I 

116TH CONGRESS 

1ST SESSION H. R. 3630 

To amend title XXVII of the Public Health Service Act to protect health 

care consumers from surprise billing practices, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 9, 2019 

Mr. PALLONE (for himself and Mr. WALDEN) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Education and Labor, for a period to be 

subsequently determined by the Speaker, in each case for consideration 

of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XXVII of the Public Health Service Act 

to protect health care consumers from surprise billing 

practices, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘No Surprises Act’’. 

5 SEC. 2. PREVENTING SURPRISE MEDICAL BILLS. 

6 (a) COVERAGE OF EMERGENCY SERVICES.—Section 

7 2719A(b) of the Public Health Service Act (42 U.S.C. 

8 300gg–19a(b)) is amended— 


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1 (1) in paragraph (1)— 

2 (A) in the matter preceding subparagraph 

3 (A)— 

4 (i) by striking ‘‘a group health plan, 

5 or a health insurance issuer offering group 

6 or individual health insurance issuer,’’ and 

7 inserting ‘‘a health plan (as defined in sub8 section (e)(2)(A))’’; 

9 (ii) by inserting ‘‘or, for plan year 

10 2021 or a subsequent plan year, with re11 spect to emergency services in an inde12 pendent freestanding emergency depart13 ment (as defined in paragraph (3)(D))’’ 

14 after ‘‘emergency department of a hos15 pital’’; 

16 (iii) by striking ‘‘the plan or issuer’’ 

17 and inserting ‘‘the plan’’; and 

18 (iv) by striking ‘‘paragraph (2)(B)’’ 

19 and inserting ‘‘paragraph (3)(C)’’; 

20 (B) in subparagraph (B), by inserting ‘‘or 

21 a participating emergency facility, as applica22 ble,’’ after ‘‘participating provider’’; and 

23 (C) in subparagraph (C)— 

24 (i) in the matter preceding clause (i), 

25 by inserting ‘‘by a nonparticipating proVerDate Sep 11 2014 18:15 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3630.IH H3630

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1 vider or a nonparticipating emergency fa2 cility’’ after ‘‘enrollee’’; 

3 (ii) by striking clause (i); 

4 (iii) by striking ‘‘(ii)(I) such services’’ 

5 and inserting ‘‘(i) such services’’; 

6 (iv) by striking ‘‘where the provider of 

7 services does not have a contractual rela8 tionship with the plan for the providing of 

9 services’’; 

10 (v) by striking ‘‘emergency depart11 ment services received from providers who 

12 do have such a contractual relationship 

13 with the plan; and’’ and inserting ‘‘emer14 gency services received from participating 

15 providers and participating emergency fa16 cilities with respect to such plan;’’; 

17 (vi) by striking ‘‘(II) if such services’’ 

18 and all that follows through ‘‘were pro19 vided in-network’’ and inserting the fol20 lowing: 

21 ‘‘(ii) the cost-sharing requirement (ex22 pressed as a copayment amount or coinsur23 ance rate) is not greater than the require24 ment that would apply if such services 


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1 were provided by a participating provider 

2 or a participating emergency facility;’’; and 

3 (vii) by adding at the end the fol4 lowing new clauses: 

5 ‘‘(iii) such requirement is calculated 

6 as if the total amount that would have 

7 been charged for such services by such 

8 participating provider or participating 

9 emergency facility were equal to— 

10 ‘‘(I) in the case of such services 

11 furnished in a State described in 

12 paragraph (3)(H)(ii), the median con13 tracted rate (as defined in paragraph 

14 (3)(E)(i)) for such services; and 

15 ‘‘(II) in the case of such services 

16 furnished in a State described in 

17 paragraph (3)(H)(i), the lesser of— 

18 ‘‘(aa) the amount deter19 mined by such State for such 

20 services in accordance with the 

21 method described in such para22 graph; and 

23 ‘‘(bb) the median contracted 

24 rate (as so defined) for such 

25 services; 


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1 ‘‘(iv) the health plan pays to such pro2 vider or facility, respectively, the amount 

3 by which the recognized amount (as de4 fined in paragraph (3)(H)) for such serv5 ices exceeds the cost-sharing amount for 

6 such services (as determined in accordance 

7 with clauses (ii) and (iii)); and 

8 ‘‘(v) any cost-sharing payments made 

9 by the participant, beneficiary, or enrollee 

10 with respect to such emergency services so 

11 furnished shall be counted toward any in12 network deductible or out-of-pocket maxi13 mums applied under the plan in the same 

14 manner as if such cost-sharing payments 

15 were with respect to emergency services 

16 furnished by a participating provider and a 

17 participating emergency facility; and’’; 

18 (2) by redesignating paragraph (2) as para19 graph (3); 

20 (3) by inserting after paragraph (1) the fol21 lowing new paragraph: 

22 ‘‘(2) AUDIT PROCESS FOR MEDIAN CON23 TRACTED RATES.—Not later than July 1, 2020, the 

24 Secretary shall, in consultation with appropriate 

25 State agencies, establish through rulemaking a procVerDate Sep 11 2014 18:15 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3630.IH H3630

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1 ess under which sponsors and issuers of health plans 

2 are audited to ensure that such sponsors and issuers 

3 are in compliance with the requirement of applying 

4 a median contracted rate under this section that sat5 isfies the definition under paragraph (3)(E).’’; and 

6 (4) in paragraph (3), as redesignated by para7 graph (2) of this subsection— 

8 (A) in the matter preceding subparagraph 

9 (A), by inserting ‘‘and subsections (e) and (f)’’ 

10 after ‘‘this subsection’’; 

11 (B) by redesignating subparagraphs (A) 

12 through (C) as subparagraphs (B) through (D), 

13 respectively; 

14 (C) by inserting before subparagraph (B), 

15 as redesignated by subparagraph (B) of this 

16 paragraph, the following new subparagraph: 

17 ‘‘(A) EMERGENCY DEPARTMENT OF A HOS18 PITAL.—The term ‘emergency department of a 

19 hospital’ includes a hospital outpatient depart20 ment that provides emergency services.’’; 

21 (D) by amending subparagraph (C), as re22 designated by subparagraph (B) of this para23 graph, to read as follows: 

24 ‘‘(C) EMERGENCY SERVICES.— 


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1 ‘‘(i) IN GENERAL.—The term ‘emer2 gency services’, with respect to an emer3 gency medical condition means— 

4 ‘‘(I) a medical screening exam5 ination (as required under section 

6 1867 of the Social Security Act, or as 

7 would be required under such section 

8 if such section applied to an inde9 pendent freestanding emergency de10 partment) that is within the capability 

11 of the emergency department of a hos12 pital or of an independent free13 standing emergency department, as 

14 applicable, including ancillary services 

15 routinely available to the emergency 

16 department to evaluate such emer17 gency medical condition; and 

18 ‘‘(II) within the capabilities of 

19 the staff and facilities available at the 

20 hospital or the independent free21 standing emergency department, as 

22 applicable, such further medical exam23 ination and treatment as are required 

24 under section 1867 of such Act, or as 

25 would be required under such section 


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1 if such section applied to an inde2 pendent freestanding emergency de3 partment, to stabilize the patient. 

