Title: Medical Billing Fairness Act of 2019
Policy area: Health

Summary:
Medical Billing Fairness Act of 2019
This bill requires hospitals, as a condition of Medicare participation, to (1) allow in-network patients, when scheduling a nonemergency procedure, to request only in-network treatment; and (2) if in-network treatment is not available, pay for any additional costs to the patient or the patient's insurer.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1607 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                S. 1607

To amend title XVIII of the Social Security Act to provide protections 
    for patients scheduling non-emergency procedures at in-network 
                   hospitals, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 22, 2019

  Mr. Kennedy introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide protections 
    for patients scheduling non-emergency procedures at in-network 
                   hospitals, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medical Billing Fairness Act of 
2019''.

SEC. 2. ADDITIONAL CONDITIONS OF PARTICIPATION FOR HOSPITALS UNDER THE 
              MEDICARE PROGRAM WITH RESPECT TO SCHEDULING OF NON-
              EMERGENCY PROCEDURES AT IN-NETWORK HOSPITALS.

    (a) In General.--Section 1866(a)(1) of the Social Security Act (42 
U.S.C. 1395cc(a)(1)) is amended--
            (1) by moving the indentation of subparagraph (W) 2 ems to 
        the left;
            (2) in subparagraph (X)--
                    (A) by moving the indentation 2 ems to the left; 
                and
                    (B) by striking ``and'' at the end;
            (3) in subparagraph (Y), by striking the period at the end 
        and inserting ``, and''; and
            (4) by inserting after subparagraph (Y) the following new 
        subparagraph:
            ``(Z)(i) in the case of a hospital, with respect to a non-
        emergency procedure scheduled by a patient in the hospital 
        where the hospital is in-network for the patient--
                    ``(I) to provide to the patient at the time of 
                scheduling the opportunity to inform the hospital that 
                they would like in-network treatment only for the 
                procedure; and
                    ``(II) if such treatment is not available at the 
                time of the procedure despite the patient informing the 
                hospital that they would like such treatment at the 
                time of scheduling, to provide for payment by the 
                hospital of any additional cost to the patient, group 
                health plan, or group or individual health insurance 
                coverage for the procedure as a result of any treatment 
                that is not in-network.
            ``(ii) For purposes of this subparagraph, the term `non-
        emergency procedure' means examination or treatment for a 
        medical condition (other than an emergency medical condition, 
        as defined in section 1867(e)(1)).''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date of the enactment of this Act and apply to 
contracts entered into or renewed on or after the date that is six 
months after such date of enactment.
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