‘‘(1) IN GENERAL.—Subject to paragraph (3), in 
the case of items or services (other than emergency 
services to which subsection (b) applies) furnished to 
a participant, beneficiary, or enrollee of a health plan 
(as defined in paragraph (2)(A)) by a nonpartici-
pating provider (as defined in subsection (b)(3)(G)(i)) 
during a visit (as defined by the Secretary in accord-
ance with paragraph (2)(C)) at a participating 
health care facility (as defined in paragraph (2)(B)), 
with respect to such plan, the plan— 
‘‘(A) shall not impose on such participant, 
beneficiary, or enrollee a cost-sharing amount 
(expressed as a copayment amount or coinsur-
ance rate) for such items and services so fur-
nished that is greater than the cost-sharing 
amount that would apply under such plan had 
such items or services been furnished by a par-
ticipating provider (as defined in subsection 
(b)(3)(G)(ii)); 
‘‘(B) 
shall 
calculate 
such 
cost-sharing 
amount as if the amount that would have been 
charged for such items and services by such par-
ticipating provider were equal to— 
‘‘(i) in the case of such items and serv-
ices furnished in a State described in sub-
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00048
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
section (b)(3)(H)(ii), the median contracted 
rate (as defined in subsection (b)(3)(E)(i)) 
for such items and services; and 
‘‘(ii) in the case of such items and 
services furnished in a State described in 
subsection (b)(3)(H)(i), the lesser of— 
‘‘(I) the amount determined by 
such State for such items and services 
in accordance with the method de-
scribed in such subsection; and 
‘‘(II) the median contracted rate 
(as so defined) for such items and serv-
ices; 
‘‘(C) shall pay to such provider furnishing 
such items and services to such participant, ben-
eficiary, or enrollee the amount by which the rec-
ognized amount (as defined in subsection 
(b)(3)(H)) for such items and services exceeds the 
cost-sharing amount imposed under the plan for 
such items and services (as determined in ac-
cordance with subparagraphs (A) and (B)); and 
‘‘(D) shall count toward any in-network de-
ductible or out-of-pocket maximums applied 
under the plan any cost-sharing payments made 
by the participant, beneficiary, or enrollee (and 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00049
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
such in-network deductible shall be applied) with 
respect to such items and services so furnished in 
the same manner as if such cost-sharing pay-
ments were with respect to items and services 
furnished by a participating provider. 
‘‘(2) DEFINITIONS.—In this subsection and sub-
section (b): 
‘‘(A) HEALTH
PLAN.—The term ‘health 
plan’ means a group health plan and health in-
surance coverage offered by a heath insurance 
issuer in the group or individual market and in-
cludes a grandfathered health plan (as defined in 
section 1251(e) of the Patient Protection and Af-
fordable Care Act). 
‘‘(B) PARTICIPATING HEALTH CARE FACIL-
ITY.— 
‘‘(i) IN GENERAL.—The term ‘partici-
pating health care facility’ means, with re-
spect to an item or service and a health 
plan, a health care facility described in 
clause (ii) that has a contractual relation-
ship with the plan (or, if applicable, issuer 
offering the plan) for furnishing such item 
or service. 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00050
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(ii) HEALTH
CARE
FACILITY
DE-
SCRIBED.—A health care facility described 
in this clause is each of the following: 
‘‘(I) A hospital (as defined in 
1861(e) of the Social Security Act). 
‘‘(II) A critical access hospital (as 
defined in section 1861(mm) of such 
Act). 
‘‘(III) An ambulatory surgical 
center 
(as 
defined 
in 
section 
1833(i)(1)(A) of such Act). 
‘‘(IV) A laboratory. 
‘‘(V) A radiology facility or imag-
ing center. 
‘‘(C) DURING A VISIT.—The term ‘during a 
visit’ shall, with respect to items and services 
furnished to an individual at a participating 
health care facility, include equipment and de-
vices, telemedicine services, imaging services, lab-
oratory services, and such other items and serv-
ices as the Secretary may specify, regardless of 
whether or not the provider furnishing such 
items or services is at the facility. 
