protocol described in 
                paragraph (3);
                    ``(C) establish the database described in paragraph 
                (4); and
                    ``(D) include in any print directory containing 
                provider directory information with respect to such 
                plan or such coverage the information described in 
                paragraph (5).
            ``(2) Verification process.--The verification process 
        described in this paragraph is, with respect to a group health 
        plan or a health insurance issuer offering group or individual 
        health insurance coverage, a process--
                    ``(A) under which not less frequently than once 
                every 90 days, such plan or such issuer (as applicable) 
                verifies and updates the provider directory information 
                included on the database described in paragraph (4) of 
                such plan or issuer of each health care provider and 
                health care facility included in such database; and
                    ``(B) that establishes a procedure for the removal 
                of such a provider or facility with respect to which 
                such plan or issuer has been unable to verify such 
                information during a period specified by the plan or 
                issuer.
            ``(3) Response protocol.--The response protocol described 
        in this paragraph is, in the case of an individual enrolled 
        under a group health plan or group or individual health 
        insurance coverage offered by a health insurance issuer who 
        requests information on whether a health care provider or 
        health care facility has a contractual relationship to furnish 
        items and services under such plan or such coverage, a protocol 
        under which such plan or such issuer (as applicable), in the 
        case such request is made through a telephone call--
                    ``(A) responds to such individual as soon as 
                practicable and in no case later than 1 business day 
                after such call is received through a written 
                electronic communication; and
                    ``(B) retains such communication in such 
                individual's file for at least 2 years following such 
                response.
            ``(4) Database.--The database described in this paragraph 
        is, with respect to a group health plan or health insurance 
        issuer offering group or individual health insurance coverage, 
        a database on the public website of such plan or issuer that 
        contains--
                    ``(A) a list of each health care provider and 
                health care facility with which such plan or such 
                issuer has a contractual relationship for furnishing 
                items and services under such plan or such coverage; 
                and
                    ``(B) provider directory information with respect 
                to each such provider and facility.
            ``(5) Information.--The information described in this 
        paragraph is, with respect to a print directory containing 
        provider directory information with respect to a group health 
        plan or individual or group health insurance coverage offered 
        by a health insurance issuer, a notification that such 
        information contained in such directory was accurate as of the 
        date of publication of such directory and that an individual 
        enrolled under such plan or such coverage should consult the 
        database described in paragraph (4) with respect to such plan 
        or such coverage or contact such plan or the issuer of such 
        coverage to obtain the most current provider directory 
        information with respect to such plan or such coverage.
            ``(6) Definition.--For purposes of this subsection, the 
        term `provider directory information' includes, with respect to 
        a group health plan and a health insurance issuer offering 
        group or individual health insurance coverage, the name, 
        address, specialty, and telephone number of each health care 
        provider or health care facility with which such plan or such 
        issuer has a contractual relationship for furnishing items and 
        services under such plan or such coverage.
    ``(h) Disclosure on Patient Protections.--Each group health plan 
and health insurance issuer offering group or individual health 
insurance coverage shall make publicly available, and (if applicable) 
post on a public website of such plan or issuer--
            ``(1) information in plain language on--
                    ``(A) the requirements and prohibitions applied 
                under sections 2799 and 2799A (relating to prohibitions 
                on balance billing in certain circumstances);
                    ``(B) if provided for under applicable State law, 
                any other requirements on providers and facilities 
                regarding the amounts such providers and facilities 
                may, with respect to an item or service, charge a 
                participant, beneficiary, or enrollee of such plan or 
                coverage with respect to which such a provider or 
                facility does not have a contractual relationship for 
                furnishing such item or service under the plan or 
                coverage after receiving payment from the plan or 
                coverage for such item or service and any applicable 
                cost-sharing payment from such participant, 
                beneficiary, or enrollee; and
                    ``(C) the requirements applied under subsections 
                (b) and (e); and
            ``(2) information on contacting appropriate State and 
        Federal agencies in the case that an individual believes that 
        such a provider or facility has violated any requirement 
        described in paragraph (1) with respect to such individual.''.
    (d) Preventing Certain Cases of Balance Billing.--Title XXVII of 
the Public Health Service Act is amended by adding at the end the 
following new part:

         ``PART D--PREVENTING CERTAIN CASES OF BALANCE BILLING

``SEC. 2799. BALANCE BILLING IN CASES OF EMERGENCY SERVICES.

    ``(a) In General.--In the case of a participant, beneficiary, or 
enrollee with benefits under a health plan who is furnished on or after 
January 1, 2021, emergency services with respect to an emergency 
medical condition during a visit at an emergency department of a 
hospital or an independent freestanding emergency department--
            ``(1) the emergency department of a hospital or independent 
        freestanding emergency department shall not hold the 
        participant, beneficiary, or enrollee liable for a payment 
        amount for such emergency services so furnished that is more 
        than the cost-sharing amount for such services (as determined 
        in accordance with clauses (ii) and (iii) of section 
        2719A(b)(1)(C)); and
            ``(2) a health care provider shall not hold such 
        participant, beneficiary, or enrollee liable for a payment 
        amount for an emergency service furnished to such individual by 
        such provider with respect to such emergency medical condition 
        and visit for which the individual receives emergency services 
        at the hospital or emergency department that is more than the 
        cost-sharing amount for such services furnished by the provider 
        (as determined in accordance with clauses (ii) and (iii) of 
        section 2719A(b)(1)(C)).
    ``(b) Definitions.--In this section:
            ``(1) The terms `emergency department of a hospital', 
        `emergency medical condition', `emergency services', and 
        `independent freestanding emergency department' have the 
        meanings given such terms, respectively, in section 
        2719A(b)(3).
            ``(2) The term `health plan' has the meaning given such 
        term in section 2719A(e).
            ``(3) The term `during a visit' shall have such meaning as 
        applied to such term for purposes of section 2719A(e).