4 ‘‘(ii) INCLUSION OF

5 POSTSTABILIZATION SERVICES.—For pur6 poses of this subsection and section 2799, 

7 in the case of an individual enrolled in a 

8 health plan who is furnished services de9 scribed in clause (i) by a provider or facil10 ity to stabilize such individual with respect 

11 to an emergency medical condition, the 

12 term ‘emergency services’ shall include 

13 such items and services in addition to 

14 those described in clause (i) that such a 

15 provider or facility determines are needed 

16 to be furnished to such individual during 

17 the visit in which such individual is so sta18 bilized after such stabilization, unless each 

19 of the following conditions are met: 

20 ‘‘(I) Such a provider or facility 

21 determines such individual is able to 

22 travel using nonmedical transpor23 tation or nonemergency medical trans24 portation. 


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1 ‘‘(II) Such provider furnishing 

2 such additional items and services is 

3 in compliance with section 2799A(d) 

4 with respect to such items and serv5 ices.’’; 

6 (E) by redesignating subparagraph (D), as 

7 redesignated by subparagraph (B) of this para8 graph, as subparagraph (I); and 

9 (F) by inserting after subparagraph (C), 

10 as redesignated by subparagraph (B) of this 

11 paragraph, the following new subparagraphs: 

12 ‘‘(D) INDEPENDENT FREESTANDING

13 EMERGENCY DEPARTMENT.—The term ‘inde14 pendent freestanding emergency department’ 

15 means a facility that— 

16 ‘‘(i) is geographically separate and 

17 distinct and licensed separately from a hos18 pital under applicable State law; and 

19 ‘‘(ii) provides emergency services. 

20 ‘‘(E) MEDIAN CONTRACTED RATE.— 

21 ‘‘(i) IN GENERAL.—The term ‘median 

22 contracted rate’ means, with respect to an 

23 item or service and a health plan (as de24 fined in subsection (e)(2)(A))— 


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1 ‘‘(I) for 2021, the median of the 

2 negotiated rates recognized by the 

3 sponsor or issuer of such plan (deter4 mined with respect to all such plans 

5 of such sponsor or such issuer) as the 

6 total maximum payment (including 

7 the cost-sharing amount imposed for 

8 such services (as determined in ac9 cordance with paragraph (1)(C)(ii) or 

10 subsection (e)(1)(A), as applicable) 

11 and the amount to be paid by the plan 

12 or issuer) under such plans in 2019 

13 for the same or a similar item or serv14 ice that is provided by a provider in 

15 the same or similar specialty and pro16 vided in the geographic region in 

17 which the item or service is furnished, 

18 consistent with the methodology es19 tablished by the Secretary under sec20 tion 2(e) of the No Surprises Act, in21 creased by the percentage increase in 

22 the consumer price index for all urban 

23 consumers (United States city aver24 age) over 2019 and 2020; and 


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1 ‘‘(II) for 2022 and each subse2 quent year, the median contracted 

3 rate for the previous year, increased 

4 by the percentage increase in the con5 sumer price index for all urban con6 sumers (United States city average) 

7 over such previous year. 

8 ‘‘(ii) SPECIAL RULE; RULE OF CON9 STRUCTION.— 

10 ‘‘(I) CERTAIN INSURERS.—The 

11 Secretary shall provide pursuant to 

12 rulemaking described in clause (ii) 

13 that— 

14 ‘‘(aa) if the sponsor or 

15 issuer of a health plan does not 

16 have sufficient information to 

17 calculate a median contracted 

18 rate for an item or service or 

19 provider type, or amount of, 

20 claims for items or services (as 

21 determined by the Secretary) 

22 provided in a particular geo23 graphic area (other than in a 

24 case described in item (bb)), such 

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1 onstrate that such sponsor or 

2 issuer will use any database free 

3 of conflicts of interest that has 

4 sufficient information reflecting 

5 allowed amounts paid to indi6 vidual health care providers for 

7 relevant services provided in the 

8 applicable geographic region 

9 (such as All Payer Claims Data10 bases (as defined in section 4(d) 

11 of the No Surprises Act) of 

12 States), and that such sponsor or 

13 issuer will use any such database 

14 to determine a median contracted 

15 rate and cover the cost of access16 ing any such database; and 

17 ‘‘(bb) in the case of a spon18 sor or issuer offering a health 

19 plan in a geographic region that 

20 did not offer any health plan in 

21 such region during 2019, such 

22 sponsor or issuer shall use a 

23 methodology established by the 

24 Secretary for determining the 

25 median contracted rate for items 


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1 and services covered by such plan 

2 for the first year in which such 

3 plan is offered in such region, 

4 and that, for each succeeding 

5 year, the median contracted rate 

6 for such items and services under 

7 such plan shall be the median 

8 contracted rate for such items 

9 and services under such plan for 

10 the previous year, increased by 

11 the percentage increase in the 

12 consumer price index for all 

13 urban consumers (United States 

14 city average) over such previous 

15 year. 

16 ‘‘(II) RULE OF CONSTRUC17 TION.—Nothing in this subparagraph 

18 shall prevent the sponsor or issuer of 

19 a health plan from establishing sepa20 rate calculations of a median con21 tracted rate under this subparagraph 

22 for items and services delivered in 

23 non-hospital facilities, including inde24 pendent freestanding emergency de25 partments. 


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1 ‘‘(F) NONPARTICIPATING EMERGENCY FA2 CILITY; PARTICIPATING EMERGENCY FACIL3 ITY.— 

4 ‘‘(i) NONPARTICIPATING EMERGENCY

5 FACILITY.—The term ‘nonparticipating 

6 emergency facility’ means, with respect to 

7 an item or service and a health plan, an 

8 emergency department of a hospital, or an 

9 independent freestanding emergency de10 partment, that does not have a contractual 

11 relationship with the plan (or, if applicable, 

12 issuer offering the plan) for furnishing 

13 such item or service under the plan. 

