H. R. 133—1652 
‘‘(2) INDEPENDENT DISPUTE RESOLUTION PROCESS AVAILABLE 
IN CASE OF FAILED OPEN NEGOTIATIONS.— 
‘‘(A) ESTABLISHMENT.—Not later than 1 year after the 
date of the enactment of this subsection, the Secretary, 
jointly with the Secretary of Labor and the Secretary of 
the Treasury, shall establish by regulation one independent 
dispute resolution process (referred to in this subsection 
as the ‘IDR process’) under which, in the case of air ambu-
lance services with respect to which a provider or group 
health plan or health insurance issuer offering group or 
individual health insurance coverage submits a notification 
under paragraph (1)(B) (in this subsection referred to as 
a ‘qualified IDR air ambulance services’), a certified IDR 
entity under paragraph (4) determines, subject to subpara-
graph (B) and in accordance with the succeeding provisions 
of this subsection, the amount of payment under the plan 
or coverage for such services furnished by such provider. 
‘‘(B) AUTHORITY TO CONTINUE NEGOTIATIONS.—Under 
the independent dispute resolution process, in the case 
that the parties to a determination for qualified IDR air 
ambulance services agree on a payment amount for such 
services during such process but before the date on which 
the entity selected with respect to such determination 
under paragraph (4) makes such determination under para-
graph (5), such amount shall be treated for purposes of 
section 2799A–1(a)(3)(K)(ii) as the amount agreed to by 
such parties for such services. In the case of an agreement 
described in the previous sentence, the independent dispute 
resolution process shall provide for a method to determine 
how to allocate between the parties to such determination 
the payment of the compensation of the entity selected 
with respect to such determination. 
‘‘(C) CLARIFICATION.—A nonparticipating provider may 
not, with respect to an item or service furnished by such 
provider, submit a notification under paragraph (1)(B) if 
such provider is exempt from the requirement under sub-
section (a) of section 2799B–2 with respect to such item 
or service pursuant to subsection (b) of such section. 
‘‘(3) TREATMENT OF BATCHING OF SERVICES.—The provisions 
of section 2799A–1(c)(3) shall apply with respect to a notifica-
tion submitted under this subsection with respect to air ambu-
lance services in the same manner and to the same extent 
such provisions apply with respect to a notification submitted 
under section 2799A–1(c) with respect to items and services 
described in such section. 
‘‘(4) IDR ENTITIES.— 
‘‘(A) ELIGIBILITY.—An IDR entity certified under this 
subsection is an IDR entity certified under section 2799A– 
1(c)(4). 
‘‘(B) SELECTION OF CERTIFIED IDR ENTITY.—The provi-
sions of subparagraph (F) of section 2799A–1(c)(4) shall 
apply with respect to selecting an IDR entity certified 
pursuant to subparagraph (A) with respect to the deter-
mination of the amount of payment under this subsection 
of air ambulance services in the same manner as such 
provisions apply with respect to selecting an IDR entity
H. R. 133—1653 
certified under such section with respect to the determina-
tion of the amount of payment under section 2799A–1(c) 
of an item or service. An entity selected pursuant to the 
previous sentence to make a determination described in 
such sentence shall be referred to in this subsection as 
the ‘certified IDR entity’ with respect to such determina-
tion. 
‘‘(5) PAYMENT DETERMINATION.— 
‘‘(A) IN GENERAL.—Not later than 30 days after the 
date of selection of the certified IDR entity with respect 
to a determination for qualified IDR ambulance services, 
the certified IDR entity shall— 
‘‘(i) taking into account the considerations specified 
in subparagraph (C), select one of the offers submitted 
under subparagraph (B) to be the amount of payment 
for such services determined under this subsection for 
purposes of subsection (a)(3); and 
‘‘(ii) notify the provider or facility and the group 
health plan or health insurance issuer offering group 
or individual health insurance coverage party to such 
determination of the offer selected under clause (i). 
‘‘(B) SUBMISSION OF OFFERS.—Not later than 10 days 
after the date of selection of the certified IDR entity with 
respect to a determination for qualified IDR air ambulance 
services, the provider and the group health plan or health 
insurance issuer offering group or individual health insur-
ance coverage party to such determination— 
‘‘(i) shall each submit to the certified IDR entity 
with respect to such determination— 
‘‘(I) an offer for a payment amount for such 
services furnished by such provider; and 
‘‘(II) such information as requested by the cer-
tified IDR entity relating to such offer; and 
‘‘(ii) may each submit to the certified IDR entity 
with respect to such determination any information 
relating to such offer submitted by either party, 
including information relating to any circumstance 
described in subparagraph (C)(ii). 
‘‘(C) CONSIDERATIONS IN DETERMINATION.— 
‘‘(i) IN GENERAL.—In determining which offer is 
the payment to be applied pursuant to this paragraph, 
the certified IDR entity, with respect to the determina-
tion for a qualified IDR air ambulance service shall 
consider— 
‘‘(I) the qualifying payment amounts (as 
defined in section 2799A–1(a)(3)(E)) for the 
applicable year for items or services that are com-
parable to the qualified IDR air ambulance service 
and that are furnished in the same geographic 
region (as defined by the Secretary for purposes 
of such subsection) as such qualified IDR air ambu-
lance service; and 
‘‘(II) subject to clause (iii), information on any 
circumstance described in clause (ii), such informa-
tion as requested in subparagraph (B)(i)(II), and 
any additional information provided in subpara-
graph (B)(ii).
H. R. 133—1654 
‘‘(ii) ADDITIONAL CIRCUMSTANCES.—For purposes of 
clause (i)(II), the circumstances described in this clause 
are, with respect to air ambulance services included 
in the notification submitted under paragraph (1)(B) 
of a nonparticipating provider, group health plan, or 
health insurance issuer the following: 
‘‘(I) The quality and outcomes measurements 
of the provider that furnished such services. 
‘‘(II) The acuity of the individual receiving 
such services or the complexity of furnishing such 
services to such individual. 
‘‘(III) The training, experience, and quality of 
the medical personnel that furnished such services. 
‘‘(IV) Ambulance vehicle type, including the 
clinical capability level of such vehicle. 
‘‘(V) Population density of the pick up location 
(such as urban, suburban, rural, or frontier). 
‘‘(VI) Demonstrations of good faith efforts (or 
lack of good faith efforts) made by the nonpartici-
pating provider or nonparticipating facility or the 
plan or issuer to enter into network agreements 
and, if applicable, contracted rates between the 
provider and the plan or issuer, as applicable, 
during the previous 4 plan years. 
‘‘(iii) PROHIBITION ON CONSIDERATION OF CERTAIN 
FACTORS.—In determining which offer is the payment 
amount to be applied with respect to qualified IDR 
air ambulance services furnished by a provider, the 
certified IDR entity with respect to such determination 
shall not consider usual and customary charges, the 
amount that would have been billed by such provider 
with respect to such services had the provisions of 
section 2799B–5 not applied, or the payment or 
reimbursement rate for such services furnished by such 
provider payable by a public payor, including under 
the Medicare program under title XVIII of the Social 
Security Act, under the Medicaid program under title 
XIX of such Act, under the Children’s Health Insurance 
Program under title XXI of such Act, under the 
TRICARE program under chapter 55 of title 10, United 
States Code, or under chapter 17 of title 38, United 
States Code. 
‘‘(D) EFFECTS OF DETERMINATION.—The provisions of 
section 2799A–1(c)(5)(E)) shall apply with respect to a 
determination of a certified IDR entity under subparagraph 
(A), the notification submitted with respect to such deter-
mination, the services with respect to such notification, 
and the parties to such notification in the same manner 
as such provisions apply with respect to a determination 
of a certified IDR entity under section 2799A–1(c)(5)(E), 
the notification submitted with respect to such determina-
tion, the items and services with respect to such notifica-
tion, and the parties to such notification. 