‘‘(3) EXCEPTION.—Paragraph (1) shall not 
apply to a health plan in the case of items or services 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00051
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
(other than emergency services to which subsection (b) 
applies) furnished to a participant, beneficiary, or 
enrollee of a health plan (as defined in paragraph 
(2)(A)) by a nonparticipating provider (as defined in 
subsection (b)(3)(G)(i)) during a visit (as defined by 
the Secretary in accordance with paragraph (2)(C)) 
at a participating health care facility (as defined in 
paragraph (2)(B)) if such provider is in compliance 
with section 2799A(d) with respect to such items and 
services. 
‘‘(f) INDEPENDENT
DISPUTE
RESOLUTION
PROC-
ESS.— 
‘‘(1) ESTABLISHMENT.— 
‘‘(A) IN GENERAL.—Not later than 1 year 
after the date of the enactment of this subsection, 
the Secretary, in consultation with the Secretary 
of Labor, shall establish by regulation an inde-
pendent dispute resolution process (referred to in 
this subsection as the ‘IDR process’) under 
which— 
‘‘(i) a nonparticipating provider (as 
defined in subparagraph (G) of subsection 
(b)(3)), nonparticipating emergency facility 
(as defined in subparagraph (F) of such 
subsection), or health plan (as defined in 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00052
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
subsection (e)(2)(A)) may submit a request 
for resolution by an entity certified under 
paragraph (2) (in this subsection referred to 
as a ‘certified IDR entity’) of a specified 
claim; and 
‘‘(ii) in the case a settlement described 
in subparagraph (B) of paragraph (4) is 
not reached with respect to such claim, such 
entity so resolves such claim in accordance 
with such paragraph. 
‘‘(B) DEFINITIONS.—In this subsection: 
‘‘(i) SPECIFIED CLAIM.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), the term ‘specified 
claim’ means a claim by a nonpartici-
pating provider, a nonparticipating 
emergency facility, or a health plan 
with respect to qualifying items and 
services (as defined in clause (ii)) fur-
nished by such provider or facility in 
a State described in subparagraph 
(H)(ii) of subsection (b)(3) for which a 
health plan is required to make pay-
ment pursuant to subsection (b)(1) or 
subsection (e)(1)— 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00053
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(aa) that such payment 
should be increased or decreased; 
and 
‘‘(bb) that is made not later 
than— 
‘‘(AA) in the case of 
such a claim filed by such a 
provider or facility, the date 
on which the appeal with re-
spect to such items and serv-
ices 
described 
in 
clause 
(ii)(I)(aa)(AA) has been re-
solved (or the date that is 30 
days after such appeal is 
filed, whichever is earlier); or 
‘‘(BB) in the case of 
such a claim filed by such 
plan, the date on which the 
period described in clause 
(ii)(I)(bb)(BB) with respect 
to such items and services 
elapses. 
‘‘(II) LIMITATION ON PACKAGING 
OF ITEMS AND SERVICES IN A SPECI-
FIED
CLAIM.—The 
term 
‘specified 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00054
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
claim’ shall not include, in the case 
such claim is made by such provider, 
facility, or plan with respect to mul-
tiple items and services, any claim 
with respect to items and services fur-
nished by such provider or facility if— 
‘‘(aa) such items and services 
were not furnished by the same 
provider or facility; 
‘‘(bb) payment for such items 
and services made pursuant to 
subsection (b)(1) or subsection 
(e)(1) was made by multiple 
health plans; 
‘‘(cc) such items and services 
are not related to the treatment of 
the same condition; or 
‘‘(dd) such items and services 
were not furnished within 30 days 
of the date of the earliest item or 
service furnished that is included 
in such claim. 
