instruction:
In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.
question:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Union Member Protection Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Labor unions make significant political contributions 
        and expenditures that directly or indirectly influence the 
        election of candidates and support or oppose political causes. 
        Decisions to use union dues for political contributions and 
        expenditures are usually made by union leadership and 
        management, rather than union membership.
            (2) Unions, acting through their management, should be 
        obligated to conduct business in the best interests of their 
        membership.
            (3) Historically, union members have not had a way to know, 
        or to influence, the political activities of unions that are 
        supposed to represent them. Union members and the public have a 
        right to know how unions are spending members' dues to make 
        political contributions or expenditures benefitting candidates, 
        political parties, and political causes.
            (4) Unions should be accountable to their membership in 
        making political contributions or expenditures affecting 
        Federal governance and public policy. Requiring the express 
        approval of a union's membership for political contributions or 
        expenditures will establish necessary accountability.

SEC. 3. DISCLOSURE AND APPROVAL OF CERTAIN POLITICAL EXPENDITURES.

    (a) In General.--Title II of the Labor-Management Reporting and 
Disclosure Act (29 U.S.C. 431 et seq.) is amended by inserting after 
section 201 the following:

``SEC. 201A. DISCLOSURE AND APPROVAL OF CERTAIN POLITICAL EXPENDITURES 
              BY LABOR ORGANIZATIONS.

    ``(a) Disclosure.--The report required under section 201 shall 
contain, in a clear and simple format--
            ``(1) a description of the specific nature of any 
        expenditures for political activities proposed to be made by 
        the labor organization for the forthcoming fiscal year, to the 
        extent the specific nature is known to the labor organization 
        and including the total amount of such proposed expenditures; 
        and
            ``(2) a disclosure of how each officer of the labor 
        organization voted to authorize or not to authorize each 
        expenditure for political activities made by the labor 
        organization during the preceding fiscal year.
    ``(b) Restriction on Expenditures.--No labor organization shall 
make any expenditure for political activities in any fiscal year 
unless--
            ``(1) such expenditure is of the nature of those proposed 
        by the labor organization pursuant to subsection (a); and
            ``(2) the full, free, and written authorization for such 
        expenditures has been granted by a majority of the members of 
        the labor organization.
    ``(c) Mechanism for Obtaining Authorization.--Not later than 1 year 
after the date of enactment of the Union Member Protection Act, every 
labor organization shall adopt a mechanism for obtaining, by secret 
ballot, the authorization of its members as required under subsection 
(b)(2).
    ``(d) Liability.--The officers of a labor organization who 
authorize an expenditure without first obtaining the authorization of 
members required under subsection (b)(2) shall be jointly and severally 
liable in any action brought in any court of competent jurisdiction to 
any member of the labor organization or class of members for the amount 
of dues paid by such member or class of member during the 1 year period 
prior to the date that such expenditure was made.
    ``(e) Definition of Expenditure for Political Activities.--As used 
in this section:
            ``(1) The term `expenditure for political activities' 
        means--
                    ``(A) an independent expenditure, as such term is 
                defined in section 301(17) of the Federal Election 
                Campaign Act of 1971 (2 U.S.C. 431(17));
                    ``(B) contributions to any political party, 
                committee, or electioneering communication, as such 
                term is defined in section 304(f)(3)(A) of the Federal 
                Election Campaign Act of 1971 (2 U.S.C. 434(f)(3)(A)); 
                and
                    ``(C) dues or other payments to trade associations 
                or other tax exempt organizations that are, or could 
                reasonably be anticipated to be, used for the purposes 
                described in subparagraph (A).
            ``(2) Such term shall not include--
                    ``(A) direct lobbying efforts through registered 
                lobbyists employed or hired by the labor organization;
                    ``(B) communications by a labor organization to its 
                members and executive or administrative personnel and 
                their families; or
                    ``(C) the establishment, administration, and 
                solicitation of contributions to a separate segregated 
                fund to be utilized for political purposes by a labor 
                organization.''.
    (b) Conforming Amendments.--
            (1) Section 201(c) of such Act (29 U.S.C. 431(c)) is 
        amended by striking ``make available the information required 
        to be contained in'' and inserting ``provide''.
            (2) Section 209(a) of such Act (29 U.S.C. 439(a)) is 
        amended by inserting ``other than section 201A'' after ``this 
        title''.