14 ‘‘(ii) PARTICIPATING EMERGENCY FA15 CILITY.—The term ‘participating emer16 gency facility’ means, with respect to an 

17 item or service and a health plan, an emer18 gency department of a hospital, or an inde19 pendent freestanding emergency depart20 ment, that has a contractual relationship 

21 with the plan (or, if applicable, issuer of22 fering the plan) for furnishing such item 

23 or service under the plan. 

24 ‘‘(G) NONPARTICIPATING PROVIDERS; PAR25 TICIPATING PROVIDERS.— 


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1 ‘‘(i) NONPARTICIPATING PROVIDER.— 

2 The term ‘nonparticipating provider’ 

3 means, with respect to an item or service 

4 and a health plan, a physician or other 

5 health care provider who is acting within 

6 the scope of practice of that provider’s li7 cense or certification under applicable 

8 State law and who does not have a con9 tractual relationship with the plan (or, if 

10 applicable, issuer offering the plan) for 

11 furnishing such item or service under the 

12 plan. 

13 ‘‘(ii) PARTICIPATING PROVIDER.—The 

14 term ‘participating provider’ means, with 

15 respect to an item or service and a health 

16 plan, a physician or other health care pro17 vider who is acting within the scope of 

18 practice of that provider’s license or certifi19 cation under applicable State law and who 

20 has a contractual relationship with the 

21 plan (or, if applicable, issuer offering the 

22 plan) for furnishing such item or service 

23 under the plan. 


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1 ‘‘(H) RECOGNIZED AMOUNT.—The term 

2 ‘recognized amount’ means, with respect to an 

3 item or service— 

4 ‘‘(i) in the case of such item or service 

5 furnished in a State that has in effect a 

6 State law that provides for a method for 

7 determining the amount of payment that is 

8 required to be covered by a health plan 

9 regulated by such State in the case of a 

10 participant, beneficiary, or enrollee covered 

11 under such plan and receiving such item or 

12 service from a nonparticipating provider or 

13 facility, not more than the amount deter14 mined in accordance with such law plus 

15 the cost-sharing amount imposed under the 

16 plan for such item or service (as deter17 mined in accordance with paragraph 

18 (1)(C)(ii) or subsection (e)(1)(A), as appli19 cable); or 

20 ‘‘(ii) in the case of such item or serv21 ice furnished in a State that does not have 

22 in effect such a law, an amount that is at 

23 least the median contracted rate (as de24 fined in subparagraph (E)(i) and deter25 mined in accordance with rulemaking deVerDate Sep 11 2014 18:15 Jul 15, 2019 Jkt 089200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H3630.IH H3630

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1 scribed in subparagraph (E)(ii)) for such 

2 item or service.’’. 

3 (b) COVERAGE OF NON-EMERGENCY SERVICES PER4 FORMED BY NONPARTICIPATING PROVIDERS AT CERTAIN

5 PARTICIPATING FACILITIES.—Section 2719A of the Pub6 lic Health Service Act (42 U.S.C. 300gg–19a) is amended 

7 by adding at the end the following new subsection: 

8 ‘‘(e) COVERAGE OF NON-EMERGENCY SERVICES

9 PERFORMED BY NONPARTICIPATING PROVIDERS AT CER10 TAIN PARTICIPATING FACILITIES.— 

11 ‘‘(1) IN GENERAL.—Subject to paragraph (3), 

12 in the case of items or services (other than emer13 gency services to which subsection (b) applies) fur14 nished to a participant, beneficiary, or enrollee of a 

15 health plan (as defined in paragraph (2)(A)) by a 

16 nonparticipating provider (as defined in subsection 

17 (b)(3)(G)(i)) during a visit (as defined by the Sec18 retary in accordance with paragraph (2)(C)) at a 

19 participating health care facility (as defined in para20 graph (2)(B)), with respect to such plan, the plan— 

21 ‘‘(A) shall not impose on such participant, 

22 beneficiary, or enrollee a cost-sharing amount 

23 (expressed as a copayment amount or coinsur24 ance rate) for such items and services so fur25 nished that is greater than the cost-sharing 


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1 amount that would apply under such plan had 

2 such items or services been furnished by a par3 ticipating provider (as defined in subsection 

4 (b)(3)(G)(ii)); 

5 ‘‘(B) shall calculate such cost-sharing 

6 amount as if the amount that would have been 

7 charged for such items and services by such 

8 participating provider were equal to— 

9 ‘‘(i) in the case of such items and 

10 services furnished in a State described in 

11 subsection (b)(3)(H)(ii), the median con12 tracted rate (as defined in subsection 

13 (b)(3)(E)(i)) for such items and services; 

14 and 

15 ‘‘(ii) in the case of such items and 

16 services furnished in a State described in 

17 subsection (b)(3)(H)(i), the lesser of— 

18 ‘‘(I) the amount determined by 

19 such State for such items and services 

20 in accordance with the method de21 scribed in such subsection; and 

22 ‘‘(II) the median contracted rate 

23 (as so defined) for such items and 

24 services; 


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1 ‘‘(C) shall pay to such provider furnishing 

2 such items and services to such participant, 

3 beneficiary, or enrollee the amount by which the 

4 recognized amount (as defined in subsection 

5 (b)(3)(H)) for such items and services exceeds 

6 the cost-sharing amount imposed under the 

7 plan for such items and services (as determined 

8 in accordance with subparagraphs (A) and (B)); 

9 and 

10 ‘‘(D) shall count toward any in-network 

11 deductible or out-of-pocket maximums applied 

12 under the plan any cost-sharing payments made 

13 by the participant, beneficiary, or enrollee with 

14 respect to such items and services so furnished 

15 in the same manner as if such cost-sharing pay16 ments were with respect to items and services 

17 furnished by a participating provider. 

