I 
114TH CONGRESS 
1ST SESSION H. R. 3770 
To amend title XVIII of the Social Security Act to prevent surprise billing 
practices, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 20, 2015 
Mr. DOGGETT (for himself, Mr. MCDERMOTT, Mr. GENE GREEN of Texas, 
Mr. LEWIS, Mr. RANGEL, Ms. CLARKE of New York, Mr. VEASEY, Ms. 
MOORE, Ms. SCHAKOWSKY, Mr. GRIJALVA, Ms. DELAURO, Mr. BLU-
MENAUER, Mr. RUSH, Mr. VARGAS, Mr. TONKO, Mr. NADLER, Mr. 
COURTNEY, Mr. GARAMENDI, Mr. BUTTERFIELD, Mr. CARTWRIGHT, Mr. 
POCAN, Mr. DANNY K. DAVIS of Illinois, Mr. HASTINGS, and Ms. JUDY 
CHU of California) introduced the following bill; which was referred to 
the Committee on Ways and Means, and in addition to the Committee 
on Energy and Commerce, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to prevent 
surprise billing practices, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘End Surprise Billing 
Act of 2015’’. 
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SEC. 2. PREVENTING SURPRISE BILLING PRACTICES. 
(a) CONDITION OF PARTICIPATION IN MEDICARE.— 
Section 1866 of the Social Security Act (42 U.S.C. 
1395cc) is amended— 
(1) in subsection (a)(1)— 
(A) in subparagraph (X), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (Y), by striking at 
the end the period and inserting ‘‘, and’’; and 
(C) by inserting after such subparagraph 
(Y) the following new subparagraph: 
‘‘(Z) in the case of a hospital or critical ac-
cess hospital, to adopt and enforce a policy to 
ensure compliance with the requirements of 
paragraphs (1) and (4) of subsection (l) and to 
meet the requirements of such paragraphs (re-
lating to the prevention of surprise billing prac-
tices).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(l) REQUIREMENT FOR PURPOSES OF PREVENTING 
SURPRISE BILLING.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a)(1)(Z), the requirements described in this para-
graph are, with respect to a hospital or critical ac-
cess hospital, in the case of an individual with health 
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benefits coverage, including benefits under a group 
health plan or health insurance coverage offered in 
the group or individual market (as such terms are 
defined in section 2791 of the Public Health Service 
Act) or under this title, title XIX, title XXI, or an-
other government-sponsored health plan or program, 
who seeks to be furnished items or services or is to 
be furnished items or services by the hospital or crit-
ical access hospital (including by a provider of serv-
ices or supplier that furnishes items or services at 
the hospital or critical access hospital), that the hos-
pital or critical access hospital— 
‘‘(A)(i) provides to the individual (or to a 
representative of the individual), on the date on 
which the individual makes an appointment to 
be furnished such items or services, if applica-
ble, and on the date on which the individual is 
furnished such items and services, a written no-
tice specified by the Secretary through rule-
making that— 
‘‘(I) contains the information required 
under paragraph (2); and 
‘‘(II) is signed and dated by the indi-
vidual; and 
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‘‘(ii) retains a copy of each such notice for 
a period specified through rulemaking by the 
Secretary; and 
‘‘(B) in the case that such hospital or crit-
ical access hospital (or provider of services or 
supplier furnishing services at such hospital or 
critical access hospital) is not within the health 
care provider network or otherwise a partici-
pating provider of services or supplier with re-
spect to such health benefits coverage of such 
individual, obtains from the individual the con-
sent described in paragraph (3). 
‘‘(2) INFORMATION
INCLUDED
IN
NOTICE.— 
The notice described in paragraph (1)(A) shall in-
clude, with respect to an individual with health bene-
fits coverage described in paragraph (1) who seeks 
to be furnished items or services or is to be fur-
nished items or services by a hospital or critical ac-
cess hospital (including by a provider of services or 
supplier that furnishes items or services at the hos-
pital or critical access hospital), a notification of 
each of the following: 
‘‘(A) Whether the hospital or critical ac-
cess hospital is not within the health care pro-
vider network or otherwise a participating pro-
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vider of services or supplier with respect to such 
health benefits coverage of such individual. 
‘‘(B) If the hospital or critical access hos-
pital is not within such network or otherwise 
such a participating provider or supplier, the 
estimated amount that the hospital or critical 
access hospital will charge the individual for 
such items and services in excess of any cost 
sharing obligations that the individual would 
otherwise have under such health benefits cov-
erage for such items and services if the hospital 
or critical access hospital were within such net-
work or otherwise participating in such cov-
erage. 
‘‘(C) Whether any of the providers of serv-
ices or suppliers furnishing items or services at 
the hospital or critical access hospital who will 
furnish the items or services to the individual 
are not within the health care provider network 
or otherwise a participating provider of services 
or supplier with respect to such health benefits 
coverage of such individual. 