‘‘(ii) QUALIFYING
ITEMS
AND
SERV-
ICES.— 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00055
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), the term ‘qualifying 
items and services’ means— 
‘‘(aa) with respect to a speci-
fied claim made by a nonpartici-
pating provider or nonpartici-
pating emergency facility, items 
and services furnished by such 
provider or facility for which a 
health plan is required to make 
payment pursuant to subsection 
(b)(1) or subsection (e)(1), but 
only if— 
‘‘(AA) such items and 
services are included in an 
appeal 
filed 
under 
such 
plan’s internal appeals proc-
ess not later than 30 days 
after such payment is re-
ceived; and 
‘‘(BB) 
such 
appeal 
under such plan’s internal 
appeals process has been re-
solved, or a 30-day period 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00056
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
has elapsed since such appeal 
was so filed; and 
‘‘(bb) with respect to a speci-
fied claim made by a health plan, 
items and services furnished by 
such a provider or facility for 
which such health plan is required 
to make payment pursuant to 
subsection (b)(1) or subsection 
(e)(1), but only if— 
‘‘(AA) such plan sub-
mits a notice to such pro-
vider or facility not later 
than 30 days after such pro-
vider or facility receives such 
payment that such plan dis-
putes the amount of such 
payment with respect to such 
items and services; and 
‘‘(BB) a 30-day period 
has elapsed since the submis-
sion of such notice. 
‘‘(II) 
LIMITATION.—The 
term 
‘qualifying items and services’ shall 
not include an item or service fur-
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00057
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
nished in a geographic area during a 
year by such provider or facility for 
which a health plan is required to 
make payment pursuant to subsection 
(b)(1) or subsection (e)(1) if the me-
dian contracted rate (as defined in 
subsection (b)(3)(E)) under such plan 
for such year with respect to such item 
or service furnished by such a provider 
or such a facility in such area does not 
exceed— 
‘‘(aa) with respect to an item 
or service furnished during 2021, 
$1,250; and 
‘‘(bb) with respect to an item 
or service furnished during a sub-
sequent year, the amount specified 
under this subclause for the pre-
vious year, increased by the per-
centage increase in the consumer 
price index for all urban con-
sumers (United States city aver-
age) over such previous year. 
‘‘(2) CERTIFICATION OF ENTITIES.— 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00058
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(A) PROCESS
OF
CERTIFICATION.—The 
process described in paragraph (1) shall include 
a certification process under which eligible enti-
ties may be certified to carry out the IDR proc-
ess. 
‘‘(B) ELIGIBILITY.— 
‘‘(i) IN
GENERAL.—For purposes of 
subparagraph (A), an eligible entity is an 
entity that is a nongovernmental entity that 
agrees to comply with the fee limitations de-
scribed in clause (ii). 
‘‘(ii) FEE LIMITATION.—For purposes 
of clause (i), the fee limitations described in 
this clause are limitations established by the 
Secretary on the amount a certified IDR 
entity may charge a nonparticipating pro-
vider, nonparticipating emergency facility, 
or health plan for services furnished by such 
entity with respect to the resolution of a 
specified claim of such provider, facility, or 
plan under the process described in para-
graph (1). 
‘‘(3) SELECTION OF CERTIFIED IDR ENTITY FOR 
A SPECIFIED CLAIM.—With respect to the resolution of 
a specified claim under the IDR process, the health 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00059
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
plan and the nonparticipating provider or the non-
participating emergency facility (as applicable) in-
volved shall agree on a certified IDR entity to resolve 
such claim. In the case that such plan and such pro-
vider or facility (as applicable) cannot so agree, such 
an entity shall be selected by the Secretary at ran-
dom. 
‘‘(4) PAYMENT DETERMINATION.— 
‘‘(A) TIMING.—A certified IDR entity se-
lected under paragraph (3) by a health plan and 
a nonparticipating provider or a nonpartici-
pating emergency facility (as applicable) with 
respect to a specified claim shall, subject to sub-
paragraph (B), not later than 30 days after 
being so selected, determine the total reimburse-
ment that should have been made for items and 
services included in such claim in accordance 
with subparagraph (C). 
‘‘(B) SETTLEMENT.— 
‘‘(i) IN GENERAL.—If such entity de-
termines that a settlement between the 
health plan and the provider or facility is 
likely with respect to a specified claim, the 
entity may direct the parties to attempt, for 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00060
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
a period not to exceed 10 days, a good faith 
negotiation for a settlement of such claim. 
‘‘(ii) TIMING.—The period for a settle-
ment described in clause (i) shall accrue to-
wards the 30-day period described in sub-
paragraph (A). 
