‘‘(d) CIVIL MONEY PENALTY.—The Secretary may 
impose a civil money penalty of not more than $10,000 
for each knowing violation of subsection (a) or (b)(2) by 
a hospital or an ambulatory surgical center. The provi-
sions of subsection (i)(2) of section 351A shall apply with 
respect to civil money penalties under this subsection in 
the same manner as such provisions apply to civil money 
penalties under subsection (i)(1) of such section. 
‘‘(e) ADMINISTRATIVE PROVISIONS.— 
‘‘(1) IN
GENERAL.—The Secretary shall pre-
scribe such regulations and issue such guidelines as 
may be required to carry out this section. 
‘‘(2) CLASSIFICATION OF SERVICES.—The regu-
lations and guidelines under paragraph (1) shall in-
clude rules on the classification of different treat-
ment episodes and the assignment of items and pro-
cedures to those episodes. 
‘‘(3) COMPUTATION
OF
INSURED
INDIVIDUAL 
AVERAGE CHARGES.— 
‘‘(A) IN GENERAL.—For purposes of sub-
sections (a)(1)(B)(ii) and (a)(2)(B)(ii), an in-
sured individual average charge for a treatment 
episode, with respect to a hospital or ambula-
tory surgical center during a period, shall be 
computed as the average of the rates (including 
VerDate Sep 11 2014 
21:29 Aug 06, 2018
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H6508.IH
H6508
amozie on DSK3GDR082PROD with BILLS
any applicable copayment, coinsurance, other 
cost sharing, or other fees, such as facility fees, 
associated with treatment in the hospital or 
center) for such episode that have been nego-
tiated by the hospital or ambulatory surgical 
center, respectively, with the 5 most used health 
insurance providers for such hospital or center 
during such period. 
‘‘(B) 5 MOST USED HEALTH INSURANCE 
PROVIDERS.—For purposes of subparagraph 
(A), the 5 most used health insurance pro-
viders, with respect to a hospital or ambulatory 
surgical center during a period, are the 5 group 
health plans or insurance issuers offering health 
insurance coverage— 
‘‘(i) that have negotiated with the hos-
pital or center a rate for the treatment epi-
sode involved; and 
‘‘(ii) the enrollees of which represent 
the highest number of patients of the hos-
pital or center, respectively. 
‘‘(4) COMPUTATION OF UNINSURED INDIVIDUAL 
AVERAGE CHARGES.— 
‘‘(A) IN GENERAL.—For purposes of sub-
sections (a)(1)(B)(iii) and (a)(2)(B)(iii), an un-
VerDate Sep 11 2014 
21:29 Aug 06, 2018
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H6508.IH
H6508
amozie on DSK3GDR082PROD with BILLS
insured individual average charge for a treat-
ment episode, with respect to a hospital or am-
bulatory surgical center during a period, shall 
be computed as the average of the total 
amounts charged for such an episode for which 
care was furnished to an uninsured individual 
by such hospital or ambulatory surgical center 
during such period. 
‘‘(B) UNINSURED INDIVIDUAL DEFINED.— 
For purposes of subparagraph (A), the term 
‘uninsured individual’ means, with respect to 
care furnished to the individual by a hospital or 
ambulatory surgical center, an individual who 
does not have insurance or other third-party 
contractual benefits that provides payment for 
costs incurred for such care. 
‘‘(5) FORM OF REPORT AND NOTICE.—The reg-
ulations and guidelines under paragraph (1) shall 
specify the electronic form and manner by which a 
hospital or an ambulatory surgical center shall re-
port data under subsection (a) and the form for 
posting of notices under subsection (b)(2). 
‘‘(f) RULES OF CONSTRUCTION.— 
‘‘(1) NON-PREEMPTION
OF
STATE
LAWS.— 
Nothing in this section shall be construed as pre-
VerDate Sep 11 2014 
21:29 Aug 06, 2018
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H6508.IH
H6508
amozie on DSK3GDR082PROD with BILLS
empting or otherwise affecting any provision of 
State law relating to the disclosure of charges or 
other information for a hospital or an ambulatory 
surgical center. 
‘‘(2) CHARGES.—Nothing in this section shall 
be construed to regulate or set hospital or ambula-
tory surgical center charges. 
‘‘(g) HOSPITAL AND AMBULATORY SURGICAL CEN-
TER DEFINED.—For purposes of this section, the terms 
‘hospital’ and ‘ambulatory surgical center’ have the mean-
ing given such terms by the Secretary.’’. 
Æ 
VerDate Sep 11 2014 
21:29 Aug 06, 2018
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6301
E:\BILLS\H6508.IH
H6508
amozie on DSK3GDR082PROD with BILLS