``SEC. 2799A. BALANCE BILLING IN CASES OF NON-EMERGENCY SERVICES 
              PERFORMED BY NONPARTICIPATING PROVIDERS AT CERTAIN 
              PARTICIPATING FACILITIES.

    ``(a) In General.--Subject to subsection (b), in the case of a 
participant, beneficiary, or enrollee with benefits under a health plan 
(as defined in section 2799(b)) who is furnished on or after January 1, 
2021, items or services (other than emergency services to which section 
2799 applies) at a participating health care facility by a 
nonparticipating provider, such provider shall not hold such 
participant, beneficiary, or enrollee liable for a payment amount for 
such an item or service furnished by such provider during a visit at 
such facility that is more than the cost-sharing amount for such item 
or service (as determined in accordance with subparagraphs (A) and (B) 
of section 2719A(e)(1)).
    ``(b) Exception.--
            ``(1) In general.--Subsection (a) shall not apply to a 
        nonparticipating provider (other than a specified provider at a 
        participating health care facility), with respect to items or 
        services furnished by the provider to a participant, 
        beneficiary, or enrollee of a health plan, if the provider is 
        in compliance with the notice and consent requirements of 
        subsection (d).
            ``(2) Specified provider defined.--For purposes of 
        paragraph (1), the term `specified provider', with respect to a 
        participating health care facility--
                    ``(A) means a facility-based provider, including 
                emergency medicine providers, anesthesiologists, 
                pathologists, radiologists, neonatologists, assistant 
                surgeons, hospitalists, intensivists, or other 
                providers as determined by the Secretary; and
                    ``(B) includes, with respect to an item or service, 
                a nonparticipating provider if there is no 
                participating provider at such facility who can furnish 
                such item or service.
    ``(c) Clarification.--In the case of a nonparticipating provider 
(other than a specified provider at a participating health care 
facility) that complies with the notice and consent requirements of 
subsection (d) with respect to an item or service (referred to in this 
subsection as a `covered item or service'), such notice and consent 
requirements may not be construed as applying with respect to any item 
or service that is furnished as a result of unforeseen medical needs 
that arise at the time such covered item or service is furnished.
    ``(d) Compliance With Notice and Consent Requirements.--
            ``(1) In general.--A nonparticipating provider or 
        nonparticipating facility is in compliance with this 
        subsection, with respect to items or services furnished by the 
        provider or facility to a participant, beneficiary, or enrollee 
        of a health plan, if the provider (or, if applicable, the 
        participating health care facility on behalf of such provider) 
        or nonparticipating facility--
                    ``(A) provides to the participant, beneficiary, or 
                enrollee (or to an authorized representative of the 
                participant, beneficiary, or enrollee) on the date on 
                which the individual is furnished such items or 
                services and, in the case that the participant, 
                beneficiary, or enrollee makes an appointment to be 
                furnished such items or services, on such date the 
                appointment is made--
                            ``(i) an oral explanation of the written 
                        notice described in clause (ii); and
                            ``(ii) a written notice specified by the 
                        Secretary, not later than July 1, 2020, through 
                        guidance (which shall be updated as determined 
                        necessary by the Secretary) that--
                                    ``(I) contains the information 
                                required under paragraph (2); and
                                    ``(II) is signed and dated by the 
                                participant, beneficiary, or enrollee 
                                (or by an authorized representative of 
                                the participant, beneficiary, or 
                                enrollee) and, with respect to items or 
                                services to be furnished by such a 
                                provider that are not poststabilization 
                                services described in section 
                                2719A(b)(3)(C)(ii), is so signed and 
                                dated not less than 72 hours prior to 
                                the participant, beneficiary, or 
                                enrollee being furnished such items or 
                                services by such provider; and
                    ``(B) obtains from the participant, beneficiary, or 
                enrollee (or from such an authorized representative) 
                the consent described in paragraph (3).
            ``(2) Information required under written notice.--For 
        purposes of paragraph (1)(A)(ii)(I), the information described 
        in this paragraph, with respect to a nonparticipating provider 
        or nonparticipating facility and a participant, beneficiary, or 
        enrollee of a health plan, is each of the following:
                    ``(A) Notification, as applicable, that the health 
                care provider is a nonparticipating provider with 
                respect to the health plan or the health care facility 
                is a nonparticipating facility with respect to the 
                health plan.
                    ``(B) Notification of the estimated amount that 
                such provider or facility may charge the participant, 
                beneficiary, or enrollee for such items and services 
                involved.
                    ``(C) In the case of a nonparticipating facility, a 
                list of any participating providers at the facility who 
                are able to furnish such items and services involved 
                and notification that the participant, beneficiary, or 
                enrollee may be referred, at their option, to such a 
                participating provider.
            ``(3) Consent described.--For purposes of paragraph (1)(B), 
        the consent described in this paragraph, with respect to a 
        participant, beneficiary, or enrollee of a health plan who is 
        to be furnished items or services by a nonparticipating 
        provider or nonparticipating facility, is a document specified 
        by the Secretary through rulemaking that--
                    ``(A) is signed by the participant, beneficiary, or 
                enrollee (or by an authorized representative of the 
                participant, beneficiary, or enrollee) and, with 
                respect to items or services to be furnished by such a 
                provider or facility that are not poststabilization 
                services described in section 2719A(b)(3)(C)(ii), is so 
                signed not less than 72 hours prior to the participant, 
                beneficiary, or enrollee being furnished such items or 
                services by such provider or facility;
                    ``(B) acknowledges that the participant, 
                beneficiary, or enrollee has been--
                            ``(i) provided with a written estimate and 
                        an oral explanation of the charge that the 
                        participant, beneficiary, or enrollee will be 
                        assessed for the items or services anticipated 
                        to be furnished to the participant, 
                        beneficiary, or enrollee by such provider or 
                        facility; and
                            ``(ii) informed that the payment of such 
                        charge by the participant, beneficiary, or 
                        enrollee may not accrue toward meeting any 
                        limitation that the health plan places on cost-
                        sharing; and
                    ``(C) documents the consent of the participant, 
                beneficiary, or enrollee to--
                            ``(i) be furnished with such items or 
                        services by such provider or facility; and
                            ``(ii) in the case that the individual is 
                        so furnished such items or services, be charged 
                        an amount that may be greater than the amount 
                        that would otherwise be charged the individual 
                        if furnished by a participating provider or 
                        participating facility with respect to such 
                        items or services and plan.
    ``(e) Retention of Certain Documents.--A nonparticipating provider 
(or, in the case of a nonparticipating provider at a participating 
health care facility, such facility) or nonparticipating facility that 
obtains from a participant, beneficiary, or enrollee of a health plan 
(or an authorized representative of such participant, beneficiary, or 
enrollee) a written notice in accordance with subsection (c)(1)(ii), 
with respect to furnishing an item or service to such participant, 
beneficiary, or enrollee, shall retain such notice for at least a 2-
year period after the date on which such item or service is so 
furnished.
    ``(f) Definitions.--In this section:
            ``(1) The terms `nonparticipating provider' and 
        `participating provider' have the meanings given such terms, 
        respectively, in subsection (b)(3) of section 2719A.
            ``(2) The terms `participating health care facility' and 
        `health plan' have the meanings given such terms, respectively, 
        in subsection (e)(2) of section 2719A.
            ``(3) The term `nonparticipating facility' means--
                    ``(A) with respect to emergency services (as 
                defined in section 2719A(b)(3)(C)(i)) and a health 
                plan, an emergency department of a hospital, or an 
                independent freestanding emergency department, that 
                does not have a contractual relationship with the plan 
                (or, if applicable, issuer offering the plan) for 
                furnishing such services under the plan; and
                    ``(B) with respect to poststabilization services 
                described in section 2719A(b)(3)(C)(ii) and a health 
                plan, an emergency department of a hospital (or other 
                department of such hospital), or an independent 
                freestanding emergency department, that does not have a 
                contractual relationship with the plan (or, if 
                applicable, issuer offering the plan) for furnishing 
                such services under the plan.
            ``(4) The term `participating facility' means--
                    ``(A) with respect to emergency services (as 
                defined in section 2719A(b)(3)(C)(i)) and a health 
                plan, an emergency department of a hospital, or an 
                independent freestanding emergency department, that has 
                a contractual relationship with the plan (or, if 
                applicable, issuer offering the plan) for furnishing 
                such services under the plan; and
                    ``(B) with respect to poststabilization services 
                described in section 2719A(b)(3)(C)(ii) and a health 
                plan, an emergency department of a hospital (or other 
                department of such hospital), or an independent 
                freestanding emergency department, that has a 
                contractual relationship with the plan (or, if 
                applicable, issuer offering the plan) for furnishing 
                such services under the plan.