‘‘(D) If any of such providers of services or 
suppliers are not within such network or other-
wise such a participating provider or supplier, 
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the estimated amount that such providers of 
services or suppliers will charge the individual 
for such items and services in excess of any cost 
sharing obligations that the individual would 
otherwise have for such items and services if 
the providers of services or suppliers were with-
in the such network or otherwise participating 
in such coverage. 
‘‘(3) CONSENT DESCRIBED.—For purposes of 
paragraph (1)(B), the consent described in this 
paragraph, with respect to an individual with health 
benefits coverage described in paragraph (1) who is 
to be furnished items or services by a hospital or 
critical access hospital (or provider of services or 
supplier furnishing services at such hospital or crit-
ical access hospital) that is not within the health 
care provider network or otherwise a participating 
provider of services or supplier with respect to such 
health benefits coverage of such individual, is a doc-
ument specified by the Secretary through rule-
making that is signed by the individual (or by a rep-
resentative of the individual) not less than 24 hours 
prior to the individual being furnished such items or 
services by such hospital, critical access hospital, 
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provider of services, or supplier, respectively, and 
that— 
‘‘(A) acknowledges that the individual has 
been— 
‘‘(i) provided with a written estimate 
of the charge that the individual will be as-
sessed for the items or services anticipated 
to be furnished to the individual by the 
hospital, critical access hospital, provider 
of services, or supplier that is not within 
such network or otherwise such a partici-
pating provider of services or supplier; and 
‘‘(ii) informed that the payment of 
such charge by the individual will not ac-
crue toward any limitation that the health 
benefits coverage places upon the annual 
out-of-pocket expenses to be paid by the 
individual or upon the in-network deduct-
ible to be paid by the individual; and 
‘‘(B) documents the consent of the indi-
vidual to— 
‘‘(i) be furnished with such items or 
services by such hospital, critical access 
hospital, provider of services, or supplier, 
as applicable; and 
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‘‘(ii) in the case that the individual is 
so furnished such items or services, be 
charged an amount approximate to the es-
timated charge described in subparagraph 
(A)(i) with respect to such items or serv-
ices. 
‘‘(4) LIMITATIONS
ON
PAYMENT
BY
INDI-
VIDUAL.—For purposes of subsection (a)(1)(Z), the 
requirements under this paragraph are the following: 
‘‘(A) IN
CASE
OF
NONCOMPLIANCE
BY 
HOSPITALS
AND
CRITICAL
ACCESS
HOS-
PITALS.—In the case of an individual with 
health benefits coverage described in paragraph 
(1) who is furnished items or services by a hos-
pital or critical access hospital (or provider of 
services or supplier furnishing services at such 
hospital or critical access hospital) that is not 
within the health care provider network or oth-
erwise a participating provider of services or 
supplier with respect to such health benefits 
coverage of such individual, if the hospital or 
critical access hospital does not comply with the 
requirements of paragraph (1) with respect to 
the furnishing of such items or services to such 
individual, the hospital or critical access hos-
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pital (or, as applicable, the provider of services 
or supplier furnishing such items or services to 
such individual) may not charge the individual 
more than the amount that the individual would 
have been required to pay in cost sharing if 
such items or services had been furnished by a 
hospital or critical access hospital, as applicable 
(or by a provider of services or supplier, as ap-
plicable) that is within such network or that is 
otherwise such a participating provider of serv-
ices or supplier. 
‘‘(B) IN CASE OF SAME-DAY EMERGENCY 
SERVICES.—In the case of an individual with 
health benefits coverage described in paragraph 
(1) who is furnished items or services by a hos-
pital or critical access hospital (or provider of 
services or supplier furnishing services at such 
hospital or critical access hospital) that is not 
within the health care provider network or oth-
erwise a participating provider of services or 
supplier with respect to such health benefits 
coverage of such individual on the same date on 
which the individual makes an appointment for 
such items or services (or otherwise presents at 
the hospital or critical access hospital for such 
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services such as in the case of items and serv-
ices furnished with respect to an emergency 
medical 
condition, 
as 
defined 
in 
section 
1867(e)), the hospital or critical access hospital 
(or, as applicable, the provider of services or 
supplier furnishing such items or services to 
such individual) may not charge the individual 
more than the amount that the individual would 
have been required to pay in cost sharing if 
such items or services had been furnished by a 
hospital or critical access hospital, as applicable 
(or by a provider of services or supplier, as ap-
plicable) that is within such network or that is 
otherwise such a participating provider of serv-
ices or supplier.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply with respect to agreements 
under section 1866(a)(1) of the Social Security Act (42 
U.S.C. 1395cc(a)(1)) that are filed with the Secretary of 
Health and Human Services on a date that is not less 
than 12 months after the date of the enactment of this 
Act. 
Æ 
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