SEC. 4. REQUIREMENT OF VOTE BY PRINCIPAL OFFICERS.

    Section 201 of the Labor-Management Reporting and Disclosure Act 
(29 U.S.C. 431) is further amended by adding at the end the following:
    ``(f) The bylaws required under this section shall expressly 
provide for a vote of the principal officers of the labor organization 
on any individual expenditure for political activities (as such term is 
defined in section 201A(e)) in excess of $50,000. A labor organization 
shall make publicly available the individual votes of principal 
officers required by the preceding sentence within 48 hours of the 
vote, including in a clear and conspicuous location on the Internet 
website of the labor organization.''.

SEC. 5. REPORT.

    The Comptroller General of the United States shall annually conduct 
a study on the compliance with the requirements of this Act by labor 
organizations and their management. Not later than April 1 of each 
year, the Comptroller General shall submit to Congress a report of such 
study.

SEC. 6. EFFECTIVE DATE.

    The amendments made by this Act shall take effect on the date of 
enactment of the Shareholder Protection Act of 2010.
answer:
Union Member Protection Act - Amends the Labor-Management Reporting and Disclosure Act (Landrum-Griffin Act) to require a labor organization's mandatory report to the Secretary of Labor on its constitution, officers, and basic organization to include, in a clear and simple format, both: (1) a description of the specific nature and total amount of political expenditures the labor organization proposes to make for the upcoming fiscal year; and (2) a disclosure of how each labor organization officer voted on each political expenditure made by the organization during the preceding fiscal year.

Prohibits a labor organization from making political expenditures unless: (1) they are of the nature of those proposed in such report; and (2) they have received a full, free, and written authorization by secret ballot by a majority of the labor organization members.

Makes officers jointly and severally liable for authorizing a political expenditure without first obtaining the authorization of labor organization members.

Requires labor organization bylaws to provide expressly for a vote of the organization's principal officers on individual political expenditures in excess of $50,000. Requires a labor organization to make public the individual votes of such officers within 48 hours, including in a clear and conspicuous location on its website.


question:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Senator Paul Simon Water for the 
World Act of 2009''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The Senator Paul Simon Water for the Poor Act of 2005 
        (Public Law 109-121)--
                    (A) makes access to safe water and sanitation for 
                developing countries a specific policy objective of 
                United States foreign assistance programs;
                    (B) requires the Secretary of State to--
                            (i) develop a strategy to elevate the role 
                        of water and sanitation policy; and
                            (ii) improve the effectiveness of United 
                        States assistance programs undertaken in 
                        support of that strategy;
                    (C) codifies Target 10 of the United Nations 
                Millennium Development Goals; and
                    (D) seeks to reduce by half between 1990 (the 
                baseline year) and 2015--
                            (i) the proportion of people who are unable 
                        to reach or afford safe drinking water; and
                            (ii) the proportion of people without 
                        access to basic sanitation.
            (2) On December 20, 2006, the United Nations General 
        Assembly, in GA Resolution 61/192, declared 2008 as the 
        International Year of Sanitation, in recognition of the impact 
        of sanitation on public health, poverty reduction, economic and 
        social development, and the environment.
            (3) On August 1, 2008, Congress passed H. Con. Res. 318, 
        which--
                    (A) supports the goals and ideals of the 
                International Year of Sanitation; and
                    (B) recognizes the importance of sanitation on 
                public health, poverty reduction, economic and social 
                development, and the environment.
            (4) While progress is being made on safe water and 
        sanitation efforts--
                    (A) more than 884,000,000 people throughout the 
                world lack access to safe drinking water; and
                    (B) 2 of every 5 people in the world do not have 
                access to basic sanitation services.
            (5) The health consequences of unsafe drinking water and 
        poor sanitation are significant, accounting for--
                    (A) nearly 10 percent of the global burden of 
                disease; and
                    (B) more than 2,000,000 deaths each year.
            (6) The effects of climate change are expected to produce 
        severe consequences for water availability and resource 
        management in the future, with 2,800,000,000 people in more 
        than 48 countries expected to face severe and chronic water 
        shortages by 2025.
            (7) According to the November 2008 report entitled, 
        ``Global Trends 2025: A Transformed World'', the National 
        Intelligence Council expects rapid urbanization and future 
        population growth to exacerbate already limited access to 
        water, particularly in agriculture-based economies.
            (8) A 2009 report published in the Proceedings of the 
        National Academy of Sciences projects that the effects of 
        climate change will produce long-term droughts and raise sea 
        levels for the next 1,000 years, regardless of future efforts 
        to combat climate change.
            (9) According to the 2005 Millennium Ecosystem Assessment, 
        commissioned by the United Nations, more than \1/5\ of the 
        world population relies on freshwater that is either polluted 
        or excessively withdrawn.
            (10) The impact of water scarcity on conflict and 
        instability is evident in many parts of the world, including 
        the Darfur region of Sudan, where demand for water resources 
        has contributed to armed conflict between nomadic ethnic groups 
        and local farming communities.
            (11) In order to further the United States contribution to 
        safe water and sanitation efforts, it is necessary to--
                    (A) expand foreign assistance capacity to address 
                the challenges described in this section; and
                    (B) represent issues related to water and 
                sanitation at the highest levels of United States 
                foreign assistance and diplomatic deliberations, 
                including those related to issues of global health, 
                food security, the environment, global warming, and 
                maternal and child mortality.

