H. R. 133—1576 
(B) in section 8103(g), by striking ‘‘Saint Lawrence 
Seaway Development Corporation’’ and inserting ‘‘Great 
Lakes St. Lawrence Seaway Development Corporation’’; 
(C) in section 8503(c), by striking ‘‘Saint Lawrence 
Seaway Development Corporation’’ and inserting ‘‘Great 
Lakes St. Lawrence Seaway Development Corporation’’; 
(D) in section 55112(a)(3), by striking ‘‘St. Lawrence 
Seaway Development Corporation’’ and inserting ‘‘Great 
Lakes St. Lawrence Seaway Development Corporation’’; 
(E) in section 55331(3), by striking ‘‘Saint Lawrence 
Seaway Development Corporation’’ and inserting ‘‘Great 
Lakes St. Lawrence Seaway Development Corporation’’; 
and 
(F) in section 70032, by striking ‘‘Saint Lawrence Sea-
way Development Corporation’’ and inserting ‘‘Great Lakes 
St. Lawrence Seaway Development Corporation’’ each place 
it appears. 
(7) TITLE 49.— 
(A) IN
GENERAL.—Title 49, United States Code, is 
amended— 
(i) in section 110— 
(I) in the heading, by striking ‘‘Saint Law-
rence Seaway Development Corporation’’ and 
inserting ‘‘Great Lakes St. Lawrence Seaway 
Development Corporation’’; and 
(II) in subsection (a), by striking ‘‘Saint Law-
rence Seaway Development Corporation’’ and 
inserting ‘‘Great Lakes St. Lawrence Seaway 
Development Corporation’’; and 
(ii) in section 6314(c)(2)(G), by striking ‘‘Saint Law-
rence Seaway Development Corporation’’ and inserting 
‘‘Great Lakes St. Lawrence Seaway Development Cor-
poration’’. 
(B) TABLE
OF
SECTIONS.—The table of sections for 
chapter 1 of subtitle I of title 49, United States Code, 
is amended by amending the item relating to section 110 
to read as follows: 
‘‘110. Great Lakes St. Lawrence Seaway Development Corporation.’’. 
DIVISION BB—PRIVATE HEALTH INSUR-
ANCE AND PUBLIC HEALTH PROVI-
SIONS 
SEC. 1. TABLE OF CONTENTS. 
The table of contents of the division is as follows: 
DIVISION BB—PRIVATE HEALTH INSURANCE AND PUBLIC HEALTH 
PROVISIONS 
Sec. 1. Table of contents. 
TITLE I—NO SURPRISES ACT 
Sec. 101. Short title. 
Sec. 102. Health insurance requirements regarding surprise medical billing. 
Sec. 103. Determination of out-of-network rates to be paid by health plans; Inde-
pendent dispute resolution process.