‘‘(E) COSTS
OF
INDEPENDENT
DISPUTE
RESOLUTION 
PROCESS.—The provisions of section 2799A–1(c)(5)(F) shall 
apply to a notification made under this subsection, the 
parties to such notification, and a determination under
H. R. 133—1655 
subparagraph (A) in the same manner and to the same 
extent such provisions apply to a notification under section 
2799A–1(c), the parties to such notification and a deter-
mination made under section 2799A–1(c)(5)(A). 
‘‘(6) TIMING OF PAYMENT.—The total plan or coverage pay-
ment required pursuant to subsection (a)(3), with respect to 
qualified IDR air ambulance services for which a determination 
is made under paragraph (5)(A) or with respect to an air 
ambulance service for which a payment amount is determined 
under open negotiations under paragraph (1), shall be made 
directly to the nonparticipating provider not later than 30 days 
after the date on which such determination is made. 
‘‘(7) PUBLICATION OF INFORMATION RELATING TO THE IDR 
PROCESS.— 
‘‘(A) IN GENERAL.—For each calendar quarter in 2022 
and each calendar quarter in a subsequent year, the Sec-
retary shall publish on the public website of the Depart-
ment of Health and Human Services— 
‘‘(i) the number of notifications submitted under 
the IDR process during such calendar quarter; 
‘‘(ii) the number of such notifications with respect 
to which a final determination was made under para-
graph (5)(A); 
‘‘(iii) the information described in subparagraph 
(B) with respect to each notification with respect to 
which such a determination was so made. 
‘‘(iv) the number of times the payment amount 
determined (or agreed to) under this subsection exceeds 
the qualifying payment amount; 
‘‘(v) the amount of expenditures made by the Sec-
retary during such calendar quarter to carry out the 
IDR process; 
‘‘(vi) the total amount of fees paid under paragraph 
(8) during such calendar quarter; and 
‘‘(vii) the total amount of compensation paid to 
certified IDR entities under paragraph (5)(E)during 
such calendar quarter. 
‘‘(B) INFORMATION WITH RESPECT TO REQUESTS.—For 
purposes of subparagraph (A), the information described 
in this subparagraph is, with respect to a notification under 
the IDR process of a nonparticipating provider, group 
health plan, or health insurance issuer offering group or 
individual health insurance coverage— 
‘‘(i) a description of each air ambulance service 
included in such notification; 
‘‘(ii) the geography in which the services included 
in such notification were provided; 
‘‘(iii) the amount of the offer submitted under para-
graph (2) by the group health plan or health insurance 
issuer (as applicable) and by the nonparticipating pro-
vider expressed as a percentage of the qualifying pay-
ment amount; 
‘‘(iv) whether the offer selected by the certified 
IDR entity under paragraph (5) to be the payment 
applied was the offer submitted by such plan or issuer 
(as applicable) or by such provider and the amount
H. R. 133—1656 
of such offer so selected expressed as a percentage 
of the qualifying payment amount; 
‘‘(v) ambulance vehicle type, including the clinical 
capability level of such vehicle; 
‘‘(vi) the identity of the group health plan or health 
insurance issuer or air ambulance provider with 
respect to such notification; 
‘‘(vii) the length of time in making each determina-
tion; 
‘‘(viii) the compensation paid to the certified IDR 
entity with respect to the settlement or determination; 
and 
‘‘(ix) any other information specified by the Sec-
retary. 
‘‘(C) IDR ENTITY REQUIREMENTS.—For 2022 and each 
subsequent year, an IDR entity, as a condition of certifi-
cation as an IDR entity, shall submit to the Secretary 
such information as the Secretary determines necessary 
for the Secretary to carry out the provisions of this para-
graph. 
‘‘(D) CLARIFICATION.—The Secretary shall ensure the 
public reporting under this paragraph does not contain 
information that would disclose privileged or confidential 
information of a group health plan or health insurance 
issuer offering group or individual health insurance cov-
erage or of a provider or facility. 
‘‘(8) ADMINISTRATIVE FEE.— 
‘‘(A) IN GENERAL.—Each party to a determination under 
paragraph (5) to which an entity is selected under para-
graph (4) in a year shall pay to the Secretary, at such 
time and in such manner as specified by the Secretary, 
a fee for participating in the IDR process with respect 
to such determination in an amount described in subpara-
graph (B) for such year. 
‘‘(B) AMOUNT OF FEE.—The amount described in this 
subparagraph for a year is an amount established by the 
Secretary in a manner such that the total amount of fees 
paid under this paragraph for such year is estimated to 
be equal to the amount of expenditures estimated to be 
made by the Secretary for such year in carrying out the 
IDR process. 
‘‘(9) WAIVER AUTHORITY.—The Secretary may modify any 
deadline or other timing requirement specified under this sub-
section (other than the establishment date for the IDR process 
under paragraph (2)(A) and other than under paragraph (6)) 
in cases of extenuating circumstances, as specified by the Sec-
retary, or to ensure that all claims that occur during a 90- 
day period applied through paragraph (5)(D), but with respect 
to which a notification is not permitted by reason of such 
paragraph to be submitted under paragraph (1)(B) during such 
period, are eligible for the IDR process. 
‘‘(c) DEFINITIONS.—For purposes of this section: 
‘‘(1) AIR AMBULANCE SERVICE.—The term ‘air ambulance 
service’ means medical transport by helicopter or airplane for 
patients.
H. R. 133—1657 
‘‘(2) QUALIFYING PAYMENT AMOUNT.—The term ‘qualifying 
payment amount’ has the meaning given such term in section 
2799A–1(a)(3). 
‘‘(3) NONPARTICIPATING PROVIDER.—The term ‘nonpartici-
pating provider’ has the meaning given such term in section 
2799A–1(a)(3).’’. 
(2) ERISA AMENDMENT.— 
(A) IN GENERAL.—Subpart B of part 7 of title I of 
the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1185 et seq.), as amended by section 102(b) and 
further amended by the previous provisions of this title, 
is further amended by inserting after section 716 the fol-
lowing: 
‘‘SEC. 717. ENDING SURPRISE AIR AMBULANCE BILLS. 
‘‘(a) IN GENERAL.—In the case of a participant or beneficiary 
who is in a group health plan or group health insurance coverage 
offered by a health insurance issuer and who receives air ambulance 
services from a nonparticipating provider (as defined in section 
716(a)(3)(G)) with respect to such plan or coverage, if such services 
would be covered if provided by a participating provider (as defined 
in such section) with respect to such plan or coverage— 
‘‘(1) the cost-sharing requirement with respect to such serv-
ices shall be the same requirement that would apply if such 
services were provided by such a participating provider, and 
any coinsurance or deductible shall be based on rates that 
would apply for such services if they were furnished by such 
a participating provider; 
‘‘(2) such cost-sharing amounts shall be counted towards 
the in-network deductible and in-network out-of-pocket max-
imum amount under the plan or coverage for the plan year 
(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; and 
‘‘(3) the group health plan or health insurance issuer, 
respectively, shall— 
‘‘(A) not later than 30 calendar days after the bill 
for such services is transmitted by such provider, send 
to the provider, an initial payment or notice of denial 
of payment; and 
‘‘(B) pay a total plan or coverage payment, in accord-
ance with, if applicable, subsection (b)(6), directly to such 
provider furnishing such services to such participant, bene-
ficiary, or enrollee that is, with application of any initial 
payment under subparagraph (A), equal to the amount 
by which the out-of-network rate (as defined in section 
716(a)(3)(K)) for such services and year involved exceeds 
the cost-sharing amount imposed under the plan or cov-
erage, respectively, for such services (as determined in 
accordance with paragraphs (1) and (2)). 
