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<dc:title>111 HR 2328 RH: REACH Act</dc:title>
<dc:publisher>U.S. House of Representatives</dc:publisher>
<dc:date>2020-12-31</dc:date>
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<dc:language>EN</dc:language>
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<distribution-code display="yes">IB</distribution-code><calendar display="yes">Union Calendar No. 587</calendar><congress display="yes">116th CONGRESS</congress><session display="yes">2d Session</session><legis-num display="yes">H. R. 2328</legis-num><associated-doc role="report" display="yes">[Report No. 116–332, Part I]</associated-doc><current-chamber>IN THE HOUSE OF REPRESENTATIVES</current-chamber><action display="yes"><action-date date="20190415">April 15, 2019</action-date><action-desc><sponsor name-id="O000171">Mr. O'Halleran</sponsor> (for himself and <cosponsor name-id="S001196">Ms. Stefanik</cosponsor>) introduced the following bill; which was referred to the <committee-name committee-id="HIF00">Committee on Energy and Commerce</committee-name></action-desc></action><action display="yes"><action-date date="20191209">December 9, 2019</action-date><action-desc>Reported with amendments and referred to the Committee on<committee-name committee-id="HPW00"> Transportation and Infrastructure</committee-name> for a period ending not later than January 29, 2020, for consideration of such provisions of the bill as fall within the jurisdiction of that committee pursuant to clause 1(r) of rule X</action-desc><action-instruction>Strike out all after the enacting clause and insert the part printed in italic</action-instruction></action><action display="yes"><action-date date="20200129">January 29, 2020</action-date><action-desc>Referral to the Committee on<committee-name committee-id="HPW00"> Transportation and Infrastructure</committee-name> extended for a period ending not later than February 19, 2020</action-desc></action><action display="yes"><action-date date="20200219">February 19, 2020</action-date><action-desc>Referral to the Committee on<committee-name committee-id="HPW00"> Transportation and Infrastructure</committee-name> extended for a period ending not later than April 23, 2020</action-desc></action><action display="yes"><action-date date="20200423">April 23, 2020</action-date><action-desc>Referral to the Committee on<committee-name committee-id="HPW00"> Transportation and Infrastructure</committee-name> extended for a period ending not later than July 31, 2020</action-desc></action><action display="yes"><action-date date="20200731">July 31, 2020</action-date><action-desc>Referral to the Committee on<committee-name committee-id="HPW00"> Transportation and Infrastructure</committee-name> extended for a period ending not later than September 21, 2020</action-desc></action><action display="yes"><action-date date="20200921">September 21, 2020</action-date><action-desc>Referral to the Committee on<committee-name committee-id="HPW00"> Transportation and Infrastructure</committee-name> extended for a period ending not later than November 20, 2020</action-desc></action><action display="yes"><action-date date="20201117">November 17, 2020</action-date><action-desc>Referral to the Committee on<committee-name committee-id="HPW00"> Transportation and Infrastructure</committee-name> extended for a period ending not later than December 31, 2020</action-desc></action><action display="yes"><action-date date="20201231">December 31, 2020</action-date><action-desc>Additional sponsors: <cosponsor name-id="S001193">Mr. Swalwell of California</cosponsor>, <cosponsor name-id="E000297">Mr. Espaillat</cosponsor>, <cosponsor name-id="G000571">Ms. Gabbard</cosponsor>, <cosponsor name-id="O000173">Ms. Omar</cosponsor>, <cosponsor name-id="M001143">Ms. McCollum</cosponsor>, <cosponsor name-id="S000510">Mr. Smith of Washington</cosponsor>, <cosponsor name-id="K000389">Mr. Khanna</cosponsor>, <cosponsor name-id="C001068">Mr. Cohen</cosponsor>, <cosponsor name-id="G000551">Mr. Grijalva</cosponsor>, <cosponsor name-id="C001069">Mr. Courtney</cosponsor>, <cosponsor name-id="H001053">Mrs. Hartzler</cosponsor>, <cosponsor name-id="M001207">Ms. Mucarsel-Powell</cosponsor>, <cosponsor name-id="J000298">Ms. Jayapal</cosponsor>, <cosponsor name-id="K000382">Ms. Kuster of New Hampshire</cosponsor>, <cosponsor name-id="D000598">Mrs. Davis of California</cosponsor>, <cosponsor name-id="R000515">Mr. Rush</cosponsor>, <cosponsor name-id="L000563">Mr. Lipinski</cosponsor>, <cosponsor name-id="E000179">Mr. Engel</cosponsor>, <cosponsor name-id="S001150">Mr. Schiff</cosponsor>, <cosponsor name-id="C001084">Mr. Cicilline</cosponsor>, <cosponsor name-id="S000248">Mr. Serrano</cosponsor>, <cosponsor name-id="L000560">Mr. Larsen of Washington</cosponsor>, <cosponsor name-id="K000391">Mr. Krishnamoorthi</cosponsor>, <cosponsor name-id="P000608">Mr. Peters</cosponsor>, <cosponsor name-id="L000551">Ms. Lee of California</cosponsor>, <cosponsor name-id="K000381">Mr. Kilmer</cosponsor>, <cosponsor name-id="S001180">Mr. Schrader</cosponsor>, <cosponsor name-id="T000463">Mr. Turner</cosponsor>, <cosponsor name-id="K000210">Mr. King of New York</cosponsor>, <cosponsor name-id="Y000062">Mr. Yarmuth</cosponsor>, <cosponsor name-id="V000132">Mr. Vela</cosponsor>, <cosponsor name-id="H001064">Mr. Heck</cosponsor>, <cosponsor name-id="L000578">Mr. LaMalfa</cosponsor>, <cosponsor name-id="Y000033">Mr. Young</cosponsor>, <cosponsor name-id="D000630">Mr. Delgado</cosponsor>, <cosponsor name-id="T000470">Mr. Tipton</cosponsor>, <cosponsor name-id="J000126">Ms. Johnson of Texas</cosponsor>, <cosponsor name-id="H000324">Mr. Hastings</cosponsor>, <cosponsor name-id="S001165">Mr. Sires</cosponsor>, <cosponsor name-id="B001303">Ms. Blunt Rochester</cosponsor>, <cosponsor name-id="B001301">Mr. Bergman</cosponsor>, <cosponsor name-id="W000822">Mrs. Watson Coleman</cosponsor>, <cosponsor name-id="J000288">Mr. Johnson of Georgia</cosponsor>, <cosponsor name-id="C001053">Mr. Cole</cosponsor>, <cosponsor name-id="G000585">Mr. Gomez</cosponsor>, <cosponsor name-id="K000385">Ms. Kelly of Illinois</cosponsor>, <cosponsor name-id="R000602">Miss Rice of New York</cosponsor>, <cosponsor name-id="Z000017">Mr. Zeldin</cosponsor>, <cosponsor name-id="N000189">Mr. Newhouse</cosponsor>, <cosponsor name-id="D000619">Mr. Rodney Davis of Illinois</cosponsor>, <cosponsor name-id="C001067">Ms. Clarke of New York</cosponsor>, <cosponsor name-id="D000191">Mr. DeFazio</cosponsor>, <cosponsor name-id="N000002">Mr. Nadler</cosponsor>, <cosponsor name-id="M001137">Mr. Meeks</cosponsor>, <cosponsor name-id="S001187">Mr. Stivers</cosponsor>, <cosponsor name-id="M000087">Mrs. Carolyn B. Maloney of New York</cosponsor>, <cosponsor name-id="R000613">Mr. Rose of New York</cosponsor>, <cosponsor name-id="L000564">Mr. Lamborn</cosponsor>, <cosponsor name-id="B001306">Mr. Balderson</cosponsor>, <cosponsor name-id="F000459">Mr. Fleischmann</cosponsor>, <cosponsor name-id="G000574">Mr. Gallego</cosponsor>, <cosponsor name-id="S001145">Ms. Schakowsky</cosponsor>, <cosponsor name-id="W000800">Mr. Welch</cosponsor>, <cosponsor name-id="L000480">Mrs. Lowey</cosponsor>, <cosponsor name-id="O000172">Ms. Ocasio-Cortez</cosponsor>, <cosponsor name-id="M001185">Mr. Sean Patrick Maloney of New York</cosponsor>, <cosponsor name-id="B001270">Ms. Bass</cosponsor>, <cosponsor name-id="N000190">Mr. Norman</cosponsor>, <cosponsor name-id="T000472">Mr. Takano</cosponsor>, <cosponsor name-id="L000570">Mr. Luján</cosponsor>, <cosponsor name-id="R000606">Mr. Raskin</cosponsor>, <cosponsor name-id="C001080">Ms. Judy Chu of California</cosponsor>, <cosponsor name-id="L000592">Mr. Levin of Michigan</cosponsor>, <cosponsor name-id="D000624">Mrs. Dingell</cosponsor>, <cosponsor name-id="P000597">Ms. Pingree</cosponsor>, <cosponsor name-id="L000582">Mr. Ted Lieu of California</cosponsor>, <cosponsor name-id="T000484">Ms. Torres Small of New Mexico</cosponsor>, <cosponsor name-id="D000623">Mr. DeSaulnier</cosponsor>, <cosponsor name-id="K000386">Mr. Katko</cosponsor>, <cosponsor name-id="S001177">Mr. Sablan</cosponsor>, <cosponsor name-id="R000486">Ms. Roybal-Allard</cosponsor>, <cosponsor name-id="B001250">Mr. Bishop of Utah</cosponsor>, <cosponsor name-id="G000568">Mr. Griffith</cosponsor>, <cosponsor name-id="R000600">Mrs. Radewagen</cosponsor>, <cosponsor name-id="B001295">Mr. Bost</cosponsor>, <cosponsor name-id="W000791">Mr. Walden</cosponsor>, <cosponsor name-id="S001211">Mr. Stanton</cosponsor>, <cosponsor name-id="C001110">Mr. Correa</cosponsor>, <cosponsor name-id="L000397">Ms. Lofgren</cosponsor>, <cosponsor name-id="C001114">Mr. Curtis</cosponsor>, <cosponsor name-id="L000579">Mr. Lowenthal</cosponsor>, <cosponsor name-id="S001208">Ms. Slotkin</cosponsor>, <cosponsor name-id="F000467">Ms. Finkenauer</cosponsor>, <cosponsor name-id="F000454">Mr. Foster</cosponsor>, <cosponsor name-id="L000559">Mr. Langevin</cosponsor>, <cosponsor name-id="B001286">Mrs. Bustos</cosponsor>, <cosponsor name-id="K000009">Ms. Kaptur</cosponsor>, <cosponsor name-id="S001192">Mr. Stewart</cosponsor>, <cosponsor name-id="H001068">Mr. Huffman</cosponsor>, <cosponsor name-id="S001190">Mr. Schneider</cosponsor>, <cosponsor name-id="M001209">Mr. McAdams</cosponsor>, <cosponsor name-id="V000081">Ms. Velázquez</cosponsor>, <cosponsor name-id="J000032">Ms. Jackson Lee</cosponsor>, <cosponsor name-id="S001200">Mr. Soto</cosponsor>, <cosponsor name-id="C000754">Mr. Cooper</cosponsor>, <cosponsor name-id="S001189">Mr. Austin Scott of Georgia</cosponsor>, <cosponsor name-id="U000040">Ms. Underwood</cosponsor>, <cosponsor name-id="B001308">Mr. Brindisi</cosponsor>, <cosponsor name-id="S001212">Mr. Stauber</cosponsor>, <cosponsor name-id="C001061">Mr. Cleaver</cosponsor>, <cosponsor name-id="P000258">Mr. Peterson</cosponsor>, <cosponsor name-id="M001166">Mr. McNerney</cosponsor>, <cosponsor name-id="K000375">Mr. Keating</cosponsor>, <cosponsor name-id="S001209">Ms. Spanberger</cosponsor>, <cosponsor name-id="P000593">Mr. Perlmutter</cosponsor>, <cosponsor name-id="A000371">Mr. Aguilar</cosponsor>, <cosponsor name-id="C001124">Mr. Cox of California</cosponsor>, <cosponsor name-id="H001090">Mr. Harder of California</cosponsor>, <cosponsor name-id="H001083">Ms. Kendra S. Horn of Oklahoma</cosponsor>, <cosponsor name-id="P000523">Mr. Price of North Carolina</cosponsor>, <cosponsor name-id="M001205">Mrs. Miller</cosponsor>, <cosponsor name-id="V000133">Mr. Van Drew</cosponsor>, <cosponsor name-id="F000466">Mr. Fitzpatrick</cosponsor>, <cosponsor name-id="C001123">Mr. Cisneros</cosponsor>, <cosponsor name-id="L000557">Mr. Larson of Connecticut</cosponsor>, <cosponsor name-id="D000627">Mrs. Demings</cosponsor>, and <cosponsor name-id="H001081">Mrs. Hayes</cosponsor></action-desc><action-desc><pagebreak></pagebreak></action-desc></action><action display="yes"><action-date date="20201231">December 31, 2020</action-date><action-desc>Committee on <committee-name committee-id="HPW00">Transportation and Infrastructure</committee-name> discharged; committed to the Committee of the Whole House on the State of the Union and ordered to be printed</action-desc><action-instruction>For text of introduced bill, see copy of bill as introduced on April 15, 2019</action-instruction></action><action><action-desc><pagebreak></pagebreak></action-desc></action><legis-type>A BILL</legis-type><official-title display="yes">To reauthorize and extend funding for community health centers and the National Health Service Corps.<pagebreak></pagebreak></official-title></form><legis-body display-enacting-clause="yes-display-enacting-clause" changed="added" style="OLC" committee-id="HIF00" reported-display-style="italic" id="HCD56EC38EA4B427685E9DF88D25B6972"><section id="H53AB9E36085048CF924A826ACA0E6688" section-type="section-one"><enum>1.</enum><header>Short title; table of contents</header><subsection id="H194D3727813E4FC7ABF13B328FCBDEE1"><enum>(a)</enum><header>Short title</header><text display-inline="yes-display-inline">This Act may be cited as the <quote><short-title></short-title><short-title>Reauthorizing and Extending America’s Community Health Act</short-title></quote> or the <quote>REACH Act</quote>.</text></subsection><subsection id="H4503E2FDE680476BA47FD11C162D7F67"><enum>(b)</enum><header>Table of contents</header><text>The table of contents for this Act is as follows:</text><toc container-level="amendment-block-container" quoted-block="no-quoted-block" lowest-level="section" regeneration="yes-regeneration" lowest-bolded-level="division-lowest-bolded" changed="added" reported-display-style="italic" committee-id="HIF00"><toc-entry idref="H53AB9E36085048CF924A826ACA0E6688" level="section">Sec. 1. Short title; table of contents.</toc-entry><toc-entry idref="HA68C4D7A4EE74D4080D41FAE17FF9500" level="title">Title I—Public Health Extenders</toc-entry><toc-entry idref="HEB9C2F1B8A1648A9B07B05A443EFA279" level="section">Sec. 101. Extension for community health centers, the National Health Service Corps, and teaching health centers that operate GME programs.</toc-entry><toc-entry idref="H74945954D3334275BA095B27383E98D7" level="section">Sec. 102. Extension for special diabetes programs.</toc-entry><toc-entry idref="HBDFC28775D5241BA8CA246210D8B6855" level="section">Sec. 103. Extension of Personal Responsibility Education Program.</toc-entry><toc-entry idref="H5DB3875D134449D4878B6D69D16663DD" level="section">Sec. 104. Extension of sexual risk avoidance education program.</toc-entry><toc-entry idref="HFD84B99FC275455CA3E5C2DE9B2086E3" level="title">Title II—Medicare Extenders</toc-entry><toc-entry idref="HD7B33D6E2CB44F74A4266A280DDBDBE4" level="section">Sec. 201. Extension of the work geographic index floor under the Medicare program.</toc-entry><toc-entry idref="H86BC621642FF4F45A3BA5A10577A37B5" level="section">Sec. 202. Extension of funding outreach and assistance for low-income programs.</toc-entry><toc-entry idref="H174236E8EC254D13937EF8CE9D4E1203" level="section">Sec. 203. Extension of funding for quality measure endorsement, input, and selection under the Medicare program.</toc-entry><toc-entry idref="HE5AFF5DAD7D2487A9D36AA419643AC86" level="section">Sec. 204. Extension of the Independence at Home Medical Practice Demonstration Program under the Medicare program.</toc-entry><toc-entry idref="H452A24DEE98544599E652C0E588E19F0" level="section">Sec. 205. Extension of appropriations and transfers to the Patient-Centered Outcomes Research Trust Fund; extension of certain health insurance fees.</toc-entry><toc-entry idref="H0118AE58CD6B454C8376C5F70D687F5A" level="section">Sec. 206. Transitional coverage and retroactive Medicare part D coverage for certain low-income beneficiaries.</toc-entry><toc-entry idref="H2C75D46DD8DE42F09AEB7B9240D9F8E2" level="section">Sec. 207. Health Equity and Access for Returning Troops and Servicemembers Act of 2019.</toc-entry><toc-entry idref="H3B2124BA874343239911C67EC5B40783" level="section">Sec. 208. Exclusion of complex rehabilitative manual wheelchairs from Medicare competitive acquisition program; Non-application of Medicare fee-schedule adjustments for certain wheelchair accessories and cushions.</toc-entry><toc-entry idref="H2765197B4B2E4A94BBD9D830D5094888" level="title">Title III—Medicaid Provisions</toc-entry><toc-entry idref="HF7546870DFCC42278B74D891B05F944C" level="section">Sec. 301. Modification of reductions in Medicaid DSH allotments.</toc-entry><toc-entry idref="H83D1EC3E2365489E8EA5204E5674E9F8" level="section">Sec. 302. Public availability of hospital upper payment limit demonstrations.</toc-entry><toc-entry idref="H6C64D399E71D4A88BD26E09EBACA666D" level="section">Sec. 303. Report by Comptroller General.</toc-entry><toc-entry idref="H7B11F9B7B7D6408EA611645432495581" level="section">Sec. 304. Sense of Congress regarding the need to develop a more permanent legislative solution to provide the territories with a reliable and consistent source of Federal funding under the Medicaid program.</toc-entry><toc-entry idref="H9D1992FA914C4FB182BA016E9187CD6A" level="title">Title IV—No Surprises Act</toc-entry><toc-entry idref="H0492EB1A25594385BA88B82DDA96A833" level="section">Sec. 401. Short title.</toc-entry><toc-entry idref="H0D56DB314B0945628058DDD14587E6CB" level="section">Sec. 402. Preventing surprise medical bills.</toc-entry><toc-entry idref="H65BC3BC7653E47D3BDBE6255327AC7B1" level="section">Sec. 403. Government Accountability Office study on profit- and revenue-sharing in health care.</toc-entry><toc-entry idref="HD415CCB057324B15AF7E83CA5C30608C" level="section">Sec. 404. State All Payer Claims Databases.</toc-entry><toc-entry idref="H41001913F9D149FCAD2A4C8810592C8B" level="section">Sec. 405. Air ambulance cost data reporting program.</toc-entry><toc-entry idref="HF056C1B19AC9493C8C5E928EBBA20C6C" level="section">Sec. 406. Report by Secretary of Labor.</toc-entry><toc-entry idref="H20780A8056D34ADEAAC95552AD45ABC7" level="section">Sec. 407. Billing statute of limitations.</toc-entry><toc-entry idref="HAACC45A0209E4C8F8371579C0965AD81" level="section">Sec. 408. GAO report on impact of surprise billing provisions.</toc-entry><toc-entry idref="H1682D92EA7AE442482746BC5D5246670" level="section">Sec. 409. Report by the Secretary of Health and Human Services.</toc-entry><toc-entry idref="HB1FCA295B6474859A9F6321DAB166ACC" level="title">Title V—Territories Health Care Improvement Act</toc-entry><toc-entry idref="HAE8F4E9EEF834F8BAA542AC02303B9E7" level="section">Sec. 501. Short title.</toc-entry><toc-entry idref="HA1110EAD15B8449BB50CB107BE169585" level="section">Sec. 502. Medicaid payments for Puerto Rico and the other territories for certain fiscal years.</toc-entry><toc-entry idref="HF3D952639C92424E8963877463600E4F" level="section">Sec. 503. Application of certain requirements under Medicaid program to certain territories.</toc-entry><toc-entry idref="H8720834EFFDD4DC98F5C83A4392AD185" level="section">Sec. 504. Additional program integrity requirements.</toc-entry></toc></subsection></section><title id="HA68C4D7A4EE74D4080D41FAE17FF9500"><enum>I</enum><header>Public Health Extenders</header><section id="HEB9C2F1B8A1648A9B07B05A443EFA279" section-type="subsequent-section"><enum>101.</enum><header>Extension for community health centers, the National Health Service Corps, and teaching health centers that operate GME programs</header><subsection id="H0F1E9362C1864323978C059A1FC7B012"><enum>(a)</enum><header>Community Health Centers</header><text>Section 10503(b)(1)(F) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254b-2">42 U.S.C. 254b–2(b)(1)(F)</external-xref>) is amended by striking <quote>fiscal year 2019</quote> and inserting <quote>each of fiscal years 2019 through 2023</quote>.</text></subsection><subsection id="H45031475803B4491BDAB1A8A35C86BEF"><enum>(b)</enum><header>National Health Service Corps</header><text display-inline="yes-display-inline">Section 10503(b)(2)(F) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254b-2">42 U.S.C. 254b–2(b)(2)(F)</external-xref>) is amended by striking <quote>2018 and 2019</quote> and inserting <quote>2019 through 2023</quote>.</text></subsection><subsection id="H230ACF61F4EC47C283D7A0A3B083F888"><enum>(c)</enum><header>Teaching health centers that operate graduate medical education programs</header><text>Section 340H(g)(1) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/256h">42 U.S.C. 256h(g)(1)</external-xref>) is amended by striking <quote>2018 and 2019</quote> and inserting <quote>2019 through 2023</quote>.</text></subsection><subsection id="H9FF3CEF4F9DF4CF483183EE4E641B32F"><enum>(d)</enum><header>Application</header><text display-inline="yes-display-inline">Amounts appropriated for a program pursuant to the amendments made by subsection (a), (b), or (c) for fiscal years 2020 through 2023 are subject to the requirements and limitations of the most recently enacted regular or full-year continuing appropriations Act or resolution (as of the date of obligation of current funds) applicable to the respective program.</text></subsection></section><section id="H74945954D3334275BA095B27383E98D7"><enum>102.</enum><header>Extension for special diabetes programs</header><subsection id="H117CC26BF86E4521A5B978DDAE2ED9F5"><enum>(a)</enum><header>Reauthorization of special diabetes programs for Type I diabetes</header><text>Section 330B(b)(2)(D) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254c-2">42 U.S.C. 254c–2(b)(2)(D)</external-xref>) is amended by striking <quote>each of fiscal years 2018 and 2019</quote> and inserting <quote>fiscal years 2019 through 2023</quote>.</text></subsection><subsection id="H81423DE695C14690B91A33453C289828"><enum>(b)</enum><header>Reauthorization of special diabetes programs for Indians for diabetes services</header><text>Section 330C(c)(2)(D) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254c-3">42 U.S.C. 254c–3(c)(2)(D)</external-xref>) is amended by striking <quote>fiscal years 2018 and 2019</quote> and inserting <quote>fiscal years 2019 through 2023</quote>.</text></subsection></section><section id="HBDFC28775D5241BA8CA246210D8B6855"><enum>103.</enum><header>Extension of Personal Responsibility Education Program</header><text display-inline="no-display-inline">Section 513 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/713">42 U.S.C. 713</external-xref>) is amended—</text><paragraph id="HDDB414102FAD4E23AE7A7066B54DA3FA"><enum>(1)</enum><text>in paragraphs (1)(A) and (4)(A) of subsection (a), by striking <quote>2019</quote> and inserting <quote>2023</quote> each place it appears;</text></paragraph><paragraph commented="no" id="H7A6B1707A57A48C1B796700A21F8BDFE"><enum>(2)</enum><text>in subsection (a)(4)(B)(i), by striking <quote>2019</quote> and inserting <quote>2023</quote>; and</text></paragraph><paragraph id="HEDC4A9DDFAC443ACB671E358428E003E"><enum>(3)</enum><text>in subsection (f), by striking <quote>2019</quote> and inserting <quote>2023</quote>.</text></paragraph></section><section id="H5DB3875D134449D4878B6D69D16663DD" section-type="subsequent-section"><enum>104.</enum><header>Extension of sexual risk avoidance education program</header><text display-inline="no-display-inline">Section 510 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/710">42 U.S.C. 710</external-xref>) is amended by striking <quote>fiscal years 2018 and 2019</quote> each place it appears in subsections (a)(1), (a)(2)(A), (f)(1) and (f)(2) and inserting <quote>fiscal years 2019 through 2023</quote>.</text></section></title><title id="HFD84B99FC275455CA3E5C2DE9B2086E3"><enum>II</enum><header>Medicare Extenders</header><section id="HD7B33D6E2CB44F74A4266A280DDBDBE4" section-type="subsequent-section"><enum>201.</enum><header>Extension of the work geographic index floor under the Medicare program</header><text display-inline="no-display-inline">Section 1848(e)(1)(E) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(e)(1)(E)</external-xref>) is amended by striking <quote>2020</quote> and inserting <quote>2023</quote>.</text></section><section id="H86BC621642FF4F45A3BA5A10577A37B5" section-type="subsequent-section"><enum>202.