SEC. 3. SENSE OF CONGRESS.

    It is the sense of Congress that the United States should lead a 
global effort to bring sustainable access to clean water and sanitation 
to poor people throughout the world.

SEC. 4. PURPOSE.

    The purpose of this Act is--
            (1) to provide first-time access to safe water and 
        sanitation, on a sustainable basis, for 100,000,000 people in 
        high priority countries (as designated under section 6(f) of 
        the Senator Paul Simon Water for the Poor Act of 2005 (22 
        U.S.C. 2152h note)) by 2015; and
            (2) to enhance the capacity of the United States Government 
        to fully implement the Senator Paul Simon Water for the Poor 
        Act of 2005 (Public Law 109-121).

SEC. 5. DEVELOPING UNITED STATES GOVERNMENT CAPACITY.

    Section 135 of the Foreign Assistance Act of 1961 (22 U.S.C. 2152h) 
is amended by adding at the end the following:
    ``(e) Office of Water.--
            ``(1) Establishment.--To carry out the purposes of 
        subsection (a), the Administrator of the United States Agency 
        for International Development shall establish the Office of 
        Water within the Bureau for Economic Growth, Agriculture, and 
        Trade.
            ``(2) Leadership.--The Office of Water shall be headed by a 
        Director for Safe Water and Sanitation, who shall report 
        directly to the Assistant Administrator of the Bureau for 
        Economic Growth, Agriculture, and Trade.
            ``(3) Duties.--The Director shall--
                    ``(A) implement this section and the Senator Paul 
                Simon Water for the Poor Act of 2005 (Public Law 109-
                121);
                    ``(B) develop and implement country-specific water 
                strategies and expertise, in collaboration with 
                appropriate United States Agency for International 
                Development Mission Directors, to meet the goal of 
                providing 100,000,000 additional people with 
                sustainable access to safe water and sanitation by 
                2015; and
                    ``(C) place primary emphasis on providing safe, 
                affordable, and sustainable drinking water, sanitation, 
                and hygiene in a manner that--
                            ``(i) is consistent with sound water 
                        resource management principles; and
                            ``(ii) utilizes such approaches as direct 
                        service provision, capacity building, 
                        institutional strengthening, regulatory reform, 
                        and partnership collaboration.
            ``(4) Capacity.--The Director may utilize interagency 
        details or partnerships with universities, civil society, and 
        the private sector, as needed, to strengthen implementation 
        capacity.
    ``(f) Special Coordinator for International Water.--
            ``(1) Establishment.--To increase the capacity of the 
        Department of State to address international issues regarding 
        safe water, sanitation, integrated river basin management, and 
        other international water programs, the Secretary of State 
        shall establish a Special Coordinator for International Water 
        (referred to in this subsection as the `Special Coordinator'), 
        who shall report to the Under Secretary for Democracy and 
        Global Affairs.
            ``(2) Duties.--The Special Coordinator shall--
                    ``(A) oversee and coordinate the diplomatic policy 
                of the United States Government with respect to global 
                freshwater issues, including interagency coordination 
                related to--
                            ``(i) sustainable access to safe drinking 
                        water, sanitation, and hygiene;
                            ``(ii) integrated river basin and watershed 
                        management;
                            ``(iii) transboundary conflict;
                            ``(iv) agricultural and urban productivity 
                        of water resources;
                            ``(v) disaster recovery, response, and 
                        rebuilding;
                            ``(vi) pollution mitigation; and
                            ``(vii) adaptation to hydrologic change due 
                        to climate variability; and
                    ``(B) ensure that international freshwater issues 
                are represented--
                            ``(i) within the United States Government; 
                        and
                            ``(ii) in key diplomatic, development, and 
                        scientific efforts with other nations and 
                        multilateral organizations.
            ``(3) Staff.--The Special Coordinator is authorized to hire 
        a limited number of staff to carry out the duties described in 
        paragraph (2).''.

