178 
‘‘(9) SECRETARIAL REPORT; PUBLICATION OF 
INFORMATION.— 
‘‘(A) SECRETARIAL
REPORT.—Beginning 
not later than July 1, 2023, the Secretary shall, 
in coordination with the Secretary of Health 
and Human Services and the Secretary of the 
Treasury, periodically study and submit to Con-
gress a report on— 
‘‘(i) the extent to which the payment 
amount determined under this subsection 
for an item or service furnished in a year 
(or otherwise agreed to by a health plan 
and provider or facility for purposes of de-
termining payment by the plan to the pro-
vider or facility pursuant to subsection 
(b)(1), (e)(1), or (i)(1)) differs from the 
median contracted rate for such item or 
service and year, including the number of 
times such determined (or agreed to) 
amount exceeds such median contracted 
rate; and 
‘‘(ii) the effect of such difference on 
the cost-sharing for such item or service 
for a participant or beneficiary of a health 
plan. 
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‘‘(B) PUBLICATION
OF
INFORMATION.— 
Beginning with July 1, 2023, and for each cal-
endar quarter thereafter, the Secretary shall, in 
coordination with the Secretary of Health and 
Human Services and the Secretary of Labor, 
make publicly available a summary of the fol-
lowing: 
‘‘(i) The information described in sub-
clauses (I) through (V) of clause (ii) of 
paragraph (7)(F) that was submitted to 
the Secretary under clause (i) of such 
paragraph during such quarter. 
‘‘(ii) The amount of expenditures 
made by the Secretary during such year to 
carry out the mediated dispute process. 
‘‘(iii) The total amount of fees paid 
under paragraph (8) during such quarter. 
‘‘(iv) The total amount of compensa-
tion paid to selected independent entities 
under paragraph (6) during such quar-
ter.’’. 
(d) RULE OF CONSTRUCTION.—Nothing in this Act, 
or the amendment made by this Act, shall be construed 
as removing any obligation of a health plan (as defined 
in subsection (k)(6) of section 2719A of the Public Health 
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180 
Service Act (42 U.S.C. 300gg–19A), as amended by this 
Act) to provide payment to a health care provider or 
health care facility for items and services furnished by 
such provider or facility to an individual enrolled in such 
plan. 
SEC. 8. PROHIBITING BALANCE BILLING PRACTICES BY 
PROVIDERS FOR EMERGENCY SERVICES, FOR 
SERVICES 
FURNISHED 
BY 
NONPARTICI-
PATING PROVIDER AT PARTICIPATING FACIL-
ITY, AND IN CERTAIN CASES OF MISINFORMA-
TION. 
(a) NO BALANCE BILLING.—Part A of title XI of the 
Social Security Act (42 U.S.C. 1301 et seq.) is amended 
by adding at the end the following new section: 
‘‘SEC. 1150C. PROHIBITION ON CERTAIN BALANCE BILLING 
PRACTICES. 
‘‘(a) EMERGENCY SERVICES.—In the case of an indi-
vidual with benefits under a group health plan or health 
insurance coverage offered in the group or individual mar-
ket who is furnished in a plan year that begins on or after 
January 1, 2022, emergency services with respect to an 
emergency medical condition during a visit at an emer-
gency department of a hospital or an independent free-
standing emergency department— 
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‘‘(1) if the hospital or independent freestanding 
emergency department does not have a contractual 
relationship with such plan or coverage for fur-
nishing such services, the hospital or independent 
freestanding emergency department shall not bill, 
and shall not hold liable, the individual for a pay-
ment amount for such emergency services so fur-
nished that is more than the cost-sharing amount 
for such services (as determined in accordance with 
section 2719A(b) of the Public Health Service Act, 
section 716(b) of the Employee Retirement Income 
Security Act of 1974, or section 9816(b) of the In-
ternal Revenue Code of 1986, as applicable); and 
‘‘(2) a health care provider without a contrac-
tual relationship with such plan or coverage for fur-
nishing such services shall not bill, and shall not 
hold liable, such individual for a payment amount 
for such services furnished to such individual by 
such provider with respect to such emergency med-
ical condition and visit for which the individual re-
ceives emergency services at the emergency depart-
ment of the hospital or independent freestanding 
emergency department that is more than the cost- 
sharing amount for such services furnished by the 
provider (as determined in accordance with section 
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182 
2719A(b) of the Public Health Service Act, section 
716(b) of the Employee Retirement Income Security 
Act of 1974, or section 9816(b) of the Internal Rev-
enue Code of 1986, as applicable). 