</enum><header>Extension of funding outreach and assistance for low-income programs</header><subsection id="HFFF329D9FC98485F9B15AF680173BBA0"><enum>(a)</enum><header>Additional funding for State health insurance programs</header><text display-inline="yes-display-inline">Subsection (a)(1)(B) of section 119 of the Medicare Improvements for Patients and Providers Act of 2008 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395b-3">42 U.S.C. 1395b–3</external-xref> note), as amended by section 3306 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>), section 610 of the American Taxpayer Relief Act of 2012 (<external-xref legal-doc="public-law" parsable-cite="pl/112/240">Public Law 112–240</external-xref>), section 1110 of the Pathway for SGR Reform Act of 2013 (<external-xref legal-doc="public-law" parsable-cite="pl/113/67">Public Law 113–67</external-xref>), section 110 of the Protecting Access to Medicare Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/93">Public Law 113–93</external-xref>), section 208 of the Medicare Access and CHIP Reauthorization Act of 2015 (<external-xref legal-doc="public-law" parsable-cite="pl/114/10">Public Law 114–10</external-xref>), and section 50207 of the Bipartisan Budget Act of 2018 (<external-xref legal-doc="public-law" parsable-cite="pl/115/123">Public Law 115–123</external-xref>), is amended—</text><paragraph id="H3DF75FC081F24026B48D9C4CB1DEBB21"><enum>(1)</enum><text>in clause (vii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="H95AF20362714452394AD727EADE18C51"><enum>(2)</enum><text>in clause (viii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="H0FDAB21CD31F4B619CA6FB06308AC82B"><enum>(3)</enum><text>in clause (ix), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph><paragraph id="HCBD57D4760AE4ECDBE21BD00ACE47816"><enum>(4)</enum><text>by inserting after clause (ix) the following new clause:</text><quoted-block display-inline="no-display-inline" id="H6EB2F669ECBE4A039C7B55EC793B35CE" style="OLC" changed="added" reported-display-style="italic" committee-id="HIF00"><clause id="H9D9BCCB79D1B48E39502D1A82A4F051C"><enum>(x)</enum><text display-inline="yes-display-inline">for each of fiscal years 2020 through 2022, of $15,000,000.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="H169123ACB93D4A529DC63134A452D300"><enum>(b)</enum><header>Additional funding for area agencies on aging</header><text>Subsection (b)(1)(B) of such section 119, as so amended, is amended—</text><paragraph id="H0945B321D8B64E06A6498F64A2A5E2CF"><enum>(1)</enum><text>in clause (vii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="H4BC1322073344172BA19B61D447738B2"><enum>(2)</enum><text>in clause (viii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="HE27D58D6EA2341E7A5C6C580D7830442"><enum>(3)</enum><text>in clause (ix), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph><paragraph id="H7FD21508F212454D9E936AC6CC6DD4A7"><enum>(4)</enum><text>by inserting after clause (ix) the following new clause:</text><quoted-block display-inline="no-display-inline" id="HEDB46C387C714281A4B0A6707073067E" style="OLC" changed="added" reported-display-style="italic" committee-id="HIF00"><clause id="HA926C0386450433BA5624AC9E17E26A2"><enum>(x)</enum><text display-inline="yes-display-inline">for each of fiscal years 2020 through 2022, of $15,000,000.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="H08C6371ED79D40E0A088734F3631E474"><enum>(c)</enum><header>Additional funding for aging and disability resource centers</header><text>Subsection (c)(1)(B) of such section 119, as so amended, is amended—</text><paragraph id="HAE992BA8D3A84748976B06E5C646DD11"><enum>(1)</enum><text>in clause (vii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="H850BBA1DE4534A409D1B30A1061FC7AE"><enum>(2)</enum><text>in clause (viii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="H226577DD46C94A70A5685A2F734DBA43"><enum>(3)</enum><text>in clause (ix), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph><paragraph id="H7FB8E06FCC384413A757CFE4F202E65E"><enum>(4)</enum><text>by inserting after clause (ix) the following new clause:</text><quoted-block display-inline="no-display-inline" id="H275D59C8D28F45539014E60B8015A69F" style="OLC" changed="added" reported-display-style="italic" committee-id="HIF00"><clause id="H65F279FEAABD495B9EE0714DF41561AD"><enum>(x)</enum><text display-inline="yes-display-inline">for each of fiscal years 2020 through 2022, of $5,000,000.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="H2F83A461332B4FE58ED98130E6DAB8A7"><enum>(d)</enum><header>Additional funding for contract with the national center for benefits and outreach enrollment</header><text>Subsection (d)(2) of such section 119, as so amended, is amended—</text><paragraph id="H1C39B38D7BA748048006AA6C8A941E42"><enum>(1)</enum><text>in clause (vii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="H4430BD26D18843EAA8B899D6F46EFA8E"><enum>(2)</enum><text>in clause (viii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="H6829F0C12B1143DA8DA81E568333965A"><enum>(3)</enum><text>in clause (ix), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph><paragraph id="HC88D229CC6F849BEB8E8D4291649E0F0"><enum>(4)</enum><text>by inserting after clause (ix) the following new clause:</text><quoted-block display-inline="no-display-inline" id="H9409C54D3FC44ABABBCCA6CC3C0C2E63" style="OLC" changed="added" reported-display-style="italic" committee-id="HIF00"><clause id="H31608CCA519E40D5BED272460E2AC197"><enum>(x)</enum><text display-inline="yes-display-inline">for each of fiscal years 2020 through 2022, of $15,000,000.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section><section id="H174236E8EC254D13937EF8CE9D4E1203" section-type="subsequent-section"><enum>203.</enum><header>Extension of funding for quality measure endorsement, input, and selection under the Medicare program</header><subsection id="H2D35D90554D1450B9E6AD09277A5DA08"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1890(d)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395aaa">42 U.S.C. 1395aaa(d)(2)</external-xref>) is amended—</text><paragraph id="H1A1F6872A9B74EF29C258212811F26A1"><enum>(1)</enum><text display-inline="yes-display-inline">by striking <quote>and $7,500,000</quote> and inserting <quote>$7,500,000</quote>; and</text></paragraph><paragraph id="H4624F9B4698448B7AD22E0157C229C74"><enum>(2)</enum><text>by striking <quote>and 2019.</quote> and inserting <quote>and 2019, and $30,000,000 for each of fiscal years 2020 through 2022.</quote>.</text></paragraph></subsection><subsection id="HC880C160FCFF4D31AC5AF9922B82A65C"><enum>(b)</enum><header>Input for removal of measures</header><text display-inline="yes-display-inline">Section 1890(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395aaa">42 U.S.C. 1395aaa(b)</external-xref>) is amended by inserting after paragraph (3) the following: </text><quoted-block style="OLC" id="H58E9B6CE70284490915205BE26D380F2" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><paragraph id="H2DE38F19D6DC4B9AB08426E975AA8367"><enum>(4)</enum><header>Removal of Measures</header><text display-inline="yes-display-inline">The entity may, through the multistakeholder groups convened under paragraph (7)(A), provide input to the Secretary on quality and efficiency measures described in paragraph (7)(B) that could be considered for removal.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="HA344DD67F5CA4AEE86F20E7CDD37DFA8"><enum>(c)</enum><header>Prioritization of measure endorsement</header><text display-inline="yes-display-inline">Section 1890(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395aaa">42 U.S.C. 1395aaa(b)</external-xref>), as amended by subsection (b), is further amended by adding at the end the following:</text><quoted-block style="OLC" id="H9DDE1859AED346E6868500C60EC1E1A2" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><paragraph id="H1B39E5555D754C5E944D08CBAAD11046"><enum>(9)</enum><header>Prioritization of measure endorsement</header><text display-inline="yes-display-inline">The entity—</text><subparagraph id="H05D30EF4F8A142B8ABB418721D072619"><enum>(A)</enum><text>during the period beginning on the date of the enactment of this paragraph and ending on December 31, 2023, shall prioritize the endorsement of measures relating to maternal morbidity and mortality by the entity with a contract under subsection (a) in connection with endorsement of measures described in paragraph (2); and</text></subparagraph><subparagraph id="H15ACC81107CA4097BD5109179523294A"><enum>(B)</enum><text>on and after January 1, 2024, may prioritize the endorsement of such measures by such entity.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="HE5AFF5DAD7D2487A9D36AA419643AC86"><enum>204.</enum><header>Extension of the Independence at Home Medical Practice Demonstration Program under the Medicare program</header><subsection id="HC9688423F5574E94B572A5B30AE8EA96"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1866E(e)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc-5">42 U.S.C. 1395cc–5(e)(1)</external-xref>) is amended by striking <quote>7-year</quote> and inserting <quote>10-year</quote>. </text></subsection><subsection id="H99C090594F444EF78E78DD5C143EA83D"><enum>(b)</enum><header>Effective date</header><text display-inline="yes-display-inline">The amendment made by subsection (a) shall take effect as if included in the enactment of <external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>.</text></subsection></section><section id="H452A24DEE98544599E652C0E588E19F0"><enum>205.</enum><header>Extension of appropriations and transfers to the Patient-Centered Outcomes Research Trust Fund; extension of certain health insurance fees</header><subsection id="H7D8D111BFD954CADA0788E3599F67471"><enum>(a)</enum><header>In general</header><paragraph id="HB9EBCC4C57ED45B389795630AB57B2D2"><enum>(1)</enum><header>Internal Revenue Code</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/26/9511">Section 9511</external-xref> of the Internal Revenue Code of 1986 is amended—</text><subparagraph id="H5177F076459248608E6878318E9EE2DF"><enum>(A)</enum><text>in subsection (b)(1)(E), by striking <quote>2014</quote> and all that follows through <quote>2019</quote> and inserting <quote>2014 through 2022</quote>;</text></subparagraph><subparagraph commented="no" id="H626AFD001DE141E2AA1FBA906088CEE3"><enum>(B)</enum><text>in subsection (d)(2)(A), by striking <quote>2019</quote> and inserting <quote>2022</quote>; and</text></subparagraph><subparagraph id="HB638DD585CEE4FEB8354AD2B939F94AD"><enum>(C)</enum><text>in subsection (f), by striking <quote>2019</quote> and inserting <quote>2022</quote>.</text></subparagraph></paragraph><paragraph id="H1A6ABC5A89444C0F952B1E9E98444236"><enum>(2)</enum><header>Title XI</header><text display-inline="yes-display-inline">Section 1183(a)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1320e-2">42 U.S.C. 1320e–2(a)(2)</external-xref>) is amended by striking <quote>2014</quote> and all that follows through <quote>2019</quote> and inserting <quote>2014 through 2022</quote>.</text></paragraph></subsection><subsection id="H2214F11196AD4A62A135349788BACC40"><enum>(b)</enum><header>Extension of certain health insurance fees</header><paragraph id="HF01976D332564329BFE3A6E967A33C62"><enum>(1)</enum><header>Health insurance policies</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/26/4375">Section 4375(e)</external-xref> of the Internal Revenue Code of 1986 is amended by striking <quote>2019</quote> and inserting <quote>2022</quote>.</text></paragraph><paragraph id="H65E54EA1590846DDBDB8467E06972C40"><enum>(2)</enum><header>Self-insured health plans</header><text><external-xref legal-doc="usc" parsable-cite="usc/26/4376">Section 4376(e)</external-xref> of the Internal Revenue Code of 1986 is amended by striking <quote>2019</quote> and inserting <quote>2022</quote>.</text></paragraph></subsection></section><section id="H0118AE58CD6B454C8376C5F70D687F5A"><enum>206.</enum><header>Transitional coverage and retroactive Medicare part D coverage for certain low-income beneficiaries</header><text display-inline="no-display-inline">Section 1860D–14 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-114">42 U.S.C. 1395w–114</external-xref>) is amended—</text><paragraph id="H6BCA8F64DC1645CB92CDE1EF28E3639B"><enum>(1)</enum><text>by redesignating subsection (e) as subsection (f); and</text></paragraph><paragraph id="H1AC0807079E3439ABB3C2270E143B4CC"><enum>(2)</enum><text>by adding after subsection (d) the following new subsection:</text><quoted-block id="HBC42199737474176AA1423FB015F8D4F" style="OLC" changed="added" reported-display-style="italic" committee-id="HIF00"><subsection id="HC2289E3CEE2C45D38C932F36AA143E19"><enum>(e)</enum><header>Limited income newly eligible transition program</header><paragraph id="HC363EBC1CBFE4F3F98B65992B3B91215"><enum>(1)</enum><header>In general</header><text>Beginning not later than January 1, 2021, the Secretary shall carry out a program to provide transitional coverage for covered part D drugs for LI NET eligible individuals in accordance with this subsection.</text></paragraph><paragraph id="HD3A10B562E954E71B1D7AEE61B662C11"><enum>(2)</enum><header>LI net eligible individual defined</header><text>For purposes of this subsection, the term <term>LI NET eligible individual</term> means a part D eligible individual who—</text><subparagraph id="HC8C5E651F60546E0BF3AB9E66F65757D"><enum>(A)</enum><text>meets the requirements of clauses (ii) and (iii) of subsection (a)(3)(A); and</text></subparagraph><subparagraph id="HA9F6B0A490174017A0BE034234CB574D"><enum>(B)</enum><text>has not yet enrolled in a prescription drug plan or an MA–PD plan, or, who has so enrolled, but with respect to whom coverage under such plan has not yet taken effect.</text></subparagraph></paragraph><paragraph id="H91CB571DBD23496EA09CABBD21B6A07B"><enum>(3)</enum><header>Transitional coverage</header><text>For purposes of this subsection, the term <term>transitional coverage</term> means, with respect to an LI NET eligible individual—</text><subparagraph id="H7A17FB9B4A7B40938AFC8A957961811E"><enum>(A)</enum><text>immediate access to covered part D drugs at the point of sale during the period that begins on the first day of the month such individual is determined to meet the requirements of clauses (ii) and (iii) of subsection (a)(3)(A) and ends on the date that coverage under a prescription drug plan or MA–PD plan takes effect with respect to such individual; and</text></subparagraph><subparagraph id="H49A00FE6D904462B940C35D6686DC15F"><enum>(B)</enum><text>in the case of an LI NET eligible individual who is a full-benefit dual eligible individual (as defined in section 1935(c)(6)) or a recipient of supplemental security income benefits under title XVI, retroactive coverage (in the form of reimbursement of the amounts that would have been paid under this part had such individual been enrolled in a prescription drug plan or MA–PD plan) of covered part D drugs purchased by such individual during the period that begins on the date that is the later of—</text><clause id="HCD3804CEFFEF40E5AD42A7AEDAA160E5"><enum>(i)</enum><text>the date that such individual was first eligible for a low-income subsidy under this part; or</text></clause><clause id="H5CDE9BE667B047078535858CE6605E81"><enum>(ii)</enum><text>the date that is 36 months prior to the date such individual enrolls in a prescription drug plan or MA–PD plan,</text></clause><continuation-text continuation-text-level="subparagraph">and ends on the date that coverage under such plan takes effect. </continuation-text></subparagraph></paragraph><paragraph id="HB7E86B9F9E6048C9A15D5D05617018D9"><enum>(4)</enum><header>Program administration</header><subparagraph id="H3CB79070E17C4C9B9EDF44E72686084A"><enum>(A)</enum><header>Single point of contact</header><text>The Secretary shall, to the extent feasible, administer the program under this subsection through a contract with a single program administrator.</text></subparagraph><subparagraph id="H7B006E812E6F4B31A8C764B0B774FAD6"><enum>(B)</enum><header>Benefit design</header><text>The Secretary shall ensure that the transitional coverage provided to LI NET eligible individuals under this subsection—</text><clause id="H58B7A56C877241F3A822D384D805A720"><enum>(i)</enum><text>provides access to all covered part D drugs under an open formulary;</text></clause><clause id="HCD056E2182F042448540FED592DEB852"><enum>(ii)</enum><text>permits all pharmacies determined by the Secretary to be in good standing to process claims under the program;</text></clause><clause id="H37181FB83AA04DF2BA9B6532F26E6F92"><enum>(iii)</enum><text>is consistent with such requirements as the Secretary considers necessary to improve patient safety and ensure appropriate dispensing of medication; and</text></clause><clause id="H6663B29795C74F4EB3F5162C7A103877"><enum>(iv)</enum><text>meets such other requirements as the Secretary may establish.</text></clause></subparagraph></paragraph><paragraph id="H0DF7F9D43AE6413886CB9AB386481BEF"><enum>(5)</enum><header>Relationship to other provisions of this title; waiver authority</header><subparagraph id="H3FAEFDD623E04B0A9BC686A941C3C5F7"><enum>(A)</enum><header>In general</header><text>The following provisions shall not apply with respect to the program under this subsection:</text><clause id="H6ADE2145B6B5444592210CE4BD6BE20A"><enum>(i)</enum><text>Paragraphs (1) and (3)(B) of section 1860D–4(a) (relating to dissemination of general information; availability of information on changes in formulary through the internet).</text></clause><clause id="H587AA4949B394A7BBA3506E155B40AE5"><enum>(ii)</enum><text>Subparagraphs (A) and (B) of section 1860D–4(b)(3) (relating to requirements on development and application of formularies; formulary development).</text></clause><clause id="H93594BD2496041B898570391C5BF913A"><enum>(iii)</enum><text>Paragraphs (1)(C) and (2) of section 1860D–4(c) (relating to medication therapy management program).</text></clause></subparagraph><subparagraph id="H2EAD6AB3F3954AA98CFFFFBB192A384B"><enum>(B)</enum><header>Waiver authority</header><text>The Secretary may waive such other requirements of titles XI and this title as may be necessary to carry out the purposes of the program established under this subsection.</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section><section id="H2C75D46DD8DE42F09AEB7B9240D9F8E2" display-inline="no-display-inline" section-type="subsequent-section"><enum>207.</enum><header>Health Equity and Access for Returning Troops and Servicemembers Act of 2019</header><subsection id="HC0CB3D25BA79425E8E2F50B675AC677D"><enum>(a)</enum><header>Modification of requirement for certain former members of the Armed Forces to enroll in Medicare Part B to be eligible for TRICARE for Life</header><paragraph id="H0FC2B7865A6F4F7B9D61BE8449505280"><enum>(1)</enum><header>TRICARE eligibility</header><subparagraph id="HB65EB11F7A1C461EA1A8E5F094DA34E9"><enum>(A)</enum><header>In general</header><text>Subsection (d) of section 1086 of title 10, United States Code, is amended by adding at the end the following new paragraph:</text><quoted-block id="H0906B7C4F4A446EEB92AACA710220DC4" style="OLC" changed="added" reported-display-style="italic" committee-id="HIF00"><paragraph id="HF61A1244438B4A06991CB5E44402C1D5" indent="up1"><enum>(6)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H353FA87CCC7E4267BC9CF826F6C4A014"><enum>(A)</enum><text>The requirement in paragraph (2)(A) to enroll in the supplementary medical insurance program under part B of title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395j">42 U.S.C. 1395j</external-xref> et seq.) shall not apply to a person described in subparagraph (B) during any month in which such person is not entitled to a benefit described in subparagraph (A) of section 226(b)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/426">42 U.S.C. 426(b)(2)</external-xref>) if such person has received the counseling and information under subparagraph (C).</text></subparagraph><subparagraph id="HD05629AD5347458A8330ACA7BA047B04" indent="up1"><enum>(B)</enum><text>A person described in this subparagraph is a person—</text><clause id="H1F6DF2458C514873B0A50A18760FEDA5"><enum>(i)</enum><text>who is under 65 years of age;</text></clause><clause id="HD3A5D36A470049DC808E319C35EA8F64"><enum>(ii)</enum><text>who is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act pursuant to subparagraph (A) or (C) of section 226(b)(2) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/426">42 U.S.C. 426(b)(2)</external-xref>);</text></clause><clause id="H7B6FFFD13DA348E6AC8BF07B2AD0B969"><enum>(iii)</enum><text>whose entitlement to a benefit described in subparagraph (A) of such section has terminated due to performance of substantial gainful activity; and</text></clause><clause id="H437E0D362EAF4DDB808F92EF8C898022"><enum>(iv)</enum><text>who is retired under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/26/61">chapter 61</external-xref> of this title.</text></clause></subparagraph><subparagraph id="HC6DC55B7B14D4E1FB0C4AFF34DAF4A85" indent="up1"><enum>(C)</enum><text>The Secretary of Defense shall coordinate with the Secretary of Health and Human Services and the Commissioner of Social Security to notify persons described in subparagraph (B) of, and provide information and counseling regarding, the effects of not enrolling in the supplementary medical insurance program under part B of title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395j">42 U.S.C. 1395j</external-xref> et seq.), as described in subparagraph (A).</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph><subparagraph id="H811102F7F76F49C5AB19F099D9EEC460"><enum>(B)</enum><header>Conforming amendment</header><text>Paragraph (2)(A) of such subsection is amended by striking <quote>is enrolled</quote> and inserting <quote>except as provided by paragraph (6), is enrolled</quote>.</text></subparagraph><subparagraph id="H2428FE81D34E49E3B99FF47D5ED821A4"><enum>(C)</enum><header>Identification of persons</header><text><external-xref legal-doc="usc" parsable-cite="usc/26/1110a">Section 1110a</external-xref> of such title is amended by adding at the end the following new subsection:</text><quoted-block id="HE4E5288A1BEE46DB8301EDAE8AE8D9EE" style="OLC" changed="added" reported-display-style="italic" committee-id="HIF00"><subsection id="H3937C354EF9B46D9B61DB7CB15D29A58"><enum>(c)</enum><header>Certain individuals not required To enroll in Medicare Part B</header><text>In carrying out subsection (a), the Secretary of Defense shall coordinate with the Secretary of Health and Human Services and the Commissioner of Social Security to—</text><paragraph id="HE0A22136FAE3424BB88B0C378AB9847F"><enum>(1)</enum><text>identify persons described in subparagraph (B) of <external-xref legal-doc="usc" parsable-cite="usc/26/1086">section 1086(d)(6)</external-xref> of this title; and</text></paragraph><paragraph id="H94EC0705AF1C495689DAD2E9D8878F6F"><enum>(2)</enum><text>provide information and counseling pursuant to subparagraph (C) of such section.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="HC81D37475E3742A4856F6B75316691D9"><enum>(2)</enum><header>Non-Application of Medicare Part B late enrollment penalty</header><text>Section 1839(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395r">42 U.S.C. 1395r(b)</external-xref>) is amended, in the second sentence, by inserting <quote>or months for which the individual can demonstrate that the individual is an individual described in paragraph (6)(B) of section 1086(d) of title 10, United States Code, who is enrolled in the TRICARE program pursuant to such section</quote> after <quote>an individual described in section 1837(k)(3)</quote>.</text></paragraph><paragraph id="H5CE411BC59AF450B8F3DC94F9410DD25"><enum>(3)</enum><header>Report</header><text>Not later than October 1, 2024, the Secretary of Defense, the Secretary of Health and Human Services, and the Commissioner of Social Security shall jointly submit to the Committees on Armed Services of the House of Representatives and the Senate, the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives, and the Committee on Finance of the Senate a report on the implementation of section 1086(d)(6) of title 10, United States Code, as added by paragraph (1). Such report shall include, with respect to the period covered by the report—</text><subparagraph id="H69ADDA7F4B25486588435AB021CD0A38"><enum>(A)</enum><text>the number of individuals enrolled in TRICARE for Life who are not enrolled in the supplementary medical insurance program under part B of title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395j">42 U.S.C. 1395j</external-xref> et seq.) by reason of such section 1086(d)(6); and</text></subparagraph><subparagraph id="H733444E1E86A4D0CB2EBF7EBF613A5E4"><enum>(B)</enum><text>the number of individuals who—</text><clause id="H281A291FE35F4AE2A02C26D655F0915E"><enum>(i)</enum><text>are retired from the Armed Forces under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/10/61">chapter 61</external-xref> of title 10, United States Code;</text></clause><clause id="HC95C17E68D9243469E64F471A73FD6FC"><enum>(ii)</enum><text>are entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act pursuant to receiving benefits for 24 months as described in subparagraph (A) or (C) of section 226(b)(2) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/426">42 U.S.C. 426(b)(2)</external-xref>); and</text></clause><clause id="H100C1852DEBF427496DB1F0427619391"><enum>(iii)</enum><text>because of such entitlement, are no longer enrolled in TRICARE Standard, TRICARE Prime, TRICARE Extra, or TRICARE Select under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/10/55">chapter 55</external-xref> of title 10, United States Code.