‘‘(b) DETERMINATION OF OUT-OF-NETWORK RATES TO BE PAID 
BY HEALTH PLANS; INDEPENDENT DISPUTE RESOLUTION PROCESS.— 
‘‘(1) DETERMINATION THROUGH OPEN NEGOTIATION.— 
‘‘(A) IN GENERAL.—With respect to air ambulance serv-
ices furnished in a year by a nonparticipating provider, 
with respect to a group health plan or health insurance
H. R. 133—1658 
issuer offering group health insurance coverage, and for 
which a payment is required to be made by the plan 
or coverage pursuant to subsection (a)(3), the provider or 
plan or coverage may, during the 30-day period beginning 
on the day the provider receives a payment or a statement 
of denial of payment from the plan or coverage regarding 
a claim for payment for such service, initiate open negotia-
tions under this paragraph between such provider and 
plan or coverage for purposes of determining, during the 
open negotiation period, an amount agreed on by such 
provider, and such plan or coverage for payment (including 
any cost-sharing) for such service. For purposes of this 
subsection, the open negotiation period, with respect to 
air ambulance services, is the 30-day period beginning 
on the date of initiation of the negotiations with respect 
to such services. 
‘‘(B) ACCESSING
INDEPENDENT
DISPUTE
RESOLUTION 
PROCESS IN CASE OF FAILED NEGOTIATIONS.—In the case 
of open negotiations pursuant to subparagraph (A), with 
respect to air ambulance services, that do not result in 
a determination of an amount of payment for such services 
by the last day of the open negotiation period described 
in such subparagraph with respect to such services, the 
provider or group health plan or health insurance issuer 
offering group health insurance coverage that was party 
to such negotiations may, during the 4-day period beginning 
on the day after such open negotiation period, initiate 
the independent dispute resolution process under para-
graph (2) with respect to such item or service. The inde-
pendent dispute resolution process shall be initiated by 
a party pursuant to the previous sentence by submission 
to the other party and to the Secretary of a notification 
(containing such information as specified by the Secretary) 
and for purposes of this subsection, the date of initiation 
of such process shall be the date of such submission or 
such other date specified by the Secretary pursuant to 
regulations that is not later than the date of receipt of 
such notification by both the other party and the Secretary. 
‘‘(2) INDEPENDENT DISPUTE RESOLUTION PROCESS AVAILABLE 
IN CASE OF FAILED OPEN NEGOTIATIONS.— 
‘‘(A) ESTABLISHMENT.—Not later than 1 year after the 
date of the enactment of this subsection, the Secretary, 
jointly with the Secretary of Health and Human Services 
and the Secretary of the Treasury, shall establish by regula-
tion one independent dispute resolution process (referred 
to in this subsection as the ‘IDR process’) under which, 
in the case of air ambulance services with respect to which 
a provider or group health plan or health insurance issuer 
offering group health insurance coverage submits a notifica-
tion under paragraph (1)(B) (in this subsection referred 
to as a ‘qualified IDR air ambulance services’), a certified 
IDR entity under paragraph (4) determines, subject to 
subparagraph (B) and in accordance with the succeeding 
provisions of this subsection, the amount of payment under 
the plan or coverage for such services furnished by such 
provider.
H. R. 133—1659 
‘‘(B) AUTHORITY TO CONTINUE NEGOTIATIONS.—Under 
the independent dispute resolution process, in the case 
that the parties to a determination for qualified IDR air 
ambulance services agree on a payment amount for such 
services during such process but before the date on which 
the entity selected with respect to such determination 
under paragraph (4) makes such determination under para-
graph (5), such amount shall be treated for purposes of 
section 716(a)(3)(K)(ii) as the amount agreed to by such 
parties for such services. In the case of an agreement 
described in the previous sentence, the independent dispute 
resolution process shall provide for a method to determine 
how to allocate between the parties to such determination 
the payment of the compensation of the entity selected 
with respect to such determination. 
‘‘(C) CLARIFICATION.—A nonparticipating provider may 
not, with respect to an item or service furnished by such 
provider, submit a notification under paragraph (1)(B) if 
such provider is exempt from the requirement under sub-
section (a) of section 2799B–2 of the Public Health Service 
Act with respect to such item or service pursuant to sub-
section (b) of such section. 
‘‘(3) TREATMENT OF BATCHING OF SERVICES.—The provisions 
of section 716(c)(3) shall apply with respect to a notification 
submitted under this subsection with respect to air ambulance 
services in the same manner and to the same extent such 
provisions apply with respect to a notification submitted under 
section 716(c) with respect to items and services described 
in such section. 
‘‘(4) IDR ENTITIES.— 
‘‘(A) ELIGIBILITY.—An IDR entity certified under this 
subsection is an IDR entity certified under section 716(c)(4). 
‘‘(B) SELECTION OF CERTIFIED IDR ENTITY.—The provi-
sions of subparagraph (F) of section 716(c)(4) shall apply 
with respect to selecting an IDR entity certified pursuant 
to subparagraph (A) with respect to the determination of 
the amount of payment under this subsection of air ambu-
lance services in the same manner as such provisions apply 
with respect to selecting an IDR entity certified under 
such section with respect to the determination of the 
amount of payment under section 716(c) of an item or 
service. An entity selected pursuant to the previous sen-
tence to make a determination described in such sentence 
shall be referred to in this subsection as the ‘certified 
IDR entity’ with respect to such determination. 
‘‘(5) PAYMENT DETERMINATION.— 
‘‘(A) IN GENERAL.—Not later than 30 days after the 
date of selection of the certified IDR entity with respect 
to a determination for qualified IDR ambulance services, 
the certified IDR entity shall— 
‘‘(i) taking into account the considerations specified 
in subparagraph (C), select one of the offers submitted 
under subparagraph (B) to be the amount of payment 
for such services determined under this subsection for 
purposes of subsection (a)(3); and 
‘‘(ii) notify the provider or facility and the group 
health plan or health insurance issuer offering group
H. R. 133—1660 
health insurance coverage party to such determination 
of the offer selected under clause (i). 
‘‘(B) SUBMISSION OF OFFERS.—Not later than 10 days 
after the date of selection of the certified IDR entity with 
respect to a determination for qualified IDR air ambulance 
services, the provider and the group health plan or health 
insurance issuer offering group health insurance coverage 
party to such determination— 
‘‘(i) shall each submit to the certified IDR entity 
with respect to such determination— 
‘‘(I) an offer for a payment amount for such 
services furnished by such provider; and 
‘‘(II) such information as requested by the cer-
tified IDR entity relating to such offer; and 
‘‘(ii) may each submit to the certified IDR entity 
with respect to such determination any information 
relating to such offer submitted by either party, 
including information relating to any circumstance 
described in subparagraph (C)(ii). 
‘‘(C) CONSIDERATIONS IN DETERMINATION.— 
‘‘(i) IN GENERAL.—In determining which offer is 
the payment to be applied pursuant to this paragraph, 
the certified IDR entity, with respect to the determina-
tion for a qualified IDR air ambulance service shall 
consider— 
‘‘(I) the qualifying payment amounts (as 
defined in section 716(a)(3)(E)) for the applicable 
year for items and services that are comparable 
to the qualified IDR air ambulance service and 
that are furnished in the same geographic region 
(as defined by the Secretary for purposes of such 
subsection) as such qualified IDR air ambulance 
service; and 
‘‘(II) subject to clause (iii), information on any 
circumstance described in clause (ii), such informa-
tion as requested in subparagraph (B)(i)(II), and 
any additional information provided in subpara-
graph (B)(ii). 
‘‘(ii) ADDITIONAL CIRCUMSTANCES.—For purposes of 
clause (i)(II), the circumstances described in this clause 
are, with respect to air ambulance services included 
in the notification submitted under paragraph (1)(B) 
of a nonparticipating provider, group health plan, or 
health insurance issuer the following: 
‘‘(I) The quality and outcomes measurements 
of the provider that furnished such services. 
‘‘(II) The acuity of the individual receiving 
such services or the complexity of furnishing such 
services to such individual. 
‘‘(III) The training, experience, and quality of 
the medical personnel that furnished such services. 
‘‘(IV) Ambulance vehicle type, including the 
clinical capability level of such vehicle. 
‘‘(V) Population density of the pick up location 
(such as urban, suburban, rural, or frontier).
H. R. 133—1661 
‘‘(VI) Demonstrations of good faith efforts (or 
lack of good faith efforts) made by the nonpartici-
pating provider or nonparticipating facility or the 
plan or issuer to enter into network agreements 
and, if applicable, contracted rates between the 
provider and the plan or issuer, as applicable, 
during the previous 4 plan years. 