‘‘(b) SERVICES FURNISHED BY NONPARTICIPATING 
PROVIDER AT PARTICIPATING FACILITY.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
in the case of an individual with benefits under a 
health plan who is furnished items or services (other 
than emergency services to which subsection (a) ap-
plies or items and services to which subsection (c) 
applies) in a plan year that, with respect to such 
plan or such coverage (as applicable), begins on or 
after January 1, 2022, at a participating facility by 
a nonparticipating provider, such provider shall not 
bill, and shall not hold liable, such individual for a 
payment amount for such an item or service fur-
nished by such provider during a visit at such facil-
ity that is more than the cost-sharing amount for 
such item or service (as determined in accordance 
with section 2719A(e) of the Public Health Service 
Act, section 716(e) of the Employee Retirement In-
come Security Act of 1974, or section 9816(e) of the 
Internal Revenue Code of 1986, as applicable). 
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‘‘(2) EXCEPTION IN CASE NOTICE PROVIDED.— 
Paragraph (1) shall not apply with respect to items 
and services (other than items and services described 
in paragraph (3)) furnished to an individual enrolled 
in a group health plan or in health insurance cov-
erage offered in the group or individual market by 
a health care provider that does not have a contrac-
tual relationship with such plan or coverage for fur-
nishing such items and services if the following cri-
teria are met: 
‘‘(A) A written notice (as specified by the 
Secretary and in clear and understandable lan-
guage) is provided by the provider to such indi-
vidual, not later than 48 hours before such 
items and services are to be so furnished, that 
includes the following information: 
‘‘(i) A statement verifying that the 
provider does not have such a relationship 
with such plan or coverage. 
‘‘(ii) The estimated amount that such 
provider may charge the individual for 
such items and services. 
‘‘(iii) A statement that the individual 
may seek such items or services from a 
health care provider that does have such a 
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184 
contractual relationship and a list, if fea-
sible, of providers with such a relationship 
who are able to furnish such items and 
services involved. 
‘‘(B) On the date such item or service is 
to be furnished, before such item or service is 
so furnished, the individual signs and dates 
such notice confirming receipt of the notice and 
consent of the individual to be so furnished 
such items and services. 
‘‘(C) A copy of such signed and dated no-
tice is provided by the provider to the plan or 
coverage. 
‘‘(3) ITEMS AND SERVICES DESCRIBED.—The 
items and services described in this paragraph are 
items and services furnished by a specified provider 
(as defined in subsection (f)(3)). 
‘‘(c) RELIANCE ON INCORRECT PROVIDER INFORMA-
TION.—In the case of an individual who is furnished items 
or services by a health care provider or health care facility 
for which a group health plan or health insurance issuer 
is required to make payment under section 2719A(i) of 
the Public Health Service Act, section 716(i) of the Em-
ployee Retirement Income Security Act of 1974, or section 
9816(i) of the Internal Revenue Code of 1986, such pro-
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vider or facility shall not bill, and shall not hold liable, 
such individual for a payment amount for such an item 
or service that is more than the cost-sharing amount for 
such item or service (as determined in accordance with 
section 2719A(i) of the Public Health Service Act, section 
716(i) of the Employee Retirement Income Security Act 
of 1974, or section 9816(i) of the Internal Revenue Code 
of 1986, as applicable). 
‘‘(d) COMPLIANCE WITH REQUIREMENTS UNDER 
OPEN NEGOTIATION AND MEDIATED DISPUTE RESOLU-
TION PROCESSES.—A health care provider or health care 
facility shall comply with any requirement imposed on 
such provider or facility, respectively, under section 
2719A(j) of the Public Health Service Act, 9816(j) of the 
Internal Revenue Code of 1986, or 716(j) of the Employee 
Retirement Income Security Act of 1974. 