</text></clause></subparagraph></paragraph><paragraph id="HDE266B4E3EAD4F8FA4862FB3ABD85911"><enum>(4)</enum><header>Deposit of savings into Medicare improvement fund</header><text>Section 1898(b)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395iii">42 U.S.C. 1395iii(b)(1)</external-xref>) is amended by striking <quote>during and after fiscal year 2021, $0</quote> and inserting <quote>during and after fiscal year 2024, $5,000,000</quote>.</text></paragraph><paragraph id="H1CFF3AD5CAAB49F1A6907317D6AEC363"><enum>(5)</enum><header>Application</header><text>The amendments made by paragraphs (1) and (2) shall apply with respect to a person who, on or after October 1, 2023, is a person described in section 1086(d)(6)(B) of title 10, United States Code, as added by paragraph (1).</text></paragraph></subsection><subsection id="HAC41D8DB7E384331BFEC5EF49B3D1509" display-inline="no-display-inline"><enum>(b)</enum><header>Coverage of certain DNA specimen provenance assay tests under Medicare</header><paragraph id="H3C5001BE14A24822ACF074060CC20DA8"><enum>(1)</enum><header>Benefit</header><subparagraph id="H37CA42A2EF0D4B6C86B8173A6A7330F4"><enum>(A)</enum><header>Coverage</header><text display-inline="yes-display-inline">Section 1861 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>) is amended—</text><clause id="H2FEB580737514ECA97BC129BAACD2B47"><enum>(i)</enum><text>in subsection (s)(2)—</text><subclause id="H1185D8EE54314FEEBDD476C308CC5028"><enum>(I)</enum><text>in subparagraph (GG), by striking <quote>and</quote> at the end;</text></subclause><subclause id="H1A71389E191A4D9AA4155A7407707235"><enum>(II)</enum><text>in subparagraph (HH), by striking the period and inserting <quote>; and</quote>; and</text></subclause><subclause id="H09BD5024CEF54B0CB4D554BA90AB5736"><enum>(III)</enum><text>by adding at the end the following new subparagraph: </text><quoted-block style="OLC" id="H1219FA536FFA48FDBE66173546F7826E" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><subparagraph id="H00A16CCF361D48E191B410CFD71D4698" indent="up1"><enum>(II)</enum><text display-inline="yes-display-inline">a prostate cancer DNA Specimen Provenance Assay test (DSPA test) (as defined in subsection (kkk));</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subclause></clause><clause id="H8AFB872C694C4DEF8E8AED9DFE15DEDA"><enum>(ii)</enum><text>by adding at the end the following new subsection:</text><quoted-block style="OLC" id="H99AE84F5F1E84A0D9A67911428F4C648" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><subsection id="H73096C3A11654F358D5E686C5247C928"><enum>(kkk)</enum><header>Prostate cancer DNA Specimen Provenance Assay Test</header><text display-inline="yes-display-inline">The term <term>prostate cancer DNA Specimen Provenance Assay Test</term> (DSPA test) means a test that, after a determination of cancer in one or more prostate biopsy specimens obtained from an individual, assesses the identity of the DNA in such specimens by comparing such DNA with the DNA that was separately taken from such individual at the time of the biopsy.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></clause></subparagraph><subparagraph id="H19678617413245B3959213F0B1DBE8BA" display-inline="no-display-inline"><enum>(B)</enum><header>Exclusion from coverage</header><text display-inline="yes-display-inline">Section 1862(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(a)(1)</external-xref>) is amended—</text><clause id="HF8789ED3553349D98270C9B50A8A6BB0"><enum>(i)</enum><text>in subparagraph (O), by striking <quote>and</quote> at the end;</text></clause><clause id="H98FF9FD5DD764B669CC2E830A0E25300"><enum>(ii)</enum><text>in subparagraph (P), by striking the semicolon at the end and inserting <quote>, and</quote>; and</text></clause><clause id="H6352D706036E427FA7A9A4DC6ED2CE35"><enum>(iii)</enum><text>by adding at the end the following new subparagraph:</text><quoted-block display-inline="no-display-inline" id="HE50223A19F3C4CA8A570F3E49248C038" style="OLC" changed="added" reported-display-style="italic" committee-id="HIF00"><subparagraph id="H917A11D7D38C425E8FB349ECB652D43C" indent="up1"><enum>(Q)</enum><text display-inline="yes-display-inline">in the case of a prostate cancer DNA Specimen Provenance Assay test (DSPA test) (as defined in section 1861(kkk)), unless such test is furnished on or after January 1, 2021, and before January 1, 2026, and such test is ordered by the physician who furnished the prostate cancer biopsy that obtained the specimen tested;</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></clause></subparagraph></paragraph><paragraph id="HEF1FA8EB93304ADCAEB2229AB24A5885"><enum>(2)</enum><header>Payment amount and related requirements</header><text>Section 1834 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m</external-xref>) is amended by adding at the end the following new subsection:</text><quoted-block style="OLC" id="H6482BDFD3AA34A169AAFD98E7757A070" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><subsection id="H43243F09A31543FAB186A250CF7CFD25"><enum>(x)</enum><header>Prostate cancer DNA Specimen Provenance Assay tests</header><paragraph id="H3AD13533C84E405A827DBA88F1EA39FE"><enum>(1)</enum><header>Payment for covered tests</header><subparagraph id="H56C26CD9E7C549418C736CD4CFFEABEB"><enum>(A)</enum><header>In general</header><text>Subject to subparagraph (B), the payment amount for a prostate cancer DNA Specimen Provenance Assay test (DSPA test) (as defined in section 1861(kkk)) shall be $200. Such payment shall be payment for all of the specimens obtained from the biopsy furnished to an individual that are tested.</text></subparagraph><subparagraph id="H596EA94B3F804CF38C80BF3A58685258"><enum>(B)</enum><header>Limitation</header><text>Payment for a DSPA test under subparagraph (A) may only be made on an assignment-related basis.</text></subparagraph><subparagraph id="HA545977763BE474AB12B281A36A7EBD4"><enum>(C)</enum><header>Prohibition on separate payment</header><text>No separate payment shall be made for obtaining DNA that was separately taken from an individual at the time of a biopsy described in subparagraph (A). </text></subparagraph></paragraph><paragraph id="H55610BFC00B7416F8EA0765FC9CD2BAD"><enum>(2)</enum><header>HCPCS code and modifier assignment</header><subparagraph id="HCACF803A6FE745CE9B1051CC6B648DFF"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall assign one or more HCPCS codes to a prostate cancer DNA Specimen Provenance Assay test and may use a modifier to facilitate making payment under this section for such test.</text></subparagraph><subparagraph id="HF03A9527967B4837B1E62D5852102DAF"><enum>(B)</enum><header>Identification of DNA match on claim</header><text>The Secretary shall require an indication on a claim for a prostate cancer DNA Specimen Provenance Assay test of whether the DNA of the prostate biopsy specimens match the DNA of the individual diagnosed with prostate cancer. Such indication may be made through use of a HCPCS code, a modifier, or other means, as determined appropriate by the Secretary.</text></subparagraph></paragraph><paragraph id="H83AE3AA45A2E438A9B9C532E86B7375B"><enum>(3)</enum><header>DNA match review</header><subparagraph id="H3EE2A62BBCFD45728D7CB668274E6483"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall review at least three years of claims under part B for prostate cancer DNA Specimen Provenance Assay tests to identify whether the DNA of the prostate biopsy specimens match the DNA of the individuals diagnosed with prostate cancer.</text></subparagraph><subparagraph id="HF94450108B424BC19C6DEF938D4381CE"><enum>(B)</enum><header>Posting on internet website</header><text>Not later than July 1, 2023, the Secretary shall post on the internet website of the Centers for Medicare &amp; Medicaid Services the findings of the review conducted under subparagraph (A).</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph id="HAA3847692570456C97B04A56C55C3D33"><enum>(3)</enum><header>Cost-Sharing</header><text>Section 1833(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(a)(1)</external-xref>) is amended—</text><subparagraph id="HBEA1613CE8A2457B8B9EF06F41BB7749"><enum>(A)</enum><text>by striking <quote>and (CC)</quote> and inserting <quote>(CC)</quote>; and</text></subparagraph><subparagraph id="H70BC802C15384CB1961C79BDED2199D4"><enum>(B)</enum><text>by inserting before the semicolon at the end the following: <quote>, and (DD) with respect to a prostate cancer DNA Specimen Provenance Assay test (DSPA test) (as defined in section 1861(kkk)), the amount paid shall be an amount equal to 80 percent of the lesser of the actual charge for the test or the amount specified under section 1834(x)</quote>.</text></subparagraph></paragraph></subsection></section><section id="H3B2124BA874343239911C67EC5B40783" display-inline="no-display-inline" section-type="subsequent-section"><enum>208.</enum><header>Exclusion of complex rehabilitative manual wheelchairs from Medicare competitive acquisition program; Non-application of Medicare fee-schedule adjustments for certain wheelchair accessories and cushions</header><subsection id="HCB0DE71705364D60A24CC12C9E80F4BE"><enum>(a)</enum><header>Exclusion of complex rehabilitative manual wheelchairs from competitive acquisition program</header><text display-inline="yes-display-inline">Section 1847(a)(2)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-3">42 U.S.C. 1395w–3(a)(2)(A)</external-xref>) is amended—</text><paragraph id="HC2E6F5EAD73D40FDAD95C8984CB9DC86"><enum>(1)</enum><text>by inserting <quote>, complex rehabilitative manual wheelchairs (as determined by the Secretary), and certain manual wheelchairs (identified, as of October 1, 2018, by HCPCS codes E1235, E1236, E1237, E1238, and K0008 or any successor to such codes)</quote> after <quote>group 3 or higher</quote>; and</text></paragraph><paragraph id="HE7ED805E7A0D4E43AF5E1BF28422046E"><enum>(2)</enum><text display-inline="yes-display-inline">by striking <quote>such wheelchairs</quote> and inserting <quote>such complex rehabilitative power wheelchairs, complex rehabilitative manual wheelchairs, and certain manual wheelchairs</quote>.</text></paragraph></subsection><subsection id="H57898056D3814AA78F35BEA235C60094"><enum>(b)</enum><header>Non-Application of Medicare fee schedule adjustments for wheelchair accessories and seat and back cushions when furnished in connection with complex rehabilitative manual wheelchairs</header><paragraph id="H4BD203A0BEC248C6B50A7F2C06702B10"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Notwithstanding any other provision of law, the Secretary of Health and Human Services shall not, during the period beginning on January 1, 2020, and ending on December 31, 2020, use information on the payment determined under the competitive acquisition programs under section 1847 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-3">42 U.S.C. 1395w–3</external-xref>) to adjust the payment amount that would otherwise be recognized under section 1834(a)(1)(B)(ii) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(a)(1)(B)(ii)</external-xref>) for wheelchair accessories (including seating systems) and seat and back cushions when furnished in connection with complex rehabilitative manual wheelchairs (as determined by the Secretary), and certain manual wheelchairs (identified, as of October 1, 2018, by HCPCS codes E1235, E1236, E1237, E1238, and K0008 or any successor to such codes).</text></paragraph><paragraph id="H304DDFB740B8438DB44D6DA9D1D7C34E"><enum>(2)</enum><header>Implementation</header><text display-inline="yes-display-inline">Notwithstanding any other provision of law, the Secretary may implement this subsection by program instruction or otherwise.</text></paragraph></subsection></section></title><title id="H2765197B4B2E4A94BBD9D830D5094888"><enum>III</enum><header>Medicaid Provisions</header><section id="HF7546870DFCC42278B74D891B05F944C" section-type="subsequent-section"><enum>301.</enum><header>Modification of reductions in Medicaid DSH allotments</header><text display-inline="no-display-inline">Section 1923(f)(7)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-4">42 U.S.C. 1396r–4(f)(7)(A)</external-xref>) is amended—</text><paragraph id="HE7897341B926424A90993D1A9B1C6C71"><enum>(1)</enum><text>in clause (i), in the matter preceding subclause (I), by striking <quote>2020</quote> and inserting <quote>2022</quote>; and</text></paragraph><paragraph id="H00A7E90B286C45A08B52519C3259F0E5"><enum>(2)</enum><text>in clause (ii)—</text><subparagraph id="H53FE3FC31018439AA353E09A3D908549"><enum>(A)</enum><text>in subclause (I), by striking <quote>2020</quote> and inserting <quote>2022</quote>; and</text></subparagraph><subparagraph id="HC0B0D99398E641F3A0F8D486382563E9"><enum>(B)</enum><text>in subclause (II), by striking <quote>for each of fiscal years 2021 through 2025</quote> and inserting <quote>for each of fiscal years 2023 through 2025</quote>.</text></subparagraph></paragraph></section><section id="H83D1EC3E2365489E8EA5204E5674E9F8"><enum>302.</enum><header>Public availability of hospital upper payment limit demonstrations</header><text display-inline="no-display-inline">Section 1903 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b</external-xref>) is amended by adding at the end the following new subsection:</text><quoted-block style="OLC" id="H46979EDA06F049E983DF962AECC1FE92" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><subsection id="H31BF5CEC821F411D89983046B0455036"><enum>(bb)</enum><header>Public availability of hospital upper payment limit demonstrations</header><text display-inline="yes-display-inline">The Secretary shall make publicly available upper payment limit demonstrations for hospital services that a State submits with respect to a fiscal year of the State (beginning with State fiscal year 2022) to the Administrator of the Centers for Medicare &amp; Medicaid Services.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="H6C64D399E71D4A88BD26E09EBACA666D"><enum>303.</enum><header>Report by Comptroller General</header><text display-inline="no-display-inline">Not later than the date that is 21 months after the date of the enactment of this Act, the Comptroller General of the United States shall identify and report to Congress policy considerations for legislative action with respect to establishing an equitable formula for determining disproportionate share hospital allotments for States under section 1923 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-4">42 U.S.C. 1396r–4</external-xref>) that takes into account the following factors:</text><paragraph id="HDFBFB491CE534B02950C3937FCFA5A8F"><enum>(1)</enum><text>The level of uncompensated care costs of hospitals in a State.</text></paragraph><paragraph id="H8AC5EB3E5E1D46FEA407D453778037E3"><enum>(2)</enum><text display-inline="yes-display-inline">Expenditures of a State with respect to hospitals, including payment adjustments made under such section 1923 to disproportionate share hospitals (as defined under the State plan under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) pursuant to subsection (a)(1)(A) of such section 1923), upper payment limit supplemental payments, and other related payments that hospitals may receive from the State.</text></paragraph><paragraph id="H9E608E2F19AC450DA777E09AA0F5E650"><enum>(3)</enum><text>State policy decisions that may affect the level of uncompensated care costs of hospitals in a State.</text></paragraph></section><section id="H7B11F9B7B7D6408EA611645432495581"><enum>304.</enum><header>Sense of Congress regarding the need to develop a more permanent legislative solution to provide the territories with a reliable and consistent source of Federal funding under the Medicaid program</header><text display-inline="no-display-inline">It is the sense of Congress that—</text><paragraph id="HFAD232E424F0483395744619234C41BC"><enum>(1)</enum><text>the territories of American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, and the United States Virgin Islands are currently subject to Federal funding caps for their Medicaid programs;</text></paragraph><paragraph id="HF7FBE6FC4ACB4B29A7B0310BDD52D5DC"><enum>(2)</enum><text>as a result of these Federal funding caps, which have not been adjusted over time, the territories continue to struggle in managing their Medicaid programs, including planning for their respective financial obligations and managing health care services for low-income adults, children, pregnant women, elderly adults, and persons with disabilities;</text></paragraph><paragraph id="H5CE34543481C4CF19113BFF4386E5841"><enum>(3)</enum><text>to address this disparate funding treatment and to provide the territories with some measure of relief, Congress has had to enact legislation six times in the last 15 years, including multiple temporary increases in the Federal funding caps, higher Federal medical assistance percentage rates, and billions of dollars in supplemental block grants;</text></paragraph><paragraph id="HCBA62DD715DD4FBDB0FF37F4E1D1C7B8"><enum>(4)</enum><text>the supplemental funding provided to the territories under title V with respect to their Medicaid programs continues Congress’ commitment to ensuring the sustainability of these critically important programs and the people these programs serve; and</text></paragraph><paragraph id="H41930C6484EA4E2EBB4C1E149F58711A"><enum>(5)</enum><text>a more permanent legislative solution must be developed in order to provide the territories with a reliable and consistent source of Federal funding under their Medicaid programs so that the territories can continue to meet the health care needs of vulnerable populations.</text></paragraph></section></title><title id="H9D1992FA914C4FB182BA016E9187CD6A"><enum>IV</enum><header>No Surprises Act</header><section id="H0492EB1A25594385BA88B82DDA96A833" section-type="subsequent-section"><enum>401.</enum><header>Short title</header><text display-inline="no-display-inline">This title may be cited as the <quote>No Surprises Act</quote>.</text></section><section id="H0D56DB314B0945628058DDD14587E6CB"><enum>402.</enum><header>Preventing surprise medical bills</header><subsection id="H37BD2461765744DEA2F43FAE672D7272"><enum>(a)</enum><header>Coverage of emergency services</header><text display-inline="yes-display-inline">Section 2719A(b) of the Public Health Service Act (42 U.S.C. 300gg–19a(b)) is amended—</text><paragraph id="HF98D04D5AF79429A8884651C472D4FCC"><enum>(1)</enum><text>in paragraph (1)—</text><subparagraph id="H43AEBDD9923B4A81A7D93F2ACF1B8C0E"><enum>(A)</enum><text>in the matter preceding subparagraph (A)—</text><clause id="H433DBF6F01074781B8B41F2E38D0E634"><enum>(i)</enum><text>by striking <quote>a group health plan, or a health insurance issuer offering group or individual health insurance issuer,</quote> and inserting <quote>a health plan (as defined in subsection (e)(2)(A))</quote>;</text></clause><clause id="H0A11772B42194434A5554032DEA5723A"><enum>(ii)</enum><text>by inserting <quote>or, for plan year 2021 or a subsequent plan year, with respect to emergency services in an independent freestanding emergency department (as defined in paragraph (3)(D))</quote> after <quote>emergency department of a hospital</quote>;</text></clause><clause id="HDD17A1590A8A46A78B8EDEEE7A1D7290"><enum>(iii)</enum><text>by striking <quote>the plan or issuer</quote> and inserting <quote>the plan</quote>; and </text></clause><clause id="H38C35BE65B4F410ABE6A4112E5D071C1"><enum>(iv)</enum><text>by striking <quote>paragraph (2)(B)</quote> and inserting <quote>paragraph (3)(C)</quote>;</text></clause></subparagraph><subparagraph id="H8B70B11DF32B4FC3B72256FC38D202BF" commented="no"><enum>(B)</enum><text>in subparagraph (B), by inserting <quote>or a participating emergency facility, as applicable,</quote> after <quote>participating provider</quote>; and</text></subparagraph><subparagraph id="H8673C4E43DE9497BB6BAB42AACBFDCD6"><enum>(C)</enum><text>in subparagraph (C)—</text><clause id="HFED4C0A71A1843C9B730E490252D422E"><enum>(i)</enum><text>in the matter preceding clause (i), by inserting <quote>by a nonparticipating provider or a nonparticipating emergency facility</quote> after <quote>enrollee</quote>;</text></clause><clause id="H0F664A1C34C54372841569F706F6BB55"><enum>(ii)</enum><text>by striking clause (i);</text></clause><clause id="H9E399E84288B4CA4B1FCFCBE9DCA2A57"><enum>(iii)</enum><text>by striking <quote><header-in-text level="subclause" style="OLC"><enum-in-header>(ii)</enum-in-header><enum-in-header>(I)</enum-in-header></header-in-text> such services</quote> and inserting <quote><header-in-text level="clause" style="OLC"><enum-in-header>(i)</enum-in-header></header-in-text> such services</quote>;</text></clause><clause id="HEABD6B9A144E41C1B5998EB4E8DF3C93" commented="no"><enum>(iv)</enum><text>by striking <quote>where the provider of services does not have a contractual relationship with the plan for the providing of services</quote>;</text></clause><clause id="H227491FC82AC40BABE9A2550B9A9BC4F"><enum>(v)</enum><text>by striking <quote>emergency department services received from providers who do have such a contractual relationship with the plan; and</quote> and inserting <quote>emergency services received from participating providers and participating emergency facilities with respect to such plan;</quote>;</text></clause><clause id="H3BC30A70C5F04D10B741880272C3E7F8"><enum>(vi)</enum><text>by striking <quote><header-in-text level="subclause" style="OLC"><enum-in-header>(II) </enum-in-header></header-in-text>if such services</quote> and all that follows through <quote>were provided in-network;</quote> and inserting the following:</text><quoted-block style="OLC" id="H9B90CDE8F49A49EC92A1C769BBAAB840" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><clause id="H1769A8E087204CB2AF38A95BB2B00053" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is not greater than the requirement that would apply if such services were provided by a participating provider or a participating emergency facility;</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></clause><clause id="H14FC299C697A4E988D330C732DA10B3A"><enum>(vii)</enum><text>by adding at the end the following new clauses:</text><quoted-block style="OLC" id="H2A26EEB0E9E84222AB389A69B0C7BD20" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><clause id="H70E4167A20EA449196C1FCEE22A3C9B8" commented="no"><enum>(iii)</enum><text>such requirement is calculated as if the total amount that would have been charged for such services by such participating provider or participating emergency facility were equal to—</text><subclause id="H602308F011A540D3847EBE849A6DFD6B" commented="no"><enum>(I)</enum><text>in the case of such services furnished in a State described in paragraph (3)(H)(ii), the median contracted rate (as defined in paragraph (3)(E)(i)) for such services; and</text></subclause><subclause id="HF561818B75D14E4ABB664A4F07252E7D" commented="no"><enum>(II)</enum><text>in the case of such services furnished in a State described in paragraph (3)(H)(i), the lesser of—</text><item id="HA8904963A6374B5BB1C925DFF07C926C" commented="no"><enum>(aa)</enum><text>the amount determined by such State for such services in accordance with the method described in such paragraph; and</text></item><item id="H1DC1C4134B13494A9DCE277DC0C8ABC8" commented="no"><enum>(bb)</enum><text>the median contracted rate (as so defined) for such services;</text></item></subclause></clause><clause id="H2600A4495FBD4DFA9E9134F83D215AEC"><enum>(iv)</enum><text display-inline="yes-display-inline">the health plan pays to such provider or facility, respectively, the amount by which the recognized amount (as defined in paragraph (3)(H)) for such services exceeds the cost-sharing amount for such services (as determined in accordance with clauses (ii) and (iii)); and</text></clause><clause id="H0CCA95FD071D4CE8A2E9B8AD4E9CCDAB" commented="no"><enum>(v)</enum><text display-inline="yes-display-inline">any cost-sharing payments made by the participant, beneficiary, or enrollee with respect to such emergency services so furnished shall be counted toward any in-network deductible or out-of-pocket maximums applied under the plan (and such in-network deductible shall be applied) in the same manner as if such cost-sharing payments were with respect to emergency services furnished by a participating provider and a participating emergency facility; and</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></clause></subparagraph></paragraph><paragraph id="HB9661033AF2E43E6855F7C8C1AF2C627"><enum>(2)</enum><text>by redesignating paragraph (2) as paragraph (3);</text></paragraph><paragraph id="HEAE4C894FE9F4F5F98F6C49E3869B1E5"><enum>(3)</enum><text>by inserting after paragraph (1) the following new paragraph:</text><quoted-block style="OLC" id="H148B8DCDB15A42B6A2F12EBD8C69AC40" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><paragraph id="H64D02A8622A54269AF1310C1453BEE20"><enum>(2)</enum><header>Audit process for median contracted rates</header><subparagraph id="HA874DA77E1D543818280A0D03EECABFF"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than July 1, 2020, the Secretary, in consultation with appropriate State agencies, shall establish through rulemaking a process, in accordance with subparagraph (B), under which health plans are audited by such Secretaries to ensure that—</text><clause id="H5A725E22B7EE408A967485EC3716EA52"><enum>(i)</enum><text>such plans are in compliance with the requirement of applying a median contracted rate under this section; and</text></clause><clause id="H57EB85839E924B91A23CF441EBF8AF6C"><enum>(ii)</enum><text>that such median contracted rate so applied satisfies the definition under paragraph (3)(E) with respect to the year involved, including with respect to a health plan described in clause (ii) of such paragraph.