18 ‘‘(2) DEFINITIONS.—In this subsection and 

19 subsection (b): 

20 ‘‘(A) HEALTH PLAN.—The term ‘health 

21 plan’ means a group health plan and health in22 surance coverage offered by a heath insurance 

23 issuer in the group or individual market and in24 cludes a grandfathered health plan (as defined 


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1 in section 1251(e) of the Patient Protection and 

2 Affordable Care Act). 

3 ‘‘(B) PARTICIPATING HEALTH CARE FACIL4 ITY.— 

5 ‘‘(i) IN GENERAL.—The term ‘partici6 pating health care facility’ means, with re7 spect to an item or service and a health 

8 plan, a health care facility described in 

9 clause (ii) that has a contractual relation10 ship with the plan (or, if applicable, issuer 

11 offering the plan) for furnishing such item 

12 or service. 

13 ‘‘(ii) HEALTH CARE FACILITY DE14 SCRIBED.—A health care facility described 

15 in this clause is each of the following: 

16 ‘‘(I) A hospital (as defined in 

17 1861(e) of the Social Security Act). 

18 ‘‘(II) A critical access hospital 

19 (as defined in section 1861(mm) of 

20 such Act). 

21 ‘‘(III) An ambulatory surgical 

22 center (as defined in section 

23 1833(i)(1)(A) of such Act). 

24 ‘‘(IV) A laboratory. 


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1 ‘‘(V) A radiology facility or imag2 ing center. 

3 ‘‘(C) DURING A VISIT.—The term ‘during 

4 a visit’ shall, with respect to items and services 

5 furnished to an individual at a participating 

6 health care facility, include equipment and de7 vices, telemedicine services, imaging services, 

8 laboratory services, and such other items and 

9 services as the Secretary may specify, regard10 less of whether or not the provider furnishing 

11 such items or services is at the facility. 

12 ‘‘(3) EXCEPTION.—Paragraph (1) shall not 

13 apply to a health plan in the case of items or serv14 ices (other than emergency services to which sub15 section (b) applies) furnished to a participant, bene16 ficiary, or enrollee of a health plan (as defined in 

17 paragraph (2)(A)) by a nonparticipating provider (as 

18 defined in subsection (b)(3)(G)(i)) during a visit (as 

19 defined by the Secretary in accordance with para20 graph (2)(C)) at a participating health care facility 

21 (as defined in paragraph (2)(B)) if such provider is 

22 in compliance with section 2799A(d) with respect to 

23 such items and services.’’. 

24 (c) PROVIDER DIRECTORY REQUIREMENTS; DISCLO25 SURE ON PATIENT PROTECTIONS.—Section 2719A of the 


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1 Public Health Service Act, as amended by subsection (b), 

2 is further amended by adding at the end the following new 

3 subsections: 

4 ‘‘(f) PROVIDER DIRECTORY INFORMATION REQUIRE5 MENTS.— 

6 ‘‘(1) IN GENERAL.—Not later than 1 year after 

7 the date of the enactment of this subsection, each 

8 group health plan and health insurance issuer offer9 ing group or individual health insurance coverage 

10 shall— 

11 ‘‘(A) establish the verification process de12 scribed in paragraph (2); 

13 ‘‘(B) establish the response protocol de14 scribed in paragraph (3); 

15 ‘‘(C) establish the database described in 

16 paragraph (4); and 

17 ‘‘(D) include in any print directory con18 taining provider directory information with re19 spect to such plan or such coverage the infor20 mation described in paragraph (5). 

21 ‘‘(2) VERIFICATION PROCESS.—The verification 

22 process described in this paragraph is, with respect 

23 to a group health plan or a health insurance issuer 

24 offering group or individual health insurance cov25 erage, a process under which— 


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1 ‘‘(A) not less frequently than once every 90 

2 days, such plan or such issuer (as applicable) 

3 verifies and updates the provider directory in4 formation included on the database described in 

5 paragraph (4) of such plan or issuer of each 

6 health care provider and health care facility in7 cluded in such database; and 

8 ‘‘(B) such plan or such issuer removes any 

9 such provider or facility with respect to which 

10 such plan or such issuer has been unable to 

11 verify such information during any 6-month pe12 riod. 

13 ‘‘(3) RESPONSE PROTOCOL.—The response pro14 tocol described in this paragraph is, in the case of 

15 an individual enrolled under a group health plan or 

16 group or individual health insurance coverage of17 fered by a health insurance issuer who requests in18 formation on whether a health care provider or 

19 health care facility has a contractual relationship to 

20 furnish items and services under such plan or such 

21 coverage, a protocol under which such plan or such 

22 issuer (as applicable), in the case such request is 

23 made through a telephone call— 

24 ‘‘(A) responds to such individual as soon 

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1 ness day after such call is received through a 

2 written electronic communication; and 

3 ‘‘(B) retains such communication in such 

4 individual’s file for at least 2 years following 

5 such response. 

6 ‘‘(4) DATABASE.—The database described in 

7 this paragraph is, with respect to a group health 

8 plan or health insurance issuer offering group or in9 dividual health insurance coverage, a database on 

10 the public website of such plan or issuer that con11 tains— 

12 ‘‘(A) a list of each health care provider and 

13 health care facility with which such plan or 

14 such issuer has a contractual relationship for 

15 furnishing items and services under such plan 

16 or such coverage; and 

17 ‘‘(B) provider directory information with 

18 respect to each such provider and facility. 

19 ‘‘(5) INFORMATION.—The information de20 scribed in this paragraph is, with respect to a print 

21 directory containing provider directory information 

22 with respect to a group health plan or individual or 

23 group health insurance coverage offered by a health 

24 insurance issuer, a notification that such informa25 tion contained in such directory was accurate as of 


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1 the date of publication of such directory and that an 

2 individual enrolled under such plan or such coverage 

3 should consult the database described in paragraph 

4 (4) with respect to such plan or such coverage or 

5 contact such plan or the issuer of such coverage to 

6 obtain the most current provider directory informa7 tion with respect to such plan or such coverage. 

8 ‘‘(6) DEFINITION.—For purposes of this sub9 section, the term ‘provider directory information’ in10 cludes, with respect to a group health plan and a 

11 health insurance issuer offering group or individual 

12 health insurance coverage, the name, address, spe13 cialty, and telephone number of each health care 

14 provider or health care facility with which such plan 

15 or such issuer has a contractual relationship for fur16 nishing items and services under such plan or such 

17 coverage. 