‘‘(C) DETERMINATION OF AMOUNT.— 
‘‘(i) IN
GENERAL.—The health plan 
and the nonparticipating provider or non-
participating emergency facility (as appli-
cable) shall, with respect to a specified 
claim, each submit to the certified IDR en-
tity a final offer of payment or reimburse-
ment (as applicable) with respect to items 
and services which are the subject of the 
specified claim. Such entity shall determine 
which such offer is the most reasonable in 
accordance with clause (ii). 
‘‘(ii) CONSIDERATIONS IN DETERMINA-
TION.— 
‘‘(I) 
IN
GENERAL.—In 
deter-
mining which final offer is the most 
reasonable under clause (i), the cer-
tified IDR entity shall consider— 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00061
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(aa) the median contracted 
rates (as defined in subsection 
(b)(3)(E)) for items or services 
that are comparable to the items 
and services included in the speci-
fied claim and that are furnished 
in the same geographic area (as 
defined by the Secretary for pur-
poses of such subsection) as such 
items and services (not including 
any facility fees with respect to 
such rates); and 
‘‘(bb) the circumstances de-
scribed in subclause (II), if any 
information with respect to such 
circumstances is submitted by ei-
ther party. 
‘‘(II) 
ADDITIONAL
CIR-
CUMSTANCES.—For purposes of sub-
clause (I)(bb), the circumstances de-
scribed in this subclause are, with re-
spect to items and services included in 
the specified claim of a nonpartici-
pating 
provider, 
nonparticipating 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00062
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
emergency facility, or health plan, the 
following: 
‘‘(aa) The level of training, 
education, experience, and quality 
and outcomes measurements of the 
provider or facility that furnished 
such items and services. 
‘‘(bb) Any other extenuating 
circumstances with respect to the 
furnishing of such items and serv-
ices that relate to the acuity of the 
individual receiving such items 
and services or the complexity of 
furnishing such items and services 
to such individual. 
‘‘(III) PROHIBITION
ON
CONSID-
ERATION OF BILLED CHARGES.—In de-
termining which final offer is the most 
reasonable under clause (i) with re-
spect to items and services furnished by 
a provider or facility and included in 
a specified claim, the certified IDR en-
tity may not consider the amount that 
would have been billed by such pro-
vider or facility with respect to such 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00063
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
items and services had the provisions 
of section 2799 or 2799A (as applica-
ble) not applied. 
‘‘(iii) EFFECT OF DETERMINATION.—A 
determination of a certified IDR entity 
under clause (i)— 
‘‘(I) shall be binding; and 
‘‘(II) shall not be subject to judi-
cial review, except in a case described 
in any of paragraphs (1) through (4) 
of section 10(a) of title 9, United 
States Code. 
‘‘(iv) COSTS
OF
INDEPENDENT
DIS-
PUTE RESOLUTION PROCESS.—In the case 
of a specified claim made by a nonpartici-
pating provider, nonparticipating emer-
gency facility, or health plan and submitted 
to a certified IDR entity— 
‘‘(I) if such entity makes a deter-
mination with respect to such claim 
under clause (i), the party whose offer 
is not chosen under such clause shall be 
responsible for paying all fees charged 
by such entity; and 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00064
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(II) if the parties reach a settle-
ment with respect to such claim prior 
to such a determination, such fees shall 
be divided equally between the parties, 
unless the parties otherwise agree. 
‘‘(v) PAYMENT.—Not later than 30 
days after a determination described in 
clause (i) is made with respect to a specified 
claim of a nonparticipating provider, non-
participating emergency facility, or health 
plan— 
‘‘(I) in the case that such deter-
mination finds that the amount paid 
with respect to such specified claim by 
the health plan should have been great-
er than the amount so paid, such plan 
shall pay directly to the provider or fa-
cility (as applicable) the difference be-
tween the amount so paid and the 
amount so determined; and 
‘‘(II) in the case that such deter-
mination finds that the amount paid 
with respect to such specified claim by 
the health plan should have been less 
than the amount so paid, the provider 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00065
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
or facility (as applicable) shall pay di-
rectly to the plan the difference between 
the amount so paid and the amount so 
determined. 