``SEC. 2799B. PROVIDER REQUIREMENTS WITH RESPECT TO PROVIDER DIRECTORY 
              INFORMATION.

    ``Not later than 1 year after the date of the enactment of this 
section, each health care provider and health care facility shall 
establish a process under which such provider or facility transmits, to 
each health insurance issuer offering group or individual health 
insurance coverage and group health plan with which such provider or 
facility has in effect a contractual relationship for furnishing items 
and services under such coverage or such plan, provider directory 
information (as defined in section 2719A(g)(6)) with respect to such 
provider or facility, as applicable. Such provider or facility shall so 
transmit such information to such issuer offering such coverage or such 
group health plan--
            ``(1) when the provider or facility enters into such a 
        relationship with respect to such coverage offered by such 
        issuer or with respect to such plan;
            ``(2) when the provider or facility terminates such 
        relationship with respect to such coverage offered by such 
        issuer or with respect to such plan;
            ``(3) when there are any other material changes to such 
        provider directory information of the provider or facility with 
        respect to such coverage offered by such issuer or with respect 
        to such plan; and
            ``(4) at any other time (including upon the request of such 
        issuer or plan) determined appropriate by the provider, 
        facility, or the Secretary.

``SEC. 2799C. PROVIDER REQUIREMENT WITH RESPECT TO PUBLIC PROVISION OF 
              INFORMATION.

    ``Each health care provider and health care facility shall make 
publicly available, and (if applicable) post on a public website of 
such provider or facility--
            ``(1) information in plain language on--
                    ``(A) the requirements and prohibitions of such 
                provider or facility under sections 2799 and 2799A 
                (relating to prohibitions on balance billing in certain 
                circumstances); and
                    ``(B) if provided for under applicable State law, 
                any other requirements on such provider or facility 
                regarding the amounts such provider or facility may, 
                with respect to an item or service, charge a 
                participant, beneficiary, or enrollee of a health plan 
                (as defined in section 2719A(e)(2)) with respect to 
                which such provider or facility does not have a 
                contractual relationship for furnishing such item or 
                service under the plan after receiving payment from the 
                plan for such item or service and any applicable cost-
                sharing payment from such participant, beneficiary, or 
                enrollee; and
            ``(2) information on contacting appropriate State and 
        Federal agencies in the case that an individual believes that 
        such provider or facility has violated any requirement 
        described in paragraph (1) with respect to such individual.

``SEC. 2799D. ENFORCEMENT.