</text></clause></subparagraph><subparagraph id="H19E326524CC74729AB504DEB902FF173"><enum>(B)</enum><header>Audit samples</header><text>Under the process established pursuant to subparagraph (A), the Secretary—</text><clause id="H4261D2EF803A48B396B0A5B8F7546B8A"><enum>(i)</enum><text>shall conduct audits described in such subparagraph, with respect to a year (beginning with 2021), of a sample with respect to such year of claims data from not more than 25 health plans; and</text></clause><clause id="H5C2BD0A13E2E4B4CAE07DF2BFCB00BBB"><enum>(ii)</enum><text display-inline="yes-display-inline">may audit any health plan if the Secretary has received any complaint about such plan that involves the compliance of the plan with either of the requirements described in clauses (i) and (ii) of such subparagraph.</text></clause></subparagraph></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="HBE6F8729AFB9443A9A77CD82B96ECC45"><enum>(4)</enum><text>in paragraph (3), as redesignated by paragraph (2) of this subsection—</text><subparagraph id="HECE843CF2D44427BB881B3FA029A3090"><enum>(A)</enum><text>in the matter preceding subparagraph (A), by inserting <quote>and subsection (e)</quote> after <quote>this subsection</quote>;</text></subparagraph><subparagraph id="H5A53E21DE6DC4547BC9CB984A3E93B05"><enum>(B)</enum><text>by redesignating subparagraphs (A) through (C) as subparagraphs (B) through (D), respectively;</text></subparagraph><subparagraph id="HF957E0A0F11A4FFEAE0D622457315EDF"><enum>(C)</enum><text>by inserting before subparagraph (B), as redesignated by subparagraph (B) of this paragraph, the following new subparagraph: </text><quoted-block style="OLC" id="HAEA3957DC1E246D6862BD2FACEA93968" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><subparagraph id="HC4FECB651BF6463EB16F412847FA8773"><enum>(A)</enum><header>Emergency department of a hospital</header><text display-inline="yes-display-inline">The term <term>emergency department of a hospital</term> includes a hospital outpatient department that provides emergency services.</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph><subparagraph id="H172D712265C44930BA086DDB0E90FF69"><enum>(D)</enum><text display-inline="yes-display-inline">by amending subparagraph (C), as redesignated by subparagraph (B) of this paragraph, to read as follows:</text><quoted-block style="OLC" id="HBE978290D89C46A3A394FE047F26B608" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><subparagraph id="H66CD1B498776465DBD92DDD225C90817"><enum>(C)</enum><header>Emergency services</header><clause id="H3D6C4162951D4824A682FACF17D1FDA2"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">The term <term>emergency services</term>, with respect to an emergency medical condition, means—</text><subclause id="H3F1CBADC34DC4024979E8E945BD3955C"><enum>(I)</enum><text display-inline="yes-display-inline">a medical screening examination (as required under section 1867 of the Social Security Act, or as would be required under such section if such section applied to an independent freestanding emergency department) that is within the capability of the emergency department of a hospital or of an independent freestanding emergency department, as applicable, including ancillary services routinely available to the emergency department to evaluate such emergency medical condition; and</text></subclause><subclause id="H5BA430F84FBE4A03BCBED468BC7D15D5"><enum>(II)</enum><text display-inline="yes-display-inline">within the capabilities of the staff and facilities available at the hospital or the independent freestanding emergency department, as applicable, such further medical examination and treatment as are required under section 1867 of such Act, or as would be required under such section if such section applied to an independent freestanding emergency department, to stabilize the patient.</text></subclause></clause><clause id="HE9DE9F3144484095BB29DDE25F501C32"><enum>(ii)</enum><header>Inclusion of poststabilization services</header><text display-inline="yes-display-inline">For purposes of this subsection and section 2799, in the case of an individual enrolled in a health plan who is furnished services described in clause (i) by a provider or facility to stabilize such individual with respect to an emergency medical condition, the term <term>emergency services</term> shall include such items and services in addition to those described in clause (i) that such a provider or facility determines are needed to be furnished (after such stabilization but during such visit in which such individual is so stabilized) to such individual, unless each of the following conditions are met:</text><subclause id="HFB58E0AFA88F4451A1445D142D99B96A"><enum>(I)</enum><text>Such a provider or facility determines such individual is able to travel using nonmedical transportation or nonemergency medical transportation.</text></subclause><subclause id="H3F9EF267A98E4CFABAE1CF668C681362"><enum>(II)</enum><text>Such provider furnishing such additional items and services is in compliance with section 2799A(d) with respect to such items and services.</text></subclause></clause></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph><subparagraph id="HD2B7D382DBA7460A9AE13E75BD914AD6"><enum>(E)</enum><text display-inline="yes-display-inline">by redesignating subparagraph (D), as redesignated by subparagraph (B) of this paragraph, as subparagraph (I); and</text></subparagraph><subparagraph id="H2D810C7ED0D84DFBA581F3797E2FE4FE"><enum>(F)</enum><text display-inline="yes-display-inline">by inserting after subparagraph (C), as redesignated by subparagraph (B) of this paragraph, the following new subparagraphs:</text><quoted-block style="OLC" id="H8E3615D1CE134337B860E3BAEC717507" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><subparagraph id="HA9D734D4792C40B9BCF32E8FC1B72EFD"><enum>(D)</enum><header>Independent freestanding emergency department</header><text display-inline="yes-display-inline">The term <term>independent freestanding emergency department</term> means a facility that—</text><clause id="H808DA03C878C4B6A8D5829B2FECA85B8"><enum>(i)</enum><text>is geographically separate and distinct and licensed separately from a hospital under applicable State law; and</text></clause><clause id="HB628D46CB82749B798E10E653F7FFAF3"><enum>(ii)</enum><text>provides emergency services.</text></clause></subparagraph><subparagraph id="H6042293263E84317AAE57F75EF6B8CB2" commented="no"><enum>(E)</enum><header>Median contracted rate</header><clause id="HEC70DB8AE330471ABD44FC533E104777" commented="no" display-inline="no-display-inline"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">The term <term>median contracted rate</term> means, with respect to an item or service and a health plan (as defined in subsection (e)(2)(A))—</text><subclause id="H2CAFED184D35443CA401CD0B0A3B68D8" commented="no"><enum>(I)</enum><text display-inline="yes-display-inline">for 2021, the median of the negotiated rates recognized by the sponsor or issuer of such plan (determined with respect to all such plans of such sponsor or such issuer that are within the same line of business) as the total maximum payment (including the cost-sharing amount imposed for such services (as determined in accordance with clauses (ii) and (iii) of paragraph (1)(C) or subparagraphs (A) and (B) of subsection (e)(1), as applicable) and the amount to be paid by the plan or issuer) under such plans in 2019 for the same or a similar item or service that is provided by a provider in the same or similar specialty and provided in the geographic region in which the item or service is furnished, consistent with the methodology established by the Secretary under section 402(e) of the No Surprises Act, increased by the percentage increase in the consumer price index for all urban consumers (United States city average) over 2019 and 2020; and </text></subclause><subclause id="H0405C36AB5634F8FBB5C3F2A5D4D097E" commented="no"><enum>(II)</enum><text display-inline="yes-display-inline">for 2022 and each subsequent year, the median contracted rate determined under this clause for the previous year, increased by the percentage increase in the consumer price index for all urban consumers (United States city average) over such previous year.</text></subclause></clause><clause id="H79799C2F232249BCAF524A95297E84F5" commented="no" display-inline="no-display-inline"><enum>(ii)</enum><header>Special rule</header><text display-inline="yes-display-inline">The Secretary shall provide pursuant to rulemaking described in section 402(e) of the No Surprises Act that—</text><subclause id="HD52BD61F06B34384A108EB6AE367C152" commented="no"><enum>(I)</enum><text>if the sponsor or issuer of a health plan does not have sufficient information to calculate a median contracted rate for an item or service or provider type, or amount of, claims for items or services (as determined by the Secretary) provided in a particular geographic area (other than in a case described in item (bb)), such sponsor or issuer shall demonstrate that such sponsor or issuer will use any database free of conflicts of interest that has sufficient information reflecting allowed amounts paid to a health care provider for relevant services provided in the applicable geographic region (such as State All Payer Claims Databases (as defined in section 404(d) of such Act)), and that such sponsor or issuer will use any such database to determine a median contracted rate and cover the cost of accessing any such database; and</text></subclause><subclause id="HEFDA2A0FEF864130925EB879693B91BC" commented="no"><enum>(II)</enum><text>in the case of a sponsor or issuer offering a health plan in a geographic region that did not offer any health plan in such region during 2019, such sponsor or issuer shall use a methodology established by the Secretary for determining the median contracted rate for items and services covered by such plan for the first year in which such plan is offered in such region, and that, for each succeeding year, the median contracted rate for such items and services under such plan shall be the median contracted rate for such items and services under such plan for the previous year, increased by the percentage increase in the consumer price index for all urban consumers (United States city average) over such previous year.</text></subclause></clause></subparagraph><subparagraph id="H7A3D16995CB54F5D99D5642D892E6512"><enum>(F)</enum><header>Nonparticipating emergency facility; participating emergency facility</header><clause id="H1E1F53B4A62048F9934DB005D874C393"><enum>(i)</enum><header>Nonparticipating emergency facility</header><text display-inline="yes-display-inline">The term <term>nonparticipating emergency facility</term> means, with respect to an item or service and a health plan, an emergency department of a hospital, or an independent freestanding emergency department, that does not have a contractual relationship with the plan (or, if applicable, issuer offering the plan) for furnishing such item or service under the plan.</text></clause><clause id="H9C598CC38EC24F839A9E6D975B6F43FF"><enum>(ii)</enum><header>Participating emergency facility</header><text display-inline="yes-display-inline">The term <term>participating emergency facility</term> means, with respect to an item or service and a health plan, an emergency department of a hospital, or an independent freestanding emergency department, that has a contractual relationship with the plan (or, if applicable, issuer offering the plan) for furnishing such item or service under the plan.</text></clause></subparagraph><subparagraph id="H83FD942716FF4E0F9CC7DC20868AEDB2"><enum>(G)</enum><header>Nonparticipating providers; participating providers</header><clause id="HBEF9489990974D709DD1ABACB4E982EA"><enum>(i)</enum><header>Nonparticipating provider</header><text display-inline="yes-display-inline">The term <term>nonparticipating provider</term> means, with respect to an item or service and a health plan, a physician or other health care provider who is acting within the scope of practice of that provider’s license or certification under applicable State law and who does not have a contractual relationship with the plan (or, if applicable, issuer offering the plan) for furnishing such item or service under the plan.</text></clause><clause id="H7619160E0645421DB1E9D164ADC8D98C"><enum>(ii)</enum><header>Participating provider</header><text display-inline="yes-display-inline">The term <term>participating provider</term> means, with respect to an item or service and a health plan, a physician or other health care provider who is acting within the scope of practice of that provider’s license or certification under applicable State law and who has a contractual relationship with the plan (or, if applicable, issuer offering the plan) for furnishing such item or service under the plan.</text></clause></subparagraph><subparagraph id="HEE01F7CBD8414CAAA814B3565E489CF3"><enum>(H)</enum><header>Recognized amount</header><text display-inline="yes-display-inline">The term <term>recognized amount</term> means, with respect to an item or service—</text><clause id="H14124C0585264704A2B357BD5AB8DEAB"><enum>(i)</enum><text>in the case of such item or service furnished in a State that has in effect a State law that provides for a method for determining the amount of payment that is required to be covered by a health plan regulated by such State in the case of a participant, beneficiary, or enrollee covered under such plan and receiving such item or service from a nonparticipating provider or facility, not more than the amount determined in accordance with such law plus the cost-sharing amount imposed under the plan for such item or service (as determined in accordance with clauses (ii) and (iii) of paragraph (1)(C) or subparagraphs (A) and (B) of subsection (e)(1), as applicable); or</text></clause><clause id="HE0CCBFC612904E02A834F78E0C0FCC8F"><enum>(ii)</enum><text display-inline="yes-display-inline">in the case of such item or service furnished in a State that does not have in effect such a law, an amount that is at least the median contracted rate (as defined in subparagraph (E)(i) and determined in accordance with rulemaking described in section 402(e) of the No Surprises Act) for such item or service.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph></subsection><subsection id="H77F371D5BA554457935EDA63A8CA26E6"><enum>(b)</enum><header>Coverage of non-emergency services performed by nonparticipating providers at certain participating facilities; independent dispute resolution process</header><text display-inline="yes-display-inline">Section 2719A of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-19a">42 U.S.C. 300gg–19a</external-xref>) is amended by adding at the end the following new subsections:</text><quoted-block style="OLC" id="HF88E30070D4B484B9ED3C31D2305C221" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><subsection id="HEC706AA2CE564DB898E684E0622759B9"><enum>(e)</enum><header>Coverage of non-emergency services performed by nonparticipating providers at certain participating facilities</header><paragraph id="HB2288E086DA9414EAAD4F5DADBDF79EF"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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 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)), with respect to such plan, the plan—</text><subparagraph id="H62A520ECEF1042808A8356F2E68BC9A3" commented="no"><enum>(A)</enum><text display-inline="yes-display-inline">shall not impose on such participant, beneficiary, or enrollee a cost-sharing amount (expressed as a copayment amount or coinsurance rate) for such items and services so furnished that is greater than the cost-sharing amount that would apply under such plan had such items or services been furnished by a participating provider (as defined in subsection (b)(3)(G)(ii));</text></subparagraph><subparagraph id="H176D40C807DF4544B0B050B4B8066BB4" commented="no"><enum>(B)</enum><text>shall calculate such cost-sharing amount as if the amount that would have been charged for such items and services by such participating provider were equal to—</text><clause id="H126FE4BB243A4A0CA2646D0C817C0687" commented="no"><enum>(i)</enum><text>in the case of such items and services furnished in a State described in subsection (b)(3)(H)(ii), the median contracted rate (as defined in subsection (b)(3)(E)(i)) for such items and services; and</text></clause><clause id="HC7F23A7377E34946ACE9FA5B9E25DD1A" commented="no"><enum>(ii)</enum><text>in the case of such items and services furnished in a State described in subsection (b)(3)(H)(i), the lesser of—</text><subclause id="H0FDFAF665069482C9E0888E74DACEB10" commented="no"><enum>(I)</enum><text>the amount determined by such State for such items and services in accordance with the method described in such subsection; and</text></subclause><subclause id="HE3A3805E5FF44BA296A8F27A6160AF3D" commented="no"><enum>(II)</enum><text>the median contracted rate (as so defined) for such items and services;</text></subclause></clause></subparagraph><subparagraph id="H1421CC2FB6F242ED8DBE09DA77551367"><enum>(C)</enum><text display-inline="yes-display-inline">shall pay to such provider furnishing such items and services to such participant, beneficiary, or enrollee the amount by which the recognized 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 accordance with subparagraphs (A) and (B)); and</text></subparagraph><subparagraph id="H8210898E629448F2B4DCFA519B7E0CB6"><enum>(D)</enum><text display-inline="yes-display-inline">shall count toward any in-network deductible or out-of-pocket maximums applied under the plan any cost-sharing payments made by the participant, beneficiary, or enrollee (and 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 payments were with respect to items and services furnished by a participating provider.</text></subparagraph></paragraph><paragraph id="H028FCE6119DA463AB8F2D1485004FC8A" commented="no"><enum>(2)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this subsection and subsection (b):</text><subparagraph id="H88A2E2E2D7274DF084887A05AB744390" commented="no"><enum>(A)</enum><header>Health plan</header><text display-inline="yes-display-inline">The term <term>health plan</term> means a group health plan and health insurance coverage offered by a heath insurance issuer in the group or individual market and includes a grandfathered health plan (as defined in section 1251(e) of the Patient Protection and Affordable Care Act).</text></subparagraph><subparagraph id="H2A23DAE1A509416CA7102D8D131BD7E1" commented="no"><enum>(B)</enum><header>Participating health care facility</header><clause id="H2AD1B72F872A406A8E8EA76F4D3EC597" commented="no"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">The term <term>participating health care facility</term> means, with respect to an item or service and a health plan, a health care facility described in clause (ii) that has a contractual relationship with the plan (or, if applicable, issuer offering the plan) for furnishing such item or service.</text></clause><clause id="H5B18799EC4FA4B1988CE5C621D7D405E" commented="no"><enum>(ii)</enum><header>Health care facility described</header><text>A health care facility described in this clause is each of the following: </text><subclause id="HB8DE0DE6DC1B41899094690415E29C28" commented="no"><enum>(I)</enum><text display-inline="yes-display-inline">A hospital (as defined in 1861(e) of the Social Security Act). </text></subclause><subclause id="H5AB4BED16F014C3E9927B0DECBF77B60" commented="no"><enum>(II)</enum><text display-inline="yes-display-inline">A critical access hospital (as defined in section 1861(mm) of such Act).</text></subclause><subclause id="HD869D9EAF6D64E97867F7693F14DF82D" commented="no"><enum>(III)</enum><text display-inline="yes-display-inline">An ambulatory surgical center (as defined in section 1833(i)(1)(A) of such Act).</text></subclause><subclause id="HD6C633F50C1D447A955709E61FF795DE"><enum>(IV)</enum><text>A laboratory.</text></subclause><subclause id="H7ACA20575FC74517AB11CA3FC92147FB"><enum>(V)</enum><text>A radiology facility or imaging center.</text></subclause></clause></subparagraph><subparagraph id="H5B50604B94A2422B854A03AB0378111C" commented="no"><enum>(C)</enum><header>During a visit</header><text>The term <term>during a visit</term> shall, with respect to items and services furnished to an individual at a participating health care facility, include equipment and devices, telemedicine services, imaging services, laboratory services, and such other items and services as the Secretary may specify, regardless of whether or not the provider furnishing such items or services is at the facility.</text></subparagraph></paragraph><paragraph id="H53EA087AF9584B1BA6FF946199CD3F70"><enum>(3)</enum><header>Exception</header><text display-inline="yes-display-inline">Paragraph (1) shall not apply to a health plan 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 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.