‘‘(5) PUBLICATION OF INFORMATION RELATING 
TO DISPUTES.— 
‘‘(A) IN GENERAL.—For 2021 and each sub-
sequent year, the Secretary and the Secretary of 
Labor shall publish on the public website of the 
Department of Health and Human Services and 
the Department of Labor, respectively— 
‘‘(i) the number of specified claims 
filed during such year; 
‘‘(ii) the number of such claims with 
respect to which a final determination was 
made under paragraph (4)(C)(i); and 
‘‘(iii) the information described in sub-
paragraph (B) with respect to each specified 
claim with respect to which such a decision 
was so made. 
‘‘(B) INFORMATION
WITH
RESPECT
TO 
SPECIFIED CLAIMS.—For purposes of subpara-
graph (A), the information described in this sub-
paragraph is, with respect to a specified claim 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00066
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
of a nonparticiapting provider, nonparticipating 
emergency facility, or health plan— 
‘‘(i) a description of each item and 
service included in such claim; 
‘‘(ii) the amount of the offer submitted 
under paragraph (4)(C)(i) by the health 
plan and by the nonparticipating provider 
or nonparticipating emergency facility (as 
applicable); 
‘‘(iii) whether the offer selected by the 
certified IDR entity under such paragraph 
was the offer submitted by such plan or by 
such provider or facility (as applicable) and 
the amount of such offer so selected; and 
‘‘(iv) the category and practice spe-
cialty of each such provider or facility in-
volved in furnishing such items and serv-
ices. 
‘‘(C) CONFIDENTIALITY OF PARTIES.—None 
of the information published under this para-
graph may specify the identity of a health plan, 
provider, facility, or individual with respect to 
a specified claim.’’. 
(c) PROVIDER DIRECTORY REQUIREMENTS; DISCLO-
SURE ON PATIENT PROTECTIONS.—Section 2719A of the 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00067
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
Public Health Service Act, as amended by subsection (b), 
is further amended by adding at the end the following new 
subsections: 
‘‘(g) PROVIDER DIRECTORY INFORMATION REQUIRE-
MENTS.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this subsection, each 
group health plan and health insurance issuer offer-
ing group or individual health insurance coverage 
shall— 
‘‘(A) establish the verification process de-
scribed in paragraph (2); 
‘‘(B) establish the response protocol de-
scribed in paragraph (3); 
‘‘(C) establish the database described in 
paragraph (4); and 
‘‘(D) include in any print directory con-
taining provider directory information with re-
spect to such plan or such coverage the informa-
tion described in paragraph (5). 
‘‘(2) VERIFICATION PROCESS.—The verification 
process described in this paragraph is, with respect to 
a group health plan or a health insurance issuer of-
fering group or individual health insurance coverage, 
a process— 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00068
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(A) under which not less frequently than 
once every 90 days, such plan or such issuer (as 
applicable) verifies and updates the provider di-
rectory information included on the database de-
scribed in paragraph (4) of such plan or issuer 
of each health care provider and health care fa-
cility included in such database; and 
‘‘(B) that establishes a procedure for the re-
moval of such a provider or facility with respect 
to which such plan or issuer has been unable to 
verify such information during a period speci-
fied by the plan or issuer. 
‘‘(3) RESPONSE PROTOCOL.—The response pro-
tocol described in this paragraph is, in the case of an 
individual enrolled under a group health plan or 
group or individual health insurance coverage offered 
by a health insurance issuer who requests information 
on whether a health care provider or health care facil-
ity has a contractual relationship to furnish items 
and services under such plan or such coverage, a pro-
tocol under which such plan or such issuer (as appli-
cable), in the case such request is made through a tele-
phone call— 
‘‘(A) responds to such individual as soon as 
practicable and in no case later than 1 business 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00069
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
day after such call is received through a written 
electronic communication; and 
‘‘(B) retains such communication in such 
individual’s file for at least 2 years following 
such response. 
