142 
sponsible for paying all fees charged by 
such entity; and 
(ii) if the parties reach a settlement 
with respect to such request prior to such 
a determination, each party shall pay half 
of all fees charged by such entity, unless 
the parties otherwise agree. 
(E) PAYMENT.—Not later than 30 days 
after the date on which a determination de-
scribed in subparagraph (B) is made with re-
spect to a request under the IDR process of a 
nonparticipating 
provider, 
nonparticipating 
emergency facility, group health plan, or health 
insurance issuer offering health insurance cov-
erage in the group or individual market— 
(i) in the case that the alternative 
payment determined to be applied is great-
er than the amount paid with respect to 
such request, such plan or issuer (as appli-
cable) shall pay directly to the provider or 
facility (as applicable) the difference be-
tween such alternative payment and the 
amount so paid; and 
(ii) in the case that the alternative 
payment determined to be applied is less 
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143 
than the amount paid with respect to such 
request, such provider or facility (as appli-
cable) shall pay directly to the plan or 
issuer (as applicable) the difference be-
tween the amount so paid and such alter-
native payment. 
(e) PUBLICATION OF INFORMATION RELATING TO 
DISPUTES.— 
(1) PUBLICATION OF INFORMATION.—For 2022 
and each subsequent year, the Secretaries shall 
make available on the public website of the Depart-
ment of Health and Human Services, the Depart-
ment of Labor, and the Department of the Treas-
ury— 
(A) the number of requests submitted 
under the IDR process during such year; 
(B) the practice size of the providers and 
facilities submitting requests under the IDR 
process during such year; 
(C) the number of such requests with re-
spect to which a final determination was made 
under subsection (d)(3)(A); and 
(D) the information described in para-
graph (2) with respect to each request with re-
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144 
spect to which such a determination was so 
made. 
(2) INFORMATION
WITH
RESPECT
TO
RE-
QUESTS.—For purposes of paragraph (1), the infor-
mation described in this paragraph is, with respect 
to a request under the IDR process of a nonpartici-
pating provider, nonparticipating emergency facility, 
group health plan, or health insurance issuer offer-
ing health insurance coverage in the group or indi-
vidual market— 
(A) a description of each item and service 
(or air ambulance service) included in such re-
quest; 
(B) the geography in which the items and 
services (or air ambulance services) included in 
such request were provided; 
(C) the amount of the offer submitted 
under subsection (d)(3)(A) by the group health 
plan or health insurance issuer (as applicable) 
and by the nonparticipating provider or non-
participating emergency facility (as applicable) 
expressed as a percentage of the median con-
tracted rate; 
(D) whether the offer selected by the cer-
tified IDR entity under such subsection to be 
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145 
the alternative payment applied was the offer 
submitted by such plan or issuer (as applicable) 
or by such provider or facility (as applicable) 
and the amount of such offer so selected ex-
pressed as a percentage of the median con-
tracted rate; 
(E) the category and practice specialty of 
each such provider or facility involved in fur-
nishing such items and services (or, in the case 
of air ambulance services, the ambulance vehicle 
type, including the clinical capability level of 
such vehicle); and 
(F) the identity of the group health plan or 
health insurance issuer, provider, or facility, 
with respect to the request. 
(3) IDR ENTITY
REQUIREMENTS.—For 2022 
and each subsequent year, an IDR entity, as a con-
dition of certification as an IDR entity, shall submit 
to the Secretaries such information as the Secre-
taries determines necessary for the Secretaries to 
carry out the provisions of this subsection. 
(f) ENFORCEMENT.— 
(1) IN
GENERAL.—Any health care provider, 
health care facility, group health plan, or health in-
surance issuer offering group or individual health in-
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pamtmann on DSKBC07HB2PROD with BILLS
146 
surance coverage that violates a provision of this 
section shall be subject to a civil monetary penalty 
in an amount not to exceed $10,000 for each such 
violation. 
(2) APPLICATION.—The provisions of section 
1128A of the Social Security Act (other than sub-
sections (a) and (b) and the first sentence of sub-
section (c)(1)) shall apply with respect to a civil 
monetary penalty imposed under this subsection in 
the same manner as such provisions apply with re-
spect to a penalty or proceeding under subsection 
(a) of such section, except that any reference to ‘‘the 
Secretary’’ in such provisions shall be treated as a 
reference to ‘‘the Secretaries’’. 
(g) DEFINITIONS.—In this subsection, terms ‘‘group 
health plan’’, ‘‘group market’’, ‘‘health insurance issuer’’, 
‘‘health insurance coverage’’, ‘‘individual health insurance 
coverage’’, ‘‘group health insurance coverage’’, and ‘‘indi-
vidual market’’ have the meanings given such terms, re-
spectively, in section 2791 of the Public Health Service 
Act. 