‘‘(iii) PROHIBITION ON CONSIDERATION OF CERTAIN 
FACTORS.—In determining which offer is the payment 
amount to be applied with respect to qualified IDR 
air ambulance services furnished by a provider, the 
certified IDR entity with respect to such determination 
shall not consider usual and customary charges, the 
amount that would have been billed by such provider 
with respect to such services had the provisions of 
section 2799B–5 of the Public Health Service Act not 
applied, or the payment or reimbursement rate for 
such services furnished by such provider payable by 
a public payor, including under the Medicare program 
under title XVIII of the Social Security Act, under 
the Medicaid program under title XIX of such Act, 
under the Children’s Health Insurance Program under 
title XXI of such Act, under the TRICARE program 
under chapter 55 of title 10, United States Code, or 
under chapter 17 of title 38, United States Code. 
‘‘(D) EFFECTS OF DETERMINATION.—The provisions of 
section 716(c)(5)(E)) shall apply with respect to a deter-
mination of a certified IDR entity under subparagraph 
(A), the notification submitted with respect to such deter-
mination, the services with respect to such notification, 
and the parties to such notification in the same manner 
as such provisions apply with respect to a determination 
of a certified IDR entity under section 716(c)(5)(E), the 
notification submitted with respect to such determination, 
the items and services with respect to such notification, 
and the parties to such notification. 
‘‘(E) COSTS
OF
INDEPENDENT
DISPUTE
RESOLUTION 
PROCESS.—The provisions of section 716(c)(5)(F) shall apply 
to a notification made under this subsection, the parties 
to such notification, and a determination under subpara-
graph (A) in the same manner and to the same extent 
such provisions apply to a notification under section 716(c), 
the parties to such notification and a determination made 
under section 716(c)(5)(A). 
‘‘(6) TIMING OF PAYMENT.—The total plan or coverage pay-
ment required pursuant to subsection (a)(3), with respect to 
qualified IDR air ambulance services for which a determination 
is made under paragraph (5)(A) or with respect to air ambu-
lance services for which a payment amount is determined under 
open negotiations under paragraph (1), shall be made directly 
to the nonparticipating provider not later than 30 days after 
the date on which such determination is made. 
‘‘(7) PUBLICATION OF INFORMATION RELATING TO THE IDR 
PROCESS.—
H. R. 133—1663 
‘‘(C) IDR ENTITY REQUIREMENTS.—For 2022 and each 
subsequent year, an IDR entity, as a condition of certifi-
cation as an IDR entity, shall submit to the Secretary 
such information as the Secretary determines necessary 
for the Secretary to carry out the provisions of this para-
graph. 
‘‘(D) CLARIFICATION.—The Secretary shall ensure the 
public reporting under this paragraph does not contain 
information that would disclose privileged or confidential 
information of a group health plan or health insurance 
issuer offering group or individual health insurance cov-
erage or of a provider or facility. 
‘‘(8) ADMINISTRATIVE FEE.— 
‘‘(A) IN GENERAL.—Each party to a determination under 
paragraph (5) to which an entity is selected under para-
graph (4) in a year shall pay to the Secretary, at such 
time and in such manner as specified by the Secretary, 
a fee for participating in the IDR process with respect 
to such determination in an amount described in subpara-
graph (B) for such year. 
‘‘(B) AMOUNT OF FEE.—The amount described in this 
subparagraph for a year is an amount established by the 
Secretary in a manner such that the total amount of fees 
paid under this paragraph for such year is estimated to 
be equal to the amount of expenditures estimated to be 
made by the Secretary for such year in carrying out the 
IDR process. 
‘‘(9) WAIVER AUTHORITY.—The Secretary may modify any 
deadline or other timing requirement specified under this sub-
section (other than the establishment date for the IDR process 
under paragraph (2)(A) and other than under paragraph (6)) 
in cases of extenuating circumstances, as specified by the Sec-
retary, or to ensure that all claims that occur during a 90- 
day period applied through paragraph (5)(D), but with respect 
to which a notification is not permitted by reason of such 
paragraph to be submitted under paragraph (1)(B) during such 
period, are eligible for the IDR process. 
‘‘(c) DEFINITION.—For purposes of this section: 
‘‘(1) AIR AMBULANCE SERVICES.—The term ‘air ambulance 
service’ means medical transport by helicopter or airplane for 
patients. 
‘‘(2) QUALIFYING PAYMENT AMOUNT.—The term ‘qualifying 
payment amount’ has the meaning given such term in section 
716(a)(3). 
‘‘(3) NONPARTICIPATING PROVIDER.—The term ‘nonpartici-
pating provider’ has the meaning given such term in section 
716(a)(3).’’. 
(3) IRC AMENDMENTS.— 
(A) IN GENERAL.—Subchapter B of chapter 100 of the 
Internal Revenue Code of 1986, as amended by section 
102(c) and further amended by the previous provisions 
of this title, is further amended by inserting after section 
9816 the following: 
‘‘SEC. 9817. ENDING SURPRISE AIR AMBULANCE BILLS. 
‘‘(a) IN GENERAL.—In the case of a participant or beneficiary 
in a group health plan who receives air ambulance services from
H. R. 133—1664 
a nonparticipating provider (as defined in section 9816(a)(3)(G)) 
with respect to such plan, if such services would be covered if 
provided by a participating provider (as defined in such section) 
with respect to such plan— 
‘‘(1) the cost-sharing requirement with respect to such serv-
ices shall be the same requirement that would apply if such 
services were provided by such a participating provider, and 
any coinsurance or deductible shall be based on rates that 
would apply for such services if they were furnished by such 
a participating provider; 
‘‘(2) such cost-sharing amounts shall be counted towards 
the in-network deductible and in-network out-of-pocket max-
imum amount under the plan for the plan year (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; and 
‘‘(3) the group health plan shall— 
‘‘(A) not later than 30 calendar days after the bill 
for such services is transmitted by such provider, send 
to the provider, an initial payment or notice of denial 
of payment; and 
‘‘(B) pay a total plan payment, in accordance with, 
if applicable, subsection (b)(6), directly to such provider 
furnishing such services to such participant, beneficiary, 
or enrollee that is, with application of any initial payment 
under subparagraph (A), equal to the amount by which 
the out-of-network rate (as defined in section 9816(a)(3)(K)) 
for such services and year involved exceeds the cost-sharing 
amount imposed under the plan for such services (as deter-
mined in accordance with paragraphs (1) and (2)). 
‘‘(b) DETERMINATION OF OUT-OF-NETWORK RATES TO BE PAID 
BY HEALTH PLANS; INDEPENDENT DISPUTE RESOLUTION PROCESS.— 
‘‘(1) DETERMINATION THROUGH OPEN NEGOTIATION.— 
‘‘(A) IN GENERAL.—With respect to air ambulance serv-
ices furnished in a year by a nonparticipating provider, 
with respect to a group health plan, and for which a pay-
ment is required to be made by the plan pursuant to 
subsection (a)(3), the provider or plan may, during the 
30-day period beginning on the day the provider receives 
a payment or a statement of denial of payment from the 
plan regarding a claim for payment for such service, initiate 
open negotiations under this paragraph between such pro-
vider and plan for purposes of determining, during the 
open negotiation period, an amount agreed on by such 
provider, and such plan for payment (including any cost- 
sharing) for such service. For purposes of this subsection, 
the open negotiation period, with respect to air ambulance 
services, is the 30-day period beginning on the date of 
initiation of the negotiations with respect to such services. 