H. R. 133—1592 
‘‘(B) whether the health care provider furnishing such 
services is a participating provider or a participating emer-
gency facility, as applicable, with respect to such services; 
‘‘(C) in a manner so that, if such services are provided 
to a participant or beneficiary by a nonparticipating pro-
vider or a nonparticipating emergency facility— 
‘‘(i) such services will be provided without imposing 
any requirement under the plan for prior authorization 
of services or any limitation on coverage that is more 
restrictive than the requirements or limitations that 
apply to emergency services received from participating 
providers and participating emergency facilities with 
respect to such plan or coverage, respectively; 
‘‘(ii) the cost-sharing requirement is not greater 
than the requirement that would apply if such services 
were provided by a participating provider or a partici-
pating emergency facility; 
‘‘(iii) such cost-sharing requirement is calculated 
as if the total amount that would have been charged 
for such services by such participating provider or 
participating emergency facility were equal to the rec-
ognized amount (as defined in paragraph (3)(H)) for 
such services, plan or coverage, and year; 
‘‘(iv) the group health plan or health insurance 
issuer, respectively— 
‘‘(I) not later than 30 calendar days after the 
bill for such services is transmitted by such pro-
vider or facility, sends to the provider or facility, 
as applicable, an initial payment or notice of denial 
of payment; and 
‘‘(II) pays a total plan or coverage payment 
directly to such provider or facility, respectively 
(in accordance, if applicable, with the timing 
requirement described in subsection (c)(6)) that 
is, with application of any initial payment under 
subclause (I), equal to the amount by which the 
out-of-network rate (as defined in paragraph 
(3)(K)) for such services exceeds the cost-sharing 
amount for such services (as determined in accord-
ance with clauses (ii) and (iii)) and year; and 
‘‘(v) any cost-sharing payments made by the 
participant or beneficiary with respect to such emer-
gency services so furnished shall be counted toward 
any in-network deductible or out-of-pocket maximums 
applied under the plan or coverage, respectively (and 
such in-network deductible and out-of-pocket maxi-
mums shall be applied) in the same manner as if 
such cost-sharing payments were made with respect 
to emergency services furnished by a participating pro-
vider or a participating emergency facility; and 
‘‘(D) without regard to any other term or condition 
of such coverage (other than exclusion or coordination of 
benefits, or an affiliation or waiting period, permitted under 
section 2704 of the Public Health Service Act, including 
as incorporated pursuant to section 715 of this Act and 
section 9815 of the Internal Revenue Code of 1986, and 
other than applicable cost-sharing).
H. R. 133—1598 
of the contracted rates described in clause (i)(I) 
in 2019, the first year subsequent to 2022 
for which such sponsor or issuer has such 
sufficient information to calculate the median 
of such contracted rates in the year previous 
to such first subsequent year; and 
‘‘(bb) in the case of a newly covered item 
or service, the first year subsequent to the 
first coverage year for such item or service 
with respect to such plan or coverage for which 
the sponsor or issuer has sufficient informa-
tion to calculate the median of the contracted 
rates described in clause (i)(I) in the year pre-
vious to such first subsequent year. 
‘‘(III) NEWLY COVERED ITEM OR SERVICE.—The 
term ‘newly covered item or service’ means, with 
respect to a group health plan or health insurance 
issuer offering group health insurance coverage, 
an item or service for which coverage was not 
offered in 2019 under such plan or coverage, but 
is offered under such plan or coverage in a year 
after 2019. 
‘‘(F) NONPARTICIPATING EMERGENCY FACILITY; PARTICI-
PATING EMERGENCY FACILITY.— 
‘‘(i) NONPARTICIPATING EMERGENCY FACILITY.—The 
term ‘nonparticipating emergency facility’ means, with 
respect to an item or service and a group health plan 
or group health insurance coverage offered by a health 
insurance issuer, an emergency department of a hos-
pital, or an independent freestanding emergency 
department, that does not have a contractual relation-
ship directly or indirectly with the plan or issuer, 
respectively, for furnishing such item or service under 
the plan or coverage, respectively. 
‘‘(ii) PARTICIPATING
EMERGENCY
FACILITY.—The 
term ‘participating emergency facility’ means, with 
respect to an item or service and a group health plan 
or group health insurance coverage offered by a health 
insurance issuer, an emergency department of a hos-
pital, or an independent freestanding emergency 
department, that has a contractual relationship 
directly or indirectly with the plan or issuer, respec-
tively, with respect to the furnishing of such an item 
or service at such facility. 
‘‘(G) NONPARTICIPATING PROVIDERS; PARTICIPATING PRO-
VIDERS.— 
‘‘(i) NONPARTICIPATING PROVIDER.—The term ‘non-
participating provider’ means, with respect to an item 
or service and a group health plan or group health 
insurance coverage offered by a health insurance 
issuer, a physician or other health care provider who 
is acting within the scope of practice of that provider’s 
license or certification under applicable State law and 
who does not have a contractual relationship with the 
plan or issuer, respectively, for furnishing such item 
or service under the plan or coverage, respectively.