SEC. 5. ADVISORY COMMITTEE ON GROUND AMBULANCE 
AND PATIENT BILLING. 
(a) IN GENERAL.—Not later than 60 days after the 
date of enactment of this Act, the Secretary of Labor, Sec-
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pamtmann on DSKBC07HB2PROD with BILLS
147 
retary of Health and Human Services, and the Secretary 
of the Treasury (the Secretaries) shall jointly establish an 
advisory committee for the purpose of reviewing options 
to improve the disclosure of charges and fees for ground 
ambulance services, better inform consumers of insurance 
options for such services, and protect consumers from bal-
ance billing. 
(b) COMPOSITION OF THE ADVISORY COMMITTEE.— 
The advisory committee shall be composed of the following 
members: 
(1) The Secretary of Labor, or the Secretary’s 
designee. 
(2) The Secretary of Health and Human Serv-
ices, or the Secretary’s designee. 
(3) The Secretary of the Treasury, or the Sec-
retary’s designee. 
(4) One representative, to be appointed jointly 
by the Secretaries, for each of the following: 
(A) Each relevant Federal agency, as de-
termined by the Secretaries. 
(B) State insurance regulators. 
(C) Health insurance providers or trade or-
ganization. 
(D) Patient advocacy groups. 
(E) Consumer advocacy groups. 
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pamtmann on DSKBC07HB2PROD with BILLS
148 
(F) State and local governments. 
(G) Physician specializing in emergency, 
trauma, cardiac, or stroke. 
(5) Three representatives, to be appointed joint-
ly by the Secretaries, to represent the various seg-
ments of the ground ambulance industry. 
(6) Up to an additional three representatives 
otherwise not described in paragraphs (1) through 
(5), as determined necessary and appropriate by the 
Secretaries. 
(c) CONSULTATION.—The advisory committee shall, 
as appropriate, consult with relevant experts and stake-
holders, including those not otherwise included under sub-
section (b), while conducting the review described in sub-
section (a). 
(d) RECOMMENDATIONS.—The advisory committee 
shall make recommendations with respect to disclosure of 
charges and fees for ground ambulance services and insur-
ance coverage, consumer protection and enforcement au-
thorities of the Departments of Labor, Health and Human 
Services, and the Treasury and State authorities, and the 
prevention of balance billing to consumers. The rec-
ommendations shall address, at a minimum— 
(1) options, best practices, and identified stand-
ards to prevent instances of balance billing; 
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149 
(2) steps that can be taken by State legisla-
tures, State insurance regulators, State attorneys 
general, and other State officials as appropriate, 
consistent with current legal authorities regarding 
consumer protection; and 
(3) legislative options for Congress to prevent 
balance billing. 
(e) REPORT.—Not later than 180 days after the date 
of the first meeting of the advisory committee, the advi-
sory committee shall submit to the Secretaries, and the 
Committees on Education and Labor, Energy and Com-
merce, and Ways and Means of the House of Representa-
tives and the Committees on Finance and Health, Edu-
cation, Labor, and Pensions a report containing the rec-
ommendations made under subsection (d). 
(f) RULEMAKING.—Upon receipt of the report under 
subsection (e), the Secretaries shall consider the rec-
ommendations of the advisory committee and issue regula-
tions or other guidance as deemed necessary to provide 
consumer protections for patients of ground ambulance 
providers. 
SEC. 6. IMPROVING PROVIDER DIRECTORIES. 
(a) PHSA.—Part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg et seq.) is amended 
by adding at the end the following new section: 
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150 
‘‘SEC. 2730. PROTECTING PATIENTS AND IMPROVING THE 
ACCURACY OF PROVIDER DIRECTORY INFOR-
MATION. 