SEC. 6. SAFE WATER, SANITATION, AND HYGIENE STRATEGY.

    Section 6 of the Senator Paul Simon Water for the Poor Act of 2005 
(22 U.S.C. 2152h note) is amended--
            (1) in subsection (c), by adding at the end the following: 
        ``In developing the program activities needed to implement the 
        strategy, the Secretary shall consider the results of the 
        assessment described in subsection (e)(9).''; and
            (2) in subsection (e)--
                    (A) in paragraph (5), by striking ``and'' at the 
                end;
                    (B) in paragraph (6), by striking the period at the 
                end and inserting a semicolon; and
                    (C) by adding at the end the following:
            ``(7) an assessment of all United States Government foreign 
        assistance allocated to the drinking water and sanitation 
        sector during the 3 previous fiscal years, across all United 
        States Government agencies and programs, including an 
        assessment of the extent to which the United States 
        Government's efforts are reaching the goal of providing first-
        time access to safe water and sanitation on a sustainable basis 
        for 100,000,000 people in high priority countries;
            ``(8) recommendations on what the United States Government 
        would need to do to achieve the goals referred to in paragraph 
        (7), in support of the United Nation's Millennium Development 
        Goal on access to safe drinking water; and
            ``(9) an assessment of best practices for mobilizing and 
        leveraging the financial and technical capacity of business, 
        governments, nongovernmental organizations, and civil society 
        in forming public-private partnerships that measurably increase 
        access to safe drinking water and sanitation.''.

SEC. 7. DEVELOPING LOCAL CAPACITY.

    The Senator Paul Simon Water for the Poor Act of 2005 (Public Law 
109-121) is amended--
            (1) by redesignating sections 9, 10, and 11 as sections 10, 
        11, and 12, respectively; and
            (2) by inserting after section 8 the following:

``SEC. 9. WATER AND SANITATION INSTITUTIONAL CAPACITY-BUILDING PROGRAM.

    ``(a) Establishment.--
            ``(1) In general.--The Secretary of State and the 
        Administrator of the United States Agency for International 
        Development (referred to in this section as the `Secretary' and 
        the `Administrator', respectively), in consultation with host 
        country institutions, the Centers for Disease Control and 
        Prevention, the Department of Agriculture, and other agencies, 
        as appropriate, shall establish, in every high priority 
        country, a program to build the capacity of host country 
        institutions and officials responsible for water and sanitation 
        in countries that receive assistance under section 135 of the 
        Foreign Assistance Act of 1961, including training at 
        appropriate levels, to--
                    ``(A) provide affordable, equitable, and 
                sustainable access to safe drinking water and 
                sanitation;
                    ``(B) educate the populations of such countries 
                about the dangers of unsafe drinking water and lack of 
                proper sanitation; and
                    ``(C) encourage behavior change to reduce 
                individuals' risk of disease from unsafe drinking water 
                and lack of proper sanitation and hygiene.
            ``(2) Coordination.--The programs established under 
        subsection (a) shall be coordinated in each country by the lead 
        country water manager designated in subsection (b)(2).
            ``(3) Expansion.--The Secretary and the Administrator may 
        establish the program described in this section in additional 
        countries if the receipt of such capacity building would be 
        beneficial for promoting access to safe drinking water and 
        sanitation, with due consideration given to good governance.
            ``(4) Capacity.--The Secretary and the Administrator--
                    ``(A) shall designate staff with appropriate 
                expertise to carry out the strategy developed under 
                section 4; and
                    ``(B) may utilize, as needed, interagency details 
                or partnerships with universities, civil society, and 
                the private sector to strengthen implementation 
                capacity.
    ``(b) Designation.--The United States Agency for International 
Development Mission Director for each country receiving a `high 
priority' designation under section 6(f) and for each region containing 
a country receiving such designation shall--
            ``(1) designate safe drinking water and sanitation as a 
        strategic objective;
            ``(2) appoint an employee of the United States Agency for 
        International Development as in-country water and sanitation 
        manager to coordinate the in-country implementation of this Act 
        and section 135 of the Foreign Assistance Act of 1961 (22 
        U.S.C. 2152h) with host country officials at various levels of 
        government responsible for water and sanitation, the Department 
        of State, and other relevant United States Government agencies; 
        and
            ``(3) coordinate with the Development Credit Authority and 
        the Global Development Alliance to further the purposes of this 
        Act.''.