‘‘(e) PENALTY.— 
‘‘(1) IN GENERAL.—Any health care provider or 
health care facility 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 OF PROVISIONS.—The provi-
sions of section 1128A (other than subsection (a), 
subsection (b), the first sentence of subsection 
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186 
(c)(1), and subsection (o)) shall apply with respect 
to a civil monetary penalty imposed under this sub-
section in the same manner as such provisions apply 
with respect to a penalty or proceeding under sub-
section (a) of such section. 
‘‘(f) DEFINITIONS.—For purposes of this section and 
sections 1150D and 1150E: 
‘‘(1) The terms ‘during a visit’,‘emergency de-
partment of a hospital’, ‘emergency medical condi-
tion’, ‘emergency services’, ‘independent freestanding 
emergency department’, ‘nonparticipating provider’, 
‘nonparticipating facility’, ‘participating facility’, 
‘participating provider’ have the meanings given 
such terms, respectively, in section 2719A(k) of the 
Public Health Service Act. 
‘‘(2) The terms ‘group health plan’, ‘group mar-
ket’, ‘health insurance issuer’, ‘health insurance cov-
erage’, and ‘individual market’ have the meanings 
given such terms, respectively, in section 2791 of the 
Public Health Service Act. 
‘‘(3) The term ‘specified provider’, with respect 
to an individual with benefits under a group health 
plan or health insurance coverage and a hospital 
with a contractual relationship with such plan or 
coverage for furnishing items and services— 
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187 
‘‘(A) means an ancillary health care pro-
vider, including emergency medicine providers 
or suppliers, anesthesiologists, pathologists, ra-
diologists, neonatologists, assistant surgeons, 
hospitalists, intensivists, or other providers de-
termined by the Secretary (including providers 
who furnish similar items and services as the 
providers specified in this paragraph); and 
‘‘(B) includes, with respect to an item or 
service, any health care provider furnishing 
such item or service at such hospital if there is 
no health care provider at such hospital who 
can furnish such item or service who has such 
a relationship with such plan or coverage for 
furnishing such item or service.’’. 
(b) PROVIDER DIRECTORY; PATIENT-PROVIDER DIS-
PUTE RESOLUTION PROCESS.—Part A of title XI of the 
Social Security Act (42 U.S.C. 1301 et seq.), as amended 
by subsection (a), is further amended by adding at the 
end the following new sections: 
‘‘SEC. 1150D. PATIENT PROTECTIONS AGAINST SURPRISE 
BILLING THROUGH TRANSPARENCY. 
‘‘(a) SUBMISSION
OF INFORMATION
TO HEALTH 
PLANS OF CERTAIN PROVIDER INFORMATION.—Begin-
ning not later than 1 year after the date of the enactment 
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188 
of this section, each health care provider and health care 
facility shall establish a process under which such provider 
or facility transmits, to each health insurance issuer offer-
ing group or individual health insurance coverage and 
group health plan with which such provider or supplier 
has in effect a contractual relationship for furnishing 
items and services under such coverage or such plan, pro-
vider directory information (as defined in section 
2719A(f)(6) of the Public Health Service Act, section 
716(f)(6) of the Employee Retirement Income Security 
Act of 1974, or section 9816(f)(6) of the Internal Revenue 
Code of 1986, as applicable) with respect to such provider 
or facility, as applicable. Such provider or facility shall so 
transmit such information to such issuer offering such 
coverage or such group health plan— 
‘‘(1) when there are any material changes (in-
cluding a change in address, telephone number, or 
other contact information) to such provider directory 
information of the provider or facility with respect to 
such coverage offered by such issuer or with respect 
to such plan; and 
‘‘(2) at any other time (including upon the re-
quest of such issuer or plan) determined appropriate 
by the provider, facility, or the Secretary. 