‘‘(B) ACCESSING
INDEPENDENT
DISPUTE
RESOLUTION 
PROCESS IN CASE OF FAILED NEGOTIATIONS.—In the case 
of open negotiations pursuant to subparagraph (A), with 
respect to air ambulance services, that do not result in 
a determination of an amount of payment for such services 
by the last day of the open negotiation period described 
in such subparagraph with respect to such services, the
H. R. 133—1665 
provider or group health plan that was party to such nego-
tiations may, during the 4-day period beginning on the 
day after such open negotiation period, initiate the inde-
pendent dispute resolution process under paragraph (2) 
with respect to such services. The independent dispute 
resolution process shall be initiated by a party pursuant 
to the previous sentence by submission to the other party 
and to the Secretary of a notification (containing such 
information as specified by the Secretary) and for purposes 
of this subsection, the date of initiation of such process 
shall be the date of such submission or such other date 
specified by the Secretary pursuant to regulations that 
is not later than the date of receipt of such notification 
by both the other party and the Secretary. 
‘‘(2) INDEPENDENT DISPUTE RESOLUTION PROCESS AVAILABLE 
IN CASE OF FAILED OPEN NEGOTIATIONS.— 
‘‘(A) ESTABLISHMENT.—Not later than 1 year after the 
date of the enactment of this subsection, the Secretary, 
jointly with the Secretary of Health and Human Services 
and the Secretary of Labor, shall establish by regulation 
one independent dispute resolution process (referred to in 
this subsection as the ‘IDR process’) under which, in the 
case of air ambulance services with respect to which a 
provider or group health plan submits a notification under 
paragraph (1)(B) (in this subsection referred to as a ‘quali-
fied IDR air ambulance services’), a certified IDR entity 
under paragraph (4) determines, subject to subparagraph 
(B) and in accordance with the succeeding provisions of 
this subsection, the amount of payment under the plan 
for such services furnished by such provider. 
‘‘(B) AUTHORITY TO CONTINUE NEGOTIATIONS.—Under 
the independent dispute resolution process, in the case 
that the parties to a determination for qualified IDR air 
ambulance services agree on a payment amount for such 
services during such process but before the date on which 
the entity selected with respect to such determination 
under paragraph (4) makes such determination under para-
graph (5), such amount shall be treated for purposes of 
section 9816(a)(3)(K)(ii) as the amount agreed to by such 
parties for such services. In the case of an agreement 
described in the previous sentence, the independent dispute 
resolution process shall provide for a method to determine 
how to allocate between the parties to such determination 
the payment of the compensation of the entity selected 
with respect to such determination. 
‘‘(C) CLARIFICATION.—A nonparticipating provider may 
not, with respect to an item or service furnished by such 
provider, submit a notification under paragraph (1)(B) if 
such provider is exempt from the requirement under sub-
section (a) of section 2799B–2 of the Public Health Service 
Act with respect to such item or service pursuant to sub-
section (b) of such section. 
‘‘(3) TREATMENT OF BATCHING OF SERVICES.—The provisions 
of section 9816(c)(3) shall apply with respect to a notification 
submitted under this subsection with respect to air ambulance 
services in the same manner and to the same extent such 
provisions apply with respect to a notification submitted under
H. R. 133—1666 
section 9816(c) with respect to items and services described 
in such section. 
‘‘(4) IDR ENTITIES.— 
‘‘(A) ELIGIBILITY.—An IDR entity certified under this 
subsection is an IDR entity certified under section 
9816(c)(4). 
‘‘(B) SELECTION OF CERTIFIED IDR ENTITY.—The provi-
sions of subparagraph (F) of section 9816(c)(4) shall apply 
with respect to selecting an IDR entity certified pursuant 
to subparagraph (A) with respect to the determination of 
the amount of payment under this subsection of air ambu-
lance services in the same manner as such provisions apply 
with respect to selecting an IDR entity certified under 
such section with respect to the determination of the 
amount of payment under section 9816(c) of an item or 
service. An entity selected pursuant to the previous sen-
tence to make a determination described in such sentence 
shall be referred to in this subsection as the ‘certified 
IDR entity’ with respect to such determination. 
‘‘(5) PAYMENT DETERMINATION.— 
‘‘(A) IN GENERAL.—Not later than 30 days after the 
date of selection of the certified IDR entity with respect 
to a determination for qualified IDR ambulance services, 
the certified IDR entity shall— 
‘‘(i) taking into account the considerations specified 
in subparagraph (C), select one of the offers submitted 
under subparagraph (B) to be the amount of payment 
for such services determined under this subsection for 
purposes of subsection (a)(3); and 
‘‘(ii) notify the provider or facility and the group 
health plan party to such determination of the offer 
selected under clause (i). 
‘‘(B) SUBMISSION OF OFFERS.—Not later than 10 days 
after the date of selection of the certified IDR entity with 
respect to a determination for qualified IDR air ambulance 
services, the provider and the group health plan party 
to such determination— 
‘‘(i) shall each submit to the certified IDR entity 
with respect to such determination— 
‘‘(I) an offer for a payment amount for such 
services furnished by such provider; and 
‘‘(II) such information as requested by the cer-
tified IDR entity relating to such offer; and 
‘‘(ii) may each submit to the certified IDR entity 
with respect to such determination any information 
relating to such offer submitted by either party, 
including information relating to any circumstance 
described in subparagraph (C)(ii). 
‘‘(C) CONSIDERATIONS IN DETERMINATION.— 
‘‘(i) IN GENERAL.—In determining which offer is 
the payment to be applied pursuant to this paragraph, 
the certified IDR entity, with respect to the determina-
tion for a qualified IDR air ambulance service shall 
consider— 
‘‘(I) the qualifying payment amounts (as 
defined in section 9816(a)(3)(E)) for the applicable 
year for items or services that are comparable
H. R. 133—1667 
to the qualified IDR air ambulance service and 
that are furnished in the same geographic region 
(as defined by the Secretary for purposes of such 
subsection) as such qualified IDR air ambulance 
service; and 
‘‘(II) subject to clause (iii), information on any 
circumstance described in clause (ii), such informa-
tion as requested in subparagraph (B)(i)(II), and 
any additional information provided in subpara-
graph (B)(ii). 
‘‘(ii) ADDITIONAL CIRCUMSTANCES.—For purposes of 
clause (i)(II), the circumstances described in this clause 
are, with respect to air ambulance services included 
in the notification submitted under paragraph (1)(B) 
of a nonparticipating provider, or group health plan 
the following: 
‘‘(I) The quality and outcomes measurements 
of the provider that furnished such services. 
‘‘(II) The acuity of the individual receiving 
such services or the complexity of furnishing such 
services to such individual. 
‘‘(III) The training, experience, and quality of 
the medical personnel that furnished such services. 
‘‘(IV) Ambulance vehicle type, including the 
clinical capability level of such vehicle. 
‘‘(V) Population density of the pick up location 
(such as urban, suburban, rural, or frontier). 
‘‘(VI) Demonstrations of good faith efforts (or 
lack of good faith efforts) made by the nonpartici-
pating provider or nonparticipating facility or the 
plan to enter into network agreements and, if 
applicable, contracted rates between the provider 
and the plan during the previous 4 plan years. 
‘‘(iii) PROHIBITION ON CONSIDERATION OF CERTAIN 
FACTORS.—In determining which offer is the payment 
amount to be applied with respect to qualified IDR 
air ambulance services furnished by a provider, the 
certified IDR entity with respect to such determination 
shall not consider usual and customary charges, the 
amount that would have been billed by such provider 
with respect to such services had the provisions of 
section 2799B–5 of the Public Health Service Act not 
applied, or the payment or reimbursement rate for 
such services furnished by such provider payable by 
a public payor, including under the Medicare program 
under title XVIII of the Social Security Act, under 
the Medicaid program under title XIX of such Act, 
under the Children’s Health Insurance Program under 
title XXI of such Act, under the TRICARE program 
under chapter 55 of title 10, United States Code, or 
under chapter 17 of title 38, United States Code. 