SEC. 8. OTHER ACTIVITIES SUPPORTED.

    Section 135(c) of the Foreign Assistance Act (22 U.S.C. 2152h(c)) 
is amended--
            (1) in paragraph (3), by striking ``and'' at the end;
            (2) in paragraph (4), by striking the period at the end; 
        and
            (3) by adding at the end the following:
            ``(5) foster global cooperation on research and technology 
        development, including regional partnerships among water 
        experts to address safe drinking water, sanitation, water 
        resource management, and other water-related issues;
            ``(6) establish regional and cross-border cooperative 
        activities between scientists and specialists that work to 
        share technologies and best practices, mitigate shared water 
        challenges, foster international cooperation, and defuse cross-
        border tensions;
            ``(7) provide grants through the United States Agency for 
        International Development to foster the development, 
        dissemination, and increased and consistent use of low cost and 
        sustainable technologies, such as household water treatment, 
        hand washing stations, and latrines, for providing safe 
        drinking water, sanitation, and hygiene that are suitable for 
        use in high priority countries, particularly in places with 
        limited resources and infrastructure;
            ``(8) in collaboration with the Centers for Disease Control 
        and Prevention, Department of Agriculture, the Environmental 
        Protection Agency, the National Oceanic and Atmospheric 
        Administration, and other agencies, as appropriate, conduct 
        formative and operational research and monitor and evaluate the 
        effectiveness of programs that provide safe drinking water and 
        sanitation; and
            ``(9) integrate efforts to promote safe drinking water, 
        sanitation and hygiene with existing foreign assistance 
        programs, as appropriate, including activities focused on HIV/
        AIDS, malaria, tuberculosis, maternal and child health, food 
        security, and nutritional support.''.

SEC. 9. UPDATED REPORT REGARDING WATER FOR PEACE AND SECURITY.

    Section 11(b) of the Senator Paul Simon Water for the Poor Act of 
2005, as redesignated by section 7, is amended by adding at the end the 
following: ``The report submitted under this subsection shall include 
an assessment of current and likely future political tensions over 
water sources and multidisciplinary assessment of the expected impacts 
of global climate change on water supplies in 10, 25, and 50 years.''.

SEC. 10. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated for fiscal 
year 2009 and for each subsequent fiscal year such sums as may be 
necessary to carry out this Act and the amendments made by this Act, 
pursuant to the criteria set forth in the Senator Paul Simon Water for 
the Poor Act of 2005 (Public Law 109-121).
    (b) Use of Funds.--
            (1) General water resource management activities.--Up to 20 
        percent of the amounts appropriated to implement this Act may 
        be used to support general water resource management activities 
        that improve countries' overall water sources.
            (2) Other activities.--Any amounts appropriated to 
        implement this Act that are not used to carry out the 
        activities described in paragraph (1) shall be allocated for 
        activities related to safe drinking water, sanitation, and 
        hygiene.
answer:
Senator Paul Simon Water for the World Act of 2009 - Amends the Foreign Assistance Act of 1961 to direct the Administrator of the United States Agency for International Development (USAID) to establish the Office of Water within the Bureau for Economic Growth, Agriculture, and Trade to: (1) give assistance to provide safe water and sanitation for people worldwide; and (2) be headed by a Director for Safe Water and Sanitation. Outlines the Director's duties.

Requires the Secretary of State, in order to increase the capacity of the Department of State to address international issues regarding safe water, sanitation, integrated river basin management, and other international water programs, to establish a Special Coordinator for International Water. Outlines the Special Coordinator's duties.