18 ‘‘(g) DISCLOSURE ON PATIENT PROTECTIONS.— 

19 Each group health plan and health insurance issuer offer20 ing group or individual health insurance coverage shall 

21 make publicly available, and (if applicable) post on a pub22 lic website of such plan or issuer— 

23 ‘‘(1) information in plain language on— 

24 ‘‘(A) the requirements and prohibitions ap25 plied under sections 2799 and 2799A (relating 


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1 to prohibitions on balance billing in certain cir2 cumstances); 

3 ‘‘(B) if provided for under applicable State 

4 law, any other requirements on providers and 

5 facilities regarding the amounts such providers 

6 and facilities may, with respect to an item or 

7 service, charge a participant, beneficiary, or en8 rollee of such plan or coverage with respect to 

9 which such a provider or facility does not have 

10 a contractual relationship for furnishing such 

11 item or service under the plan or coverage after 

12 receiving payment from the plan or coverage for 

13 such item or service and any applicable cost14 sharing payment from such participant, bene15 ficiary, or enrollee; and 

16 ‘‘(C) the requirements applied under sub17 sections (b) and (e); and 

18 ‘‘(2) information on contacting appropriate 

19 State and Federal agencies in the case that an indi20 vidual believes that such a provider or facility has 

21 violated any requirement described in paragraph (1) 

22 with respect to such individual.’’. 

23 (d) PREVENTING CERTAIN CASES OF BALANCE

24 BILLING.—Title XXVII of the Public Health Service Act 

25 is amended by adding at the end the following new part: 


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1 ‘‘PART D—PREVENTING CERTAIN CASES OF 

2 BALANCE BILLING 

3 ‘‘SEC. 2799. BALANCE BILLING IN CASES OF EMERGENCY 

4 SERVICES. 

5 ‘‘(a) IN GENERAL.—In the case of a participant, ben6 eficiary, or enrollee with benefits under a health plan who 

7 is furnished on or after January 1, 2021, emergency serv8 ices with respect to an emergency medical condition during 

9 a visit at an emergency department of a hospital or an 

10 independent freestanding emergency department— 

11 ‘‘(1) the emergency department of a hospital or 

12 independent freestanding emergency department 

13 shall not hold the participant, beneficiary, or enrollee 

14 liable for a payment amount for such emergency 

15 services so furnished that is more than the cost16 sharing amount for such services (as determined in 

17 accordance with section 2719A(b)(1)(C)(ii)); and 

18 ‘‘(2) a health care provider shall not hold such 

19 participant, beneficiary, or enrollee liable for a pay20 ment amount for an emergency service furnished to 

21 such individual by such provider with respect to such 

22 emergency medical condition and visit for which the 

23 individual receives emergency services at the hospital 

24 or emergency department that is more than the cost25 sharing amount for such services furnished by the 


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1 provider (as determined in accordance with section 

2 2719A(b)(1)(C)(ii)). 

3 ‘‘(b) DEFINITIONS.—In this section: 

4 ‘‘(1) The terms ‘emergency department of a 

5 hospital’, ‘emergency medical condition’, ‘emergency 

6 services’, and ‘independent freestanding emergency 

7 department’ have the meanings given such terms, re8 spectively, in section 2719A(b)(3). 

9 ‘‘(2) The term ‘health plan’ has the meaning 

10 given such term in section 2719A(e). 

11 ‘‘(3) The term ‘during a visit’ shall have such 

12 meaning as applied to such term for purposes of sec13 tion 2719A(e). 

14 ‘‘SEC. 2799A. BALANCE BILLING IN CASES OF NON-EMER15 GENCY SERVICES PERFORMED BY NON16 PARTICIPATING PROVIDERS AT CERTAIN 

17 PARTICIPATING FACILITIES. 

18 ‘‘(a) IN GENERAL.—Subject to subsection (b), in the 

19 case of a participant, beneficiary, or enrollee with benefits 

20 under a health plan (as defined in section 2799(b)) who 

21 is furnished on or after January 1, 2021, items or services 

22 (other than emergency services to which section 2799 ap23 plies) at a participating health care facility by a non24 participating provider, such provider shall not hold such 

25 participant, beneficiary, or enrollee liable for a payment 


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1 amount for such an item or service furnished by such pro2 vider during a visit at such facility that is more than the 

3 cost-sharing amount for such item or service (as deter4 mined in accordance with subparagraphs (A) and (B) of 

5 section 2719A(e)(1)). 

6 ‘‘(b) EXCEPTION.— 

7 ‘‘(1) IN GENERAL.—Subsection (a) shall not 

8 apply to a nonparticipating provider (other than a 

9 specified provider at a participating health care fa10 cility), with respect to items or services furnished by 

11 the provider to a participant, beneficiary, or enrollee 

12 of a health plan, if the provider is in compliance 

13 with the notice and consent requirements of sub14 section (d). 

15 ‘‘(2) SPECIFIED PROVIDER DEFINED.—For pur16 poses of paragraph (1), the term ‘specified provider’, 

17 with respect to a participating health care facility— 

18 ‘‘(A) means a facility-based provider, in19 cluding emergency medicine providers, anesthe20 siologists, pathologists, radiologists, 

21 neonatologists, assistant surgeons, hospitalists, 

22 intensivists, or other providers as determined by 

23 the Secretary; and 

24 ‘‘(B) includes, with respect to an item or 

25 service, a nonparticipating provider if there is 


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1 no participating provider at such facility who 

2 can furnish such item or service. 

3 ‘‘(c) CLARIFICATION.—In the case of a nonpartici4 pating provider (other than a specified provider at a par5 ticipating health care facility) that complies with the no6 tice and consent requirements of subsection (d) with re7 spect to an item or service (referred to in this subsection 

8 as a ‘covered item or service’), such notice and consent 

9 requirements may not be construed as applying with re10 spect to any item or service that is furnished as a result 

11 of unforeseen medical needs that arise at the time such 

12 covered item or service is furnished. 

