furnished shall be counted toward any in- 
network deductible or out-of-pocket maxi-
mums applied under the plan (and such in- 
network deductible shall be applied) in the 
same manner as if such cost-sharing pay-
ments were with respect to emergency serv-
ices furnished by a participating provider 
and a participating emergency facility; 
and’’; 
(2) by redesignating paragraph (2) as para-
graph (3); 
(3) by inserting after paragraph (1) the fol-
lowing new paragraph: 
‘‘(2) AUDIT PROCESS FOR MEDIAN CONTRACTED 
RATES.— 
‘‘(A) IN GENERAL.—Not later than July 1, 
2020, the Secretary, in consultation with appro-
priate State agencies, shall establish through 
rulemaking a process, in accordance with sub-
paragraph (B), under which health plans are au-
dited by such Secretaries to ensure that— 
‘‘(i) such plans are in compliance with 
the requirement of applying a median con-
tracted rate under this section; and 
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‘‘(ii) that such median contracted rate 
so applied satisfies the definition under 
paragraph (3)(E) with respect to the year 
involved, including with respect to a health 
plan described in clause (ii) of such para-
graph. 
‘‘(B) AUDIT SAMPLES.—Under the process 
established pursuant to subparagraph (A), the 
Secretary— 
‘‘(i) shall conduct audits described in 
such subparagraph, with respect to a year 
(beginning with 2021), of a sample with re-
spect to such year of claims data from not 
more than 25 health plans; and 
‘‘(ii) may audit any health plan if the 
Secretary has received any complaint about 
such plan that involves the compliance of 
the plan with either of the requirements de-
scribed in clauses (i) and (ii) of such sub-
paragraph.’’; and 
(4) in paragraph (3), as redesignated by para-
graph (2) of this subsection— 
(A) in the matter preceding subparagraph 
(A), by inserting ‘‘and subsection (e)’’ after ‘‘this 
subsection’’; 
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(B) by redesignating subparagraphs (A) 
through (C) as subparagraphs (B) through (D), 
respectively; 
(C) by inserting before subparagraph (B), 
as redesignated by subparagraph (B) of this 
paragraph, the following new subparagraph: 
‘‘(A) EMERGENCY DEPARTMENT OF A HOS-
PITAL.—The term ‘emergency department of a 
hospital’ includes a hospital outpatient depart-
ment that provides emergency services.’’; 
(D) by amending subparagraph (C), as re-
designated by subparagraph (B) of this para-
graph, to read as follows: 
‘‘(C) EMERGENCY SERVICES.— 
‘‘(i) IN
GENERAL.—The term ‘emer-
gency services’, with respect to an emer-
gency medical condition, means— 
‘‘(I) a medical screening examina-
tion (as required under section 1867 of 
the Social Security Act, or as would be 
required under such section if such sec-
tion applied to an independent free-
standing emergency department) that 
is within the capability of the emer-
gency department of a hospital or of 
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an independent freestanding emergency 
department, as applicable, including 
ancillary services routinely available to 
the emergency department to evaluate 
such emergency medical condition; and 
‘‘(II) within the capabilities of the 
staff and facilities available at the hos-
pital or the independent freestanding 
emergency department, as applicable, 
such further medical examination and 
treatment as are required under section 
1867 of such Act, or as would be re-
quired under such section if such sec-
tion applied to an independent free-
standing emergency department, to sta-
bilize the patient. 
‘‘(ii) 
INCLUSION
OF 
POSTSTABILIZATION
SERVICES.—For pur-
poses of this subsection and section 2799, in 
the case of an individual enrolled in a 
health plan who is furnished services de-
scribed in clause (i) by a provider or facil-
ity to stabilize such individual with respect 
to an emergency medical condition, the 
term ‘emergency services’ shall include such 
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items and services in addition to those de-
scribed in clause (i) that such a provider or 
facility determines are needed to be fur-
nished (after such stabilization but during 
such visit in which such individual is so 
stabilized) to such individual, unless each of 
the following conditions are met: 
‘‘(I) Such a provider or facility 
determines such individual is able to 
travel using nonmedical transportation 
or nonemergency medical transpor-
tation. 
‘‘(II) Such provider furnishing 
such additional items and services is 
in compliance with section 2799A(d) 
with respect to such items and serv-
ices.’’; 
(E) by redesignating subparagraph (D), as 
redesignated by subparagraph (B) of this para-
graph, as subparagraph (I); and 
(F) by inserting after subparagraph (C), as 
redesignated by subparagraph (B) of this para-
graph, the following new subparagraphs: 
‘‘(D) INDEPENDENT FREESTANDING EMER-
GENCY
DEPARTMENT.—The term ‘independent 
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freestanding emergency department’ means a fa-
cility that— 
‘‘(i) is geographically separate and dis-
tinct and licensed separately from a hos-
pital under applicable State law; and 
‘‘(ii) provides emergency services. 
‘‘(E) MEDIAN CONTRACTED RATE.— 
‘‘(i) IN GENERAL.—The term ‘median 
contracted rate’ means, with respect to an 
item or service and a health plan (as de-
fined in subsection (e)(2)(A))— 
‘‘(I) for 2021, the median of the 
negotiated rates recognized by the 
sponsor or issuer of such plan (deter-
mined with respect to all such plans of 
such sponsor or such issuer that are 
within the same line of business) as the 
total maximum payment (including 
the cost-sharing amount imposed for 
such services (as determined in accord-
ance with clauses (ii) and (iii) of 
paragraph (1)(C) or subparagraphs 
(A) and (B) of subsection (e)(1), as ap-
plicable) and the amount to be paid by 
the plan or issuer) under such plans in 
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2019 for the same or a similar item or 
service that is provided by a provider 
in the same or similar specialty and 
provided in the geographic region in 
which the item or service is furnished, 
consistent with the methodology estab-
lished by the Secretary under section 
402(e) of the No Surprises Act, in-
creased by the percentage increase in 
the consumer price index for all urban 
consumers (United States city average) 
over 2019 and 2020; and 
‘‘(II) for 2022 and each subse-
quent year, the median contracted rate 
determined under this clause for the 
previous year, increased by the per-
centage increase in the consumer price 
index for all urban consumers (United 
States city average) over such previous 
year. 
