214 
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. 719. MAINTENANCE OF PRICE COMPARISON TOOL. 
‘‘In connection with the offering of a group health 
plan or group health insurance coverage in a geographic 
region for a plan year, a plan sponsor or health insurance 
issuer, respectively, shall employ an individual to offer 
price comparison guidance, or make available on an Inter-
net 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 geo-
graphic region, to compare the amount (determined by 
historic claims data of participating providers with respect 
to such plan or coverage) of cost-sharing (including 
deductibles, copayments, and coinsurance) that the indi-
vidual 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.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
715(a) of the Employee Retirement Income Security 
Act of 1974 (29 U.S.C. 1185d(a)), as amended by 
section 2(c), is further amended— 
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(A) in paragraph (1), by striking ‘‘section 
2719A’’ and inserting ‘‘section 2719A, 2730, 
2731, or 2732’’; and 
(B) in paragraph (2), by striking ‘‘section 
2719A’’ and inserting ‘‘section 2719A, 2730, 
2731, or 2732’’. 
(3) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement In-
come Security Act of 1974 is amended by inserting 
after the item relating to section 716 the following 
new items: 
‘‘Sec. 717. Continuity of care. 
‘‘Sec. 718. Information required to be included on health insurance membership 
cards. 
‘‘Sec. 719. Maintenance of price comparison tool.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning on or after January 1, 2022. 
SEC. 10. REPORTING REQUIREMENTS REGARDING AIR AM-
BULANCE SERVICES. 
(a) REPORTING REQUIREMENTS FOR PROVIDERS OF 
AIR AMBULANCE SERVICES.— 
(1) IN GENERAL.—A provider of air ambulance 
services shall submit to the Secretary of Health and 
Human Services and the Secretary of Transpor-
tation— 
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(A) not later than the date that is 90 days 
after the last day of the first plan year begin-
ning on or after the date on which a final rule 
is promulgated pursuant to the rulemaking de-
scribed in subsection (d), the information de-
scribed in paragraph (2) with respect to such 
plan year; and 
(B) not later than the date that is 90 days 
after the last day of the plan year immediately 
succeeding the plan year described in subpara-
graph (A), such information with respect to 
such immediately succeeding plan year. 
(2) INFORMATION DESCRIBED.—For purposes 
of paragraph (1), information described in this para-
graph, with respect to a provider of air ambulance 
services, is each of the following: 
(A) Cost data, as determined appropriate 
by the Secretary of Health and Human Serv-
ices, in consultation with the Secretary of 
Transportation, for air ambulance services fur-
nished by such provider, separated to the max-
imum extent possible by air transportation costs 
associated with furnishing such air ambulance 
services and costs of medical services and sup-
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plies associated with furnishing such air ambu-
lance services. 
(B) The number and location of all air am-
bulance bases operated by such provider. 
(C) The number and type of aircraft oper-
ated by such provider. 
(D) The number of air ambulance trans-
ports, disaggregated by payor mix, including 
group health plans, health insurance issuers, 
and Government payors. 
(E) The number of claims of such provider 
that have been denied payment by a group 
health plan or health insurance issuer and the 
reasons for any such denials. 
(F) The number of emergency and non-
emergency 
air 
ambulance 
transports, 
disaggregated by air ambulance base and type 
of aircraft. 
(b) 
REPORTING
REQUIREMENTS
FOR
GROUP 
HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 
(1) IN GENERAL.—Each group health plan and 
health insurance issuer offering health insurance 
coverage in the individual or group market shall sub-
mit to the Secretary of Health and Human Serv-
ices— 
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(A) not later than the date that is 90 days 
after the last day of the first plan year begin-
ning on or after the date on which a final rule 
is promulgated pursuant to the rulemaking de-
scribed in subsection (d), the information de-
scribed in paragraph (2) with respect to such 
plan year; and 
(B) not later than the date that is 90 days 
after the last day of the plan year immediately 
succeeding the plan year described in subpara-
graph (A), such information with respect to 
such immediately succeeding plan year. 