    ``(a) State Enforcement.--
            ``(1) State authority.--Each State may require a provider 
        or health care facility subject to the requirements of sections 
        2719A(f), 2799, 2799A, 2799B, or 2799C to satisfy such 
        requirements applicable to the provider or facility.
            ``(2) Failure to implement requirements.--In the case of a 
        determination by the Secretary that a State has failed to 
        substantially enforce the requirements specified in paragraph 
        (1) with respect to applicable providers and facilities in the 
        State, the Secretary shall enforce such requirements under 
        subsection (b) insofar as they relate to violations of such 
        requirements occurring in such State.
    ``(b) Secretarial Enforcement Authority.--
            ``(1) In general.--If a provider or facility is found to be 
        in violation specified in subsection (a)(1) by the Secretary, 
        the Secretary may apply a civil monetary penalty with respect 
        to such provider or facility in an amount not to exceed $10,000 
        per violation. The provisions of subsections (c), (d), (e), 
        (g), (h), (k), and (l) of section 1128A of the Social Security 
        Act shall apply to a civil monetary penalty or assessment under 
        this subsection in the same manner as such provisions apply to 
        a penalty, assessment, or proceeding under subsection (a) of 
        such section.
            ``(2) Limitation.--The provisions of paragraph (1) shall 
        apply to enforcement of a provision (or provisions) specified 
        in subsection (a)(1) only as provided under subsection (a)(2).
            ``(3) Complaint process.--The Secretary shall, through 
        rulemaking, establish a process to receive consumer complaints 
        of violations of such provisions and resolve such complaints 
        within 60 days of receipt of such complaints.
            ``(4) Exception.--The Secretary shall waive the penalties 
        described under paragraph (1) with respect to a facility or 
        provider who does not knowingly violate, and should not have 
        reasonably known it violated, section 2799 or 2799A with 
        respect to a participant, beneficiary, or enrollee, if such 
        facility or practitioner, within 30 days of the violation, 
        withdraws the bill that was in violation of such provision and 
        reimburses the health plan or enrollee, as applicable, in an 
        amount equal to the difference between the amount billed and 
        the amount allowed to be billed under the provision, plus 
        interest, at an interest rate determined by the Secretary.
            ``(5) Hardship exemption.--The Secretary may establish a 
        hardship exemption to the penalties under this subsection.
    ``(c) Continued Applicability of State Law.--The sections specified 
in subsection (a)(1) shall not be construed to supersede any provision 
of State law which establishes, implements, or continues in effect any 
requirement or prohibition except to the extent that such requirement 
or prohibition prevents the application of a requirement or prohibition 
of such a section.''.
    (e) Rulemaking for Median Contracted Rates.--Not later than July 1, 
2020, the Secretary of Health and Human Services, jointly with the 
Secretary of Labor, shall establish through rulemaking--
            (1) the methodology the sponsor or issuer of a health plan 
        (as defined in subsection (e) of section 2719A of the Public 
        Health Service Act (42 U.S.C. 300gg-19a), as added by 
        subsection (b) of this section) shall use to determine the 
        median contracted rate (as defined in section 2719A(b) of such 
        Act, as amended by subsection (a) of this section), 
        differentiating by business line;
            (2) the information such sponsor or issuer shall share with 
        the nonparticipating provider (as defined in such section) 
        involved when making such a determination; and
            (3) the geographic regions applied for purposes of 
        subparagraph (E) of section 2719A(b)(3), as amended by 
        subsection (a) of this section, taking into account the needs 
        of rural and underserved areas, including health professional 
        shortage areas.
Such rulemaking shall take into account payments that are made by such 
sponsor or issuer that are not on a fee-for-service basis. Such 
methodology may account for relevant payment adjustments that take into 
account facility type (including higher acuity settings and the case-
mix of various facility types) that are otherwise taken into account 
for purposes of determining payment amounts with respect to 
participating facilities.
    (f) Effective Date.--The amendments made by subsections (a) and (b) 
shall apply with respect to plan years beginning on or after January 1, 
2021.

SEC. 403. GOVERNMENT ACCOUNTABILITY OFFICE STUDY ON PROFIT- AND 
              REVENUE-SHARING IN HEALTH CARE.

    (a) Study.--The Comptroller General of the United States shall 
conduct a study to--
            (1) describe what is known about profit- and revenue-
        sharing relationships in the commercial health care markets, 
        including those relationships that--
                    (A) involve one or more--
                            (i) physician groups that practice within a 
                        hospital included in the profit- or revenue-
                        sharing relationship, or refer patients to such 
                        hospital;
                            (ii) laboratory, radiology, or pharmacy 
                        services that are delivered to privately 
                        insured patients of such hospital;
                            (iii) surgical services;
                            (iv) hospitals or group purchasing 
                        organizations; or
                            (v) rehabilitation or physical therapy 
                        facilities or services; and
                    (B) include revenue- or profit-sharing whether 
                through a joint venture, management or professional 
                services agreement, or other form of gain-sharing 
                contract;
            (2) describe Federal oversight of such relationships, 
        including authorities of the Department of Health and Human 
        Services and the Federal Trade Commission to review such 
        relationships and their potential to increase costs for 
        patients, and identify limitations in such oversight; and
            (3) as appropriate, make recommendations to improve Federal 
        oversight of such relationships.
    (b) Report.--Not later than 2 years after the date of the enactment 
of this Act, the Comptroller General of the United States shall prepare 
and submit a report on the study conducted under subsection (a) to the 
Committee on Health, Education, Labor, and Pensions of the Senate and 
the Committee on Education and Labor and Committee on Energy and 
Commerce of the House of Representatives.

SEC. 404. STATE ALL PAYER CLAIMS DATABASES.

    (a) In General.--The Secretary of Health and Human Services shall 
make one-time grants to eligible States for the purposes described in 
subsection (b).
    (b) Uses.--A State may use a grant received under subsection (a) 
for one of the following purposes:
            (1) To establish an All Payer Claims Database for the 
        State.
            (2) To maintain an existing All Payer Claims Databases for 
        the State.
    (c) Eligibility.--To be eligible to receive a grant under 
subsection (a), a State shall submit to the Secretary an application at 
such time, in such manner, and containing such information as the 
Secretary specifies. Such information shall include, with respect to an 
All Payer Claims Database for the State, at least specifics on how the 
State will ensure uniform data collection through the database and the 
security of such data submitted to and maintained in the database.
    (d) All Payer Claims Database.--For purposes of this section, the 
term ``All Payer Claims Database'' means, with respect to a State, a 
State database that may include medical claims, pharmacy claims, dental 
claims, and eligibility and provider files, which are collected from 
private and public payers.
    (e) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated $50,000,000, to remain 
available until expended.