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189 
‘‘(b) PROVISION OF INFORMATION UPON REQUEST 
AND FOR SCHEDULED APPOINTMENTS.—Each health care 
provider and health care facility shall, beginning January 
1, 2022, in the case of an individual who schedules an 
item or service to be furnished to such individual by such 
provider or facility at least 3 business days before the date 
such item or service is to be so furnished, not later than 
1 business day after the date of such scheduling (or, in 
the case of such an item or service scheduled at least 10 
business days before the date such item or service is to 
be so furnished (or if requested by the individual), not 
later than 3 business days after the date of such sched-
uling or such request)— 
‘‘(1) inquire if such individual is enrolled in a 
group health plan, group or individual health insur-
ance coverage offered by a health insurance issuer, 
or a Federal health care program (and if is so en-
rolled in such plan or coverage, seeking to have a 
claim for such item or service submitted to such 
plan or coverage); and 
‘‘(2) provide a notification (in clear and under-
standable language) of the good faith estimate of the 
expected charges for furnishing such item or service 
(including any item or service that is reasonably ex-
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190 
pected to be provided in conjunction with such 
scheduled item or service) to— 
‘‘(A) in the case the individual is enrolled 
in such a plan or such coverage (and is seeking 
to have a claim for such item or service sub-
mitted to such plan or coverage), such plan or 
issuer of such coverage; and 
‘‘(B) in the case the individual is not de-
scribed in subparagraph (A) and not enrolled in 
a Federal health care program, the individual. 
‘‘(c) CONTINUITY OF CARE.—A health care provider 
or health care facility shall, in the case of an individual 
furnished items and services by such provider or facility 
for which coverage is provided under a group health plan 
or group or individual health insurance coverage pursuant 
to section 2730 of such Act, section 9817 of the Internal 
Revenue Code of 1986, or section 717 of the Employee 
Retirement Income Security Act of 1974— 
‘‘(1) accept payment from such plan or such 
issuer (as applicable) (and cost-sharing from such 
individual, if applicable, in accordance with sub-
section (a)(2)(C) of such section 2730, 9817, or 
717) for such items and services as payment in full 
for such items and services; and 
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191 
‘‘(2) continue to adhere to all policies, proce-
dures, and quality standards imposed by such plan 
or issuer with respect to such individual and such 
items and services in the same manner as if such 
termination had not occurred. 
‘‘(d) LIMITATION.—Beginning on January 1, 2022, 
a health care provider or health care facility may not ini-
tiate a process to seek reimbursement of payment for 
items and services furnished to an individual enrolled in 
a group health plan or health insurance coverage offered 
in the group or individual market more than 1 year after 
the date on which such items and services were so fur-
nished. 
‘‘(e) PENALTY.— 
‘‘(1) GENERAL PENALTY.— 
‘‘(A) IN GENERAL.—Except as provided in 
paragraph (2), any health care provider or 
health care facility 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. 
‘‘(B) APPLICATION OF PROVISIONS.—The 
provisions of section 1128A (other than sub-
section (a), subsection (b), the first sentence of 
subsection (c)(1), and subsection (o)) shall 
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192 
apply with respect to a civil monetary penalty 
imposed under this paragraph in the same man-
ner as such provisions apply with respect to a 
penalty or proceeding under subsection (a) of 
such section. 
‘‘(2) PROVIDER DIRECTORY INFORMATION PEN-
ALTY.— 
‘‘(A) IN GENERAL.—Each health care pro-
vider or health care facility that fails to trans-
mit information as required under subsection 
(a) shall be subject to a civil monetary penalty 
of $1,000 for each day such provider or facility 
(as applicable) fails to so transmit such infor-
mation. 
‘‘(B) APPLICATION OF PROVISIONS.—The 
provisions of section 1128A (other than sub-
section (a), subsection (b), the first sentence of 
subsection (c)(1), subsection (d), and subsection 
(o)) shall apply with respect to a civil monetary 
penalty imposed under this paragraph in the 
same manner as such provisions apply with re-
spect to a penalty or proceeding under sub-
section (a) of such section. 
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‘‘SEC. 1150E. PATIENT-PROVIDER DISPUTE RESOLUTION. 
‘‘(a) IN GENERAL.—Not later than July 1, 2021, the 
Secretary shall establish a process (in this subsection re-
ferred to as the ‘patient-provider dispute resolution proc-
ess’) under which an uninsured individual, with respect 
to an item or service, who received, pursuant to section 
1150D(b), from a health care provider or health care facil-
ity a good-faith estimate of the expected charges for fur-
nishing such item or service to such individual and who 
after being furnished such item or service by such provider 
or facility is billed by such provider or facility for such 
item or service for charges that are substantially in excess 
of such estimate, may seek a determination from a se-
lected dispute resolution entity for the charges to be paid 
by such individual (in lieu of such amount so billed) to 
such provider or facility for such item or service. For pur-
poses of this subsection, the term ‘uninsured individual’ 
means, with respect to an item or service, an individual 
who does not have benefits for such item or service under 
a group health plan, health insurance coverage offered in 
the group or individual market by a health insurance 
issuer, Federal health care program (as defined in section 
1128B(f)), or a health benefits plan under chapter 89 of 
title 5, United States Code (or an individual who has bene-
fits for such item or service under a group health plan 
or health insurance coverage offered in the group or indi-
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194 
vidual market by a health insurance issuer, but who does 
not seek to have a claim for such item or service submitted 
to such plan or coverage). 