(2) INFORMATION DESCRIBED.—For purposes 
of paragraph (1), information described in this para-
graph, with respect to a group health plan or a 
health insurance issuer offering health insurance 
coverage in the individual or group market, is each 
of the following: 
(A) Claims data for air ambulance services 
furnished 
by 
providers 
of 
such 
services, 
disaggregated by each of the following factors: 
(i) Whether such services were fur-
nished on an emergent or nonemergent 
basis. 
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(ii) Whether the provider of such serv-
ices is part of a hospital-owned or spon-
sored program, municipality-sponsored pro-
gram, hospital independent partnership 
(hybrid) program, or independent program. 
(iii) Whether such services were fur-
nished in a rural or urban area. 
(iv) The type of aircraft (such as 
rotor transport or fixed wing transport) 
used to furnish such services. 
(v) Whether the provider of such serv-
ices has a contract with the plan or issuer, 
as applicable, to furnish such services 
under the plan or coverage, respectively. 
(B) Such other information regarding pro-
viders of air ambulance services as the Sec-
retary of Health and Human Services may 
specify. 
(c) PUBLICATION OF COMPREHENSIVE REPORT.— 
(1) IN GENERAL.—Not later than the date that 
is one year after the date described in subsection 
(b)(1)(B), the Secretary of Health and Human Serv-
ices, in consultation with the Secretary of Transpor-
tation (referred to in this section as the ‘‘Secre-
taries’’), shall develop, and make publicly available 
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(subject to paragraph (3)), a comprehensive report 
summarizing the information submitted under sub-
sections (a) and (b) and including each of the fol-
lowing: 
(A) The percentage of providers of air am-
bulance services that are part of a hospital- 
owned or sponsored program, municipality- 
sponsored program, hospital-independent part-
nership (hybrid) program, or independent pro-
gram. 
(B) An assessment of the extent of com-
petition among providers of air ambulance serv-
ices on the basis of price and services offered, 
and any changes in such competition over time. 
(C) An assessment of the average charges 
for air ambulance services, amounts paid by 
group health plans and health insurance issuers 
offering health insurance coverage in the indi-
vidual or group market to providers of air am-
bulance services for furnishing such services, 
and amounts paid out-of-pocket by consumers, 
and any changes in such amounts paid over 
time. 
(D) An assessment of the presence of air 
ambulance bases in, or with the capability to 
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serve, rural areas, and the relative growth in air 
ambulance bases in rural and urban areas over 
time. 
(E) Any evidence of gaps in rural access to 
providers of air ambulance services. 
(F) The percentage of providers of air am-
bulance services that have contracts with group 
health plans or health insurance issuers offering 
health insurance coverage in the individual or 
group market to furnish such services under 
such plans or coverage, respectively. 
(G) An assessment of whether there are in-
stances of unfair, deceptive, or predatory prac-
tices by providers of air ambulance services in 
collecting payments from patients to whom such 
services are furnished, such as referral of such 
patients to collections, lawsuits, and liens or 
wage garnishment actions. 
(H) An assessment of whether there are 
instances of group health plans or health insur-
ance issuers not providing substantial reasons 
for refusing to enter into contract negotiations 
with providers of air ambulance services. 
(I) An assessment of whether there are, 
within the air ambulance industry, instances of 
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unreasonable industry concentration, excessive 
market domination, or other conditions that 
would allow at least one provider of air ambu-
lance services to unreasonably increase prices or 
exclude competition in air ambulance services in 
a given geographic region. 
(J) An assessment of the frequency of pa-
tient balance billing, patient referrals to collec-
tions, lawsuits to collect balance bills, and liens 
or wage garnishment actions by providers of air 
ambulance services as part of a collections proc-
ess across hospital-owned or sponsored pro-
grams, municipality-sponsored programs, hos-
pital-independent partnership (hybrid) pro-
grams, or independent programs, providers of 
air ambulance services operated by public agen-
cies (such as a State or county health depart-
ment), and other independent providers of air 
ambulance services. 