SEC. 405. AIR AMBULANCE COST DATA REPORTING PROGRAM.

    (a) Cost Data Reporting Program.--
            (1) In general.--Not later than 6 months after the date of 
        the promulgation of the rule under subsection (c), and annually 
        thereafter, a provider of emergency air medical services shall 
        submit to the Secretary of Health and Human Services the 
        information specified in subsection (b) with respect to the 
        preceding 180-day period (in the case of the initial period) 
        and the preceding 1-year period (in each subsequent period).
            (2) Publication.--Not later than 180 days after the date 
        the Secretary of Health and Human Services receives from a 
        provider described in paragraph (1) the information specified 
        in subsection (b), the Secretary shall make publicly available 
        such information.
    (b) Specified Information.--Information described in subsection (a) 
is--
            (1) information, with respect to a claim for an item or 
        service--
                    (A) identified as paid by health insurance coverage 
                offered in the group or individual market or a group 
                health plan (including a self-insured plan);
                    (B) identified as paid for non-emergent transport 
                requiring prior authorization and emergent transport;
                    (C) identified as paid for hospital-affiliated 
                providers and independent providers;
                    (D) identified as paid for rural transport and 
                urban transport;
                    (E) identified as provided using rotor transport 
                and fixed wing transport; and
                    (F) identified as furnished by a provider of 
                emergency air medical services that has a contractual 
                relationship with the plan or coverage of an individual 
                for which such item or service is provided and such a 
                provider that does not have a contractual relationship 
                with the plan or coverage or such an individual; and
            (2) cost data for an air ambulance service furnished by 
        such a provider of emergency air medical services that the 
        Secretary of Health and Human Services, in consultation with 
        suppliers and providers of such services, determines 
        appropriate, separated by the cost of air travel and the cost 
        of emergency medical services and supplies.
    (c) Rulemaking.--Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
determine the form and manner for submitting the information described 
in subsection (b) through notice and comment rulemaking.
    (d) Civil Monetary Penalties.--
            (1) In general.--A provider of emergency air medical 
        services who violates the requirements of subsection (a)(1) 
        shall be subject to a civil monetary penalty of not more than 
        $10,000 for each act constituting such violation.
            (2) Procedure.--The provisions of section 1128A of the 
        Social Security Act (42 U.S.C. 1320a-7a), other than 
        subsections (a) and (b) and the first sentence of subsection 
        (c)(1) of such subsection, shall apply to civil monetary 
        penalties under this subsection in the same manner as such 
        provisions apply to a penalty or proceeding under such section.
    (e) Reporting.--
            (1) Secretary of health and human services.--Not later than 
        July 1, 2023, the Secretary of Health and Human Services shall 
        submit to Congress a report summarizing the information and 
        data specified in subsection (b).
            (2) Comptroller general.--Not later than July 1, 2023, the 
        Comptroller General of the United States shall submit to 
        Congress a report that includes--
                    (A) an analysis of the cost variation of providers 
                of emergency air ambulance services by geography and 
                status; and
                    (B) any other recommendations the Comptroller 
                General determines appropriate, which may include a 
                recommendation of an adequate amount of reimbursement 
                for such services that reflects operational costs of 
                such providers in order to preserve access to emergency 
                air ambulance services.
    (f) Limitation.--The information publicly disclosed under 
subsection (a) and the reports under subsection (f) may not contain any 
proprietary information.

SEC. 406. REPORT BY SECRETARY OF LABOR.

    Not later than one year after the date of the enactment of this 
Act, and annually thereafter for each of the following 5 years, the 
Secretary of Labor shall--
            (1) conduct a study of--
                    (A) the effects of the provisions of, including 
                amendments made by, this Act on premiums and out-of-
                pocket costs in group health plans, including out-of-
                pocket costs that are permitted by reason of compliance 
                with section 2799A(d) of the Public Health Service Act, 
                as added by section 2(d);
                    (B) the adequacy of provider networks in group 
                health plans; and
                    (C) such other effects of such provisions, and 
                amendments, as the Secretary deems relevant; and
            (2) submit a report on such study to the Committee on 
        Health, Education, Labor, and Pensions of the Senate and the 
        Committee on Education and Labor and the Committee on Energy 
        and Commerce of the House of Representatives.

SEC. 407. BILLING STATUTE OF LIMITATIONS.

    Notwithstanding any other provision of law, a health care provider 
or health care facility (or health insurance issuer offering health 
insurance coverage or group health plan) may not initiate a process to 
seek reimbursement from an individual for a service furnished by such 
provider or facility to such individual more than a year after such 
date of service. Any provider, facility, issuer, or plan that bills an 
individual in violation of the previous sentence shall be subject to a 
civil monetary penalty in such amount as specified by the Secretary of 
Health and Human Services.

SEC. 408. GAO REPORT ON IMPACT OF SURPRISE BILLING PROVISIONS.

    Not later than 3 years after the date of the enactment of this Act, 
the Comptroller General of the United States shall submit to Congress a 
report containing the following:
            (1) What is known about the impacts of the provisions of 
        this Act, including the amendments made by this Act, on the 
        incidence and prevalence of the furnishing of items and 
        services to individuals enrolled under a group health plan or 
        health insurance coverage by health care providers and health 
        care facilities that do not have a contractual relationship 
        with such plan or such coverage (as applicable) for furnishing 
        such items and services to such an individual.
            (2) What is known about such impacts on provider shortages 
        and accessibility to such providers, focusing on rural and 
        medically underserved communities.
            (3) The number of grants that have been awarded under 
        section 404 (relating to State All Payer Claims Databases) and 
        for what purposes States have used funds made available under 
        such grants.
            (4) An analysis of how data made available through State 
        All Payer Claims Databases receiving funding under such grants 
        has been used.

