I 
118TH CONGRESS 
2D SESSION 
H. R. 9572 
To amend title XXVII of the Public Health Service Act, the Employee 
Retirement Income Security Act of 1974, and the Internal Revenue 
Code of 1986 to increase penalties for group health plans and health 
insurance issuers for practices that violate balance billing requirements, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 12, 2024 
Mr. MURPHY (for himself, Mr. RUIZ, Mr. JOYCE of Pennsylvania, Ms. 
SCHRIER, and Mr. PANETTA) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committees on Ways and Means, and Education and the Workforce, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of the 
committee concerned 
A BILL 
To amend title XXVII of the Public Health Service Act, 
the Employee Retirement Income Security Act of 1974, 
and the Internal Revenue Code of 1986 to increase pen-
alties for group health plans and health insurance issuers 
for practices that violate balance billing requirements, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Enhanced Enforce-
ment of Health Coverage Act’’. 
SEC. 2. INCREASING PENALTIES FOR GROUP HEALTH 
PLANS AND HEALTH INSURANCE ISSUERS 
FOR PRACTICES THAT VIOLATE BALANCE 
BILLING REQUIREMENTS. 
(a) PHSA.—Section 2723(b)(2)(C) of the Public 
Health Service Act (42 U.S.C. 300gg–22(b)(2)(C)) is 
amended— 
(1) in clause (i), by inserting ‘‘(or, in the case 
of such a failure with respect to a provision specified 
in clause (iv), $10,000 per failure)’’ after ‘‘$100’’; 
and 
(2) by adding at the end the following new 
clause: 
‘‘(iv) PROVISIONS
SPECIFIED.—For 
purposes of clause (i), the provisions speci-
fied in this clause are the following: 
‘‘(I) Subparagraphs (A) and (B) 
of section 2799A–1(a)(1). 
‘‘(II) Clauses (i), (ii), (iii), and 
(v) of section 2799A–1(a)(1)(C). 
‘‘(III) Subparagraphs (A), (B), 
and (E) of section 2799A–1(b)(1). 
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‘‘(IV) Paragraphs (1) and (2) of 
section 2799A–2(a).’’. 
(b) ERISA.—Section 502 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C. 1131) is 
amended— 
(1) in subsection (a)(6), by striking ‘‘or (9)’’ 
and inserting ‘‘(9), or (12)’’; 
(2) in subsection (b)(3)— 
(A) by inserting ‘‘, (c)(12),’’ after ‘‘sub-
sections (c)(9)’’; and 
(B) by inserting ‘‘or (c)(12)’’ after ‘‘under 
subsection (c)(9)’’; and 
(3) in subsection (c), by adding at the end the 
following new paragraph: 
‘‘(12) The Secretary may assess a civil penalty 
against any group health plan or health insurance issuer 
offering group health insurance coverage of not more than 
$10,000 for each violation for each individual with respect 
to which such plan or coverage fails to comply with one 
of the following provisions: 
‘‘(A) Subparagraphs (A) and (B) of section 
716(a)(1). 
‘‘(B) Clauses (i), (ii), (iii), and (v) of section 
716(a)(1)(C). 
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‘‘(C) Subparagraphs (A), (B), and (E) of sec-
tion 716(b)(1). 
‘‘(D) Paragraphs (1) and (2) of section 
717(a).’’. 
(c) IRC.—Section 4980D(b) of the Internal Revenue 
Code of 1986 is amended— 
(1) in paragraph (1), by inserting ‘‘(or, in the 
case of such a failure with respect to a provision 
specified in paragraph (4), $10,000 per failure)’’ 
after ‘‘$100’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(4) PROVISIONS SPECIFIED.—For purposes of 
paragraph (1), the provisions specified in this para-
graph are the following: 
‘‘(A) Subparagraphs (A) and (B) of section 
9816(a)(1). 
‘‘(B) Clauses (i), (ii), (iii), and (v) of sec-
tion 9816(a)(1)(C). 
‘‘(C) Subparagraphs (A), (B), and (E) of 
section 9816(b)(1). 
‘‘(D) Paragraphs (1) and (2) of section 
9817(a).’’. 
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SEC. 3. ADDITIONAL PENALTIES FOR LATE PAYMENT OR 
NON-PAYMENT AFTER IDR ENTITY PAYMENT 
DETERMINATION. 