</text></paragraph></subsection><subsection id="H9D3A76B627F049AABD2DD578625D65B5"><enum>(f)</enum><header>Independent dispute resolution process</header><paragraph id="HC66D54DF10E14A2785A376269A549062"><enum>(1)</enum><header>Establishment</header><subparagraph id="H53A9312196994134A09D11FF6CE21FE6"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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 independent dispute resolution process (referred to in this subsection as the <quote>IDR process</quote>) under which—</text><clause id="H28BC0DC16D14436D8D263E1B25E82DC5"><enum>(i)</enum><text display-inline="yes-display-inline">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 subsection (e)(2)(A)) may submit a request for resolution by an entity certified under paragraph (2) (in this subsection referred to as a <quote>certified IDR entity</quote>) of a specified claim; and</text></clause><clause id="HF3C3A39988E9435DBD08DE1CA639726B"><enum>(ii)</enum><text>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.</text></clause></subparagraph><subparagraph id="H04DCC20A346548F290CA425C0CA9985D"><enum>(B)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this subsection:</text><clause id="HC759D079EBEC443FAB84B2FE108D8805"><enum>(i)</enum><header>Specified claim</header><subclause id="HEDA6E6FF263C450BB408C2F957A8542D"><enum>(I)</enum><header>In general</header><text display-inline="yes-display-inline">Subject to subclause (II), the term <quote>specified claim</quote> means a claim by a nonparticipating provider, a nonparticipating emergency facility, or a health plan with respect to qualifying items and services (as defined in clause (ii)) furnished 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 payment pursuant to subsection (b)(1) or subsection (e)(1)—</text><item id="H4F49EAACA3D9429DB2FBE87F9415A5B7"><enum>(aa)</enum><text>that such payment should be increased or decreased; and</text></item><item id="H6EC324429CDA4D8AB932E4624F6EB116"><enum>(bb)</enum><text>that is made not later than—</text><subitem id="H53ED7A67BAA344E4B0CB7168960234DD"><enum>(AA)</enum><text>in the case of such a claim filed by such a provider or facility, the date on which the appeal with respect to such items and services described in clause (ii)(I)(aa)(AA) has been resolved (or the date that is 30 days after such appeal is filed, whichever is earlier); or</text></subitem><subitem id="H11C92BB0BB5F42EEB9036F3E019EC967"><enum>(BB)</enum><text>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.</text></subitem></item></subclause><subclause id="HCCBD15B2B1174511925E1072DD213157"><enum>(II)</enum><header>Limitation on packaging of items and services in a specified claim</header><text display-inline="yes-display-inline">The term <quote>specified claim</quote> shall not include, in the case such claim is made by such provider, facility, or plan with respect to multiple items and services, any claim with respect to items and services furnished by such provider or facility if—</text><item id="H4567F0E611134F9BA33D5E629B041DB5"><enum>(aa)</enum><text>such items and services were not furnished by the same provider or facility;</text></item><item id="HF9B78995D434447A9A6FB3FB67FF959A"><enum>(bb)</enum><text>payment for such items and services made pursuant to subsection (b)(1) or subsection (e)(1) was made by multiple health plans;</text></item><item id="H6BAC39AE1C394197BEC86830C52F53D0"><enum>(cc)</enum><text>such items and services are not related to the treatment of the same condition; or</text></item><item id="HA4379973CC8848C28FB266741D8B4003"><enum>(dd)</enum><text>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.</text></item></subclause></clause><clause id="HCA5D2EE55ED541808ECC9452797A88EC"><enum>(ii)</enum><header>Qualifying items and services</header><subclause id="HC5EBA89A04C34FF7B83EC8D4181F7DD8"><enum>(I)</enum><header>In general</header><text>Subject to subclause (II), the term <quote>qualifying items and services</quote> means—</text><item id="H3342414B0F8C478FA929B851D61C4C90"><enum>(aa)</enum><text display-inline="yes-display-inline">with respect to a specified claim made by a nonparticipating provider or nonparticipating 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—</text><subitem id="H8DD7DCFCBEB14B4ABE1414DD7E49A782"><enum>(AA)</enum><text>such items and services are included in an appeal filed under such plan’s internal appeals process not later than 30 days after such payment is received; and</text></subitem><subitem id="HCDA248164C6149729429B47443A099F1"><enum>(BB)</enum><text>such appeal under such plan’s internal appeals process has been resolved, or a 30-day period has elapsed since such appeal was so filed; and</text></subitem></item><item id="HA41639BBBF3A4F2C9DBE57FA2C72604D"><enum>(bb)</enum><text display-inline="yes-display-inline">with respect to a specified 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—</text><subitem id="H24FE7D34C2364CA68AC95A43E3C938B2"><enum>(AA)</enum><text>such plan submits a notice to such provider or facility not later than 30 days after such provider or facility receives such payment that such plan disputes the amount of such payment with respect to such items and services; and</text></subitem><subitem id="H61311500BBCB45A3A96828CCBFCA25F8"><enum>(BB)</enum><text>a 30-day period has elapsed since the submission of such notice.</text></subitem></item></subclause><subclause id="H802CC4AC1A794B7784E0F83E4EC0E7E1"><enum>(II)</enum><header>Limitation</header><text display-inline="yes-display-inline">The term <quote>qualifying items and services</quote> shall not include an item or service furnished 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 median 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—</text><item id="HFDCABA8B11564AF8895AB09821F335CF"><enum>(aa)</enum><text display-inline="yes-display-inline">with respect to an item or service furnished during 2021, $1,250; and</text></item><item id="HEB08123B64D6422CB2965ECAE5AB93F4"><enum>(bb)</enum><text display-inline="yes-display-inline">with respect to an item or service furnished during a subsequent year, the amount specified under this subclause for the previous year, increased by the percentage increase in the consumer price index for all urban consumers (United States city average) over such previous year.</text></item></subclause></clause></subparagraph></paragraph><paragraph id="HF4BD5AE23A19443E9D4F7E9146364FA0"><enum>(2)</enum><header>Certification of entities</header><subparagraph id="HDCA40AD52E44443D85EDA7FE9D1BC555"><enum>(A)</enum><header>Process of certification</header><text>The process described in paragraph (1) shall include a certification process under which eligible entities may be certified to carry out the IDR process.</text></subparagraph><subparagraph id="HBB770172F3FA4CAA8EF9248F62D9E2A8"><enum>(B)</enum><header>Eligibility</header><clause id="H8D2DCC23BF694C67AAAB6F5FA105FB6F"><enum>(i)</enum><header>In general</header><text>For purposes of subparagraph (A), an eligible entity is an entity that is a nongovernmental entity that agrees to comply with the fee limitations described in clause (ii).</text></clause><clause id="H7BD9AAF7F59F4C7A935F8D0EC6BF89FC"><enum>(ii)</enum><header>Fee limitation</header><text>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 provider, 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 paragraph (1).</text></clause></subparagraph></paragraph><paragraph id="HCD48DD5B103F459F868665E089185260"><enum>(3)</enum><header>Selection of certified IDR entity for a specified claim</header><text>With respect to the resolution of a specified claim under the IDR process, the health plan and the nonparticipating provider or the nonparticipating emergency facility (as applicable) involved shall agree on a certified IDR entity to resolve such claim. In the case that such plan and such provider or facility (as applicable) cannot so agree, such an entity shall be selected by the Secretary at random.</text></paragraph><paragraph id="HC6626B1B5381433CA45EDA9E8408AA6F"><enum>(4)</enum><header>Payment determination</header><subparagraph id="HD5B27E80225B4C90ADAE80D3B625BB5A"><enum>(A)</enum><header>Timing</header><text>A certified IDR entity selected under paragraph (3) by a health plan and a nonparticipating provider or a nonparticipating emergency facility (as applicable) with respect to a specified claim shall, subject to subparagraph (B), not later than 30 days after being so selected, determine the total reimbursement that should have been made for items and services included in such claim in accordance with subparagraph (C).</text></subparagraph><subparagraph id="HE383BC2DF75843BD966BD17AD84489A4"><enum>(B)</enum><header>Settlement</header><clause id="H8B8BD93CA5B44DCC9599AEDAB77B45D7" display-inline="no-display-inline"><enum>(i)</enum><header>In general</header><text>If such entity determines 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 a period not to exceed 10 days, a good faith negotiation for a settlement of such claim.</text></clause><clause id="HC935B35921764F77B144BB96341DA17F"><enum>(ii)</enum><header>Timing</header><text>The period for a settlement described in clause (i) shall accrue towards the 30-day period described in subparagraph (A).</text></clause></subparagraph><subparagraph id="HFEF1933E63B8469A92A8C2FD170291E1"><enum>(C)</enum><header>Determination of amount</header><clause id="H4730ADD3D9B74C1685D967B391EC0584"><enum>(i)</enum><header>In general</header><text>The health plan and the nonparticipating provider or nonparticipating emergency facility (as applicable) shall, with respect to a specified claim, each submit to the certified IDR entity a final offer of payment or reimbursement (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).</text></clause><clause id="H82C9554B54B74ED6B76A4FB7C25F7431"><enum>(ii)</enum><header>Considerations in determination</header><subclause id="HAD3BCD2E7A3C4AB780847A9DCCFD7F4B"><enum>(I)</enum><header>In general</header><text>In determining which final offer is the most reasonable under clause (i), the certified IDR entity shall consider—</text><item id="HFC522CD5C07D42658BC2D252AE6C84D0"><enum>(aa)</enum><text display-inline="yes-display-inline">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 specified claim and that are furnished in the same geographic area (as defined by the Secretary for purposes of such subsection) as such items and services (not including any facility fees with respect to such rates); and</text></item><item id="HDACE37FFF77C4C7AAAB20C553CF80877"><enum>(bb)</enum><text>the circumstances described in subclause (II), if any information with respect to such circumstances is submitted by either party.</text></item></subclause><subclause id="H393DE57D008340BDA5C77F289D024238"><enum>(II)</enum><header>Additional circumstances</header><text display-inline="yes-display-inline">For purposes of subclause (I)(bb), the circumstances described in this subclause are, with respect to items and services included in the specified claim of a nonparticipating provider, nonparticipating emergency facility, or health plan, the following:</text><item id="HF5773F7D02BC4CC2902B956194994BA4"><enum>(aa)</enum><text>The level of training, education, experience, and quality and outcomes measurements of the provider or facility that furnished such items and services.</text></item><item id="H836E3E49B400431F9F89415CBB858D35"><enum>(bb)</enum><text display-inline="yes-display-inline">Any other extenuating circumstances with respect to the furnishing of such items and services 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.</text></item></subclause><subclause id="H5D84DD47F59B4D109046909C8AA632DF"><enum>(III)</enum><header>Prohibition on consideration of billed charges</header><text display-inline="yes-display-inline">In determining which final offer is the most reasonable under clause (i) with respect to items and services furnished by a provider or facility and included in a specified claim, the certified IDR entity may not consider the amount that would have been billed by such provider or facility with respect to such items and services had the provisions of section 2799 or 2799A (as applicable) not applied.</text></subclause></clause><clause id="H2D4AE7973EB84CCF96815835947F9A4C"><enum>(iii)</enum><header>Effect of determination</header><text>A determination of a certified IDR entity under clause (i)—</text><subclause id="HDD3F124B0B3C42178C5C3426A3261BC6"><enum>(I)</enum><text>shall be binding; and</text></subclause><subclause id="H48B53BBBB047457AB998DCE88EE9B311"><enum>(II)</enum><text>shall not be subject to judicial review, except in a case described in any of paragraphs (1) through (4) of section 10(a) of title 9, United States Code.</text></subclause></clause><clause id="HE60362C5099E434096F60780B42EEA6E"><enum>(iv)</enum><header>Costs of independent dispute resolution process</header><text>In the case of a specified claim made by a nonparticipating provider, nonparticipating emergency facility, or health plan and submitted to a certified IDR entity—</text><subclause id="HA2F8A1EFBB57412C8E4AA123AEB7F63A"><enum>(I)</enum><text>if such entity makes a determination 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</text></subclause><subclause id="H334BE3FBBD474CCCB218BA4955E7CC57"><enum>(II)</enum><text>if the parties reach a settlement with respect to such claim prior to such a determination, such fees shall be divided equally between the parties, unless the parties otherwise agree.</text></subclause></clause><clause id="H7FE811E3FCF9451AB835F4F951043491"><enum>(v)</enum><header>Payment</header><text>Not later than 30 days after a determination described in clause (i) is made with respect to a specified claim of a nonparticipating provider, nonparticipating emergency facility, or health plan—</text><subclause id="H3F6CBC32B1E7492D8E7A74EEEE6DC12E"><enum>(I)</enum><text>in the case that such determination finds that the amount paid with respect to such specified claim by the health plan should have been greater than the amount so paid, such plan shall pay directly to the provider or facility (as applicable) the difference between the amount so paid and the amount so determined; and</text></subclause><subclause id="H2ABDABA6A30749CCAAC656F5D30D4832"><enum>(II)</enum><text display-inline="yes-display-inline">in the case that such determination 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 or facility (as applicable) shall pay directly to the plan the difference between the amount so paid and the amount so determined.</text></subclause></clause></subparagraph></paragraph><paragraph id="H23D9A16B1A2640E98200CFE106499522"><enum>(5)</enum><header>Publication of information relating to disputes</header><subparagraph id="H089ED688A9F84B57B52C6D7730C50057"><enum>(A)</enum><header>In general</header><text>For 2021 and each subsequent 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—</text><clause id="H70EB66F89C6A4315BD613BFA3D783C78"><enum>(i)</enum><text>the number of specified claims filed during such year;</text></clause><clause id="HC5C22E6FFE3E40B0BCB65ED2BED4B6F0"><enum>(ii)</enum><text>the number of such claims with respect to which a final determination was made under paragraph (4)(C)(i); and</text></clause><clause id="HA7FE77DDD46C446CB9711E3D22358ACA"><enum>(iii)</enum><text>the information described in subparagraph (B) with respect to each specified claim with respect to which such a decision was so made.</text></clause></subparagraph><subparagraph id="H256FC9C4A4BF45849DB4FD72FF5D3D68"><enum>(B)</enum><header>Information with respect to specified claims</header><text display-inline="yes-display-inline">For purposes of subparagraph (A), the information described in this subparagraph is, with respect to a specified claim of a nonparticiapting provider, nonparticipating emergency facility, or health plan—</text><clause id="H577DA1CC873348A5AAB4614055BDBB29"><enum>(i)</enum><text>a description of each item and service included in such claim;</text></clause><clause id="H525766E0DFF7477C9361AC93DC3859A9"><enum>(ii)</enum><text>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);</text></clause><clause id="H4689317AD4BD4643A0481A3E43D9B13F"><enum>(iii)</enum><text>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</text></clause><clause id="HBD1AC5982FEF4772A00F3054653A890B"><enum>(iv)</enum><text display-inline="yes-display-inline">the category and practice specialty of each such provider or facility involved in furnishing such items and services.</text></clause></subparagraph><subparagraph id="H61C4CD0787E44E02AEDF8B74AF6416CD"><enum>(C)</enum><header>Confidentiality of parties</header><text>None of the information published under this paragraph may specify the identity of a health plan, provider, facility, or individual with respect to a specified claim.</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="HA79DDC76C68B46E59C61E703C8439CD8"><enum>(c)</enum><header>Provider directory requirements; disclosure on patient protections</header><text>Section 2719A of the Public Health Service Act, as amended by subsection (b), is further amended by adding at the end the following new subsections:</text><quoted-block style="OLC" id="H260A8E5060144034AA0A7E99FD07940A" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><subsection id="H55E66E3B62F547CC8A3A22460926996A" display-inline="no-display-inline"><enum>(g)</enum><header>Provider directory information requirements</header><paragraph id="H8A3BF363C7754245B060E88CB5738CB1"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 1 year after the date of the enactment of this subsection, each group health plan and health insurance issuer offering group or individual health insurance coverage shall—</text><subparagraph id="HAEE22D111F8D47FBBD84816ED54A1F35"><enum>(A)</enum><text>establish the verification process described in paragraph (2);</text></subparagraph><subparagraph id="H8E235429A12842C0B999EC6B6E30A3CA"><enum>(B)</enum><text>establish the response protocol described in paragraph (3);</text></subparagraph><subparagraph id="H0699E627D22444149A632DEF4B49B81C"><enum>(C)</enum><text>establish the database described in paragraph (4); and</text></subparagraph><subparagraph id="HCE43179896924565B4F1CFE77A676934"><enum>(D)</enum><text>include in any print directory containing provider directory information with respect to such plan or such coverage the information described in paragraph (5).</text></subparagraph></paragraph><paragraph id="HEC0B53B1675C4FACAA8FA661F8667201"><enum>(2)</enum><header>Verification process</header><text>The verification process described in this paragraph is, with respect to a group health plan or a health insurance issuer offering group or individual health insurance coverage, a process—</text><subparagraph id="HE97152E6917F46BF944A9B0EC31A5343"><enum>(A)</enum><text>under which not less frequently than once every 90 days, such plan or such issuer (as applicable) verifies and updates the provider directory information included on the database described in paragraph (4) of such plan or issuer of each health care provider and health care facility included in such database; and</text></subparagraph><subparagraph id="H5BDD244811DA4140831C0AE15E289BA9"><enum>(B)</enum><text>that establishes a procedure for the removal of such a provider or facility with respect to which such plan or issuer has been unable to verify such information during a period specified by the plan or issuer.</text></subparagraph></paragraph><paragraph id="H5EBAB3E53874415ABFDECB501A0FD6C3"><enum>(3)</enum><header>Response protocol</header><text>The response protocol 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 facility has a contractual relationship to furnish items and services under such plan or such coverage, a protocol under which such plan or such issuer (as applicable), in the case such request is made through a telephone call—</text><subparagraph id="H5B5FA68C548D4F11A213CA0CCDEAA119"><enum>(A)</enum><text>responds to such individual as soon as practicable and in no case later than 1 business day after such call is received through a written electronic communication; and</text></subparagraph><subparagraph id="H587968D6344C49C1816953CD14B6C3B6"><enum>(B)</enum><text>retains such communication in such individual’s file for at least 2 years following such response. </text></subparagraph></paragraph><paragraph id="HBF6844D0235340F4BF48B47249B466C2"><enum>(4)</enum><header>Database</header><text>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—</text><subparagraph id="H4CD51CD1A2F248818331303C0986E9D9"><enum>(A)</enum><text>a list of each health care provider and health care facility with which such plan or such issuer has a contractual relationship for furnishing items and services under such plan or such coverage; and</text></subparagraph><subparagraph id="H55708715893943B2AC218ABED261C4E6"><enum>(B)</enum><text>provider directory information with respect to each such provider and facility.</text></subparagraph></paragraph><paragraph id="HBD5257CFEA52446F825666845D813F9F"><enum>(5)</enum><header>Information</header><text>The information described in this paragraph is, with respect to a print directory containing provider directory information with respect to a group health plan or individual or group health insurance coverage offered by a health insurance issuer, a notification that such information contained in such directory was accurate as of the date of publication of such directory and that an individual enrolled under such plan or such coverage should consult the database described in paragraph (4) with respect to such plan or such coverage or contact such plan or the issuer of such coverage to obtain the most current provider directory information with respect to such plan or such coverage.</text></paragraph><paragraph id="H180820792C594048AE312A3F67EFED07"><enum>(6)</enum><header>Definition</header><text>For purposes of this subsection, the term <term>provider directory information</term> includes, with respect to a group health plan and a health insurance issuer offering group or individual health insurance coverage, the name, address, specialty, and telephone number of each health care provider or health care facility with which such plan or such issuer has a contractual relationship for furnishing items and services under such plan or such coverage.</text></paragraph></subsection><subsection id="H2EB3B5B9750B490981A0CB7A8965271C"><enum>(h)</enum><header>Disclosure on patient protections</header><text display-inline="yes-display-inline">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—</text><paragraph id="HB749944CFA7045AE9BAC37442471ED94"><enum>(1)</enum><text>information in plain language on—</text><subparagraph id="H181AFB89B1364600AE241385C2650F30"><enum>(A)</enum><text>the requirements and prohibitions applied under sections 2799 and 2799A (relating to prohibitions on balance billing in certain circumstances);</text></subparagraph><subparagraph id="HAB5C600FEE8441EC8469ACB6E8458F5C"><enum>(B)</enum><text display-inline="yes-display-inline">if provided for under applicable State law, any other requirements on providers and facilities regarding the amounts such providers and facilities may, with respect to an item or service, charge a participant, beneficiary, or enrollee 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, beneficiary, or enrollee; and</text></subparagraph><subparagraph id="HB7653893788743369AA96DD98EC9814D"><enum>(C)</enum><text>the requirements applied under subsections (b) and (e); and</text></subparagraph></paragraph><paragraph id="H1107F8F1A1224543AE5623CD525586AE" display-inline="no-display-inline"><enum>(2)</enum><text>information on contacting appropriate State and Federal agencies in the case that an individual believes that such a provider or facility has violated any requirement described in paragraph (1) with respect to such individual.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H6C6E42F577E94DE1A29EC0DEE042C344"><enum>(d)</enum><header>Preventing certain cases of balance billing</header><text>Title XXVII of the Public Health Service Act is amended by adding at the end the following new part:</text><quoted-block style="OLC" id="HD9B03962D9614FCC8AE6EBECA06DF982" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><part id="HB1370788F0354ACB865156AB5323E585"><enum>D</enum><header>Preventing Certain Cases of Balance Billing</header><section id="H40246EA95A654294816C5FC86B61DA5F"><enum>2799.