SEC. 409. REPORT BY THE SECRETARY OF HEALTH AND HUMAN SERVICES.

     Not later than one year after the date of the enactment of this 
Act, and annually thereafter for each of the following 5 years, the 
Secretary of Health and Human Services shall--
            (1) conduct a study of--
                    (A) the effects of the provisions of, including 
                amendments made by, this Act on premiums and out-of-
                pocket costs with respect to individual health 
                insurance coverage and small group health plans;
                    (B) the adequacy of provider networks with respect 
                to individual health insurance coverage and small group 
                health plans, taking into consideration maximum travel 
                time and distance; and
                    (C) such other effects of such provisions, and 
                amendments, as the Secretary deems relevant; and
            (2) submit a report on such study to the Committee on 
        Health, Education, Labor, and Pensions of the Senate and the 
        Committee on Education and Labor and the Committee on Energy 
        and Commerce of the House of Representatives.

            TITLE V--TERRITORIES HEALTH CARE IMPROVEMENT ACT

SEC. 501. SHORT TITLE.

    This title may be cited as the ``Territories Health Care 
Improvement Act''.

SEC. 502. MEDICAID PAYMENTS FOR PUERTO RICO AND THE OTHER TERRITORIES 
              FOR CERTAIN FISCAL YEARS.

    (a) Treatment of Cap.--Section 1108(g) of the Social Security Act 
(42 U.S.C. 1308(g)) is amended--
            (1) in paragraph (2)--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``subject to and section 1323(a)(2) of the 
                Patient Protection and Affordable Care Act paragraphs 
                (3) and (5)'' and inserting ``subject to section 
                1323(a)(2) of the Patient Protection and Affordable 
                Care Act and paragraphs (3) and (5)'';
                    (B) in subparagraph (A)--
                            (i) by striking ``Puerto Rico shall not 
                        exceed the sum of'' and inserting ``Puerto Rico 
                        shall not exceed--
                            ``(i) except as provided in clause (ii), 
                        the sum of'';
                            (ii) by striking ``$100,000;'' and 
                        inserting ``$100,000; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(ii) for each of fiscal years 2020 
                        through 2023, the amount specified in paragraph 
                        (6) for each such fiscal year;'';
                    (C) in subparagraph (B)--
                            (i) by striking ``the Virgin Islands shall 
                        not exceed the sum of'' and inserting ``the 
                        Virgin Islands shall not exceed--
                            ``(i) except as provided in clause (ii), 
                        the sum of'';
                            (ii) by striking ``$10,000;'' and inserting 
                        ``$10,000; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(ii) for each of fiscal years 2020 
                        through 2025, $126,000,000;'';
                    (D) in subparagraph (C)--
                            (i) by striking ``Guam shall not exceed the 
                        sum of'' and inserting ``Guam shall not 
                        exceed--
                            ``(i) except as provided in clause (ii), 
                        the sum of'';
                            (ii) by striking ``$10,000;'' and inserting 
                        ``$10,000; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(ii) for each of fiscal years 2020 
                        through 2025, $127,000,000;'';
                    (E) in subparagraph (D)--
                            (i) by striking ``the Northern Mariana 
                        Islands shall not exceed the sum of'' and 
                        inserting ``the Northern Mariana Islands shall 
                        not exceed--
                            ``(i) except as provided in clause (ii), 
                        the sum of''; and
                            (ii) by adding at the end the following new 
                        clause:
                            ``(ii) for each of fiscal years 2020 
                        through 2025, $60,000,000; and''; and
                    (F) in subparagraph (E)--
                            (i) by striking ``American Samoa shall not 
                        exceed the sum of'' and inserting ``American 
                        Samoa shall not exceed--
                            ``(i) except as provided in clause (ii), 
                        the sum of'';
                            (ii) by striking ``$10,000.'' and inserting 
                        ``$10,000; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(ii) for each of fiscal years 2020 
                        through 2025, $84,000,000.''; and
            (2) by adding at the end the following new paragraph:
            ``(6) Application to puerto rico for fiscal years 2020 
        through 2023.--For purposes of paragraph (2)(A)(ii), the amount 
        specified in this paragraph is--
                    ``(A) for fiscal year 2020, $2,823,188,000;
                    ``(B) for fiscal year 2021, $2,919,072,000;
                    ``(C) for fiscal year 2022, $3,012,610,000; and
                    ``(D) for fiscal year 2023, $3,114,331,000.''.
    (b) Treatment of Funding Under Enhanced Allotment Program.--Section 
1935(e) of the Social Security Act (42 U.S.C. 1396u-5(e)) is amended--
            (1) in paragraph (1)(B), by striking ``if the State'' and 
        inserting ``subject to paragraph (4), if the State'';
            (2) by redesignating paragraph (4) as paragraph (5); and
            (3) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) Treatment of funding for certain fiscal years.--
                    ``(A) Puerto rico.--Notwithstanding paragraph 
                (1)(B), in the case that Puerto Rico establishes and 
                submits to the Secretary a plan described in paragraph 
                (2) with respect to any of fiscal years 2020 through 
                2023, the amount specified in paragraph (3) for Puerto 
                Rico for such a year shall be taken into account in 
                applying subparagraph (A)(ii) of section 1108(g)(2) for 
                such year.
                    ``(B) Other territories.--Notwithstanding paragraph 
                (1)(B), in the case that the Virgin Islands, Guam, the 
                Northern Mariana Islands, or American Samoa establishes 
                and submits to the Secretary a plan described in 
                paragraph (2) with respect to any of fiscal years 2020 
                through 2025, the amount specified in paragraph (3) for 
                the Virgin Islands, Guam, the Northern Mariana Islands, 
                or American Samoa, as the case may be, shall be taken 
                into account in applying, as applicable, subparagraph 
                (B)(ii), (C)(ii), (D)(ii), or (E)(ii) of section 
                1108(g)(2) for such year.''.
    (c) Increased FMAP.--Section 1905 of the Social Security Act (42 
U.S.C. 1396d(b)) is amended--
            (1) in subsection (b), by striking ``and (aa)'' and 
        inserting ``(aa), and (ff)''; and
            (2) by adding at the end the following new subsection:
    ``(ff) Temporary Increase in FMAP for Territories for Certain 
Fiscal Years.--
            ``(1) Puerto rico.--Notwithstanding subsection (b) and 
        subject to subsection (z)(2), the Federal medical assistance 
        percentage for Puerto Rico shall be equal to--
                    ``(A) 83 percent for fiscal years 2020 and 2021; 
                and
                    ``(B) 76 percent for fiscal years 2022 and 2023.
            ``(2) Virgin islands.--Notwithstanding subsection (b) and 
        subject to subsection (z)(2), the Federal medical assistance 
        percentage for the Virgin Islands shall be equal to--
                    ``(A) 100 percent for fiscal year 2020;
                    ``(B) 83 percent for fiscal years 2021 through 
                2024; and
                    ``(C) 76 percent for fiscal year 2025.
            ``(3) Other territories.--Notwithstanding subsection (b) 
        and subject to subsection (z)(2), the Federal medical 
        assistance percentage for Guam, the Northern Mariana Islands, 
        and American Samoa shall be equal to--
                    ``(A) 100 percent for fiscal years 2020 and 2021;
                    ``(B) 83 percent for fiscal years 2022 through 
                2024; and
                    ``(C) 76 percent for fiscal year 2025.''.
    (d) Annual Report.--Section 1108(g) of the Social Security Act (42 
U.S.C. 1308(g)), as amended by subsection (a), is further amended by 
adding at the end the following new paragraph:
            ``(7) Annual report.--
                    ``(A) In general.--Not later than the date that is 
                180 days after the end of each fiscal year (beginning 
                with fiscal year 2020 and ending with fiscal year 
                2025), in the case that a specified territory receives 
                a Medicaid cap increase, or an increase in the Federal 
                medical assistance percentage for such territory under 
                section 1905(ff), for such fiscal year, such territory 
                shall submit to the Chair and Ranking Member of the 
                Committee on Energy and Commerce of the House of 
                Representatives and the Chair and Ranking Member of the 
                Committee on Finance of the Senate a report that 
                describes how such territory has used such Medicaid cap 
                increase, or such increase in the Federal medical 
                assistance percentage, as applicable, to increase 
                access to health care under the State Medicaid plan of 
                such territory under title XIX (or a waiver of such 
                plan). Such report may include--
                            ``(i) the extent to which such territory 
                        has, with respect to such plan (or waiver)--
                                    ``(I) increased payments to health 
                                care providers;
                                    ``(II) increased covered benefits;
                                    ``(III) expanded health care 
                                provider networks; or
                                    ``(IV) improved in any other manner 
                                the carrying out of such plan (or 
                                waiver); and
                            ``(ii) any other information as determined 
                        necessary by such territory.
                    ``(B) Definitions.--In this paragraph:
                            ``(i) Medicaid cap increase.--The term 
                        `Medicaid cap increase' means, with respect to 
                        a specified territory and fiscal year, any 
                        increase in the amounts otherwise determined 
                        under this subsection for such territory for 
                        such fiscal year by reason of the amendments 
                        made by section 502(a) of the Territories 
                        Health Care Improvement Act.
                            ``(ii) Specified territory.--The term 
                        `specified territory' means Puerto Rico, the 
                        Virgin Islands, Guam, the Northern Mariana 
                        Islands, and American Samoa.''.