(a) PHSA.— 
(1) EMERGENCY
AND
NONEMERGENCY
SERV-
ICES.—Section 2799A–1(c)(6) of the Public Health 
Service Act (42 U.S.C. 300gg–111(c)(6)) is amend-
ed— 
(A) in the paragraph heading, by inserting 
‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY-
MENT’’ after ‘‘PAYMENT’’; 
(B) by striking ‘‘The total plan’’ and in-
serting the following: 
‘‘(A) TIMING
OF
PAYMENT.—The total 
plan’’; and 
(C) by adding at the end the following new 
subparagraphs: 
‘‘(B) NOTIFICATION.—In the case of a 
plan or coverage required to make a payment 
pursuant to a determination described in sub-
paragraph (A), such plan or coverage shall sub-
mit to the Secretary a notification of such pay-
ment as of the date such payment is made in 
a manner specified by the Secretary. 
‘‘(C) PENALTY
FOR
LATE
PAYMENT
OR 
NON-PAYMENT.— 
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‘‘(i) IN GENERAL.—In the case of a 
plan or coverage that has not made the re-
quired payment described in subparagraph 
(A) with respect to an item or service in 
the time period described in such subpara-
graph, in addition to making such pay-
ment, such plan or coverage shall also pay 
to the nonparticipating provider or facility 
an amount that is three times the dif-
ference between— 
‘‘(I) the initial payment (or, in 
the case of a notice of denial of pay-
ment, $0) described in subsection 
(a)(1)(C)(iv)(I) or (b)(1)(C), as appli-
cable; and 
‘‘(II) the out-of-network rate (as 
defined in subsection (a)(3)(K)) for 
such item or service (less any cost 
sharing required to be paid by the in-
dividual receiving such item or serv-
ice). 
‘‘(ii) INTEREST.—Such late payment 
or non-payment (as applicable) shall also 
be subject to interest in a manner specified 
by the Secretary.’’. 
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(2) 
AIR
AMBULANCE
SERVICES.—Section 
2799A–2(b)(6) of the Public Health Service Act (42 
U.S.C. 300gg–112(b)(6)) is amended— 
(A) in the paragraph heading, by inserting 
‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY-
MENT’’ after ‘‘PAYMENT’’; 
(B) by striking ‘‘The total plan’’ and in-
serting the following: 
‘‘(A) TIMING
OF
PAYMENT.—The total 
plan’’; and 
(C) by adding at the end the following new 
subparagraphs: 
‘‘(B) NOTIFICATION.—In the case of a 
plan or coverage required to make a payment 
pursuant to a determination described in sub-
paragraph (A), such plan or coverage shall sub-
mit to the Secretary a notification of such pay-
ment as of the date such payment is made in 
a manner specified by the Secretary. 
‘‘(C) PENALTY
FOR
LATE
PAYMENT
OR 
NON-PAYMENT.— 
‘‘(i) IN GENERAL.—In the case of a 
plan or coverage that has not made the re-
quired payment described in subparagraph 
(A) with respect to an item or service in 
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the time period described in such subpara-
graph, in addition to making such pay-
ment, such plan or coverage shall also pay 
to the nonparticipating provider an amount 
that is three times the difference be-
tween— 
‘‘(I) the initial payment (or, in 
the case of a notice of denial of pay-
ment, $0) described in subsection 
(a)(3)(A); and 
‘‘(II) the out-of-network rate (as 
defined in section 2799–1(a)(3)(K)) 
for such item or service (less any cost 
sharing required to be paid by the in-
dividual receiving such item or serv-
ice). 
‘‘(ii) INTEREST.—Such late payment 
or non-payment (as applicable) shall also 
be subject to interest in a manner specified 
by the Secretary.’’. 
(b) ERISA.— 
(1) EMERGENCY
AND
NONEMERGENCY
SERV-
ICES.—Section 716(c)(6) of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C. 
1185e(c)(6)) is amended— 
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(A) in the paragraph heading, by inserting 
‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY-
MENT’’ after ‘‘PAYMENT’’; 
(B) by striking ‘‘The total plan’’ and in-
serting the following: 
‘‘(A) TIMING
OF
PAYMENT.—The total 
plan’’; and 
(C) by adding at the end the following new 
subparagraphs: 
‘‘(B) NOTIFICATION.—In the case of a 
plan or coverage required to make a payment 
pursuant to a determination described in sub-
paragraph (A), such plan or coverage shall sub-
mit to the Secretary a notification of such pay-
ment as of the date such payment is made in 
a manner specified by the Secretary. 