‘‘(D) EFFECTS OF DETERMINATION.—The provisions of 
section 9816(c)(5)(E)) shall apply with respect to a deter-
mination of a certified IDR entity under subparagraph 
(A), the notification submitted with respect to such deter-
mination, the services with respect to such notification, 
and the parties to such notification in the same manner
H. R. 133—1669 
‘‘(iii) the amount of the offer submitted under para-
graph (2) by the group health plan and by the non-
participating provider expressed as a percentage of 
the qualifying payment amount; 
‘‘(iv) whether the offer selected by the certified 
IDR entity under paragraph (5) to be the payment 
applied was the offer submitted by such plan or issuer 
(as applicable) or by such provider and the amount 
of such offer so selected expressed as a percentage 
of the qualifying payment amount; 
‘‘(v) ambulance vehicle type, including the clinical 
capability level of such vehicle; 
‘‘(vi) the identity of the group health plan or health 
insurance issuer or air ambulance provider with 
respect to such notification; 
‘‘(vii) the length of time in making each determina-
tion; 
‘‘(viii) the compensation paid to the certified IDR 
entity with respect to the settlement or determination; 
and 
‘‘(ix) any other information specified by the Sec-
retary. 
‘‘(C) IDR ENTITY REQUIREMENTS.—For 2022 and each 
subsequent year, an IDR entity, as a condition of certifi-
cation as an IDR entity, shall submit to the Secretary 
such information as the Secretary determines necessary 
for the Secretary to carry out the provisions of this para-
graph. 
‘‘(D) CLARIFICATION.—The Secretary shall ensure the 
public reporting under this paragraph does not contain 
information that would disclose privileged or confidential 
information of a group health plan or health insurance 
issuer offering group or individual health insurance cov-
erage or of a provider or facility. 
‘‘(8) ADMINISTRATIVE FEE.— 
‘‘(A) IN GENERAL.—Each party to a determination under 
paragraph (5) to which an entity is selected under para-
graph (4) in a year shall pay to the Secretary, at such 
time and in such manner as specified by the Secretary, 
a fee for participating in the IDR process with respect 
to such determination in an amount described in subpara-
graph (B) for such year. 
‘‘(B) AMOUNT OF FEE.—The amount described in this 
subparagraph for a year is an amount established by the 
Secretary in a manner such that the total amount of fees 
paid under this paragraph for such year is estimated to 
be equal to the amount of expenditures estimated to be 
made by the Secretary for such year in carrying out the 
IDR process. 
‘‘(9) WAIVER AUTHORITY.—The Secretary may modify any 
deadline or other timing requirement specified under this sub-
section (other than the establishment date for the IDR process 
under paragraph (2)(A) and other than under paragraph (6)) 
in cases of extenuating circumstances, as specified by the Sec-
retary, or to ensure that all claims that occur during a 90- 
day period applied through paragraph (5)(D), but with respect 
to which a notification is not permitted by reason of such
H. R. 133—1670 
paragraph to be submitted under paragraph (1)(B) during such 
period, are eligible for the IDR process. 
‘‘(c) DEFINITIONS.—For purposes of this section: 
‘‘(1) AIR AMBULANCE SERVICES.—The term ‘air ambulance 
service’ means medical transport by helicopter or airplane for 
patients. 
‘‘(2) QUALIFYING PAYMENT AMOUNT.—The term ‘qualifying 
payment amount’ has the meaning given such term in section 
9816(a)(3). 
‘‘(3) NONPARTICIPTING
PROVIDER.—The term ‘nonpartici-
pating provider’ has the meaning given such term in section 
9816(a)(3).’’. 
(B) CLERICAL AMENDMENT.—The table of sections for 
subchapter B of chapter 100 of the Internal Revenue Code 
of 1986, as amended by section 102(c)(3), is further 
amended by inserting after the item relating to section 
9816 the following new item: 
‘‘Sec. 9817. Ending surprise air ambulance bills.’’. 
(4) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply with respect to plan years beginning on 
or after January 1, 2022. 
(b) AIR AMBULANCE PROVIDER BALANCE BILLING.—Part E of 
title XXVII of the Public Health Service Act, as added and amended 
by section 104, is further amended by adding at the end the fol-
lowing new section: 
‘‘SEC. 2799B–5. AIR AMBULANCE SERVICES. 
‘‘In the case of a participant, beneficiary, or enrollee with bene-
fits under a group health plan or group or individual health insur-
ance coverage offered by a health insurance issuer and who is 
furnished in a plan year beginning on or after January 1, 2022, 
air ambulance services (for which benefits are available under such 
plan or coverage) from a nonparticipating provider (as defined in 
section 2799A–1(a)(3)(G)) with respect to such plan or coverage, 
such provider shall not bill, and shall not hold liable, such partici-
pant, beneficiary, or enrollee for a payment amount for such service 
furnished by such provider that is more than the cost-sharing 
amount for such service (as determined in accordance with para-
graphs (1) and (2) of section 2799A–2(a), section 717(a) of the 
Employee Retirement Income Security Act of 1974, or section 
9817(a) of the Internal Revenue Code of 1986, as applicable).’’. 
SEC. 106. REPORTING REQUIREMENTS REGARDING AIR AMBULANCE 
SERVICES. 
(a) REPORTING REQUIREMENTS FOR PROVIDERS OF AIR AMBU-
LANCE SERVICES.— 
(1) IN GENERAL.—A provider of air ambulance services shall 
submit to the Secretary of Health and Human Services and 
the Secretary of Transportation— 
(A) not later than the date that is 90 days after the 
last day of the first calendar year beginning on or after 
the date on which a final rule is promulgated pursuant 
to the rulemaking described in subsection (d), the informa-
tion described in paragraph (2) with respect to such plan 
year; and
H. R. 133—1671 
(B) not later than the date that is 90 days after the 
last day of the plan year immediately succeeding the plan 
year described in subparagraph (A), such information with 
respect to such immediately succeeding plan year. 
(2) INFORMATION DESCRIBED.—For purposes of paragraph 
(1), information described in this paragraph, with respect to 
a provider of air ambulance services, is each of the following: 
(A) Cost data, as determined appropriate by the Sec-
retary of Health and Human Services, in consultation with 
the Secretary of Transportation, for air ambulance services 
furnished by such provider, separated to the maximum 
extent possible by air transportation costs associated with 
furnishing such air ambulance services and costs of medical 
services and supplies associated with furnishing such air 
ambulance services. 
(B) The number and location of all air ambulance bases 
operated by such provider. 
(C) The number and type of aircraft operated by such 
provider. 
(D) 
The 
number 
of 
air 
ambulance 
transports, 
disaggregated by payor mix, including— 
(i)(I) group health plans; 
(II) health insurance issuers; and 
(III) State and Federal Government payors; and 
(ii) uninsured individuals. 
(E) The number of claims of such provider that have 
been denied payment by a group health plan or health 
insurance issuer and the reasons for any such denials. 
(F) The number of emergency and nonemergency air 
ambulance transports, disaggregated by air ambulance base 
and type of aircraft. 
(G) Such other information regarding air ambulance 
services as the Secretary of Health and Human Services 
may specify. 
(b) REPORTING REQUIREMENTS FOR GROUP HEALTH PLANS AND 
HEALTH INSURANCE ISSUERS.— 
(1) PHSA.—Part D of title XXVII of the Public Health 
Service Act, as added by section 102(a)(1), is amended by adding 
after section 2799A–7, as added by section 102(a)(2)(A) of this 
Act, the following new section: 
‘‘SEC. 2799A–8. AIR AMBULANCE REPORT REQUIREMENTS. 
‘‘(a) IN GENERAL.—Each group health plan and health insurance 
issuer offering group or individual health insurance coverage shall 
submit to the Secretary, jointly with the Secretary of Labor and 
the Secretary of the Treasury— 
‘‘(1) not later than the date that is 90 days after the 
last day of the first calendar year beginning on or after the 
date on which a final rule is promulgated pursuant to the 
rulemaking described in section 106(d) of the No Surprises 
Act, the information described in subsection (b) with respect 
to such plan year; and 
‘‘(2) not later than the date that is 90 days after the 
last day of the calendar year immediately succeeding the plan 
year described in paragraph (1), such information with respect 
to such immediately succeeding plan year.