Amends the Senator Paul Simon Water for the Poor Act of 2005 to: (1) revise requirements concerning the safe water and sanitation strategy; (2) provide for the establishment of a program to build the capacity of host country institutions and officials responsible for water and sanitation in countries that receive assistance to provide safe water and sanitation under the Foreign Assistance Act of 1961; (3) expand the list of activities that may be supported by assistance furnished by the President for programs in developing countries to provide affordable and equitable access to safe water and sanitation; and (4) require the report regarding water for peace and security to include an assessment of political tensions over water sources and a multidisciplinary assessment of the expected impacts of global climate change on water supplies in 10, 25, and 50 years.


question:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``End Surprise Billing Act of 2015''.

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 access 
                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 (relating to the prevention of surprise 
                billing practices).''; and
            (2) by adding at the end the following new subsection:
    ``(l) Requirement for Purposes of Preventing Surprise Billing.--
            ``(1) In general.--For purposes of subsection (a)(1)(Z), 
        the requirements described in this paragraph are, with respect 
        to a hospital or critical access hospital, in the case of an 
        individual with health 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 another 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 critical access hospital (including by a provider 
        of services or supplier that furnishes items or services at the 
        hospital or critical access hospital), that the hospital 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 applicable, and on the date 
                on which the individual is furnished such items and 
                services, a written notice specified by the Secretary 
                through rulemaking that--
                            ``(I) contains the information required 
                        under paragraph (2); and
                            ``(II) is signed and dated by the 
                        individual; and
                    ``(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 critical 
                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 participating provider of 
                services or supplier with respect to such health 
                benefits coverage of such individual, obtains from the 
                individual the consent described in paragraph (3).
            ``(2) Information included in notice.--The notice described 
        in paragraph (1)(A) shall include, with respect to an 
        individual with health benefits coverage described in paragraph 
        (1) who seeks to be furnished items or services or is to be 
        furnished items or services by a hospital or critical access 
        hospital (including by a provider of services or supplier that 
        furnishes items or services at the hospital or critical access 
        hospital), a notification of each of the following:
                    ``(A) Whether the hospital or critical access 
                hospital 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.
                    ``(B) If the hospital or critical access hospital 
                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 coverage for such items and services if the 
                hospital or critical access hospital were within such 
                network or otherwise participating in such coverage.
                    ``(C) Whether any of the providers of services 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 otherwise such 
                a participating provider or supplier, 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 
                within 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 critical 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 document specified by the Secretary through 
        rulemaking that is signed by the individual (or by a 
        representative of the individual) not less than 24 hours prior 
        to the individual being furnished such items or services by 
        such hospital, critical access hospital, 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 assessed 
                        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 participating provider of 
                        services or supplier; and
                            ``(ii) informed that the payment of such 
                        charge by the individual will not accrue 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 deductible to be paid by the 
                        individual; and
                    ``(B) documents the consent of the individual to--
                            ``(i) be furnished with such items or 
                        services by such hospital, critical access 
                        hospital, provider of services, or supplier, as 
                        applicable; and
                            ``(ii) in the case that the individual is 
                        so furnished such items or services, be charged 
                        an amount approximate to the estimated charge 
                        described in subparagraph (A)(i) with respect 
                        to such items or services.
            ``(4) Limitations on payment by individual.--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 hospitals.--In the case of an 
                individual with health benefits coverage described in 
                paragraph (1) who is furnished items or services by a 
                hospital 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 otherwise 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 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 applicable) that is within 
                such network or that is otherwise such a participating 
                provider of services 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 hospital 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 otherwise 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 services such as in the case of items 
                and services 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 
                applicable) that is within such network or that is 
                otherwise such a participating provider of services 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.
answer:

End Surprise Billing Act of 2015 This bill amends title XVIII (Medicare) of the Social Security Act to require a critical access hospital or other hospital to comply, as a condition of participation in Medicare, with certain requirements related to billing for out-of-network services. With respect to an individual who has health benefits coverage and is seeking services, a hospital must provide notice as to: (1) whether the hospital, or any of the providers furnishing services to the individual at the hospital, is not within the health care provider network or otherwise a participating provider with respect to the individual's health care coverage; and (2) if so, the estimated out-of-pocket costs of the services to the individual. At least 24 hours prior to providing those services, the hospital must document that the individual: (1) has been provided with the required notice, and (2) consents to be furnished with the services and charged an amount approximate to the estimate provided. Otherwise, the hospital may not charge the individual more than the individual would have been required to pay if the services had been furnished by an in-network or participating provider. With respect to such an individual who is seeking same-day emergency services, a hospital may not charge more than the individual would be required to pay for such services furnished by an in-network or participating provider.