SEC. 503. APPLICATION OF CERTAIN REQUIREMENTS UNDER MEDICAID PROGRAM TO 
              CERTAIN TERRITORIES.

    (a) Application of Payment Error Rate Measurement Requirements to 
Puerto Rico.--Section 1903(u)(4) of the Social Security Act (42 U.S.C. 
1396b(u)(4)) is amended--
            (1) by striking ``to Puerto Rico, Guam'' and inserting ``to 
        Guam''; and
            (2) by striking ``or American Samoa.'' and inserting ``or 
        American Samoa, or, for fiscal years before fiscal year 2023, 
        to Puerto Rico.''.
    (b) Application of Asset Verification Program Requirements to 
Puerto Rico and Virgin Islands.--Section 1940(a) of the Social Security 
Act (42 U.S.C. 1396w(a)) is amended--
            (1) in paragraph (3)(A), by adding at the end the following 
        new clause:
                            ``(iii) Implementation in puerto rico and 
                        virgin islands.--The Secretary shall require 
                        Puerto Rico to implement an asset verification 
                        program under this subsection by the end of 
                        fiscal year 2022 and the Virgin Islands to 
                        implement such a program by the end of fiscal 
                        year 2023.''; and
            (2) in paragraph (4)--
                    (A) in the paragraph heading, by striking 
                ``Exemption of territories'' and inserting ``Exemption 
                of certain territories''; and
                    (B) by striking ``and the District of Columbia'' 
                and inserting ``, the District of Columbia, Puerto 
                Rico, and the Virgin Islands''.
    (c) Application of Certain Data Reporting and Program Integrity 
Requirements to Northern Mariana Islands, American Samoa, and Guam.--
            (1) In general.--Section 1902 of the Social Security Act 
        (42 U.S.C. 1396a) is amended by adding at the end the following 
        new subsection:
    ``(qq) Application of Certain Data Reporting and Program Integrity 
Requirements to Northern Mariana Islands, American Samoa, and Guam.--
Not later than October 1, 2023, the Northern Mariana Islands, American 
Samoa, and Guam shall--
            ``(1) implement methods, satisfactory to the Secretary, for 
        the collection and reporting of reliable data to the 
        Transformed Medicaid Statistical Information System (T-MSIS) 
        (or a successor system); and
            ``(2) demonstrate progress in establishing a State medicaid 
        fraud control unit described in section 1903(q).''.
            (2) Conforming amendment.--Section 1902(j) of the Social 
        Security Act (42 U.S.C. 1396a(j)) is amended--
                    (A) by striking ``or the requirement'' and 
                inserting ``, the requirement''; and
                    (B) by inserting before the period at the end the 
                following: ``, or the requirement under subsection 
                (qq)(1) (relating to data reporting)''.