‘‘(ii) SPECIAL
RULE.—The Secretary 
shall provide pursuant to rulemaking de-
scribed in section 402(e) of the No Surprises 
Act that— 
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‘‘(I) if the sponsor or issuer of a 
health plan does not have sufficient in-
formation to calculate a median con-
tracted rate for an item or service or 
provider type, or amount of, claims for 
items or services (as determined by the 
Secretary) provided in a particular ge-
ographic area (other than in a case de-
scribed in item (bb)), such sponsor or 
issuer shall demonstrate that such 
sponsor or issuer will use any database 
free of conflicts of interest that has suf-
ficient information reflecting allowed 
amounts paid to a health care provider 
for relevant services provided in the 
applicable geographic region (such as 
State All Payer Claims Databases (as 
defined in section 404(d) of such Act)), 
and that such sponsor or issuer will 
use any such database to determine a 
median contracted rate and cover the 
cost of accessing any such database; 
and 
‘‘(II) in the case of a sponsor or 
issuer offering a health plan in a geo-
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graphic region that did not offer any 
health plan in such region during 
2019, such sponsor or issuer shall use 
a methodology established by the Sec-
retary for determining the median con-
tracted rate for items and services cov-
ered by such plan for the first year in 
which such plan is offered in such re-
gion, and that, for each succeeding 
year, the median contracted rate for 
such items and services under such 
plan shall be the median contracted 
rate for such items and services under 
such plan for the previous year, in-
creased by the percentage increase in 
the consumer price index for all urban 
consumers (United States city average) 
over such previous year. 
‘‘(F) NONPARTICIPATING
EMERGENCY
FA-
CILITY; PARTICIPATING EMERGENCY FACILITY.— 
‘‘(i) NONPARTICIPATING
EMERGENCY 
FACILITY.—The 
term 
‘nonparticipating 
emergency facility’ means, with respect to 
an item or service and a health plan, an 
emergency department of a hospital, or an 
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independent freestanding emergency depart-
ment, that does not have a contractual rela-
tionship with the plan (or, if applicable, 
issuer offering the plan) for furnishing such 
item or service under the plan. 
‘‘(ii) PARTICIPATING EMERGENCY FA-
CILITY.—The term ‘participating emergency 
facility’ means, with respect to an item or 
service and a health plan, an emergency de-
partment of a hospital, or an independent 
freestanding emergency department, that 
has a contractual relationship with the plan 
(or, if applicable, issuer offering the plan) 
for furnishing such item or service under 
the plan. 
‘‘(G) NONPARTICIPATING PROVIDERS; PAR-
TICIPATING PROVIDERS.— 
‘‘(i) NONPARTICIPATING
PROVIDER.— 
The 
term 
‘nonparticipating 
provider’ 
means, with respect to an item or service 
and a health plan, a physician or other 
health care provider who is acting within 
the scope of practice of that provider’s li-
cense or certification under applicable State 
law and who does not have a contractual re-
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lationship with the plan (or, if applicable, 
issuer offering the plan) for furnishing such 
item or service under the plan. 
‘‘(ii) PARTICIPATING
PROVIDER.—The 
term ‘participating provider’ means, with 
respect to an item or service and a health 
plan, a physician or other health care pro-
vider who is acting within the scope of 
practice of that provider’s license or certifi-
cation under applicable State law and who 
has a contractual relationship with the plan 
(or, if applicable, issuer offering the plan) 
for furnishing such item or service under 
the plan. 
‘‘(H) RECOGNIZED
AMOUNT.—The term 
‘recognized amount’ means, with respect to an 
item or service— 
‘‘(i) in the case of such item or service 
furnished in a State that has in effect a 
State law that provides for a method for de-
termining the amount of payment that is 
required to be covered by a health plan reg-
ulated by such State in the case of a partic-
ipant, beneficiary, or enrollee covered under 
such plan and receiving such item or service 
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from a nonparticipating provider or facil-
ity, not more than the amount determined 
in accordance with such law plus the cost- 
sharing amount imposed under the plan for 
such item or service (as determined in ac-
cordance with clauses (ii) and (iii) of para-
graph (1)(C) or subparagraphs (A) and (B) 
of subsection (e)(1), as applicable); or 
‘‘(ii) in the case of such item or service 
furnished in a State that does not have in 
effect such a law, an amount that is at least 
the median contracted rate (as defined in 
subparagraph (E)(i) and determined in ac-
cordance with rulemaking described in sec-
tion 402(e) of the No Surprises Act) for 
such item or service.’’. 
(b) COVERAGE OF NON-EMERGENCY SERVICES PER-
FORMED BY NONPARTICIPATING PROVIDERS AT CERTAIN 
PARTICIPATING FACILITIES; INDEPENDENT DISPUTE RESO-
LUTION PROCESS.—Section 2719A of the Public Health 
Service Act (42 U.S.C. 300gg–19a) is amended by adding 
at the end the following new subsections: 
‘‘(e) COVERAGE OF NON-EMERGENCY SERVICES PER-
FORMED BY NONPARTICIPATING PROVIDERS AT CERTAIN 
PARTICIPATING FACILITIES.— 
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