II 

115TH CONGRESS 

1ST SESSION S. 284 

To amend title XVIII of the Social Security Act to prevent surprise billing 

practices, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 2, 2017 

Mr. BROWN introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to prevent 

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 ‘‘End Surprise Billing 

5 Act of 2017’’. 

6 SEC. 2. PREVENTING SURPRISE BILLING PRACTICES. 

7 (a) CONDITION OF PARTICIPATION IN MEDICARE.— 

8 Section 1866 of the Social Security Act (42 U.S.C. 

9 1395cc) is amended— 

10 (1) in subsection (a)(1)— 


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1 (A) in subparagraph (X), by striking 

2 ‘‘and’’ at the end; 

3 (B) in subparagraph (Y), by striking at 

4 the end the period and inserting ‘‘, and’’; and 

5 (C) by inserting after such subparagraph 

6 (Y) the following new subparagraph: 

7 ‘‘(Z) in the case of a hospital or critical ac8 cess hospital, to adopt and enforce a policy to 

9 ensure compliance with the requirements of 

10 paragraphs (1) and (4) of subsection (l) and to 

11 meet the requirements of such paragraphs (re12 lating to the prevention of surprise billing prac13 tices).’’; and 

14 (2) by adding at the end the following new sub15 section: 

16 ‘‘(l) REQUIREMENT FOR PURPOSES OF PREVENTING

17 SURPRISE BILLING.— 

18 ‘‘(1) IN GENERAL.—For purposes of subsection 

19 (a)(1)(Z), the requirements described in this para20 graph are, with respect to a hospital or critical ac21 cess hospital, in the case of an individual with health 

22 benefits coverage, including benefits under a group 

23 health plan or health insurance coverage offered in 

24 the group or individual market (as such terms are 

25 defined in section 2791 of the Public Health Service 


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1 Act) or under this title, title XIX, title XXI, or an2 other government-sponsored health plan or program, 

3 who seeks to be furnished items or services or is to 

4 be furnished items or services by the hospital or crit5 ical access hospital (including by a provider of serv6 ices or supplier that furnishes items or services at 

7 the hospital or critical access hospital), that the hos8 pital or critical access hospital— 

9 ‘‘(A)(i) provides to the individual (or to a 

10 representative of the individual), on the date on 

11 which the individual makes an appointment to 

12 be furnished such items or services, if applica13 ble, and on the date on which the individual is 

14 furnished such items and services, a written no15 tice specified by the Secretary through rule16 making that— 

17 ‘‘(I) contains the information required 

18 under paragraph (2); and 

19 ‘‘(II) is signed and dated by the indi20 vidual; and 

21 ‘‘(ii) retains a copy of each such notice for 

22 a period specified through rulemaking by the 

23 Secretary; and 

24 ‘‘(B) in the case that such hospital or crit25 ical access hospital (or provider of services or 


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1 supplier furnishing services at such hospital or 

2 critical access hospital) is not within the health 

3 care provider network or otherwise a partici4 pating provider of services or supplier with re5 spect to such health benefits coverage of such 

6 individual, obtains from the individual the con7 sent described in paragraph (3). 

8 ‘‘(2) INFORMATION INCLUDED IN NOTICE.— 

9 The notice described in paragraph (1)(A) shall in10 clude, with respect to an individual with health bene11 fits coverage described in paragraph (1) who seeks 

12 to be furnished items or services or is to be fur13 nished items or services by a hospital or critical ac14 cess hospital (including by a provider of services or 

15 supplier that furnishes items or services at the hos16 pital or critical access hospital), a notification of 

17 each of the following: 

18 ‘‘(A) Whether the hospital or critical ac19 cess hospital is not within the health care pro20 vider network or otherwise a participating pro21 vider of services or supplier with respect to such 

22 health benefits coverage of such individual. 

23 ‘‘(B) If the hospital or critical access hos24 pital is not within such network or otherwise 

25 such a participating provider or supplier, the 


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1 estimated amount that the hospital or critical 

2 access hospital will charge the individual for 

3 such items and services in excess of any cost 

4 sharing obligations that the individual would 

5 otherwise have under such health benefits cov6 erage for such items and services if the hospital 

7 or critical access hospital were within such net8 work or otherwise participating in such cov9 erage. 

10 ‘‘(C) Whether any of the providers of serv11 ices or suppliers furnishing items or services at 

12 the hospital or critical access hospital who will 

13 furnish the items or services to the individual 

14 are not within the health care provider network 

15 or otherwise a participating provider of services 

16 or supplier with respect to such health benefits 

17 coverage of such individual. 

18 ‘‘(D) If any of such providers of services or 

19 suppliers are not within such network or other20 wise such a participating provider or supplier, 

21 the estimated amount that such providers of 

22 services or suppliers will charge the individual 

23 for such items and services in excess of any cost 

24 sharing obligations that the individual would 

25 otherwise have for such items and services if 


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1 the providers of services or suppliers were with2 in such network or otherwise participating in 

3 such coverage. 