13 ‘‘(d) COMPLIANCE WITH NOTICE AND CONSENT RE14 QUIREMENTS.— 

15 ‘‘(1) IN GENERAL.—A nonparticipating provider 

16 or nonparticipating facility is in compliance with this 

17 subsection, with respect to items or services fur18 nished by the provider or facility to a participant, 

19 beneficiary, or enrollee of a health plan, if the pro20 vider (or, if applicable, the participating health care 

21 facility on behalf of such provider) or nonpartici22 pating facility— 

23 ‘‘(A) provides to the participant, bene24 ficiary, or enrollee (or to an authorized rep25 resentative of the participant, beneficiary, or 


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1 enrollee), on the date on which the participant, 

2 beneficiary, or enrollee makes an appointment 

3 to be furnished such items or services, if appli4 cable, and on the date on which the individual 

5 is furnished such items or services— 

6 ‘‘(i) an oral explanation of the written 

7 notice described in clause (ii); and 

8 ‘‘(ii) a written notice specified, not 

9 later than July 1, 2020, by the Secretary 

10 through guidance (which shall be updated 

11 as determined necessary by the Secretary) 

12 that— 

13 ‘‘(I) contains the information re14 quired under paragraph (2); and 

15 ‘‘(II) is signed and dated by the 

16 participant, beneficiary, or enrollee (or 

17 by an authorized representative of the 

18 participant, beneficiary, or enrollee) 

19 and, with respect to items or services 

20 to be furnished by such a provider 

21 that are not poststabilization services 

22 described in section 

23 2719A(b)(3)(C)(ii), is so signed and 

24 dated not less than 72 hours prior to 

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1 rollee being furnished such items or 

2 services by such provider; and 

3 ‘‘(B) obtains from the participant, bene4 ficiary, or enrollee (or from such an authorized 

5 representative) the consent described in para6 graph (3). 

7 ‘‘(2) INFORMATION REQUIRED UNDER WRITTEN

8 NOTICE.—For purposes of paragraph (1)(A)(ii)(I), 

9 the information described in this paragraph, with re10 spect to a nonparticipating provider or nonpartici11 pating facility and a participant, beneficiary, or en12 rollee of a health plan, is each of the following: 

13 ‘‘(A) Notification, as applicable, that the 

14 health care provider is a nonparticipating pro15 vider with respect to the health plan or the 

16 health care facility is a nonparticipating facility 

17 with respect to the health plan. 

18 ‘‘(B) Notification of the estimated amount 

19 that such provider or facility may charge the 

20 participant, beneficiary, or enrollee for such 

21 items and services involved. 

22 ‘‘(C) In the case of a nonparticipating fa23 cility, a list of any participating providers at the 

24 facility who are able to furnish such items and 

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1 ticipant, beneficiary, or enrollee may be re2 ferred, at their option, to such a participating 

3 provider. 

4 ‘‘(3) CONSENT DESCRIBED.—For purposes of 

5 paragraph (1)(B), the consent described in this 

6 paragraph, with respect to a participant, beneficiary, 

7 or enrollee of a health plan who is to be furnished 

8 items or services by a nonparticipating provider or 

9 nonparticipating facility, is a document specified by 

10 the Secretary through rulemaking that— 

11 ‘‘(A) is signed by the participant, bene12 ficiary, or enrollee (or by an authorized rep13 resentative of the participant, beneficiary, or 

14 enrollee) and, with respect to items or services 

15 to be furnished by such a provider or facility 

16 that are not poststabilization services described 

17 in section 2719A(b)(3)(C)(ii), is so signed not 

18 less than 72 hours prior to the participant, ben19 eficiary, or enrollee being furnished such items 

20 or services by such provider or facility; 

21 ‘‘(B) acknowledges that the participant, 

22 beneficiary, or enrollee has been— 

23 ‘‘(i) provided with a written estimate 

24 and an oral explanation of the charge that 

25 the participant, beneficiary, or enrollee will 


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1 be assessed for the items or services antici2 pated to be furnished to the participant, 

3 beneficiary, or enrollee by such provider or 

4 facility; and 

5 ‘‘(ii) informed that the payment of 

6 such charge by the participant, beneficiary, 

7 or enrollee may not accrue toward meeting 

8 any limitation that the health plan places 

9 on cost-sharing; and 

10 ‘‘(C) documents the consent of the partici11 pant, beneficiary, or enrollee to— 

12 ‘‘(i) be furnished with such items or 

13 services by such provider or facility; and 

14 ‘‘(ii) in the case that the individual is 

15 so furnished such items or services, be 

16 charged an amount that may be greater 

17 than the amount that would otherwise be 

18 charged the individual if furnished by a 

19 participating provider or participating fa20 cility with respect to such items or services 

21 and plan. 

22 ‘‘(e) RETENTION OF CERTAIN DOCUMENTS.—A non23 participating provider (or, in the case of a nonpartici24 pating provider at a participating health care facility, such 

25 facility) or nonparticipating facility that obtains from a 


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1 participant, beneficiary, or enrollee of a health plan (or 

2 an authorized representative of such participant, bene3 ficiary, or enrollee) a written notice in accordance with 

4 subsection (c)(1)(ii), with respect to furnishing an item 

5 or service to such participant, beneficiary, or enrollee, 

6 shall retain such notice for at least a 2-year period after 

7 the date on which such item or service is so furnished. 

8 ‘‘(f) DEFINITIONS.—In this section: 

9 ‘‘(1) The terms ‘nonparticipating provider’ and 

10 ‘participating provider’ have the meanings given 

11 such terms, respectively, in subsection (b)(3) of sec12 tion 2719A. 

13 ‘‘(2) The terms ‘participating health care facil14 ity’ and ‘health plan’ have the meanings given such 

15 terms, respectively, in subsection (e)(2) of section 

16 2719A. 

17 ‘‘(3) The term ‘nonparticipating facility’ 

18 means— 

19 ‘‘(A) with respect to emergency services (as 

20 defined in section 2719A(b)(3)(C)(i)) and a 

21 health plan, an emergency department of a hos22 pital, or an independent freestanding emergency 

23 department, that does not have a contractual 

24 relationship with the plan (or, if applicable, 


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1 issuer offering the plan) for furnishing such 

2 services under the plan; and 

3 ‘‘(B) with respect to poststabilization serv4 ices described in section 2719A(b)(3)(C)(ii) and 

5 a health plan, an emergency department of a 

6 hospital (or other department of such hospital), 

7 or an independent freestanding emergency de8 partment, that does not have a contractual rela9 tionship with the plan (or, if applicable, issuer 

10 offering the plan) for furnishing such services 

11 under the plan. 

12 ‘‘(4) The term ‘participating facility’ means— 

13 ‘‘(A) with respect to emergency services (as 

14 defined in section 2719A(b)(3)(C)(i)) and a 

15 health plan, an emergency department of a hos16 pital, or an independent freestanding emergency 

17 department, that has a contractual relationship 

18 with the plan (or, if applicable, issuer offering 

19 the plan) for furnishing such services under the 

20 plan; and 

21 ‘‘(B) with respect to poststabilization serv22 ices described in section 2719A(b)(3)(C)(ii) and 

23 a health plan, an emergency department of a 

24 hospital (or other department of such hospital), 

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1 partment, that has a contractual relationship 

2 with the plan (or, if applicable, issuer offering 

3 the plan) for furnishing such services under the 

4 plan. 