(K) An assessment of the frequency of 
claims appeals made by providers of air ambu-
lance services to group health plans or health 
insurance issuers offering health insurance cov-
erage in the individual or group market with re-
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spect to air ambulance services furnished to en-
rollees of such plans or coverage, respectively. 
(L) Any other cost, quality, or other data 
relating to air ambulance services or the air 
ambulance industry, as determined necessary 
and appropriate by the Secretaries. 
(2) OTHER SOURCES OF INFORMATION.—The 
Secretaries may incorporate information from inde-
pendent experts or third-party sources in developing 
the comprehensive report required under paragraph 
(1). 
(3) PROTECTION
OF
PROPRIETARY
INFORMA-
TION.—The Secretaries may not make publicly avail-
able under this subsection any proprietary informa-
tion. 
(d) RULEMAKING.—Not later than the date that is 
one year after the date of the enactment of this Act, the 
Secretary of Health and Human Services, in consultation 
with the Secretary of Transportation, shall, through notice 
and comment rulemaking, specify the form and manner 
in which reports described in subsections (a) and (b) shall 
be submitted to such Secretaries, taking into consideration 
(as applicable and to the extent feasible) any recommenda-
tions included in the report submitted by the Advisory 
Committee on Air Ambulance and Patient Billing under 
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section 418(e) of the FAA Reauthorization Act of 2018 
(Public Law 115–254; 49 U.S.C. 42301 note prec.). 
(e) CIVIL MONEY PENALTIES.— 
(1) IN GENERAL.—Subject to paragraph (2), a 
provider of air ambulance services who fails to sub-
mit all information required under subsection (a)(2) 
by the date described in subparagraph (A) or (B) of 
subsection (a)(1), as applicable, shall be subject to 
a civil money penalty of not more than $10,000. 
(2) EXCEPTION.—In the case of a provider of 
air ambulance services that submits only some of the 
information required under subsection (a)(2) by the 
date described in subparagraph (A) or (B) of sub-
section (a)(1), as applicable, the Secretary of Health 
and Human Services may waive the civil money pen-
alty imposed under paragraph (1) if such provider 
demonstrates a good faith effort in working with the 
Secretary to submit the remaining information re-
quired under subsection (a)(2). 
(3) PROCEDURE.—The provisions of section 
1128A of the Social Security Act (42 U.S.C. 1320a– 
7a), other than subsections (a) and (b) and the first 
sentence of subsection (c)(1), shall apply to civil 
money penalties under this subsection in the same 
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225 
manner as such provisions apply to a penalty or pro-
ceeding under such section. 
(f) UNFAIR AND DECEPTIVE PRACTICES AND UN-
FAIR METHODS
OF COMPETITION.—The Secretary of 
Transportation may use any information submitted under 
subsection (a) in determining whether a provider of air 
ambulance services has violated section 41712(a) of title 
49, United States Code. 
(g) UNDERSTANDING AIR AMBULANCE QUALITY AND 
PATIENT SAFETY.—Not later than 1 year after the date 
of the enactment of this Act, the Comptroller General of 
the United States shall conduct a study and submit to 
Congress a report on options to establish quality, patient 
safety, service reliability, and clinical capability standards 
for each clinical capability level of air ambulances. Such 
report shall include analysis and recommendations, as ap-
propriate, to Congress regarding each of the following with 
respect to air ambulance services: 
(1) Qualifications of different clinical capability 
levels and tiering of such levels. 
(2) Patient safety and quality standards. 
(3) Options for improving service reliability 
during poor weather, night conditions, or other ad-
verse conditions. 
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(4) Differences between air ambulance vehicle 
types, services, and technologies, and other flight ca-
pability standards, and the impact of such dif-
ferences on patient safety. 
(5) Clinical triage criteria for air ambulances. 
(h) DEFINITIONS.—In this section, the terms ‘‘group 
health plan’’, ‘‘health insurance coverage’’, and ‘‘health in-
surance issuer’’ have the meanings given such terms in 
section 2791 of the Public Health Service Act (42 U.S.C. 