‘‘(a) NETWORK STATUS OF PROVIDERS.— 
‘‘(1) IN GENERAL.—Beginning on the date that 
is one year after the date of enactment of this sec-
tion, a group health plan or a health insurance 
issuer offering group or individual health insurance 
coverage shall— 
‘‘(A) establish business processes to ensure 
that all enrollees in such plan or coverage re-
ceive proof of a health care provider’s network 
status, based on what a plan or issuer knows or 
should know— 
‘‘(i) upon a telephone inquiry by an 
enrollee— 
‘‘(I) through a written electronic 
communication from the plan or 
issuer to the enrollee, as soon as prac-
ticable and not later than 1 business 
day after such inquiry is made by 
such participant, beneficiary, or en-
rollee for such information; 
‘‘(II) through an oral commu-
nication from the plan or issuer to the 
enrollee, as soon as practicable and 
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pamtmann on DSKBC07HB2PROD with BILLS
151 
not later than 1 business day after 
such inquiry is made by such enrollee 
for such information, which commu-
nication shall be documented by such 
plan or issuer, and such documenta-
tion shall be kept in the enrollee’s file 
for a minimum of 2 years; and 
‘‘(ii) in real-time through an online 
health care provider directory search tool 
maintained by the plan or issuer; and 
‘‘(B) include in any print directory— 
‘‘(i) a disclosure that the information 
included in the directory is accurate as of 
the date of the last data update and that 
enrollees or prospective enrollees should 
consult the group health plan’s or issuer’s 
electronic provider directory on its website 
or call a specified customer service tele-
phone number to obtain the most current 
provider directory information; and 
‘‘(ii) a list of the categories of pro-
viders of ancillary services for which the 
plan or coverage has no in-network pro-
viders. 
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152 
‘‘(2) GROUP HEALTH PLAN AND HEALTH IN-
SURANCE ISSUER BUSINESS PROCESSES.—Beginning 
on the date that is one year after the date of the en-
actment of this section, a group health plan or a 
health insurance issuer offering group or individual 
health insurance coverage shall establish business 
processes to— 
‘‘(A) verify and update, at least once every 
90 days, the provider directory information for 
all providers included in the online health care 
provider directory search tool described in para-
graph (1)(A)(ii); and 
‘‘(B) remove any provider from such online 
directory search tool if such provider has not 
verified the directory information within the 
previous 6 months or the plan or issuer has 
been unable to verify the provider’s network 
participation. 
‘‘(b) COST-SHARING LIMITATIONS.—A group health 
plan or a health insurance issuer offering group or indi-
vidual health insurance coverage shall not apply, and shall 
ensure that no provider applies, cost-sharing to an enrollee 
for treatment or services provided by a health care pro-
vider in excess of the normal cost-sharing applied for such 
treatment or services provided in-network (including any 
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153 
balance bill issued by the health care provider involved), 
if such enrollee, or health care provider referring such en-
rollee, demonstrates (based on the electronic, written in-
formation described in subsection (a)(1)(A)(i)(I), the oral 
confirmation described in subsection (a)(1)(A)(i)(II) re-
ceived by the enrollee not more than 30 days before the 
date the treatment or services were received, or a copy 
of the online provider directory described in subsection 
(a)(1)(A)(ii) on a date not more than 30 days before the 
date the treatment or services were received), that the en-
rollee relied on the information described in subsection 
(a)(1) for which such enrollee provides such documenta-
tion, that indicated that the provider is an in-network pro-
vider, if the provider was out-of-network at the time the 
treatment or service involved was received. 
‘‘(c) DEFINITION.—For purposes of this section, the 
term ‘provider directory information’ includes the names, 
addresses, specialty, and telephone numbers of individual 
health care providers, and the names, addresses, and tele-
phone numbers of each medical group, clinic, or facility 
contracted to participate in any of the networks of the 
group health plan or health insurance coverage involved. 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to preempt any provision of State 
law relating to health care provider directories.’’. 
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154 
(b) ERISA.—Subpart B of part 7 of subtitle B of 
title I of the Employee Retirement Income Security Act 
of 1974 (29 U.S.C. 1185 et seq.), as amended by section 
2, is further amended by adding at the end the following: 
‘‘SEC. 717. PROTECTING PATIENTS AND IMPROVING THE 
ACCURACY OF PROVIDER DIRECTORY INFOR-
MATION. 
‘‘(a) NETWORK STATUS OF PROVIDERS.— 
‘‘(1) IN GENERAL.—Beginning on the date that 
is one year after the date of enactment of this sec-
tion, a group health plan (or health insurance cov-
erage offered in connection with such a plan) shall— 
‘‘(A) establish business processes to ensure 
that all participants and beneficiaries in such 
plan or coverage receive proof of a health care 
provider’s network status, based on what a plan 
or issuer of such coverage knows or should 
know— 
‘‘(i) upon a telephone inquiry by a 
participant or beneficiary— 
‘‘(I) through a written electronic 
communication from the plan or 
issuer to the participant or bene-
ficiary, as soon as practicable and not 
later than 1 business day after such 
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155 
inquiry is made by such participant or 
beneficiary for such information; 
‘‘(II) through an oral commu-
nication from the plan or issuer to the 
participant or beneficiary, as soon as 
practicable and not later than 1 busi-
ness day after such inquiry is made by 
such participant or beneficiary for 
such information, which communica-
tion shall be documented by such plan 
or issuer, and such documentation 
shall be kept in the participant’s or 
beneficiary’s file for a minimum of 2 
years; and 
‘‘(ii) in real-time through an online 
health care provider directory search tool 
maintained by the plan or issuer; and 
‘‘(B) include in any print directory— 
‘‘(i) a disclosure that the information 
included in the directory is accurate as of 
the date of the last data update and that 
participants or beneficiaries or prospective 
participants or beneficiaries should consult 
the group health plan’s or issuer’s elec-
tronic provider directory on its website or 
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156 
call a specified customer service telephone 
number to obtain the most current pro-
vider directory information; and 
‘‘(ii) a list of the categories of pro-
viders of ancillary services for which the 
plan or coverage has no in-network pro-
viders. 