</enum><header>Balance billing in cases of emergency services</header><subsection id="HC7DFE20C80EB4E6B9E76E0B346E331E3" display-inline="no-display-inline"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">In the case of a participant, beneficiary, or enrollee with benefits under a health plan who is furnished on or after January 1, 2021, emergency services with respect to an emergency medical condition during a visit at an emergency department of a hospital or an independent freestanding emergency department—</text><paragraph id="H5E6708A4D09B42E194C1719F8B6D044C"><enum>(1)</enum><text display-inline="yes-display-inline">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</text></paragraph><paragraph id="HE946E2BC44814333AACED2EB22A6A918" commented="no"><enum>(2)</enum><text display-inline="yes-display-inline">a health care provider shall not hold such participant, beneficiary, or enrollee liable for a payment 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 provider (as determined in accordance with clauses (ii) and (iii) of section 2719A(b)(1)(C)).</text></paragraph></subsection><subsection id="H1EEEA0A84E4140B1BA976EB7CD1CC037"><enum>(b)</enum><header>Definitions</header><text>In this section:</text><paragraph id="H5CAD4D70F9074A248BB1488C28956A2D"><enum>(1)</enum><text>The terms <term>emergency department of a hospital</term>, <term>emergency medical condition</term>, <term>emergency services</term>, and <term>independent freestanding emergency department</term> have the meanings given such terms, respectively, in section 2719A(b)(3).</text></paragraph><paragraph id="H120DF17FCA814B7BB831A4BEA5AD3809"><enum>(2)</enum><text>The term <term>health plan</term> has the meaning given such term in section 2719A(e).</text></paragraph><paragraph id="H4C064243E11E4AC5A642FB4325A9FFFE"><enum>(3)</enum><text>The term <term>during a visit</term> shall have such meaning as applied to such term for purposes of section 2719A(e).</text></paragraph></subsection></section><section id="H4F0D395D05444B99B90078DB35BA5EC0"><enum>2799A.</enum><header>Balance billing in cases of non-emergency services performed by nonparticipating providers at certain participating facilities</header><subsection id="H1FBA9B7ECBE342B6A0E5F268E03AA498" display-inline="no-display-inline" commented="no"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subject to subsection (b), in the case of a participant, beneficiary, or enrollee with benefits under a health plan (as defined in section 2799(b)) who is furnished on or after January 1, 2021, items or services (other than emergency services to which section 2799 applies) at a participating health care facility by a nonparticipating provider, such provider shall not hold such participant, beneficiary, or enrollee liable for a payment amount for such an item or service furnished by such provider during a visit at such facility that is more than the cost-sharing amount for such item or service (as determined in accordance with subparagraphs (A) and (B) of section 2719A(e)(1)).</text></subsection><subsection id="H06A23ED359D742809E6357E8CB8C2087" commented="no"><enum>(b)</enum><header>Exception</header><paragraph id="H4CD09B2C12854C86A2916087F8BF4DBB"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Subsection (a) shall not apply to a nonparticipating provider (other than a specified provider at a participating health care facility), with respect to items or services furnished by the provider to a participant, beneficiary, or enrollee of a health plan, if the provider is in compliance with the notice and consent requirements of subsection (d).</text></paragraph><paragraph id="H1AB4CD20533E4DC3BDEEB55F2B0E7E4D"><enum>(2)</enum><header>Specified provider defined</header><text>For purposes of paragraph (1), the term <term>specified provider</term>, with respect to a participating health care facility—</text><subparagraph id="H384B9549BA06433088BBFDD90F9C23DA"><enum>(A)</enum><text>means a facility-based provider, including emergency medicine providers, anesthesiologists, pathologists, radiologists, neonatologists, assistant surgeons, hospitalists, intensivists, or other providers as determined by the Secretary; and</text></subparagraph><subparagraph id="H41E0543BA96B4571ABC0BC2FE61E5906"><enum>(B)</enum><text>includes, with respect to an item or service, a nonparticipating provider if there is no participating provider at such facility who can furnish such item or service.</text></subparagraph></paragraph></subsection><subsection id="HF9C3AA2F78764232ADE18974918BBF6F"><enum>(c)</enum><header>Clarification</header><text>In the case of a nonparticipating provider (other than a specified provider at a participating health care facility) that complies with the notice and consent requirements of subsection (d) with respect to an item or service (referred to in this subsection as a <quote>covered item or service</quote>), such notice and consent requirements may not be construed as applying with respect to any item or service that is furnished as a result of unforeseen medical needs that arise at the time such covered item or service is furnished.</text></subsection><subsection id="HCFDBDD2188B44203A586160E7CB54D57"><enum>(d)</enum><header>Compliance with notice and consent requirements</header><paragraph id="H587D30FB3A9B4B1C893D0E61CBB55798" commented="no"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">A nonparticipating provider or nonparticipating facility is in compliance with this subsection, with respect to items or services furnished by the provider or facility to a participant, beneficiary, or enrollee of a health plan, if the provider (or, if applicable, the participating health care facility on behalf of such provider) or nonparticipating facility—</text><subparagraph id="HCDD4BD840D434784A02409549D9AC240" commented="no"><enum>(A)</enum><text display-inline="yes-display-inline">provides to the participant, beneficiary, or enrollee (or to an authorized representative of the participant, beneficiary, or enrollee) on the date on which the individual is furnished such items or services and, in the case that the participant, beneficiary, or enrollee makes an appointment to be furnished such items or services, on such date the appointment is made—</text><clause id="H143BDB4BC47E443D86B17AE85883D69F" commented="no"><enum>(i)</enum><text>an oral explanation of the written notice described in clause (ii); and</text></clause><clause id="H2E53FFCB46FE49978BF6B388C2195B2A" commented="no"><enum>(ii)</enum><text>a written notice specified by the Secretary, not later than July 1, 2020, through guidance (which shall be updated as determined necessary by the Secretary) that—</text><subclause id="HEACAB655387B44D3B426625D4B7BCF87" commented="no"><enum>(I)</enum><text>contains the information required under paragraph (2); and</text></subclause><subclause id="HCEC3EF2FF04941888C313759B02ABE6B" commented="no"><enum>(II)</enum><text display-inline="yes-display-inline">is signed and dated by the participant, beneficiary, or enrollee (or by an authorized representative of the participant, beneficiary, or enrollee) and, with respect to items or services to be furnished by such a provider that are not poststabilization services described in section 2719A(b)(3)(C)(ii), is so signed and dated not less than 72 hours prior to the participant, beneficiary, or enrollee being furnished such items or services by such provider; and</text></subclause></clause></subparagraph><subparagraph id="H5F6672635E7E4651B586D4E93EB9C350" commented="no"><enum>(B)</enum><text>obtains from the participant, beneficiary, or enrollee (or from such an authorized representative) the consent described in paragraph (3).</text></subparagraph></paragraph><paragraph id="HDA89FB4B65A24CF997B7F3C575DA9852" commented="no"><enum>(2)</enum><header>Information required under written notice</header><text>For purposes of paragraph (1)(A)(ii)(I), the information described in this paragraph, with respect to a nonparticipating provider or nonparticipating facility and a participant, beneficiary, or enrollee of a health plan, is each of the following:</text><subparagraph id="HC5BB9E2777C3435D9B2D6BEEA8D7C873" commented="no"><enum>(A)</enum><text>Notification, as applicable, that the health care provider is a nonparticipating provider with respect to the health plan or the health care facility is a nonparticipating facility with respect to the health plan.</text></subparagraph><subparagraph id="H7E05E836BCD84BD69DC2A79B963A9A20" commented="no"><enum>(B)</enum><text>Notification of the estimated amount that such provider or facility may charge the participant, beneficiary, or enrollee for such items and services involved.</text></subparagraph><subparagraph id="HE3578831AAEF4E7F9332C631433FD19B"><enum>(C)</enum><text>In the case of a nonparticipating facility, a list of any participating providers at the facility who are able to furnish such items and services involved and notification that the participant, beneficiary, or enrollee may be referred, at their option, to such a participating provider.</text></subparagraph></paragraph><paragraph id="H28297909645D40F0A040806108838253"><enum>(3)</enum><header>Consent described</header><text>For purposes of paragraph (1)(B), the consent described in this paragraph, with respect to a participant, beneficiary, or enrollee of a health plan who is to be furnished items or services by a nonparticipating provider or nonparticipating facility, is a document specified by the Secretary through rulemaking that—</text><subparagraph id="H413F58A6362841799BA1BDB58F3FF514"><enum>(A)</enum><text display-inline="yes-display-inline">is signed by the participant, beneficiary, or enrollee (or by an authorized representative of the participant, beneficiary, or enrollee) and, with respect to items or services to be furnished by such a provider or facility that are not poststabilization services described in section 2719A(b)(3)(C)(ii), is so signed not less than 72 hours prior to the participant, beneficiary, or enrollee being furnished such items or services by such provider or facility;</text></subparagraph><subparagraph id="H429A3403C12443C0B599740222D5A02E"><enum>(B)</enum><text>acknowledges that the participant, beneficiary, or enrollee has been—</text><clause id="HBF985B60F1754ECEA7926466498BCE05"><enum>(i)</enum><text>provided with a written estimate and an oral explanation of the charge that the participant, beneficiary, or enrollee will be assessed for the items or services anticipated to be furnished to the participant, beneficiary, or enrollee by such provider or facility; and</text></clause><clause id="H7E98626169524C8F8872CA1E0720AD41"><enum>(ii)</enum><text>informed that the payment of such charge by the participant, beneficiary, or enrollee may not accrue toward meeting any limitation that the health plan places on cost-sharing; and</text></clause></subparagraph><subparagraph id="HD2BD0D60634A4AD9AF2CCE686D01A151"><enum>(C)</enum><text>documents the consent of the participant, beneficiary, or enrollee to—</text><clause id="HB81DF1072148442FBA6BE0992B76F395"><enum>(i)</enum><text>be furnished with such items or services by such provider or facility; and</text></clause><clause id="HDEC4DD3749B24BF491EE26E00C8DCEBA"><enum>(ii)</enum><text>in the case that the individual is so furnished such items or services, be charged an amount that may be greater than the amount that would otherwise be charged the individual if furnished by a participating provider or participating facility with respect to such items or services and plan.</text></clause></subparagraph></paragraph></subsection><subsection id="H21D19952FE0A49D480842D298DF4620E"><enum>(e)</enum><header>Retention of certain documents</header><text display-inline="yes-display-inline">A nonparticipating provider (or, in the case of a nonparticipating provider at a participating health care facility, such facility) or nonparticipating facility that obtains from a participant, beneficiary, or enrollee of a health plan (or an authorized representative of such participant, beneficiary, or enrollee) a written notice in accordance with subsection (c)(1)(ii), with respect to furnishing an item or service to such participant, beneficiary, or enrollee, shall retain such notice for at least a 2-year period after the date on which such item or service is so furnished.</text></subsection><subsection id="H9B8B44D991864B5A93225C1F2C27D81D"><enum>(f)</enum><header>Definitions</header><text>In this section:</text><paragraph id="H48F6B9F3394240F5B5DB9AAFB1DB7659"><enum>(1)</enum><text>The terms <term>nonparticipating provider</term> and <term>participating provider</term> have the meanings given such terms, respectively, in subsection (b)(3) of section 2719A.</text></paragraph><paragraph id="HD42A801AFEBA4213997B04CCCD95FEC9"><enum>(2)</enum><text>The terms <term>participating health care facility</term> and <term>health plan</term> have the meanings given such terms, respectively, in subsection (e)(2) of section 2719A.</text></paragraph><paragraph id="HBC69E34CD598463AA0D9D802A6EF4ED1"><enum>(3)</enum><text>The term <term>nonparticipating facility</term> means—</text><subparagraph id="H003274E71BC94B8FAAC946FC398707F9"><enum>(A)</enum><text display-inline="yes-display-inline">with respect to emergency services (as defined in section 2719A(b)(3)(C)(i)) and a health plan, an emergency department of a hospital, or an independent freestanding emergency department, that does not have a contractual relationship with the plan (or, if applicable, issuer offering the plan) for furnishing such services under the plan; and</text></subparagraph><subparagraph id="H05C3E16774C1481C94DD9A66560C25C6"><enum>(B)</enum><text display-inline="yes-display-inline">with respect to poststabilization services described in section 2719A(b)(3)(C)(ii) and a health plan, an emergency department of a hospital (or other department of such hospital), or an independent freestanding emergency department, that does not have a contractual relationship with the plan (or, if applicable, issuer offering the plan) for furnishing such services under the plan.</text></subparagraph></paragraph><paragraph id="H155DA09BEE2D40A48736AF9723313A97"><enum>(4)</enum><text>The term <term>participating facility</term> means—</text><subparagraph id="H515F681DB63E4CFB804EB9E45ADCD70A"><enum>(A)</enum><text display-inline="yes-display-inline">with respect to emergency services (as defined in section 2719A(b)(3)(C)(i)) and a health plan, an emergency department of a hospital, or an independent freestanding emergency department, that has a contractual relationship with the plan (or, if applicable, issuer offering the plan) for furnishing such services under the plan; and</text></subparagraph><subparagraph id="HA73F0F0DC17B49D8AFE6CF7E968028F7"><enum>(B)</enum><text display-inline="yes-display-inline">with respect to poststabilization services described in section 2719A(b)(3)(C)(ii) and a health plan, an emergency department of a hospital (or other department of such hospital), or an independent freestanding emergency department, that has a contractual relationship with the plan (or, if applicable, issuer offering the plan) for furnishing such services under the plan.</text></subparagraph></paragraph></subsection></section><section id="H95FFCFA2A064479AB058C9DBF7CDA470" display-inline="no-display-inline" section-type="subsequent-section"><enum>2799B.</enum><header>Provider requirements with respect to provider directory information</header><text display-inline="no-display-inline">Not later than 1 year after the date of the enactment of this section, each health care provider and health care facility shall establish a process under which such provider or facility transmits, to each health insurance issuer offering group or individual health insurance coverage and group health plan with which such provider or facility has in effect a contractual relationship for furnishing items and services under such coverage or such plan, provider directory information (as defined in section 2719A(g)(6)) with respect to such provider or facility, as applicable. Such provider or facility shall so transmit such information to such issuer offering such coverage or such group health plan—</text><paragraph id="HEC704F3096204749BBBFC9AB3A607B06"><enum>(1)</enum><text>when the provider or facility enters into such a relationship with respect to such coverage offered by such issuer or with respect to such plan;</text></paragraph><paragraph id="HAE61E9D532904974B3B165B5D5E3441A"><enum>(2)</enum><text>when the provider or facility terminates such relationship with respect to such coverage offered by such issuer or with respect to such plan;</text></paragraph><paragraph id="HCACFF7F0F8F34F288BD882646F940625"><enum>(3)</enum><text>when there are any other material changes to such provider directory information of the provider or facility with respect to such coverage offered by such issuer or with respect to such plan; and</text></paragraph><paragraph id="H94E546617B614B0DB0980B63B4D040DB"><enum>(4)</enum><text>at any other time (including upon the request of such issuer or plan) determined appropriate by the provider, facility, or the Secretary.</text></paragraph></section><section id="H41B14EA7B9F24AFAB5F0D8292E411363"><enum>2799C.</enum><header>Provider requirement with respect to public provision of information</header><text display-inline="no-display-inline">Each health care provider and health care facility shall make publicly available, and (if applicable) post on a public website of such provider or facility—</text><paragraph id="HA485ABC797E34A55A3AC3F4B65A8FC32"><enum>(1)</enum><text>information in plain language on—</text><subparagraph id="H24ACF49D641C48D8BB40308A569EA405"><enum>(A)</enum><text>the requirements and prohibitions of such provider or facility under sections 2799 and 2799A (relating to prohibitions on balance billing in certain circumstances); and</text></subparagraph><subparagraph id="H4A7407FFDC5242CA927E618B3A248D39"><enum>(B)</enum><text display-inline="yes-display-inline">if provided for under applicable State law, any other requirements on such provider or facility regarding the amounts such provider or facility may, with respect to an item or service, charge a participant, beneficiary, or enrollee of a health plan (as defined in section 2719A(e)(2)) with respect to which such provider or facility does not have a contractual relationship for furnishing such item or service under the plan after receiving payment from the plan for such item or service and any applicable cost-sharing payment from such participant, beneficiary, or enrollee; and</text></subparagraph></paragraph><paragraph id="HC98B438A558740AF95B70BF1A91F2C31"><enum>(2)</enum><text>information on contacting appropriate State and Federal agencies in the case that an individual believes that such provider or facility has violated any requirement described in paragraph (1) with respect to such individual.</text></paragraph></section><section id="HCA08A9CBF5C548838258A8A2EC6F6FD9"><enum>2799D.</enum><header>Enforcement</header><subsection id="HB87DDC55DC1645DC9981D0638673CEDE"><enum>(a)</enum><header>State enforcement</header><paragraph id="HA00DDC00DECD44268533BCFE08E23748"><enum>(1)</enum><header>State authority</header><text display-inline="yes-display-inline">Each State may require a provider or health care facility subject to the requirements of sections 2719A(f), 2799, 2799A, 2799B, or 2799C to satisfy such requirements applicable to the provider or facility.</text></paragraph><paragraph id="HD9FFC20CE6D04F7BAF39F47CE7F50DCB"><enum>(2)</enum><header>Failure to implement requirements</header><text display-inline="yes-display-inline">In the case of a determination by the Secretary that a State has failed to substantially enforce the requirements specified in paragraph (1) with respect to applicable providers and facilities in the State, the Secretary shall enforce such requirements under subsection (b) insofar as they relate to violations of such requirements occurring in such State.</text></paragraph></subsection><subsection id="H509AE612EE2A4E0D9A7F677A6E473A4D"><enum>(b)</enum><header>Secretarial enforcement authority</header><paragraph id="HE7CBA033BBC64472895BD2E9E24AA614"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">If a provider or facility is found to be in violation specified in subsection (a)(1) by the Secretary, the Secretary may apply a civil monetary penalty with respect to such provider or facility in an amount not to exceed $10,000 per violation. The provisions of subsections (c), (d), (e), (g), (h), (k), and (l) of section 1128A of the Social Security Act shall apply to a civil monetary penalty or assessment under this subsection in the same manner as such provisions apply to a penalty, assessment, or proceeding under subsection (a) of such section.</text></paragraph><paragraph id="HF66FC62D5E8E4A2685DECBC12744F1FE"><enum>(2)</enum><header>Limitation</header><text>The provisions of paragraph (1) shall apply to enforcement of a provision (or provisions) specified in subsection (a)(1) only as provided under subsection (a)(2).</text></paragraph><paragraph id="H4D45C55E29A64FD8AB62BBD78769E624"><enum>(3)</enum><header>Complaint process</header><text display-inline="yes-display-inline">The Secretary shall, through rulemaking, establish a process to receive consumer complaints of violations of such provisions and resolve such complaints within 60 days of receipt of such complaints.</text></paragraph><paragraph id="H336F6BC564FB459CA6B33B469059054D"><enum>(4)</enum><header>Exception</header><text display-inline="yes-display-inline">The Secretary shall waive the penalties described under paragraph (1) with respect to a facility or provider who does not knowingly violate, and should not have reasonably known it violated, section 2799 or 2799A with respect to a participant, beneficiary, or enrollee, if such facility or practitioner, within 30 days of the violation, withdraws the bill that was in violation of such provision and reimburses the health plan or enrollee, as applicable, in an amount equal to the difference between the amount billed and the amount allowed to be billed under the provision, plus interest, at an interest rate determined by the Secretary.</text></paragraph><paragraph id="H2A4EC464F2D44E829AE0200F6F50D4C1"><enum>(5)</enum><header>Hardship exemption</header><text display-inline="yes-display-inline">The Secretary may establish a hardship exemption to the penalties under this subsection.</text></paragraph></subsection><subsection id="H31C4958F8E464D8FBA04DAFEC58B5C36"><enum>(c)</enum><header>Continued Applicability of State Law</header><text display-inline="yes-display-inline">The sections specified in subsection (a)(1) shall not be construed to supersede any provision of State law which establishes, implements, or continues in effect any requirement or prohibition except to the extent that such requirement or prohibition prevents the application of a requirement or prohibition of such a section. </text></subsection></section></part><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H5D57B3551DB0401C93BED17FE7B83321"><enum>(e)</enum><header>Rulemaking for median contracted rates</header><text display-inline="yes-display-inline">Not later than July 1, 2020, the Secretary of Health and Human Services, jointly with the Secretary of Labor, shall establish through rulemaking—</text><paragraph id="H44A9BAD5007649DBB3E980EA4E02C750"><enum>(1)</enum><text>the methodology the sponsor or issuer of a health plan (as defined in subsection (e) of section 2719A of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-19a">42 U.S.C. 300gg–19a</external-xref>), as added by subsection (b) of this section) shall use to determine the median contracted rate (as defined in section 2719A(b) of such Act, as amended by subsection (a) of this section), differentiating by business line;</text></paragraph><paragraph id="H4D236A02ECE2492380D7905CC88320E4"><enum>(2)</enum><text>the information such sponsor or issuer shall share with the nonparticipating provider (as defined in such section) involved when making such a determination; and</text></paragraph><paragraph id="HB49EE35D23844F74BDE0FECEF37D5C9A"><enum>(3)</enum><text display-inline="yes-display-inline">the geographic regions applied for purposes of subparagraph (E) of section 2719A(b)(3), as amended by subsection (a) of this section, taking into account the needs of rural and underserved areas, including health professional shortage areas.