‘‘(4) DATABASE.—The database described in this 
paragraph is, with respect to a group health plan or 
health insurance issuer offering group or individual 
health insurance coverage, a database on the public 
website of such plan or issuer that contains— 
‘‘(A) a list of each health care provider and 
health care facility with which such plan or such 
issuer has a contractual relationship for fur-
nishing items and services under such plan or 
such coverage; and 
‘‘(B) provider directory information with 
respect to each such provider and facility. 
‘‘(5) INFORMATION.—The information described 
in this paragraph is, with respect to a print directory 
containing provider directory information with re-
spect to a group health plan or individual or group 
health insurance coverage offered by a health insur-
ance issuer, a notification that such information con-
tained in such directory was accurate as of the date 
of publication of such directory and that an indi-
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00070
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
vidual enrolled under such plan or such coverage 
should consult the database described in paragraph 
(4) with respect to such plan or such coverage or con-
tact such plan or the issuer of such coverage to obtain 
the most current provider directory information with 
respect to such plan or such coverage. 
‘‘(6) DEFINITION.—For purposes of this sub-
section, the term ‘provider directory information’ in-
cludes, with respect to a group health plan and a 
health insurance issuer offering group or individual 
health insurance coverage, the name, address, spe-
cialty, and telephone number of each health care pro-
vider or health care facility with which such plan or 
such issuer has a contractual relationship for fur-
nishing items and services under such plan or such 
coverage. 
‘‘(h) DISCLOSURE ON PATIENT PROTECTIONS.—Each 
group health plan and health insurance issuer offering 
group or individual health insurance coverage shall make 
publicly available, and (if applicable) post on a public 
website of such plan or issuer— 
‘‘(1) information in plain language on— 
‘‘(A) the requirements and prohibitions ap-
plied under sections 2799 and 2799A (relating to 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00071
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
prohibitions on balance billing in certain cir-
cumstances); 
‘‘(B) if provided for under applicable State 
law, any other requirements on providers and fa-
cilities regarding the amounts such providers 
and facilities may, with respect to an item or 
service, charge a participant, beneficiary, or en-
rollee of such plan or coverage with respect to 
which such a provider or facility does not have 
a contractual relationship for furnishing such 
item or service under the plan or coverage after 
receiving payment from the plan or coverage for 
such item or service and any applicable cost- 
sharing payment from such participant, bene-
ficiary, or enrollee; and 
‘‘(C) the requirements applied under sub-
sections (b) and (e); and 
‘‘(2) information on contacting appropriate 
State and Federal agencies in the case that an indi-
vidual believes that such a provider or facility has 
violated any requirement described in paragraph (1) 
with respect to such individual.’’. 
(d) PREVENTING CERTAIN CASES OF BALANCE BILL-
ING.—Title XXVII of the Public Health Service Act is 
amended by adding at the end the following new part: 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00072
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS
‘‘PART D—PREVENTING CERTAIN CASES OF 
BALANCE BILLING 
‘‘SEC. 2799. BALANCE BILLING IN CASES OF EMERGENCY 
SERVICES. 
‘‘(a) IN GENERAL.—In the case of a participant, bene-
ficiary, or enrollee with benefits under a health plan who 
is furnished on or after January 1, 2021, emergency serv-
ices with respect to an emergency medical condition during 
a visit at an emergency department of a hospital or an 
independent freestanding emergency department— 
‘‘(1) the emergency department of a hospital or 
independent freestanding emergency department shall 
not hold the participant, beneficiary, or enrollee liable 
for a payment amount for such emergency services so 
furnished that is more than the cost-sharing amount 
for such services (as determined in accordance with 
clauses (ii) and (iii) of section 2719A(b)(1)(C)); and 
‘‘(2) a health care provider shall not hold such 
participant, beneficiary, or enrollee liable for a pay-
ment amount for an emergency service furnished to 
such individual by such provider with respect to such 
emergency medical condition and visit for which the 
individual receives emergency services at the hospital 
or emergency department that is more than the cost- 
sharing amount for such services furnished by the 
VerDate Sep 11 2014 
21:36 Dec 31, 2020
Jkt 019200
PO 00000
Frm 00073
Fmt 6652
Sfmt 6203
E:\BILLS\H2328.RH
H2328
pamtmann on DSKBC07HB2PROD with BILLS