300gg–91). 
SEC. 11. GAO REPORT ON EFFECTS OF LEGISLATION. 
Not later than 2 years after the date of the enact-
ment of this Act, the Comptroller General of the United 
States shall submit to Congress a report summarizing the 
effects of the provisions of this Act, including the amend-
ments made by such provisions, on changes during such 
period in health care provider networks of group health 
plans and health insurance coverage offered by a health 
insurance issuer in the group or individual market, in fee 
schedules and amounts for health care services, and to 
contracted rates under such plans or coverage. Such re-
port shall— 
(1) to the extent practicable, sample a statis-
tically significant group of national health care pro-
viders; and 
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(2) examine— 
(A) provider network participation, includ-
ing nonparticipating providers furnishing items 
and services at participating facilities; 
(B) health care provider group network 
participation, including specialty, size, and own-
ership; and 
(C) the impact of State surprise billing 
laws and network adequacy standards on par-
ticipation of health care providers and facilities 
in provider networks of group health plans and 
of health insurance coverage offered by health 
insurance issuers in the group or individual 
market. 
SEC. 12. TRANSITIONAL RULE ALLOWING DEDUCTION FOR 
SURPRISE BILLING EXPENSES BELOW AGI 
FLOOR. 
(a) IN GENERAL.—Section 213 of the Internal Rev-
enue Code of 1986 is amended by adding at the end the 
following new subsection: 
‘‘(g) TRANSITIONAL RULE ALLOWING DEDUCTION 
FOR
SURPRISE
BILLING
EXPENSES
BELOW
AGI 
FLOOR.— 
‘‘(1) IN GENERAL.—In addition to the deduc-
tion allowed by subsection (a) for any taxable year, 
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there shall be allowed as a deduction an amount 
equal to the lesser of— 
‘‘(A) the excess of— 
‘‘(i) the surprise billing expenses 
which would be allowed as a deduction for 
such taxable year under subsection (a) if 
such subsection were applied without re-
gard to the limitation based on the tax-
payer’s adjusted gross income, over 
‘‘(ii) $600, or 
‘‘(B) the applicable percentage of the tax-
payer’s adjusted gross income. 
‘‘(2) SURPRISE BILLING EXPENSES.—For pur-
poses of this subsection, the term ‘surprise billing 
expenses’ means expenses paid for medical care of 
an individual who is a participant, beneficiary, or en-
rollee in a group health plan or in group or indi-
vidual health insurance coverage offered by a health 
insurance issuer (as such terms are defined in sec-
tion 2791 of the Public Health Service Act), if— 
‘‘(A) benefits are provided for such medical 
care under such plan or coverage, and 
‘‘(B) such medical care— 
‘‘(i) is furnished by a provider without 
a contractual relationship with such plan 
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or coverage with respect to the furnishing 
of such medical care during a visit at a fa-
cility with a contractual relationship with 
such plan or coverage, or 
‘‘(ii) is furnished in an emergency de-
partment of a hospital or an independent 
freestanding emergency department. 
‘‘(3) APPLICABLE PERCENTAGE.—For purposes 
of this section, the term ‘applicable percentage’ 
means, with respect to any taxpayer for any taxable 
year, the percentage in effect under subsection (a) 
with respect to such taxpayer for such taxable year. 
‘‘(4) LIMITATIONS.—Surprise billing expenses 
shall be taken into account under paragraph (1) only 
if such expenses are paid during the period begin-
ning on January 1, 2020, and ending on the date 
which is 1 year after the day before the date speci-
fied in section 2(a)(5) of the Consumer Protections 
Against Surprise Medical Bills Act of 2020.’’. 
(b) CONFORMING AMENDMENTS.—Sections 105(f), 
162(l)(3), and 7702B(e)(2) of such Code are each amend-
ed by striking ‘‘213(a)’’ and inserting ‘‘213’’. 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years ending after De-
cember 31, 2019. 
Æ 
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