SEC. 504. ADDITIONAL PROGRAM INTEGRITY REQUIREMENTS.

    (a) Audit Relating to Fraud, Waste, and Abuse.--Not sooner than the 
date that is one year after the date of the enactment of this Act, the 
Inspector General of the Department of Health and Human Services 
(referred to in this section as the ``Inspector General'') shall 
conduct an audit of Puerto Rico with respect to any part of the 
administration of Puerto Rico's State plan under title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.) (or a waiver of such 
plan), such as contracting protocols, denials of care, and financial 
management, that the Inspector General determines to be at high risk 
for waste, fraud, or abuse.
    (b) Plan for Audits and Investigations of Contracting Practices.--
Not later than the date that is one year after the date of the 
enactment of this Act, the Inspector General shall develop and submit 
to Congress a plan for auditing and investigating contracting practices 
relating to Puerto Rico's State plan under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan).
    (c) Report on Contracting Oversight and Approval.--Not later than 
the date that is two years after the date of the enactment of this Act, 
the Comptroller General of the United States shall issue, and submit to 
the Chair and Ranking Member of the Committee on Energy and Commerce of 
the House of Representatives and the Chair and Ranking Member of the 
Committee on Finance of the Senate, a report on contracting oversight 
and approval with respect to Puerto Rico's State plan under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.) (or a waiver of 
such plan). Such report shall--
            (1) examine--
                    (A) the process used by Puerto Rico to evaluate 
                bids and award contracts under such plan (or waiver);
                    (B) which contracts are not subject to competitive 
                bidding or requests for proposals under such plan (or 
                waiver); and
                    (C) oversight by the Centers for Medicare & 
                Medicaid Services of contracts awarded under such plan 
                (or waiver); and
            (2) include any recommendations for Congress, the Secretary 
        of Health and Human Services, or Puerto Rico relating to 
        changes that the Inspector General determines necessary to 
        improve the program integrity of such plan (or waiver).
    (d) Reevaluation of Waivers of Medicaid Fraud Control Unit 
Requirement.--Not later than the date that is one year after the date 
of the enactment of this Act, the Secretary of Health and Human 
Services shall--
            (1) reevaluate any waiver approved (and in effect as of the 
        date of the enactment of this Act) for Guam, the Northern 
        Mariana Islands, or American Samoa under subsection (a)(61) or 
        subsection (j) of section 1902 of the Social Security Act (42 
        U.S.C. 1396a) with respect to the requirement to establish a 
        State medicaid fraud control unit (as described in section 
        1903(q) of such Act (42 U.S.C. 1396b(q)); and
            (2) determine whether any such waiver should continue to be 
        approved with respect to Guam, the Northern Mariana Islands, or 
        American Samoa, respectively, after October 1, 2023.
    (e) System for Tracking Federal Funding Provided to Puerto Rico.--
Section 1902 of the Social Security Act (42 U.S.C. 1396a), as amended 
by section 503(c), is further amended by adding at the end the 
following new subsection:
    ``(rr) Program Integrity Requirements for Puerto Rico.--
            ``(1) System for tracking federal funding provided to 
        puerto rico.--
                    ``(A) In general.--Puerto Rico shall establish and 
                maintain a system for tracking any amounts paid by the 
                Federal Government to Puerto Rico with respect to the 
                State plan of Puerto Rico (or a waiver of such plan). 
                Under such system, Puerto Rico shall ensure that 
                information is available, with respect to each quarter 
                in a fiscal year (beginning with the first quarter 
                beginning on or after the date that is one year after 
                the date of the enactment of this subsection), on the 
                following:
                            ``(i) In the case of a quarter other than 
                        the first quarter of such fiscal year--
                                    ``(I) the total amount expended by 
                                Puerto Rico during any previous quarter 
                                of such fiscal year under the State 
                                plan of Puerto Rico (or a waiver of 
                                such plan); and
                                    ``(II) a description of how such 
                                amount was so expended.
                            ``(ii) The total amount that Puerto Rico 
                        expects to expend during the quarter under the 
                        State plan of Puerto Rico (or a waiver of such 
                        plan), and a description of how Puerto Rico 
                        expects to expend such amount.
                    ``(B) Report to cms.--For each quarter with respect 
                to which Puerto Rico is required under subparagraph (A) 
                to ensure that information described in such 
                subparagraph is available, Puerto Rico shall submit to 
                the Administrator of the Centers for Medicare & 
                Medicaid Services a report on such information for such 
                quarter.
            ``(2) Submission of documentation on contracts upon 
        request.--Puerto Rico shall, upon request, submit to the 
        Administrator of the Centers for Medicare & Medicaid Services 
        all documentation requested with respect to contracts awarded 
        under the State plan of Puerto Rico (or a waiver of such 
        plan).''.
            Amend the title so as to read: ``A bill to reauthorize and 
        extend funding for critical public health programs that improve 
        access to health care and strengthen the health care workforce, 
        to extend provisions of the Medicare program, to strengthen the 
        Medicaid program in the territories, to protect health care 
        consumers from surprise billing practices, and for other 
        purposes.''.
                                                 Union Calendar No. 587

116th CONGRESS

  2d Session

                               H. R. 2328

                      [Report No. 116-332, Part I]

_______________________________________________________________________

                                 A BILL

To reauthorize and extend funding for community health centers and the 
                     National Health Service Corps.

_______________________________________________________________________

                           December 31, 2020

Committee on Transportation and Infrastructure discharged; committed to 
the Committee of the Whole House on the State of the Union and ordered 
                             to be printed
```