‘‘(2) GROUP HEALTH PLAN AND HEALTH IN-
SURANCE ISSUER BUSINESS PROCESSES.—Beginning 
on the date that is one year after the date of enact-
ment of this section, a group health plan (or health 
insurance coverage offered in connection with such a 
plan) shall establish business processes to— 
‘‘(A) verify and update, at least once every 
90 days, the provider directory information for 
all providers included in the online health care 
provider directory search tool described in para-
graph (1)(A)(ii); and 
‘‘(B) remove any provider from such online 
directory search tool if such provider has not 
verified the directory information within the 
previous 6 months or the plan or issuer has 
been unable to verify the provider’s network 
participation. 
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157 
‘‘(b) COST-SHARING LIMITATIONS.—A group health 
plan (or health insurance coverage offered in connection 
with such a plan) shall not apply, and shall ensure that 
no provider applies, cost-sharing to a participant or bene-
ficiary for treatment or services provided by a health care 
provider in excess of the normal cost-sharing applied for 
such treatment or services provided in-network (including 
any balance bill issued by the health care provider in-
volved), if such participant or beneficiary, or health care 
provider referring such participant or beneficiary, dem-
onstrates (based on the electronic, written information de-
scribed in subsection (a)(1)(A)(i)(I), the oral confirmation 
described in subsection (a)(1)(A)(i)(II) received by the 
participant or beneficiary not more than 30 days before 
the date the treatment or services were received, or a copy 
of the online provider directory described in subsection 
(a)(1)(A)(ii) on a date not more than 30 days before the 
date the treatment or services were received), that the par-
ticipant or beneficiary relied on the information described 
in subsection (a)(1) for which such participant or bene-
ficiary provides such documentation, that indicated that 
the provider is an in-network provider, if the provider was 
out-of-network at the time the treatment or service in-
volved was received. 
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158 
‘‘(c) DEFINITION.—For purposes of this section, the 
term ‘provider directory information’ includes the names, 
addresses, specialty, and telephone numbers of individual 
health care providers, and the names, addresses, and tele-
phone numbers of each medical group, clinic, or facility 
contracted to participate in any of the networks of the 
group health plan or health insurance coverage involved.’’. 
(c) IRC.—Subchapter B of chapter 100 of the Inter-
nal Revenue Code of 1986, as amended by section 2, is 
further amended by adding at the end the following: 
‘‘SEC. 9817. PROTECTING PATIENTS AND IMPROVING THE 
ACCURACY OF PROVIDER DIRECTORY INFOR-
MATION. 
‘‘(a) NETWORK STATUS OF PROVIDERS.— 
‘‘(1) IN GENERAL.—Beginning on the date that 
is one year after the date of enactment of this sec-
tion, a group health plan shall— 
‘‘(A) establish business processes to ensure 
that all participants or beneficiaries in such 
plan receive proof of a health care provider’s 
network status, based on what a plan or issuer 
knows or should know— 
‘‘(i) upon a telephone inquiry by a 
participant or beneficiary— 
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159 
‘‘(I) through a written electronic 
communication from the plan to the 
participant or beneficiary, as soon as 
practicable and not later than 1 busi-
ness day after such inquiry is made by 
such participant or beneficiary for 
such information; 
‘‘(II) through an oral commu-
nication from the plan to the partici-
pant or beneficiary, as soon as prac-
ticable and not later than 1 business 
day after such inquiry is made by 
such participant or beneficiary for 
such information, which communica-
tion shall be documented by such 
plan, and such documentation shall be 
kept in the participant’s or bene-
ficiary’s file for a minimum of 2 
years; and 
‘‘(ii) in real-time through an online 
health care provider directory search tool 
maintained by the plan; and 
‘‘(B) include in any print directory— 
‘‘(i) a disclosure that the information 
included in the directory is accurate as of 
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