</text></paragraph><continuation-text continuation-text-level="subsection">Such rulemaking shall take into account payments that are made by such sponsor or issuer that are not on a fee-for-service basis. Such methodology may account for relevant payment adjustments that take into account facility type (including higher acuity settings and the case-mix of various facility types) that are otherwise taken into account for purposes of determining payment amounts with respect to participating facilities. </continuation-text></subsection><subsection id="HE011928226744732B6A6334501A06716"><enum>(f)</enum><header>Effective date</header><text display-inline="yes-display-inline">The amendments made by subsections (a) and (b) shall apply with respect to plan years beginning on or after January 1, 2021.</text></subsection></section><section id="H65BC3BC7653E47D3BDBE6255327AC7B1" display-inline="no-display-inline" section-type="subsequent-section"><enum>403.</enum><header>Government Accountability Office study on profit- and revenue-sharing in health care</header><subsection id="H54E2EAB34DDA4E4183DFB872058B8032"><enum>(a)</enum><header>Study</header><text>The Comptroller General of the United States shall conduct a study to—</text><paragraph id="H20BC46F70FA14D0492632D3FC916193C"><enum>(1)</enum><text>describe what is known about profit- and revenue-sharing relationships in the commercial health care markets, including those relationships that—</text><subparagraph id="H7B674F45560E40FA8D02C1B1F09AC5C1"><enum>(A)</enum><text>involve one or more—</text><clause id="HCB809F91CA004EB9BE297B1598518D81"><enum>(i)</enum><text>physician groups that practice within a hospital included in the profit- or revenue-sharing relationship, or refer patients to such hospital;</text></clause><clause id="HA746D200CA704F78A59AF499D5036E20"><enum>(ii)</enum><text>laboratory, radiology, or pharmacy services that are delivered to privately insured patients of such hospital;</text></clause><clause id="H3DE590A02FE9413AA11B98B33E58450E"><enum>(iii)</enum><text>surgical services;</text></clause><clause id="H6A17310D4FA94D1F9228FCE39B118871"><enum>(iv)</enum><text>hospitals or group purchasing organizations; or</text></clause><clause id="H50F155D7EAC547EE9B82C9F63990B582"><enum>(v)</enum><text>rehabilitation or physical therapy facilities or services; and</text></clause></subparagraph><subparagraph id="H33004E046216491D89CD3D6F6F8A3AE0"><enum>(B)</enum><text>include revenue- or profit-sharing whether through a joint venture, management or professional services agreement, or other form of gain-sharing contract;</text></subparagraph></paragraph><paragraph id="H47E34D3E22EF4B2B88E082983FA78A1E"><enum>(2)</enum><text>describe Federal oversight of such relationships, including authorities of the Department of Health and Human Services and the Federal Trade Commission to review such relationships and their potential to increase costs for patients, and identify limitations in such oversight; and</text></paragraph><paragraph id="HFAD96FB9C50E4DCDB9E0B35E7AE74E73"><enum>(3)</enum><text>as appropriate, make recommendations to improve Federal oversight of such relationships.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H671B122B68DA49889CB77D1C2DBBADE0"><enum>(b)</enum><header>Report</header><text>Not later than 2 years after the date of the enactment of this Act, the Comptroller General of the United States shall prepare and submit a report on the study conducted under subsection (a) to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Education and Labor and Committee on Energy and Commerce of the House of Representatives.</text></subsection></section><section id="HD415CCB057324B15AF7E83CA5C30608C"><enum>404.</enum><header>State All Payer Claims Databases</header><subsection id="H3E047B9229AA443B80C539BACD381D4F"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services shall make one-time grants to eligible States for the purposes described in subsection (b).</text></subsection><subsection id="H2AF6C8F98C604101BD2278B86F4B7C12"><enum>(b)</enum><header>Uses</header><text>A State may use a grant received under subsection (a) for one of the following purposes:</text><paragraph id="H589F7C897A8A4178B7AE7BB84AF4968D"><enum>(1)</enum><text>To establish an All Payer Claims Database for the State.</text></paragraph><paragraph id="H1B2D5B33DC394E9AA1F978767ADFF578"><enum>(2)</enum><text>To maintain an existing All Payer Claims Databases for the State.</text></paragraph></subsection><subsection id="HF1A5355DCF7F43D9891DDFA163FEF10A"><enum>(c)</enum><header>Eligibility</header><text display-inline="yes-display-inline">To be eligible to receive a grant under subsection (a), a State shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary specifies. Such information shall include, with respect to an All Payer Claims Database for the State, at least specifics on how the State will ensure uniform data collection through the database and the security of such data submitted to and maintained in the database.</text></subsection><subsection id="H24A4DDC0E1C947B2ADA5ED13000F78F4"><enum>(d)</enum><header>All Payer Claims Database</header><text>For purposes of this section, the term <term>All Payer Claims Database</term> means, with respect to a State, a State database that may include medical claims, pharmacy claims, dental claims, and eligibility and provider files, which are collected from private and public payers.</text></subsection><subsection id="HE534678582FA47F2B83BC335C40F605C"><enum>(e)</enum><header>Authorization of appropriations</header><text>To carry out this section, there are authorized to be appropriated $50,000,000, to remain available until expended.</text></subsection></section><section id="H41001913F9D149FCAD2A4C8810592C8B"><enum>405.</enum><header>Air ambulance cost data reporting program</header><subsection id="HCC529D0D9C39438DB08E68A633D91C84"><enum>(a)</enum><header>Cost data reporting program</header><paragraph id="H72610F73587A4E7B80E8C4D333C390C6"><enum>(1)</enum><header>In general</header><text>Not later than 6 months after the date of the promulgation of the rule under subsection (c), and annually thereafter, a provider of emergency air medical services shall submit to the Secretary of Health and Human Services the information specified in subsection (b) with respect to the preceding 180-day period (in the case of the initial period) and the preceding 1-year period (in each subsequent period).</text></paragraph><paragraph id="H9B6CE8DA62934532999624F620BE3559"><enum>(2)</enum><header>Publication</header><text>Not later than 180 days after the date the Secretary of Health and Human Services receives from a provider described in paragraph (1) the information specified in subsection (b), the Secretary shall make publicly available such information.</text></paragraph></subsection><subsection id="HFB0AC6B1C8A943A1A67BE061E77E068A"><enum>(b)</enum><header>Specified information</header><text display-inline="yes-display-inline">Information described in subsection (a) is—</text><paragraph id="HD06CD54D6B1144108DD1EDDDC4CC26D6"><enum>(1)</enum><text>information, with respect to a claim for an item or service—</text><subparagraph id="HBEDE21456A2749429FCC3C77F6875244"><enum>(A)</enum><text>identified as paid by health insurance coverage offered in the group or individual market or a group health plan (including a self-insured plan);</text></subparagraph><subparagraph id="HB5BFD01E579543EE9B03CA262A063197"><enum>(B)</enum><text>identified as paid for non-emergent transport requiring prior authorization and emergent transport;</text></subparagraph><subparagraph id="H3DE0B2BECCF74F479C65757AA0738860"><enum>(C)</enum><text>identified as paid for hospital-affiliated providers and independent providers;</text></subparagraph><subparagraph id="H8939C3BE167E45B1BEDA9D3827B2D58D"><enum>(D)</enum><text>identified as paid for rural transport and urban transport;</text></subparagraph><subparagraph id="H3F1A836992624135A86311D72992C552"><enum>(E)</enum><text>identified as provided using rotor transport and fixed wing transport; and</text></subparagraph><subparagraph id="HC6C66A66A0684B88B710D4D13D9755CF"><enum>(F)</enum><text>identified as furnished by a provider of emergency air medical services that has a contractual relationship with the plan or coverage of an individual for which such item or service is provided and such a provider that does not have a contractual relationship with the plan or coverage or such an individual; and</text></subparagraph></paragraph><paragraph id="H4CCB31705C4B47C0B70E37F5282A0E8D"><enum>(2)</enum><text display-inline="yes-display-inline">cost data for an air ambulance service furnished by such a provider of emergency air medical services that the Secretary of Health and Human Services, in consultation with suppliers and providers of such services, determines appropriate, separated by the cost of air travel and the cost of emergency medical services and supplies.</text></paragraph></subsection><subsection id="H89E1D5FF6E6344B4B5C561C9F6949956"><enum>(c)</enum><header>Rulemaking</header><text>Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall determine the form and manner for submitting the information described in subsection (b) through notice and comment rulemaking.</text></subsection><subsection id="H019AC0F36E1C4B71B094485306500B7B"><enum>(d)</enum><header>Civil monetary penalties</header><paragraph id="HB6C925C87435499DAAAE2CFEEF3E1028"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">A provider of emergency air medical services who violates the requirements of subsection (a)(1) shall be subject to a civil monetary penalty of not more than $10,000 for each act constituting such violation.</text></paragraph><paragraph id="H807B3F4AC2114AB88A77D442F2BD5AAA"><enum>(2)</enum><header>Procedure</header><text>The provisions of section 1128A of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1320a-7a">42 U.S.C. 1320a–7a</external-xref>), other than subsections (a) and (b) and the first sentence of subsection (c)(1) of such subsection, shall apply to civil monetary penalties under this subsection in the same manner as such provisions apply to a penalty or proceeding under such section.</text></paragraph></subsection><subsection id="HDD239A3D674D4FED8B2885F5000A3A1A"><enum>(e)</enum><header>Reporting</header><paragraph id="HDFFCC5DE0C3748F8B40569F48C6771DE"><enum>(1)</enum><header>Secretary of Health and Human Services</header><text display-inline="yes-display-inline">Not later than July 1, 2023, the Secretary of Health and Human Services shall submit to Congress a report summarizing the information and data specified in subsection (b).</text></paragraph><paragraph id="H112FD0F0F5EF4BB5884ABF21D17A3001"><enum>(2)</enum><header>Comptroller General</header><text display-inline="yes-display-inline">Not later than July 1, 2023, the Comptroller General of the United States shall submit to Congress a report that includes—</text><subparagraph id="H683A09412F934B21922952B972E1586F"><enum>(A)</enum><text>an analysis of the cost variation of providers of emergency air ambulance services by geography and status; and</text></subparagraph><subparagraph id="HC52B7AF0DF314B4C9C883083F6DE4D8F"><enum>(B)</enum><text>any other recommendations the Comptroller General determines appropriate, which may include a recommendation of an adequate amount of reimbursement for such services that reflects operational costs of such providers in order to preserve access to emergency air ambulance services.</text></subparagraph></paragraph></subsection><subsection id="H06EAAAD253F24FC6ABFC77566E0663F1"><enum>(f)</enum><header>Limitation</header><text>The information publicly disclosed under subsection (a) and the reports under subsection (f) may not contain any proprietary information.</text></subsection></section><section id="HF056C1B19AC9493C8C5E928EBBA20C6C"><enum>406.</enum><header>Report by Secretary of Labor</header><text display-inline="no-display-inline">Not later than one year after the date of the enactment of this Act, and annually thereafter for each of the following 5 years, the Secretary of Labor shall—</text><paragraph id="H567012873DEC4CB088200F8443689877"><enum>(1)</enum><text>conduct a study of—</text><subparagraph id="H92B2529C41E244558B012FF64E9E1BB1"><enum>(A)</enum><text>the effects of the provisions of, including amendments made by, this Act on premiums and out-of-pocket costs in group health plans, including out-of-pocket costs that are permitted by reason of compliance with section 2799A(d) of the Public Health Service Act, as added by section 2(d);</text></subparagraph><subparagraph id="H976E886BCAAC49449C950380E7EC23A7"><enum>(B)</enum><text>the adequacy of provider networks in group health plans; and</text></subparagraph><subparagraph id="H75242554CC594BC1826A27BCC3EF3856"><enum>(C)</enum><text>such other effects of such provisions, and amendments, as the Secretary deems relevant; and</text></subparagraph></paragraph><paragraph id="HB8687DD0BDA5459A99B791E04D202D65"><enum>(2)</enum><text>submit a report on such study to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Education and Labor and the Committee on Energy and Commerce of the House of Representatives.</text></paragraph></section><section id="H20780A8056D34ADEAAC95552AD45ABC7"><enum>407.</enum><header>Billing statute of limitations</header><text display-inline="no-display-inline">Notwithstanding any other provision of law, a health care provider or health care facility (or health insurance issuer offering health insurance coverage or group health plan) may not initiate a process to seek reimbursement from an individual for a service furnished by such provider or facility to such individual more than a year after such date of service. Any provider, facility, issuer, or plan that bills an individual in violation of the previous sentence shall be subject to a civil monetary penalty in such amount as specified by the Secretary of Health and Human Services.</text></section><section id="HAACC45A0209E4C8F8371579C0965AD81"><enum>408.</enum><header>GAO report on impact of surprise billing provisions</header><text display-inline="no-display-inline">Not later than 3 years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report containing the following:</text><paragraph id="HAD3A444E5CA24F008D93C7E5CB4C4619"><enum>(1)</enum><text display-inline="yes-display-inline">What is known about the impacts of the provisions of this Act, including the amendments made by this Act, on the incidence and prevalence of the furnishing of items and services to individuals enrolled under a group health plan or health insurance coverage by health care providers and health care facilities that do not have a contractual relationship with such plan or such coverage (as applicable) for furnishing such items and services to such an individual.</text></paragraph><paragraph id="HADD781F8EF1F4778BF724D393ADFC477"><enum>(2)</enum><text display-inline="yes-display-inline">What is known about such impacts on provider shortages and accessibility to such providers, focusing on rural and medically underserved communities. </text></paragraph><paragraph id="HCAE0BBD57F614F3FA72B6F9E09022B75"><enum>(3)</enum><text display-inline="yes-display-inline">The number of grants that have been awarded under section 404 (relating to State All Payer Claims Databases) and for what purposes States have used funds made available under such grants.</text></paragraph><paragraph id="HAAC3AD0A269F41E3BCECAE7B9E508713"><enum>(4)</enum><text>An analysis of how data made available through State All Payer Claims Databases receiving funding under such grants has been used.</text></paragraph></section><section id="H1682D92EA7AE442482746BC5D5246670"><enum>409.</enum><header>Report by the Secretary of Health and Human Services</header><text display-inline="no-display-inline"> Not later than one year after the date of the enactment of this Act, and annually thereafter for each of the following 5 years, the Secretary of Health and Human Services shall—</text><paragraph id="HA6DD3FDF4611464CA5D4B4FEAFBCF230"><enum>(1)</enum><text>conduct a study of—</text><subparagraph id="H72115FF49AA14A689310EC084AC03DE9"><enum>(A)</enum><text>the effects of the provisions of, including amendments made by, this Act on premiums and out-of-pocket costs with respect to individual health insurance coverage and small group health plans;</text></subparagraph><subparagraph id="H7D2604FD8B8841D4814A704F7A9C42ED"><enum>(B)</enum><text>the adequacy of provider networks with respect to individual health insurance coverage and small group health plans, taking into consideration maximum travel time and distance; and</text></subparagraph><subparagraph id="HD33E0B8315D647A5B89E15594ADE431D"><enum>(C)</enum><text>such other effects of such provisions, and amendments, as the Secretary deems relevant; and</text></subparagraph></paragraph><paragraph id="HEB6D25C84E5F4ADD95CFD243E6AC2130"><enum>(2)</enum><text>submit a report on such study to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Education and Labor and the Committee on Energy and Commerce of the House of Representatives.</text></paragraph></section></title><title id="HB1FCA295B6474859A9F6321DAB166ACC"><enum>V</enum><header>Territories Health Care Improvement Act</header><section id="HAE8F4E9EEF834F8BAA542AC02303B9E7" section-type="subsequent-section"><enum>501.</enum><header>Short title</header><text display-inline="no-display-inline">This title may be cited as the <quote>Territories Health Care Improvement Act</quote>.</text></section><section id="HA1110EAD15B8449BB50CB107BE169585" section-type="subsequent-section"><enum>502.</enum><header>Medicaid payments for Puerto Rico and the other territories for certain fiscal years</header><subsection id="H2F9720CC22714FFE9A7328EFE30621B5"><enum>(a)</enum><header>Treatment of cap</header><text display-inline="yes-display-inline">Section 1108(g) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1308">42 U.S.C. 1308(g)</external-xref>) is amended—</text><paragraph id="H165AFF27CD9145AC9E510C50EF8E4C63"><enum>(1)</enum><text>in paragraph (2)—</text><subparagraph id="H4EDAA41C3CC94D9E8EF246CBB8CCEB8D"><enum>(A)</enum><text>in the matter preceding subparagraph (A), by striking <quote>subject to and section 1323(a)(2) of the Patient Protection and Affordable Care Act paragraphs (3) and (5)</quote> and inserting <quote>subject to section 1323(a)(2) of the Patient Protection and Affordable Care Act and paragraphs (3) and (5)</quote>;</text></subparagraph><subparagraph id="HBA5110EC796C4D9CAAC88326196A7039"><enum>(B)</enum><text>in subparagraph (A)—</text><clause id="HA1C0A4DECFF94929AA6074ACB3CAEE89"><enum>(i)</enum><text>by striking <quote>Puerto Rico shall not exceed the sum of</quote> and inserting </text><quoted-block style="OLC" id="HE1B5C5D24A8546FDB0D79ECFFCA1F3DB" display-inline="yes-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><text>Puerto Rico shall not exceed—</text><clause id="HB0F05EC9F66C4F8B9D052A43D62FED93"><enum>(i)</enum><text display-inline="yes-display-inline">except as provided in clause (ii), the sum of</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></clause><clause id="HF63FFE0C55B84A02AED772BDD6F65213"><enum>(ii)</enum><text>by striking <quote>$100,000;</quote> and inserting <quote>$100,000; and</quote>; and </text></clause><clause id="HDD08C7F2239142889FEAEEAFCED1B3A2"><enum>(iii)</enum><text>by adding at the end the following new clause:</text><quoted-block style="OLC" id="HEF61F233064448E4BC2BE4A969EC23DB" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><clause id="HF15A4D78EF884F00B8DD4F465FCF2ADD"><enum>(ii)</enum><text display-inline="yes-display-inline">for each of fiscal years 2020 through 2023, the amount specified in paragraph (6) for each such fiscal year;</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></clause></subparagraph><subparagraph id="H8FACC90ED90F4E11A571F0FC17A15536"><enum>(C)</enum><text>in subparagraph (B)—</text><clause id="H215145E18A8840B28932B1630EFCBB0F"><enum>(i)</enum><text>by striking <quote>the Virgin Islands shall not exceed the sum of</quote> and inserting </text><quoted-block style="OLC" id="H89CB8055F8334E83B63D0039FCE44C4F" display-inline="yes-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><text>the Virgin Islands shall not exceed—</text><clause id="HAD9C3EC060AF4716989852512E1F435F"><enum>(i)</enum><text display-inline="yes-display-inline">except as provided in clause (ii), the sum of</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></clause><clause id="HB2DDACC5FD3B4DE4A856FCF921546D41"><enum>(ii)</enum><text>by striking <quote>$10,000;</quote> and inserting <quote>$10,000; and</quote>; and</text></clause><clause id="HA3556DE7CA83400D9F2BE26627D2B674"><enum>(iii)</enum><text>by adding at the end the following new clause:</text><quoted-block style="OLC" id="H5CB4CB4F9F434934AC1C98150B3D7D5F" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><clause id="H73E7D338501B4AA4AE4EA6E488067851"><enum>(ii)</enum><text display-inline="yes-display-inline">for each of fiscal years 2020 through 2025, $126,000,000;</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></clause></subparagraph><subparagraph id="H3CD43873A3C34A678AB7D1FFDC01F096"><enum>(D)</enum><text>in subparagraph (C)—</text><clause id="H1D022DC1CE254948BCD2215940D8FC1B"><enum>(i)</enum><text>by striking <quote>Guam shall not exceed the sum of</quote> and inserting </text><quoted-block style="OLC" id="H691F77E371FF45308F59A8DAA428DB86" display-inline="yes-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><text>Guam shall not exceed—</text><clause id="H1ECB4BDF646B41C08140D2CBEA5A0129"><enum>(i)</enum><text display-inline="yes-display-inline">except as provided in clause (ii), the sum of</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></clause><clause id="H61FB7141648C4794ADDB94B742627223"><enum>(ii)</enum><text>by striking <quote>$10,000;</quote> and inserting <quote>$10,000; and</quote>; and</text></clause><clause id="H3E03B7C23BCB4BC0BA1F73225B54CB64"><enum>(iii)</enum><text>by adding at the end the following new clause:</text><quoted-block style="OLC" id="HB0F33C74608B4E91AE419306D707B483" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><clause id="HCF74247D99EB43708632114697E72C8F"><enum>(ii)</enum><text display-inline="yes-display-inline">for each of fiscal years 2020 through 2025, $127,000,000;</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></clause></subparagraph><subparagraph id="H5D88041E990349468836F3BF086A3DB8"><enum>(E)</enum><text>in subparagraph (D)—</text><clause id="H6DB2DD762340475A93AFC9A0A6F2AE2C"><enum>(i)</enum><text>by striking <quote>the Northern Mariana Islands shall not exceed the sum of</quote> and inserting </text><quoted-block style="OLC" id="HEA208DE7E79544AE974A6C51004D3AC7" display-inline="yes-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><text>the Northern Mariana Islands shall not exceed—</text><clause id="HFDC6E0575DB04551B4EA3709B99EC431"><enum>(i)</enum><text display-inline="yes-display-inline">except as provided in clause (ii), the sum of</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></clause><clause id="H3AE42DFB459C4D6A973BF9F5D398031C"><enum>(ii)</enum><text>by adding at the end the following new clause:</text><quoted-block style="OLC" id="HE4588E8C7BDC4795A16307A07882C16C" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><clause id="HD9EBB44552B54B81B4CC442743F5D915"><enum>(ii)</enum><text display-inline="yes-display-inline">for each of fiscal years 2020 through 2025, $60,000,000; and</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></clause></subparagraph><subparagraph id="HEF84ED99EED9486DA5508406F04C79EB"><enum>(F)</enum><text>in subparagraph (E)—</text><clause id="H67D25AF333F541F4BD015A851FE5428B"><enum>(i)</enum><text>by striking <quote>American Samoa shall not exceed the sum of</quote> and inserting </text><quoted-block style="OLC" id="HB5B70D7ACF98429EBC83A7548051DE63" display-inline="yes-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><text>American Samoa shall not exceed—</text><clause id="HE4AC102BA2E840B6A6C4CB681D4C4551"><enum>(i)</enum><text display-inline="yes-display-inline">except as provided in clause (ii), the sum of</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></clause><clause id="H9B12AAE8B4E941DD81CCD7AA0C541FA5"><enum>(ii)</enum><text>by striking <quote>$10,000.