H. R. 133—1672 
‘‘(b) INFORMATION DESCRIBED.—For purposes of subsection (a), 
information described in this subsection, with respect to a group 
health plan or a health insurance issuer offering group or individual 
health insurance coverage, is each of the following: 
‘‘(1) Claims data for air ambulance services furnished by 
providers of such services, disaggregated by each of the fol-
lowing factors: 
‘‘(A) Whether such services were furnished on an emer-
gent or nonemergent basis. 
‘‘(B) Whether the provider of such services is part 
of a hospital-owned or sponsored program, municipality- 
sponsored program, hospital independent partnership 
(hybrid) program, independent program, or tribally oper-
ated program in Alaska. 
‘‘(C) Whether the transport in which the services were 
furnished originated in a rural or urban area. 
‘‘(D) The type of aircraft (such as rotor transport or 
fixed wing transport) used to furnish such services. 
‘‘(E) Whether the provider of such services has a con-
tract with the plan or issuer, as applicable, to furnish 
such services under the plan or coverage, respectively. 
‘‘(2) Such other information regarding providers of air 
ambulance services as the Secretary may specify.’’. 
(2) ERISA.— 
(A) IN GENERAL.—Subpart B of part 7 of title I of 
the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1185 et seq.) is amended by adding after section 
722, as added by section 102(b)(2)(A) of this Act, the fol-
lowing new section: 
‘‘SEC. 723. AIR AMBULANCE REPORT REQUIREMENTS. 
‘‘(a) IN GENERAL.—Each group health plan and health insurance 
issuer offering group health insurance coverage shall submit to 
the Secretary, jointly with the Secretary of Health and Human 
Services and the Secretary of the Treasury— 
‘‘(1) not later than the date that is 90 days after the 
last day of the first calendar year beginning on or after the 
date on which a final rule is promulgated pursuant to the 
rulemaking described in section 106(d) of the No Surprises 
Act, the information described in subsection (b) with respect 
to such plan year; and 
‘‘(2) not later than the date that is 90 days after the 
last day of the plan year immediately succeeding the calendar 
year described in paragraph (1), such information with respect 
to such immediately succeeding plan year. 
‘‘(b) INFORMATION DESCRIBED.—For purposes of subsection (a), 
information described in this subsection, with respect to a group 
health plan or a health insurance issuer offering group health 
insurance coverage, is each of the following: 
‘‘(1) Claims data for air ambulance services furnished by 
providers of such services, disaggregated by each of the fol-
lowing factors: 
‘‘(A) Whether such services were furnished on an emer-
gent or nonemergent basis. 
‘‘(B) Whether the provider of such services is part 
of a hospital-owned or sponsored program, municipality- 
sponsored program, hospital independent partnership
H. R. 133—1673 
(hybrid) program, independent program, or tribally oper-
ated program in Alaska. 
‘‘(C) Whether the transport in which the services were 
furnished originated in a rural or urban area. 
‘‘(D) The type of aircraft (such as rotor transport or 
fixed wing transport) used to furnish such services. 
‘‘(E) Whether the provider of such services has a con-
tract with the plan or issuer, as applicable, to furnish 
such services under the plan or coverage, respectively. 
‘‘(2) Such other information regarding providers of air 
ambulance services as the Secretary may specify.’’. 
(B) CLERICAL AMENDMENT.—The table of contents of 
the Employee Retirement Income Security Act of 1974 is 
amended by adding after the item relating to section 722, 
as added by section 102(b) the following: 
‘‘Sec. 723. Air ambulance report requirements.’’. 
(3) IRC.— 
(A) IN GENERAL.—Subchapter B of chapter 100 of the 
Internal Revenue Code of 1986 is amended by adding after 
section 9822, as added by section 102(c)(2)(A) of this Act, 
the following new section: 
‘‘SEC. 9823. AIR AMBULANCE REPORT REQUIREMENTS. 
‘‘(a) IN GENERAL.—Each group health plan shall submit to 
the Secretary, jointly with the Secretary of Labor and the Secretary 
of Health and Human Services— 
‘‘(1) not later than the date that is 90 days after the 
last day of the first calendar year beginning on or after the 
date on which a final rule is promulgated pursuant to the 
rulemaking described in section 106(d) of the No Surprises 
Act, the information described in subsection (b) with respect 
to such plan year; and 
‘‘(2) not later than the date that is 90 days after the 
last day of the calendar year immediately succeeding the plan 
year described in paragraph (1), such information with respect 
to such immediately succeeding plan year. 
‘‘(b) INFORMATION DESCRIBED.—For purposes of subsection (a), 
information described in this subsection, with respect to a group 
health plan is each of the following: 
‘‘(1) Claims data for air ambulance services furnished by 
providers of such services, disaggregated by each of the fol-
lowing factors: 
‘‘(A) Whether such services were furnished on an emer-
gent or nonemergent basis. 
‘‘(B) Whether the provider of such services is part 
of a hospital-owned or sponsored program, municipality- 
sponsored program, hospital independent partnership 
(hybrid) program, independent program, or tribally oper-
ated program in Alaska. 
‘‘(C) Whether the transport in which the services were 
furnished originated in a rural or urban area. 
‘‘(D) The type of aircraft (such as rotor transport or 
fixed wing transport) used to furnish such services. 
‘‘(E) Whether the provider of such services has a con-
tract with the plan or issuer, as applicable, to furnish 
such services under the plan or coverage, respectively.
H. R. 133—1674 
‘‘(2) Such other information regarding providers of air 
ambulance services as the Secretary may specify.’’. 
(B) CLERICAL AMENDMENT.—The table of sections for 
subchapter B of chapter 100 of the Internal Revenue Code 
of 1986 is amended by adding after the item relating to 
section 9822, as added by section 102(c), the following 
new item: 
‘‘Sec. 9823. Air ambulance report requirements.’’. 
(c) PUBLICATION OF COMPREHENSIVE REPORT.— 
(1) IN GENERAL.—Not later than the date that is one year 
after the date described in subsection (a)(2) of section 2799A– 
8 of the Public Health Service Act, of section 723 of the 
Employee Retirement Income Security Act of 1974, and of sec-
tion 9823 of the Internal Revenue Code of 1986, as such sections 
are added by subsection (b), the Secretary of Health and Human 
Services, in consultation with the Secretary of Transportation 
(referred to in this section as the ‘‘Secretaries’’), shall develop, 
and make publicly available (subject to paragraph (3)), a com-
prehensive report summarizing the information submitted 
under subsection (a) and the amendments made by subsection 
(b) and including each of the following: 
(A) The percentage of providers of air ambulance serv-
ices that are part of a hospital-owned or sponsored program, 
municipality-sponsored 
program, 
hospital-independent 
partnership (hybrid) program, or independent program. 
(B) An assessment of the extent of competition among 
providers of air ambulance services on the basis of price 
and services offered, and any changes in such competition 
over time. 
(C) An assessment of the average charges for air ambu-
lance services, amounts paid by group health plans and 
health insurance issuers offering group or individual health 
insurance coverage to providers of air ambulance services 
for furnishing such services, and amounts paid out-of- 
pocket by consumers, and any changes in such amounts 
paid over time. 
(D) An assessment of the presence of air ambulance 
bases in, or with the capability to serve, rural areas, and 
the relative growth in air ambulance bases in rural and 
urban areas over time. 
(E) Any evidence of gaps in rural access to providers 
of air ambulance services. 
(F) The percentage of providers of air ambulance serv-
ices that have contracts with group health plans or health 
insurance issuers offering group or individual health insur-
ance coverage to furnish such services under such plans 
or coverage, respectively. 
(G) An assessment of whether there are instances of 
unfair, deceptive, or predatory practices by providers of 
air ambulance services in collecting payments from patients 
to whom such services are furnished, such as referral of 
such patients to collections, lawsuits, and liens or wage 
garnishment actions. 
(H) An assessment of whether there are, within the 
air ambulance industry, instances of unreasonable industry
H. R. 133—1675 
concentration, excessive market domination, or other condi-
tions that would allow at least one provider of air ambu-
lance services to unreasonably increase prices or exclude 
competition in air ambulance services in a given geographic 
region. 