‘‘(b) SELECTION OF ENTITIES.—Under the patient- 
provider dispute resolution process, the Secretary shall, 
with respect to a determination sought by an individual 
under subsection (a), with respect to charges to be paid 
by such individual to a health care provider or health care 
facility described in such paragraph for an item or service 
furnished to such individual by such provider or facility, 
provide for— 
‘‘(1) a method to select to make such deter-
mination an entity certified under subsection (d) 
that— 
‘‘(A) is not a party to such determination 
or an employee or agent of such party; 
‘‘(B) does not have a material familial, fi-
nancial, or professional relationship with such a 
party; and 
‘‘(C) does not otherwise have a conflict of 
interest with such a party (as determined by 
the Secretary); and 
‘‘(2) the provision of a notification of such se-
lection to the individual and the provider or facility 
(as applicable) party to such determination. 
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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 ‘selected dispute reso-
lution entity’ with respect to such determination. 
‘‘(c) ADMINISTRATIVE FEE.—The Secretary shall es-
tablish a fee to participate in the patient-provider dispute 
resolution process in such a manner as to not create a 
barrier to an uninsured individual’s access to such process. 
‘‘(d) CERTIFICATION.—The Secretary shall establish 
or recognize a process to certify entities under this sub-
paragraph. Such process shall ensure that an entity so cer-
tified satisfies at least the criteria specified in section 
2719A(j)(7) of the Public Health Service Act.’’. 
SEC. 9. ADDITIONAL CONSUMER PROTECTIONS. 
(a) PUBLIC HEALTH SERVICE ACT.—Subpart II of 
part A of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg–11 et seq.) is amended by adding at 
the end the following new sections: 
‘‘SEC. 2730. CONTINUITY OF CARE. 
‘‘(a) ENSURING CONTINUITY OF CARE WITH RE-
SPECT
TO TERMINATIONS
OF CERTAIN CONTRACTUAL 
RELATIONSHIPS RESULTING IN CHANGES IN PROVIDER 
NETWORK STATUS.— 
‘‘(1) IN GENERAL.—In the case of an individual 
with benefits under a group health plan or group or 
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individual health insurance coverage offered by a 
health insurance issuer and with respect to a health 
care provider or facility that has a contractual rela-
tionship with such plan or such issuer (as applica-
ble) for furnishing items and services under such 
plan or such coverage, if, while such individual is a 
continuing care patient (as defined in subsection (b)) 
with respect to such provider or facility— 
‘‘(A) such contractual relationship is termi-
nated (as defined in subsection (b)); 
‘‘(B) benefits provided under such plan or 
such health insurance coverage with respect to 
such provider or facility are terminated because 
of a change in the terms of the participation of 
such provider or facility in such plan or cov-
erage; or 
‘‘(C) a contract between such group health 
plan and a health insurance issuer offering 
health insurance coverage in connection with 
such plan is terminated, resulting in a loss of 
benefits provided under such plan with respect 
to such provider or facility; 
the plan or issuer, respectively, shall meet the re-
quirements of paragraph (2) with respect to such in-
dividual. 