</quote> and inserting <quote>$10,000; and</quote>; and</text></clause><clause id="H27CAF2692B864D26818DE2DCAFB54EC1"><enum>(iii)</enum><text>by adding at the end the following new clause:</text><quoted-block style="OLC" id="H5C362296D4554B68B98C7128DDF882C2" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><clause id="H91FF3B04AC7A42589899C0D30A4A08BF"><enum>(ii)</enum><text display-inline="yes-display-inline">for each of fiscal years 2020 through 2025, $84,000,000.</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></clause></subparagraph></paragraph><paragraph id="H7008310440FD427881CEE5EC74333287"><enum>(2)</enum><text>by adding at the end the following new paragraph:</text><quoted-block style="OLC" id="H1AA7E1484D4345F1A0D706DA8587D534" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><paragraph id="H35156F41D6DF4BF0932EF7FC501B8B08"><enum>(6)</enum><header>Application to Puerto Rico for fiscal years <enum-in-header>2020</enum-in-header> through <enum-in-header>2023</enum-in-header></header><text display-inline="yes-display-inline">For purposes of paragraph (2)(A)(ii), the amount specified in this paragraph is—</text><subparagraph id="H3D040B3BE2A340308B637170F5334429"><enum>(A)</enum><text display-inline="yes-display-inline">for fiscal year 2020, $2,823,188,000;</text></subparagraph><subparagraph id="H37110810F59240618B2AE78DAEA25F99"><enum>(B)</enum><text display-inline="yes-display-inline">for fiscal year 2021, $2,919,072,000;</text></subparagraph><subparagraph id="H57396E4672A9474BB94E1741D4332C7A"><enum>(C)</enum><text display-inline="yes-display-inline">for fiscal year 2022, $3,012,610,000; and</text></subparagraph><subparagraph id="H9BB858E197DE4DB28F4B018EB293EEE8"><enum>(D)</enum><text display-inline="yes-display-inline">for fiscal year 2023, $3,114,331,000.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="H40739AFC6383462FAA984F707A16D2B5"><enum>(b)</enum><header>Treatment of funding under enhanced allotment program</header><text>Section 1935(e) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396u-5">42 U.S.C. 1396u–5(e)</external-xref>) is amended—</text><paragraph id="HCD0938FFC7F64A78B94DF18860C46090"><enum>(1)</enum><text>in paragraph (1)(B), by striking <quote>if the State</quote> and inserting <quote>subject to paragraph (4), if the State</quote>;</text></paragraph><paragraph id="HC0E293701B7C44EC9789B0CEB9888524"><enum>(2)</enum><text>by redesignating paragraph (4) as paragraph (5); and</text></paragraph><paragraph id="H672F130C5E6F4EBCABFFF904EF1EFC4F"><enum>(3)</enum><text>by inserting after paragraph (3) the following new paragraph:</text><quoted-block style="OLC" id="H1A84BA4D28524A25B9E7BB70DE8FABF9" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><paragraph id="H671C81663C8F4272AF5D9984C5357A89"><enum>(4)</enum><header>Treatment of funding for certain fiscal years</header><subparagraph id="H36CC4E21886747C198729F9CB3436C00"><enum>(A)</enum><header>Puerto Rico</header><text display-inline="yes-display-inline">Notwithstanding paragraph (1)(B), in the case that Puerto Rico establishes and submits to the Secretary a plan described in paragraph (2) with respect to any of fiscal years 2020 through 2023, the amount specified in paragraph (3) for Puerto Rico for such a year shall be taken into account in applying subparagraph (A)(ii) of section 1108(g)(2) for such year.</text></subparagraph><subparagraph id="H21B9311A4BF34E6582B5A25D3F430119"><enum>(B)</enum><header>Other territories</header><text display-inline="yes-display-inline">Notwithstanding paragraph (1)(B), in the case that the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa establishes and submits to the Secretary a plan described in paragraph (2) with respect to any of fiscal years 2020 through 2025, the amount specified in paragraph (3) for the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, as the case may be, shall be taken into account in applying, as applicable, subparagraph (B)(ii), (C)(ii), (D)(ii), or (E)(ii) of section 1108(g)(2) for such year.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="H38376F8CF52F40FD9790B2F74C9B5D8F"><enum>(c)</enum><header>Increased FMAP</header><text>Section 1905 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(b)</external-xref>) is amended—</text><paragraph id="HC66B1C8B13CD470EBBE7C0F9F9024413"><enum>(1)</enum><text>in subsection (b), by striking <quote>and (aa)</quote> and inserting <quote>(aa), and (ff)</quote>; and</text></paragraph><paragraph id="H07CF8787A8EC4B5C8F49E4CA168B7286"><enum>(2)</enum><text>by adding at the end the following new subsection:</text><quoted-block style="OLC" id="HA620D51CFD4F477DB7D4CA79788194E9" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><subsection id="H67C0B97FAD3A4C31A6295D2AC4036C2E"><enum>(ff)</enum><header>Temporary increase in FMAP for territories for certain fiscal years</header><paragraph id="H6E8D624083CF4A3EBEC897DB4F69A170"><enum>(1)</enum><header>Puerto Rico</header><text display-inline="yes-display-inline">Notwithstanding subsection (b) and subject to subsection (z)(2), the Federal medical assistance percentage for Puerto Rico shall be equal to—</text><subparagraph id="HF4D7A7176F8B480BB9075346793CD0BD"><enum>(A)</enum><text display-inline="yes-display-inline">83 percent for fiscal years 2020 and 2021; and</text></subparagraph><subparagraph id="H98D0C9A9252C4684AD8B1EC1AEDF8261"><enum>(B)</enum><text display-inline="yes-display-inline">76 percent for fiscal years 2022 and 2023.</text></subparagraph></paragraph><paragraph id="H5DBBDF5780D649509AD8E3581F9ED26E"><enum>(2)</enum><header>Virgin Islands</header><text display-inline="yes-display-inline">Notwithstanding subsection (b) and subject to subsection (z)(2), the Federal medical assistance percentage for the Virgin Islands shall be equal to—</text><subparagraph id="H07AAC775B82B48E280AA2B8EA62E3E51"><enum>(A)</enum><text>100 percent for fiscal year 2020;</text></subparagraph><subparagraph id="H802520EE0B544BF4AC48852DD08FF406"><enum>(B)</enum><text>83 percent for fiscal years 2021 through 2024; and</text></subparagraph><subparagraph id="HA54E48BDC3AD4FFC9921F43FEFB24DB0"><enum>(C)</enum><text>76 percent for fiscal year 2025.</text></subparagraph></paragraph><paragraph id="H9FDA5465FEB147A9A900EE52471134D3"><enum>(3)</enum><header>Other territories</header><text display-inline="yes-display-inline">Notwithstanding subsection (b) and subject to subsection (z)(2), the Federal medical assistance percentage for Guam, the Northern Mariana Islands, and American Samoa shall be equal to—</text><subparagraph id="H0ADF31485A4748C483FA22028BFAFBE9"><enum>(A)</enum><text>100 percent for fiscal years 2020 and 2021;</text></subparagraph><subparagraph id="HAAF5F22294774FC7AD528A91AE839342"><enum>(B)</enum><text>83 percent for fiscal years 2022 through 2024; and</text></subparagraph><subparagraph id="H98B85A0D8DC744C39CC5E153E44C0B82"><enum>(C)</enum><text>76 percent for fiscal year 2025.</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="H2339BEC7F7504CA8B935357CD5C88CC2" commented="no"><enum>(d)</enum><header>Annual report</header><text display-inline="yes-display-inline">Section 1108(g) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1308">42 U.S.C. 1308(g)</external-xref>), as amended by subsection (a), is further amended by adding at the end the following new paragraph:</text><quoted-block style="OLC" id="HAC7B5707E7A64F2B908053B6E66EA8AF" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><paragraph id="HD8A7BB55394945EA9AF7447EF506544B"><enum>(7)</enum><header>Annual report</header><subparagraph id="HBC6C4FAC267A4FF7B42360E2504F0E22"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than the date that is 180 days after the end of each fiscal year (beginning with fiscal year 2020 and ending with fiscal year 2025), in the case that a specified territory receives a Medicaid cap increase, or an increase in the Federal medical assistance percentage for such territory under section 1905(ff), for such fiscal year, such territory shall submit to the Chair and Ranking Member of the Committee on Energy and Commerce of the House of Representatives and the Chair and Ranking Member of the Committee on Finance of the Senate a report that describes how such territory has used such Medicaid cap increase, or such increase in the Federal medical assistance percentage, as applicable, to increase access to health care under the State Medicaid plan of such territory under title XIX (or a waiver of such plan). Such report may include—</text><clause id="H2AD94077D57B4F69BD3D57AE5F6E069F"><enum>(i)</enum><text>the extent to which such territory has, with respect to such plan (or waiver)—</text><subclause id="HC07560811E56413F84BF49E2A77C96BB"><enum>(I)</enum><text>increased payments to health care providers;</text></subclause><subclause id="H01891B94E3D14B399F0A1E8B1F29DBC5"><enum>(II)</enum><text>increased covered benefits;</text></subclause><subclause id="H068B03526FBE4EFEAC9908E18FE64ADF"><enum>(III)</enum><text>expanded health care provider networks; or</text></subclause><subclause id="H968A10FE11BF49819DD26820CCE6A5A8"><enum>(IV)</enum><text>improved in any other manner the carrying out of such plan (or waiver); and</text></subclause></clause><clause id="HCF509D8177044825A8282B508746A40A"><enum>(ii)</enum><text>any other information as determined necessary by such territory.</text></clause></subparagraph><subparagraph id="H1498CD639EE9475E94672B114FCAAC2D"><enum>(B)</enum><header>Definitions</header><text>In this paragraph:</text><clause id="HBA9AB3CCFC3F40E791F2A52772BDB670"><enum>(i)</enum><header>Medicaid cap increase</header><text display-inline="yes-display-inline">The term <term>Medicaid cap increase</term> means, with respect to a specified territory and fiscal year, any increase in the amounts otherwise determined under this subsection for such territory for such fiscal year by reason of the amendments made by section 502(a) of the Territories Health Care Improvement Act.</text></clause><clause id="H7569AF35205A4A20894D99D84C4402D4"><enum>(ii)</enum><header>Specified territory</header><text display-inline="yes-display-inline">The term <term>specified territory</term> means Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="HF3D952639C92424E8963877463600E4F"><enum>503.</enum><header>Application of certain requirements under Medicaid program to certain territories</header><subsection id="H2560080228A5439D9FE848558C1ED95D"><enum>(a)</enum><header>Application of payment error rate measurement requirements to Puerto Rico</header><text display-inline="yes-display-inline">Section 1903(u)(4) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b(u)(4)</external-xref>) is amended—</text><paragraph id="H8EF3C4F57C06464D955D6227ABB621FC"><enum>(1)</enum><text>by striking <quote>to Puerto Rico, Guam</quote> and inserting <quote>to Guam</quote>; and </text></paragraph><paragraph id="HA07159B93BC249968971F9B4F6E05C15"><enum>(2)</enum><text>by striking <quote>or American Samoa.</quote> and inserting <quote>or American Samoa, or, for fiscal years before fiscal year 2023, to Puerto Rico.</quote>.</text></paragraph></subsection><subsection id="H9857C5FD64804AF1A9879709420350DB"><enum>(b)</enum><header>Application of asset verification program requirements to Puerto Rico and Virgin Islands</header><text>Section 1940(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396w">42 U.S.C. 1396w(a)</external-xref>) is amended—</text><paragraph id="H665442A3368F430ABA42EC4D50B56F03"><enum>(1)</enum><text>in paragraph (3)(A), by adding at the end the following new clause:</text><quoted-block style="OLC" id="H8C497FB3BC2B46F7AA6467811246E3A4" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><clause id="H17E263189F944A32AB92ACB0BB0274C6"><enum>(iii)</enum><header>Implementation in Puerto Rico and Virgin Islands</header><text display-inline="yes-display-inline">The Secretary shall require Puerto Rico to implement an asset verification program under this subsection by the end of fiscal year 2022 and the Virgin Islands to implement such a program by the end of fiscal year 2023.</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="H394926469E274C9687F01273F13FA373"><enum>(2)</enum><text>in paragraph (4)—</text><subparagraph id="H24D0857E916D48758647D4E031B35850"><enum>(A)</enum><text>in the paragraph heading, by striking <quote><header-in-text level="paragraph" style="OLC">Exemption of territories</header-in-text></quote> and inserting <quote><header-in-text level="paragraph" style="OLC">Exemption of certain territories</header-in-text></quote>; and</text></subparagraph><subparagraph id="H2B8ADD7DFB3B4A48A5AEAFB3E8D44CE4"><enum>(B)</enum><text>by striking <quote>and the District of Columbia</quote> and inserting <quote>, the District of Columbia, Puerto Rico, and the Virgin Islands</quote>.</text></subparagraph></paragraph></subsection><subsection id="HDFF1EC364B1C40F39177DA2768806A4A"><enum>(c)</enum><header>Application of certain data reporting and program integrity requirements to Northern Mariana Islands, American Samoa, and Guam</header><paragraph id="H7CAE021FC92849FFB2321F4DDEAB0676"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1902 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref>) is amended by adding at the end the following new subsection:</text><quoted-block style="OLC" id="H6A30F877330446A0BE224485DEBADB2E" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><subsection id="HF5526657361F4CDEB7B10FD0E2E0C6A2"><enum>(qq)</enum><header>Application of certain data reporting and program integrity requirements to Northern Mariana Islands, American Samoa, and Guam</header><text display-inline="yes-display-inline">Not later than October 1, 2023, the Northern Mariana Islands, American Samoa, and Guam shall—</text><paragraph id="HC278BE8B68EA4276AC9B45E523204D48"><enum>(1)</enum><text>implement methods, satisfactory to the Secretary, for the collection and reporting of reliable data to the Transformed Medicaid Statistical Information System (T–MSIS) (or a successor system); and</text></paragraph><paragraph id="HB164659F601840D2936B110B92EFDF43"><enum>(2)</enum><text display-inline="yes-display-inline">demonstrate progress in establishing a State medicaid fraud control unit described in section 1903(q).</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph id="HCF100073D43148079837631700098478"><enum>(2)</enum><header>Conforming amendment</header><text display-inline="yes-display-inline">Section 1902(j) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(j)</external-xref>) is amended—</text><subparagraph id="HCA04E7751A424EE59451F2FC279435AB"><enum>(A)</enum><text>by striking <quote>or the requirement</quote> and inserting <quote>, the requirement</quote>; and</text></subparagraph><subparagraph id="HD084691B47CA4C35A552B7181FBE0ECF"><enum>(B)</enum><text>by inserting before the period at the end the following: <quote>, or the requirement under subsection (qq)(1) (relating to data reporting)</quote>.</text></subparagraph></paragraph></subsection></section><section id="H8720834EFFDD4DC98F5C83A4392AD185"><enum>504.</enum><header>Additional program integrity requirements</header><subsection id="HE82681300D0F4035B6C4B32EEC939670"><enum>(a)</enum><header>Audit relating to fraud, waste, and abuse</header><text display-inline="yes-display-inline">Not sooner than the date that is one year after the date of the enactment of this Act, the Inspector General of the Department of Health and Human Services (referred to in this section as the <quote>Inspector General</quote>) shall conduct an audit of Puerto Rico with respect to any part of the administration of Puerto Rico’s State plan under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) (or a waiver of such plan), such as contracting protocols, denials of care, and financial management, that the Inspector General determines to be at high risk for waste, fraud, or abuse.</text></subsection><subsection id="H609D31ACFFF54F3E83FBD896D5EA5C8E"><enum>(b)</enum><header>Plan for audits and investigations of contracting practices</header><text display-inline="yes-display-inline">Not later than the date that is one year after the date of the enactment of this Act, the Inspector General shall develop and submit to Congress a plan for auditing and investigating contracting practices relating to Puerto Rico’s State plan under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) (or a waiver of such plan).</text></subsection><subsection id="H31763A09C62041B28122DFE332760BA0"><enum>(c)</enum><header>Report on contracting oversight and approval</header><text display-inline="yes-display-inline">Not later than the date that is two years after the date of the enactment of this Act, the Comptroller General of the United States shall issue, and submit to the Chair and Ranking Member of the Committee on Energy and Commerce of the House of Representatives and the Chair and Ranking Member of the Committee on Finance of the Senate, a report on contracting oversight and approval with respect to Puerto Rico’s State plan under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) (or a waiver of such plan). Such report shall—</text><paragraph id="HC992DF6D429F4F6098A51398B6B53BEA"><enum>(1)</enum><text>examine—</text><subparagraph id="HFD8749656F404D5C8AD9E73990B9BE9A"><enum>(A)</enum><text>the process used by Puerto Rico to evaluate bids and award contracts under such plan (or waiver);</text></subparagraph><subparagraph id="H4CE394BB600141B19090BA148CC74CF3"><enum>(B)</enum><text>which contracts are not subject to competitive bidding or requests for proposals under such plan (or waiver); and</text></subparagraph><subparagraph id="H8AA0FB93C1BD4D4480F2E42400519799"><enum>(C)</enum><text>oversight by the Centers for Medicare &amp; Medicaid Services of contracts awarded under such plan (or waiver); and</text></subparagraph></paragraph><paragraph id="H6E82558F427946C69974F311FA37B1C0"><enum>(2)</enum><text>include any recommendations for Congress, the Secretary of Health and Human Services, or Puerto Rico relating to changes that the Inspector General determines necessary to improve the program integrity of such plan (or waiver).</text></paragraph></subsection><subsection id="HDA4CE194AC98413DBF0870D36DBCCDB9"><enum>(d)</enum><header>Reevaluation of waivers of Medicaid fraud control unit requirement</header><text display-inline="yes-display-inline">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 shall—</text><paragraph id="H28627627D3C1411D80D3D292FC34AB45"><enum>(1)</enum><text>reevaluate any waiver approved (and in effect as of the date of the enactment of this Act) for Guam, the Northern Mariana Islands, or American Samoa under subsection (a)(61) or subsection (j) of section 1902 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref>) with respect to the requirement to establish a State medicaid fraud control unit (as described in section 1903(q) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b(q)</external-xref>); and</text></paragraph><paragraph id="HB00A75B5D86D416BBC4F403058E1B861"><enum>(2)</enum><text display-inline="yes-display-inline">determine whether any such waiver should continue to be approved with respect to Guam, the Northern Mariana Islands, or American Samoa, respectively, after October 1, 2023.</text></paragraph></subsection><subsection id="HCE67723A40514B31A810338BB0DD972A"><enum>(e)</enum><header>System for tracking Federal funding provided to Puerto Rico</header><text>Section 1902 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref>), as amended by section 503(c), is further amended by adding at the end the following new subsection:</text><quoted-block style="OLC" id="H2A481EB025B6482C9EC43873D7A32340" display-inline="no-display-inline" changed="added" reported-display-style="italic" committee-id="HIF00"><subsection id="H3393641E74A74E1EACF86B1BBA6C99C4"><enum>(rr)</enum><header>Program integrity requirements for Puerto Rico</header><paragraph id="H31DC08BA62B449DF816D801B3BC65DDD"><enum>(1)</enum><header>System for tracking Federal funding provided to Puerto Rico</header><subparagraph id="HE9BD70318DC44246A71423CB0DD99545"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Puerto Rico shall establish and maintain a system for tracking any amounts paid by the Federal Government to Puerto Rico with respect to the State plan of Puerto Rico (or a waiver of such plan). Under such system, Puerto Rico shall ensure that information is available, with respect to each quarter in a fiscal year (beginning with the first quarter beginning on or after the date that is one year after the date of the enactment of this subsection), on the following:</text><clause id="HC500E4F957C54A2696A93E199B128B40"><enum>(i)</enum><text>In the case of a quarter other than the first quarter of such fiscal year—</text><subclause id="H1B5B7B257A8E413EAFA40801C19A1208"><enum>(I)</enum><text>the total amount expended by Puerto Rico during any previous quarter of such fiscal year under the State plan of Puerto Rico (or a waiver of such plan); and</text></subclause><subclause id="H35E162CFF75D430597F529CC5F94AE4E"><enum>(II)</enum><text>a description of how such amount was so expended.</text></subclause></clause><clause id="H05AE9A4F19B84A988833EF655F8CAF98"><enum>(ii)</enum><text>The total amount that Puerto Rico expects to expend during the quarter under the State plan of Puerto Rico (or a waiver of such plan), and a description of how Puerto Rico expects to expend such amount.</text></clause></subparagraph><subparagraph id="H5234E1C7665C4236B5E70FBE70EA5AA0"><enum>(B)</enum><header>Report to CMS</header><text>For each quarter with respect to which Puerto Rico is required under subparagraph (A) to ensure that information described in such subparagraph is available, Puerto Rico shall submit to the Administrator of the Centers for Medicare &amp; Medicaid Services a report on such information for such quarter.</text></subparagraph></paragraph><paragraph id="H5E3D56C7BCFF4EE8AC0436D465430E08"><enum>(2)</enum><header>Submission of documentation on contracts upon request</header><text display-inline="yes-display-inline">Puerto Rico shall, upon request, submit to the Administrator of the Centers for Medicare &amp; Medicaid Services all documentation requested with respect to contracts awarded under the State plan of Puerto Rico (or a waiver of such plan).</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section></title></legis-body><official-title-amendment>Amend the title so as to read: <quote>A bill to reauthorize and extend funding for critical public health programs that improve access to health care and strengthen the health care workforce, to extend provisions of the Medicare program, to strengthen the Medicaid program in the territories, to protect health care consumers from surprise billing practices, and for other purposes.</quote>.</official-title-amendment><endorsement display="yes"><action-date>December 31, 2020</action-date><action-desc>Committee on <committee-name committee-id="HPW00">Transportation and Infrastructure</committee-name> discharged; committed to the Committee of the Whole House on the State of the Union and ordered to be printed</action-desc></endorsement></bill> 