‘‘(C) PENALTY
FOR
LATE
PAYMENT
OR 
NON-PAYMENT.— 
‘‘(i) IN GENERAL.—In the case of a 
plan or coverage that has not made the re-
quired payment described in subparagraph 
(A) with respect to an item or service in 
the time period described in such subpara-
graph, in addition to making such pay-
ment, such plan or coverage shall also pay 
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to the nonparticipating provider or facility 
an amount that is three times the dif-
ference between— 
‘‘(I) the initial payment (or, in 
the case of a notice of denial of pay-
ment, $0) described in subsection 
(a)(1)(C)(iv)(I) or (b)(1)(C), as appli-
cable; and 
‘‘(II) the out-of-network rate (as 
defined in subsection (a)(3)(K)) for 
such item or service (less any cost 
sharing required to be paid by the in-
dividual receiving such item or serv-
ice). 
‘‘(ii) INTEREST.—Such late payment 
or non-payment (as applicable) shall also 
be subject to interest in a manner specified 
by the Secretary.’’. 
(2) 
AIR
AMBULANCE
SERVICES.—Section 
717(b)(6) of the Employee Retirement Income Secu-
rity Act of 1974 (29 U.S.C. 1185f(b)(6)) is amend-
ed— 
(A) in the paragraph heading, by inserting 
‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY-
MENT’’ after ‘‘PAYMENT’’; 
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(B) by striking ‘‘The total plan’’ and in-
serting the following: 
‘‘(A) TIMING
OF
PAYMENT.—The total 
plan’’; and 
(C) by adding at the end the following new 
subparagraphs: 
‘‘(B) NOTIFICATION.—In the case of a 
plan or coverage required to make a payment 
pursuant to a determination described in sub-
paragraph (A), such plan or coverage shall sub-
mit to the Secretary a notification of such pay-
ment as of the date such payment is made in 
a manner specified by the Secretary. 
‘‘(C) PENALTY
FOR
LATE
PAYMENT
OR 
NON-PAYMENT.— 
‘‘(i) IN GENERAL.—In the case of a 
plan or coverage that has not made the re-
quired payment described in subparagraph 
(A) with respect to an item or service in 
the time period described in such subpara-
graph, in addition to making such pay-
ment, such plan or coverage shall also pay 
to the nonparticipating provider an amount 
that is three times the difference be-
tween— 
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‘‘(I) the initial payment (or, in 
the case of a notice of denial of pay-
ment, $0) described in subsection 
(a)(3)(A); and 
‘‘(II) the out-of-network rate (as 
defined in section 716(a)(3)(K)) for 
such item or service (less any cost 
sharing required to be paid by the in-
dividual receiving such item or serv-
ice). 
‘‘(ii) INTEREST.—Such late payment 
or non-payment (as applicable) shall also 
be subject to interest in a manner specified 
by the Secretary.’’. 
(c) IRC.— 
(1) EMERGENCY
AND
NONEMERGENCY
SERV-
ICES.—Section 9816(c)(6) of the Internal Revenue 
Code of 1986 is amended— 
(A) in the paragraph heading, by inserting 
‘‘; PENALTY FOR LATE PAYMENT OR NON-PAY-
MENT’’ after ‘‘PAYMENT’’; 
(B) by striking ‘‘The total plan’’ and in-
serting the following: 
‘‘(A) TIMING
OF
PAYMENT.—The total 
plan’’; and 
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(C) by adding at the end the following new 
subparagraphs: 
‘‘(B) NOTIFICATION.—In the case of a 
plan required to make a payment pursuant to 
a determination described in subparagraph (A), 
such plan shall submit to the Secretary a notifi-
cation of such payment as of the date such pay-
ment is made in a manner specified by the Sec-
retary. 
‘‘(C) PENALTY
FOR
LATE
PAYMENT
OR 
NON-PAYMENT.— 
‘‘(i) IN GENERAL.—In the case of a 
plan that has not made the required pay-
ment described in subparagraph (A) with 
respect to an item or service in the time 
period described in such subparagraph, in 
addition to making such payment, such 
plan shall also pay to the nonparticipating 
provider or facility an amount that is three 
times the difference between— 
‘‘(I) the initial payment (or, in 
the case of a notice of denial of pay-
ment, $0) described in subsection 
(a)(1)(C)(iv)(I) or (b)(1)(C), as appli-
cable; and 
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‘‘(BB) 
APPLICABLE 
SECTION.—The term ‘appli-
cable section’ means this 
section and each of sections 
9817 through 9825.’’. 
Æ 
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