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

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

6 paragraph, with respect to an individual with health 

7 benefits coverage described in paragraph (1) who is 

8 to be furnished items or services by a hospital or 

9 critical access hospital (or provider of services or 

10 supplier furnishing services at such hospital or crit11 ical access hospital) that is not within the health 

12 care provider network or otherwise a participating 

13 provider of services or supplier with respect to such 

14 health benefits coverage of such individual, is a doc15 ument specified by the Secretary through rule16 making that is signed by the individual (or by a rep17 resentative of the individual) not less than 24 hours 

18 prior to the individual being furnished such items or 

19 services by such hospital, critical access hospital, 

20 provider of services, or supplier, respectively, and 

21 that— 

22 ‘‘(A) acknowledges that the individual has 

23 been— 

24 ‘‘(i) provided with a written estimate 

25 of the charge that the individual will be asVerDate Sep 11 2014 05:01 Feb 10, 2017 Jkt 069200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S284.IS S284

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1 sessed for the items or services anticipated 

2 to be furnished to the individual by the 

3 hospital, critical access hospital, provider 

4 of services, or supplier that is not within 

5 such network or otherwise such a partici6 pating provider of services or supplier; and 

7 ‘‘(ii) informed that the payment of 

8 such charge by the individual will not ac9 crue toward any limitation that the health 

10 benefits coverage places upon the annual 

11 out-of-pocket expenses to be paid by the 

12 individual or upon the in-network deduct13 ible to be paid by the individual; and 

14 ‘‘(B) documents the consent of the indi15 vidual to— 

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

17 services by such hospital, critical access 

18 hospital, provider of services, or supplier, 

19 as applicable; and 

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

21 so furnished such items or services, be 

22 charged an amount approximate to the es23 timated charge described in subparagraph 

24 (A)(i) with respect to such items or serv25 ices. 


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1 ‘‘(4) LIMITATIONS ON PAYMENT BY INDI2 VIDUAL.—For purposes of subsection (a)(1)(Z), the 

3 requirements under this paragraph are the following: 

4 ‘‘(A) IN CASE OF NONCOMPLIANCE BY

5 HOSPITALS AND CRITICAL ACCESS HOS6 PITALS.—In the case of an individual with 

7 health benefits coverage described in paragraph 

8 (1) who is furnished items or services by a hos9 pital or critical access hospital (or provider of 

10 services or supplier furnishing services at such 

11 hospital or critical access hospital) that is not 

12 within the health care provider network or oth13 erwise a participating provider of services or 

14 supplier with respect to such health benefits 

15 coverage of such individual, if the hospital or 

16 critical access hospital does not comply with the 

17 requirements of paragraph (1) with respect to 

18 the furnishing of such items or services to such 

19 individual, the hospital or critical access hos20 pital (or, as applicable, the provider of services 

21 or supplier furnishing such items or services to 

22 such individual) may not charge the individual 

23 more than the amount that the individual would 

24 have been required to pay in cost sharing if 

25 such items or services had been furnished by a 


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1 hospital or critical access hospital, as applicable 

2 (or by a provider of services or supplier, as ap3 plicable) that is within such network or that is 

4 otherwise such a participating provider of serv5 ices or supplier. 

6 ‘‘(B) IN CASE OF SAME-DAY EMERGENCY

7 SERVICES.—In the case of an individual with 

8 health benefits coverage described in paragraph 

9 (1) who is furnished items or services by a hos10 pital or critical access hospital (or provider of 

11 services or supplier furnishing services at such 

12 hospital or critical access hospital) that is not 

13 within the health care provider network or oth14 erwise a participating provider of services or 

15 supplier with respect to such health benefits 

16 coverage of such individual on the same date on 

17 which the individual makes an appointment for 

18 such items or services (or otherwise presents at 

19 the hospital or critical access hospital for such 

20 services such as in the case of items and serv21 ices furnished with respect to an emergency 

22 medical condition, as defined in section 

23 1867(e)), the hospital or critical access hospital 

24 (or, as applicable, the provider of services or 

25 supplier furnishing such items or services to 


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1 such individual) may not charge the individual 

2 more than the amount that the individual would 

3 have been required to pay in cost sharing if 

4 such items or services had been furnished by a 

5 hospital or critical access hospital, as applicable 

6 (or by a provider of services or supplier, as ap7 plicable) that is within such network or that is 

8 otherwise such a participating provider of serv9 ices or supplier.’’. 

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

11 subsection (a) shall apply with respect to agreements 

12 under section 1866(a)(1) of the Social Security Act (42 

13 U.S.C. 1395cc(a)(1)) that are filed with the Secretary of 

14 Health and Human Services on a date that is not less 

15 than 12 months after the date of the enactment of this 

16 Act. 

Æ 


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