5 ‘‘SEC. 2799B. PROVIDER REQUIREMENTS WITH RESPECT TO 

6 PROVIDER DIRECTORY INFORMATION. 

7 ‘‘Not later than 1 year after the date of the enact8 ment of this section, each health care provider and health 

9 care facility shall establish a process under which such 

10 provider or facility transmits, to each health insurance 

11 issuer offering group or individual health insurance cov12 erage and group health plan with which such provider or 

13 facility has in effect a contractual relationship for fur14 nishing items and services under such coverage or such 

15 plan, provider directory information (as defined in section 

16 2719A(f)(6)) with respect to such provider or facility, as 

17 applicable. Such provider or facility shall so transmit such 

18 information to such issuer offering such coverage or such 

19 group health plan— 

20 ‘‘(1) when the provider or facility enters into 

21 such a relationship with respect to such coverage of22 fered by such issuer or with respect to such plan; 

23 ‘‘(2) when the provider or facility terminates 

24 such relationship with respect to such coverage of25 fered by such issuer or with respect to such plan; 


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1 ‘‘(3) when there are any other material changes 

2 to such provider directory information of the pro3 vider or facility with respect to such coverage offered 

4 by such issuer or with respect to such plan; and 

5 ‘‘(4) at any other time determined appropriate 

6 by the provider, facility, or the Secretary. 

7 ‘‘SEC. 2799C. PROVIDER REQUIREMENT WITH RESPECT TO 

8 PUBLIC PROVISION OF INFORMATION. 

9 ‘‘Each health care provider and health care facility 

10 shall make publicly available, and (if applicable) post on 

11 a public website of such provider or facility— 

12 ‘‘(1) information in plain language on— 

13 ‘‘(A) the requirements and prohibitions of 

14 such provider or facility under sections 2799 

15 and 2799A (relating to prohibitions on balance 

16 billing in certain circumstances); and 

17 ‘‘(B) if provided for under applicable State 

18 law, any other requirements on such provider or 

19 facility regarding the amounts such provider or 

20 facility may, with respect to an item or service, 

21 charge a participant, beneficiary, or enrollee of 

22 a health plan (as defined in section 

23 2719A(e)(2)) with respect to which such pro24 vider or facility does not have a contractual re25 lationship for furnishing such item or service 


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1 under the plan after receiving payment from 

2 the plan for such item or service and any appli3 cable cost-sharing payment from such partici4 pant, beneficiary, or enrollee; and 

5 ‘‘(2) information on contacting appropriate 

6 State and Federal agencies in the case that an indi7 vidual believes that such provider or facility has vio8 lated any requirement described in paragraph (1) 

9 with respect to such individual. 

10 ‘‘SEC. 2799D. ENFORCEMENT. 

11 ‘‘(a) STATE ENFORCEMENT.— 

12 ‘‘(1) STATE AUTHORITY.—Each State may re13 quire a provider or health care facility subject to the 

14 requirements of sections 2799, 2799A, 2799B, or 

15 2799C to satisfy such requirements applicable to the 

16 provider or facility. 

17 ‘‘(2) FAILURE TO IMPLEMENT REQUIRE18 MENTS.—In the case of a State that fails to sub19 stantially enforce the requirements set forth in this 

20 part with respect to applicable providers and facili21 ties in the State, the Secretary shall enforce the re22 quirements of this part under subsection (b) insofar 

23 as they relate to actions prohibited under this part 

24 occurring in such State. 

25 ‘‘(b) SECRETARIAL ENFORCEMENT AUTHORITY.— 


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1 ‘‘(1) IN GENERAL.—If a provider or facility is 

2 found to be in violation of this part by the Sec3 retary, the Secretary may apply a civil monetary 

4 penalty with respect to such provider or facility in 

5 an amount not to exceed $10,000 per violation. The 

6 provisions of subsections (c), (d), (e), (g), (h), (k), 

7 and (l) of section 1128A of the Social Security Act 

8 shall apply to a civil monetary penalty or assessment 

9 under this subsection in the same manner as such 

10 provisions apply to a penalty, assessment, or pro11 ceeding under subsection (a) of such section. 

12 ‘‘(2) LIMITATION.—The provisions of para13 graph (1) shall apply to enforcement of a provision 

14 (or provisions) of this part only as provided under 

15 subsection (a)(2). 

16 ‘‘(3) COMPLAINT PROCESS.—The Secretary 

17 shall, through rulemaking, establish a process to re18 ceive consumer complaints of violations of this part 

19 and resolve such complaints within 60 days of re20 ceipt of such complaints. 

21 ‘‘(4) EXCEPTION.—The Secretary shall waive 

22 the penalties described under paragraph (1) with re23 spect to a facility or provider who does not know24 ingly violate, and should not have reasonably known 

25 it violated, a provision of this part with respect to 


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1 a participant, beneficiary, or enrollee, if such facility 

2 or practitioner, within 30 days of the violation, with3 draws the bill that was in violation of such provision, 

4 and reimburses the health plan or enrollee, as appli5 cable, in an amount equal to the difference between 

6 the amount billed and the amount allowed to be 

7 billed under the provision, plus interest, at an inter8 est rate determined by the Secretary. 

9 ‘‘(5) HARDSHIP EXEMPTION.—The Secretary 

10 may establish a hardship exemption to the penalties 

11 under this subsection. 

12 ‘‘(c) CONTINUED APPLICABILITY OF STATE LAW.— 

13 This part shall not be construed to supersede any provi14 sion of State law which establishes, implements, or con15 tinues in effect any requirement or prohibition except to 

16 the extent that such requirement or prohibition prevents 

17 the application of a requirement or prohibition of this 

18 part.’’. 

19 (e) RULEMAKING FOR MEDIAN CONTRACTED

20 RATES.—Not later than July 1, 2020, the Secretary of 

21 Health and Human Services, jointly with the Secretary of 

22 Labor, shall establish through rulemaking the method23 ology the sponsor or issuer of a health plan (as defined 

24 in subsection (e) of section 2719A of the Public Health 

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1 section (b) of this section) shall use to determine the me2 dian contracted rate (as defined in section 2719A(b) of 

3 such Act, as amended by subsection (a) of this section), 

4 the information such sponsor or issuer shall share with 

5 the nonparticipating provider (as defined in such section) 

6 involved when making such a determination, and the geo7 graphic regions applied for purposes of this subparagraph 

8 (E) of section 2719A(b)(3), as amended by subsection (a) 

9 of this section. 

