105 
under subsection (a), the amount that the Sec-
retary would, but for this subsection, otherwise 
pay under title XVIII for items and services 
furnished to such an individual in such State 
for such quarters. 
‘‘(4) FULL-BENEFIT
DUAL
ELIGIBLE
INDI-
VIDUAL
DEFINED.—In this subsection, the term 
‘full-benefit dual eligible individual’ means an indi-
vidual who meets the requirements of section 
1935(c)(6)(A)(ii). 
‘‘(h) AUDITS.—The Secretary shall conduct such au-
dits on the number and classification of Medicaid bene-
ficiaries under such subsections and expenditures under 
this section as may be necessary to ensure appropriate 
payments under this section. 
‘‘(i) TREATMENT OF WAIVERS.— 
‘‘(1) NO IMPACT ON CURRENT WAIVERS.—In 
the case of a waiver of requirements of this title pur-
suant to section 1115 or other law that is in effect 
as of the date of the enactment of this section, noth-
ing in this section shall be construed to affect such 
waiver for the period of the waiver as approved as 
of such date. 
‘‘(2) APPLICATION OF BUDGET NEUTRALITY TO 
SUBSEQUENT WAIVERS AND RENEWALS TAKING SEC-
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106 
TION INTO ACCOUNT.—In the case of a waiver of re-
quirements of this title pursuant to section 1115 or 
other law that is approved or renewed after the date 
of the enactment of this section, to the extent that 
such approval or renewal is conditioned upon a dem-
onstration of budget neutrality, budget neutrality 
shall be determined taking into account the applica-
tion of this section. 
‘‘(j) REPORT TO CONGRESS.—Not later than Janu-
ary 1 of the second reform year, the Secretary shall submit 
to Congress a report on the implementation of this section. 
‘‘(k) DEFINITIONS.—In this section: 
‘‘(1) IMPLEMENTATION DATE.—The term ‘im-
plementation date’ means— 
‘‘(A) July 1, 2017, if this section is en-
acted on or before July 1, 2016; or 
‘‘(B) July 1, 2018, if this section is en-
acted after July 1, 2016. 
‘‘(2) REFORM YEARS.— 
‘‘(A) The term ‘reform year’ means a fiscal 
year beginning with the first reform year. 
‘‘(B) The term ‘first reform year’ means 
the fiscal year in which the implementation date 
occurs. 
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107 
‘‘(C) The terms ‘second’, ‘third’, and suc-
cessive similar terms mean, with respect to a 
reform year, the second, third, or successive re-
form year, respectively, succeeding the first re-
form year.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) CONTINUED
APPLICATION
OF
CLAWBACK 
PROVISIONS.— 
(A) 
CONTINUED
APPLICATION.—Sub-
sections (a) and (c)(1)(C) of section 1935 of 
such Act (42 U.S.C. 1396u–5) are each amend-
ed by inserting ‘‘or 1903A(a)’’ after ‘‘1903(a)’’. 
(B) 
TECHNICAL
AMENDMENT.—Section 
1935(d)(1) of the Social Security Act (42 
U.S.C. 1396u–5(d)(1)) is amended by inserting 
‘‘except as provided in section 1903A(g)’’ after 
‘‘any other provision of this title’’. 
(2) PAYMENT RULES UNDER SECTION 1903.— 
(A) Section 1903(a) of such Act (42 
U.S.C. 1396b(a)) is amended, in the matter be-
fore paragraph (1), by inserting ‘‘and section 
1903A’’ after ‘‘except as otherwise provided in 
this section’’. 
(B) Section 1903(d) of such Act (42 
U.S.C. 1396b(d)) is amended— 
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(i) in paragraph (1), by inserting 
‘‘and under section 1903A’’ after ‘‘sub-
sections (a) and (b)’’; 
(ii) in paragraph (2)— 
(I) in subparagraph (A), by in-
serting ‘‘or section 1903A’’ after ‘‘was 
made under this section’’; and 
(II) in subparagraph (B), by in-
serting ‘‘or section 1903A’’ after 
‘‘under subsection (a)’’; 
(iii) in paragraph (4)— 
(I) by striking ‘‘under this sub-
section’’ and inserting ‘‘, with respect 
to this section or section 1903A, 
under this subsection’’; and 
(II) by striking ‘‘under this sec-
tion’’ and inserting ‘‘under the respec-
tive section’’; and 
(iv) in paragraph (5), by inserting ‘‘or 
section 1903A’’ after ‘‘overpayment under 
this section’’. 
(3) CONFORMING WAIVER AUTHORITY.—Section 
1115(a)(2)(A) of the Social Security Act (42 U.S.C. 
1315(a)(2)(A)) is amended by striking ‘‘or 1903’’ 
and inserting ‘‘1903, or 1903A’’. 
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(4) REPORT
ON
ADDITIONAL
CONFORMING 
AMENDMENTS NEEDED.—Not later than 6 months 
after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall submit 
to Congress a report that includes a description of 
any additional technical and conforming amend-
ments to law that are required to properly carry out 
this Act. 
TITLE 
V—INCREASING 
PRICE 
TRANSPARENCY AND FREE-
DOM OF PRACTICE 
SEC. 501. ENSURING ACCESS TO EMERGENCY SERVICES 
WITHOUT EXCESSIVE CHARGES FOR OUT-OF- 
NETWORK SERVICES. 
(a) IN GENERAL.—Section 1867 of the Social Secu-
rity Act (42 U.S.C. 1395dd) is amended— 
(1) in subsection (d), by adding at the end the 
following new paragraph: 
‘‘(5) ENFORCEMENT WITH RESPECT TO EXCES-
SIVE CHARGES.—A hospital, physician, or other enti-
ty that violates the requirements of subsection (j)(1) 
with respect to the furnishing of items and services 
is subject to a civil money penalty of not more than 
$25,000 for each such violation. The provisions of 
section 1128A (other than subsections (a) and (b)) 
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