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‘‘(2) REQUIREMENTS.—The requirements of 
this paragraph are that the plan or issuer— 
‘‘(A) notify each individual enrolled under 
such plan or coverage who is a continuing care 
patient with respect to a provider or facility at 
the time of a termination described in para-
graph (1) affecting such provider or facility on 
a timely basis of such termination and such in-
dividual’s right to elect continued transitional 
care from such provider or facility under this 
section; 
‘‘(B) provide such individual with an op-
portunity to notify the plan or issuer of the in-
dividual’s need for transitional care; and 
‘‘(C) permit the patient to elect to continue 
to have benefits provided under such plan or 
such coverage, under the same terms and condi-
tions as would have applied and with respect to 
such items and services as would have been cov-
ered under such plan or coverage had such ter-
mination not occurred, with respect to the 
course of treatment furnished by such provider 
or facility relating to such individual’s status as 
a continuing care patient during the period be-
ginning on the date on which the notice under 
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subparagraph (A) is provided and ending on the 
earlier of— 
‘‘(i) the 90-day period beginning on 
such date; or 
‘‘(ii) the date on which such individual 
is no longer a continuing care patient with 
respect to such provider or facility. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) CONTINUING CARE PATIENT.—The term 
‘continuing care patient’ means an individual who, 
with respect to a provider or facility— 
‘‘(A) is undergoing a course of treatment 
for a serious and complex condition from the 
provider or facility; 
‘‘(B) is undergoing a course of institu-
tional or inpatient care from the provider or fa-
cility; 
‘‘(C) is scheduled to undergo nonelective 
surgery from the provider, including receipt of 
postoperative care from such provider or facility 
with respect to such a surgery; 
‘‘(D) is pregnant and undergoing a course 
of treatment for the pregnancy from the pro-
vider or facility; or 
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‘‘(E) is or was determined to be terminally 
ill (as determined under section 1861(dd)(3)(A) 
of the Social Security Act) and is receiving 
treatment for such illness from such provider or 
facility. 
‘‘(2) SERIOUS AND COMPLEX CONDITION.—The 
term ‘serious and complex condition’ means, with re-
spect to a participant, beneficiary, or enrollee under 
a group health plan or health insurance coverage— 
‘‘(A) in the case of an acute illness, a con-
dition that is serious enough to require special-
ized medical treatment to avoid the reasonable 
possibility of death or permanent harm; or 
‘‘(B) in the case of a chronic illness or con-
dition, a condition that is— 
‘‘(i) is life-threatening, degenerative, 
potentially disabling, or congenital; and 
‘‘(ii) requires specialized medical care 
over a prolonged period of time. 
‘‘(3) TERMINATED.—The term ‘terminated’ in-
cludes, with respect to a contract, the expiration or 
nonrenewal of the contract, but does not include a 
termination of the contract for failure to meet appli-
cable quality standards or for fraud. 
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‘‘SEC. 2731. INFORMATION REQUIRED TO BE INCLUDED ON 
HEALTH INSURANCE MEMBERSHIP CARDS. 
‘‘In the case of a group health plan or health insur-
ance issuer offering group or individual health insurance 
coverage that provides a physical or electronic card indi-
cating membership in such plan or coverage to an indi-
vidual enrolled under such plan or coverage, such group 
health plan or issuer shall include on such card each of 
the following: 
‘‘(1) The nearest hospital to the primary resi-
dence of such individual that has in effect a contrac-
tual relationship with such plan or coverage for fur-
nishing items and services under such plan or cov-
erage. 
‘‘(2) A telephone number or Internet website 
address through which such individual may seek con-
sumer 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. 
‘‘(3) Any deductible applicable to such indi-
vidual. 
‘‘(4) Any out-of-pocket maximum applicable to 
such individual. 
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‘‘(5) Any cost-sharing obligation applicable to 
such individual for a visit at an emergency depart-
ment, or urgent care facility, that has in effect a 
contractual relationship with such plan or coverage 
for furnishing items and services under such plan or 
coverage. 
‘‘SEC. 2732. MAINTENANCE OF PRICE COMPARISON TOOL. 
‘‘In connection with the offering of a group health 
plan or group or individual health insurance coverage in 
a geographic region for a plan year, a plan sponsor or 
health insurance issuer, respectively, shall employ an indi-
vidual to offer price comparison guidance, or make avail-
able on an Internet website a price comparison tool, that 
(to the extent practicable) allows an individual enrolled 
under such plan or coverage, with respect to such plan 
year and such geographic region, to compare the amount 
(determined by historic claims data of participating pro-
viders with respect to such plan or coverage) of cost-shar-
ing (including deductibles, copayments, and coinsurance) 
that the individual would be responsible for paying under 
such plan or coverage with respect to the furnishing of 
a specific item or service by any such provider.’’. 
(b) INTERNAL REVENUE CODE.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986, as 
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