10 (f) EFFECTIVE DATE.—The amendments made by 

11 subsections (a) and (b) shall apply with respect to plan 

12 years beginning on or after January 1, 2021. 

13 SEC. 3. GOVERNMENT ACCOUNTABILITY OFFICE STUDY ON 

14 PROFIT- AND REVENUE-SHARING IN HEALTH 

15 CARE. 

16 (a) STUDY.—Not later than 1 year after the date of 

17 enactment of this Act, the Comptroller General of the 

18 United States shall conduct a study to— 

19 (1) describe what is known about profit- and 

20 revenue-sharing relationships in the commercial 

21 health care markets, including those relationships 

22 that— 

23 (A) involve one or more— 

24 (i) physician groups that practice 

25 within a hospital included in the profit- or 


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1 revenue-sharing relationship, or refer pa2 tients to such hospital; 

3 (ii) laboratory, radiology, or pharmacy 

4 services that are delivered to privately in5 sured patients of such hospital; 

6 (iii) surgical services; 

7 (iv) hospitals or group purchasing or8 ganizations; or 

9 (v) rehabilitation or physical therapy 

10 facilities or services; and 

11 (B) include revenue- or profit-sharing 

12 whether through a joint venture, management 

13 or professional services agreement, or other 

14 form of gain-sharing contract; 

15 (2) describe Federal oversight of such relation16 ships, including authorities of the Department of 

17 Health and Human Services and the Federal Trade 

18 Commission to review such relationships and their 

19 potential to increase costs for patients, and identify 

20 limitations in such oversight; and 

21 (3) as appropriate, make recommendations to 

22 improve Federal oversight of such relationships. 

23 (b) REPORT.—Not later than 1 year after the date 

24 of enactment of this Act, the Comptroller General of the 

25 United States shall prepare and submit a report on the 


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1 study conducted under subsection (a) to the Committee 

2 on Health, Education, Labor, and Pensions of the Senate 

3 and the Committee on Education and Labor and Com4 mittee on Energy and Commerce of the House of Rep5 resentatives. 

6 SEC. 4. STATE ALL PAYER CLAIMS DATABASES. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services shall make one-time grants to eligible 

9 States for the purposes described in subsection (b). 

10 (b) USES.—A State may use a grant received under 

11 subsection (a) for one of the following purposes: 

12 (1) To establish an All Payer Claims Database 

13 for the State. 

14 (2) To maintain an existing All Payer Claims 

15 Databases for the State. 

16 (c) ELIGIBILITY.—To be eligible to receive a grant 

17 under subsection (a), a State shall submit to the Secretary 

18 an application at such time, in such manner, and con19 taining such information as the Secretary specifies. Such 

20 information shall include, with respect to an All Payer 

21 Claims Database for the State, at least specifics on how 

22 the State will ensure uniform data collection through the 

23 database and the security of such data submitted to and 

24 maintained in the database. 


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1 (d) ALL PAYER CLAIMS DATABASE.—For purposes 

2 of this section, the term ‘‘All Payer Claims Database’’ 

3 means, with respect to a State, a State database that may 

4 include medical claims, pharmacy claims, dental claims, 

5 and eligibility and provider files, which are collected from 

6 private and public payers. 

7 (e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

8 out this section, there are authorized to be appropriated 

9 $50,000,000, to remain available until expended. 

10 SEC. 5. SIMPLIFYING EMERGENCY AIR AMBULANCE BILL11 ING. 

12 (a) IN GENERAL.—Providers of emergency air med13 ical services shall submit to a group health plan or health 

14 insurance issuer offering group or individual health insur15 ance coverage, together with an electronic claims trans16 action with respect to an enrollee in such plan or coverage, 

17 a description of charges for such services that are sepa18 rated by— 

19 (1) the cost of air travel; and 

20 (2) the cost of emergency medical services and 

21 supplies. 

22 (b) RULEMAKING.—Not later than 1 year after the 

23 date of the enactment of this Act, the Secretary of Health 

24 and Human Services shall determine the form and manner 


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1 for submitting the description of charges in subsection (a) 

2 through notice and comment rulemaking. 

3 (c) CIVIL MONETARY PENALTIES.— 

4 (1) IN GENERAL.—A provider of emergency air 

5 medical services who violates the requirement of sub6 section (a) shall be subject to a civil monetary pen7 alty of not more than $10,000 for each act consti8 tuting such violation. 

9 (2) PROCEDURE.—The provisions of section 

10 1128A of the Social Security Act (42 U.S.C. 1320a– 

11 7a), other than subsections (a) and (b) and the first 

12 sentence of subsection (c)(1) of such section, shall 

13 apply to civil money penalties under this subsection 

14 in the same manner as such provisions apply to a 

15 penalty or proceeding under section 1128A of the 

16 Social Security Act. 

17 (d) DEFINITIONS.—In this section, the terms ‘‘group 

18 health plan’’, ‘‘health insurance coverage’’, and ‘‘health in19 surance issuer’’ have the meanings given such terms in 

20 section 2791 of the Public Health Service Act (42 U.S.C. 

21 300gg–91). 

22 (e) EFFECTIVE DATE.—The requirement under sub23 section (a) shall take effect 6 months after the rules de24 scribed in subsection (b) are finalized. 


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1 SEC. 6. REPORT BY SECRETARY OF LABOR. 

2 Not later than one year after the date of the enact3 ment of this Act, and annually thereafter for each of the 

4 following 5 years, the Secretary of Labor shall— 

5 (1) conduct a study of— 

6 (A) the effects of the provisions of, includ7 ing amendments made by, this Act on pre8 miums and out-of-pocket costs in group health 

9 plans, including out-of-pocket costs that are 

10 permitted by reason of compliance with section 

11 2799A(d) of the Public Health Service Act, as 

12 added by section 2(d); 

13 (B) the adequacy of provider networks in 

14 group health plans; and 

15 (C) such other effects of such provisions, 

16 and amendments, as the Secretary deems rel17 evant; and 

18 (2) submit a report on such study to the Com19 mittee on Health, Education, Labor, and Pensions 

20 of the Senate and the Committee on Education and 

21 Labor and the Committee on Energy and Commerce 

22 of the House of Representatives. 

Æ 


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