(I) An assessment of the frequency of patient balance 
billing, patient referrals to collections, lawsuits to collect 
balance bills, and liens or wage garnishment actions by 
providers of air ambulance services as part of a collections 
process across hospital-owned or sponsored programs, 
municipality-sponsored 
programs, 
hospital-independent 
partnership (hybrid) programs, tribally operated programs 
in Alaska, or independent programs, providers of air ambu-
lance services operated by public agencies (such as a State 
or county health department), and other independent pro-
viders of air ambulance services. 
(J) An assessment of the frequency of claims appeals 
made by providers of air ambulance services to group 
health plans or health insurance issuers offering group 
or individual health insurance coverage with respect to 
air ambulance services furnished to enrollees of such plans 
or coverage, respectively. 
(K) Any other cost, quality, or other data relating to 
air ambulance services or the air ambulance industry, as 
determined necessary and appropriate by the Secretaries. 
(2) OTHER SOURCES OF INFORMATION.—The Secretaries may 
incorporate information from independent experts or third- 
party sources in developing the comprehensive report required 
under paragraph (1). 
(3) PROTECTION OF PROPRIETARY INFORMATION.—The Secre-
taries may not make publicly available under this subsection 
any proprietary information. 
(d) RULEMAKING.—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, in consultation with the Secretary of 
Transportation, shall, through notice and comment rulemaking, 
specify the form and manner in which reports described in sub-
section (a) and in the amendments made by subsection (b) shall 
be submitted to such Secretaries, taking into consideration (as 
applicable and to the extent feasible) any recommendations included 
in the report submitted by the Advisory Committee on Air Ambu-
lance and Patient Billing under section 418(e) of the FAA Reauthor-
ization Act of 2018 (Public Law 115–254; 49 U.S.C. 42301 note 
prec.). 
(e) CIVIL MONEY PENALTIES.— 
(1) IN GENERAL.—Subject to paragraph (2), a provider of 
air ambulance services who fails to submit all information 
required under subsection (a)(2) by the date described in 
subparagraph (A) or (B) of subsection (a)(1), as applicable, 
shall be subject to a civil money penalty of not more than 
$10,000. 
(2) EXCEPTION.—In the case of a provider of air ambulance 
services that submits only some of the information required 
under subsection (a)(2) by the date described in subparagraph 
(A) or (B) of subsection (a)(1), as applicable, the Secretary 
of Health and Human Services may waive the civil money
H. R. 133—1676 
penalty imposed under paragraph (1) if such provider dem-
onstrates a good faith effort (as defined by the Secretary pursu-
ant to regulation) in working with the Secretary to submit 
the remaining information required under subsection (a)(2). 
(3) PROCEDURE.—The provisions of section 1128A of the 
Social Security Act (42 U.S.C. 1320a–7a), other than sub-
sections (a) and (b) and the first sentence of subsection (c)(1), 
shall apply to civil money penalties under this subsection in 
the same manner as such provisions apply to a penalty or 
proceeding under such section. 
(f) UNFAIR AND DECEPTIVE PRACTICES AND UNFAIR METHODS 
OF COMPETITION.—The Secretary of Transportation may use any 
information submitted under subsection (a) in determining whether 
a provider of air ambulance services has violated section 41712(a) 
of title 49, United States Code. 
(g) ADVISORY COMMITTEE ON AIR AMBULANCE QUALITY AND 
PATIENT SAFETY.— 
(1) ESTABLISHMENT.—Not later than the date that is 60 
days after the date of the enactment of this Act, the Secretary 
of Health and Human Services and the Secretary of Transpor-
tation, shall establish an Advisory Committee on Air Ambu-
lance Quality and Patient Safety (referred to in this subsection 
as the ‘‘Committee’’) for the purpose of reviewing options to 
establish quality, patient safety, and clinical capability stand-
ards for each clinical capability level of air ambulances. 
(2) MEMBERSHIP.—The Committee shall be composed of 
the following members: 
(A) The Secretary of Health and Human Services, or 
a designee of the Secretary, who shall serve as the Chair 
of the Committee. 
(B) The Secretary of Transportation, or a designee 
of the Secretary. 
(C) One representative, to be appointed by the Sec-
retary of Health and Human Services, of each of the fol-
lowing: 
(i) State health insurance regulators. 
(ii) Health care providers. 
(iii) Group health plans and health insurance 
issuers offering group or individual health insurance 
coverage. 
(iv) Patient advocacy groups. 
(v) Accrediting bodies with experience in quality 
measures. 
(D) Three representatives of the air ambulance 
industry, to be appointed by the Secretary of Transpor-
tation. 
(E) Additional three representatives not covered under 
subparagraphs (A) through (D), as determined necessary 
and appropriate by the Secretary of Health and Human 
Services and Secretary of Transportation. 
(3) FIRST MEETING.—Not later than the date that is 90 
days after the date of the enactment of this Act, the Committee 
shall hold its first meeting. 
(4) DUTIES.—The Committee shall study and make rec-
ommendations, as appropriate, to Congress regarding each of 
the following with respect to air ambulance services:
H. R. 133—1677 
(A) Qualifications of different clinical capability levels 
and tiering of such levels. 
(B) Patient safety and quality standards. 
(C) Options for improving service reliability during 
poor weather, night conditions, or other adverse conditions. 
(D) Differences between air ambulance vehicle types, 
services, and technologies, and other flight capability stand-
ards, and the impact of such differences on patient safety. 
(E) Clinical triage criteria for air ambulances. 
(5) REPORT.—Not later than the date that is 180 days 
after the date of the first meeting of the Committee, the Com-
mittee, in consultation with relevant experts and stakeholders, 
as appropriate, shall develop and make publicly available a 
report on any recommendations submitted to Congress under 
paragraph (4). The Committee may update such report, as 
determined appropriate by the Committee. 
(h) DEFINITIONS.—In this section, the terms ‘‘group health 
plan’’, ‘‘health insurance coverage’’, ‘‘individual health insurance 
coverage’’, ‘‘group health insurance coverage’’, and ‘‘health insurance 
issuer’’ have the meanings given such terms in section 2791 of 
the Public Health Service Act (42 U.S.C. 300gg–91). 
SEC. 107. TRANSPARENCY REGARDING IN-NETWORK AND OUT-OF-NET-
WORK DEDUCTIBLES AND OUT-OF-POCKET LIMITATIONS. 
(a) PHSA.—Section 2799A–1 of the Public Health Service Act, 
as added by section 102(a) and amended by section 103, is further 
amended by adding at the end the following new subsection: 
‘‘(e) TRANSPARENCY REGARDING IN-NETWORK AND OUT-OF-NET-
WORK DEDUCTIBLES
AND OUT-OF-POCKET LIMITATIONS.—A group 
health plan or a health insurance issuer offering group or individual 
health insurance coverage and providing or covering any benefit 
with respect to items or services shall include, in clear writing, 
on any physical or electronic plan or insurance identification card 
issued to the participants, beneficiaries, or enrollees in the plan 
or coverage the following: 
‘‘(1) Any deductible applicable to such plan or coverage. 
‘‘(2) Any out-of-pocket maximum limitation applicable to 
such plan or coverage. 
‘‘(3) A telephone number and Internet website address 
through which such individual may seek consumer assistance 
information, such as information related to hospitals and urgent 
care facilities that have in effect a contractual relationship 
with such plan or coverage for furnishing items and services 
under such plan or coverage’’. 
(b) ERISA.—Section 716 of the Employee Retirement Income 
Security Act of 1974, as added by section 102(b) and amended 
by section 103, is further amended by adding at the end the fol-
lowing new subsection: 
‘‘(e) TRANSPARENCY REGARDING IN-NETWORK AND OUT-OF-NET-
WORK DEDUCTIBLES
AND OUT-OF-POCKET LIMITATIONS.—A group 
health plan or a health insurance issuer offering group health 
insurance coverage and providing or covering any benefit with 
respect to items or services shall include, in clear writing, on 
any physical or electronic plan or insurance identification card 
issued to the participants or beneficiaries in the plan or coverage 
the following: 
‘‘(1) Any deductible applicable to such plan or coverage.