[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 861 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 861
To amend title XVIII of the Social Security Act to prevent surprise
billing practices, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 30, 2019
Mr. Doggett (for himself, Mr. Cartwright, Ms. Judy Chu of California,
Mr. Cicilline, Mr. Cohen, Mr. Courtney, Mr. Danny K. Davis of Illinois,
Ms. DeLauro, Mr. Grijalva, Ms. Hill of California, Ms. Jayapal, Ms.
Kaptur, Ms. Kelly of Illinois, Mr. Khanna, Ms. Kuster of New Hampshire,
Ms. Lee of California, Mr. Lewis, Ms. Moore, Ms. Norton, Ms. Pingree,
Mr. Pocan, Ms. Velazquez, Ms. Schakowsky, Mr. Lipinski, Ms. DeGette,
Mr. Espaillat, Mr. Welch, Ms. Porter, and Mr. Langevin) introduced the
following bill; which was referred to the Committee on Ways and Means,
and in addition to the Committee on Energy and Commerce, for a period
to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to prevent surprise
billing practices, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``End Surprise Billing Act of 2019''.
SEC. 2. PREVENTING SURPRISE BILLING PRACTICES.
(a) Condition of Participation in Medicare.--Section 1866 of the
Social Security Act (42 U.S.C. 1395cc) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (X), by striking ``and'' at the
end;
(B) in subparagraph (Y), by striking at the end the
period and inserting ``, and''; and
(C) by inserting after such subparagraph (Y) the
following new subparagraph:
``(Z) in the case of a hospital or critical access
hospital, to adopt and enforce a policy to ensure
compliance with the requirements of paragraphs (1) and
(4) of subsection (l) and to meet the requirements of
such paragraphs (relating to the prevention of surprise
billing practices).''; and
(2) by adding at the end the following new subsection:
``(l) Requirement for Purposes of Preventing Surprise Billing.--
``(1) In general.--For purposes of subsection (a)(1)(Z),
the requirements described in this paragraph are, with respect
to a hospital or critical access hospital, in the case of an
individual with health benefits coverage, including benefits
under a group health plan or health insurance coverage offered
in the group or individual market (as such terms are defined in
section 2791 of the Public Health Service Act) or under this
title, title XIX, title XXI, or another government-sponsored
health plan or program, who seeks to be furnished items or
services or is to be furnished items or services by the
hospital or critical access hospital (including by a provider
of services or supplier that furnishes items or services at the
hospital or critical access hospital), that the hospital or
critical access hospital--
``(A)(i) provides to the individual (or to a
representative of the individual), on the date on which
the individual makes an appointment to be furnished
such items or services, if applicable, and on the date
on which the individual is furnished such items and
services, a written notice specified by the Secretary
through rulemaking that--
``(I) contains the information required
under paragraph (2); and
``(II) is signed and dated by the
individual; and
``(ii) retains a copy of each such notice for a
period specified through rulemaking by the Secretary;
and
``(B) in the case that such hospital or critical
access hospital (or provider of services or supplier
furnishing services at such hospital or critical access
hospital) is not within the health care provider
network or otherwise a participating provider of
services or supplier with respect to such health
benefits coverage of such individual, obtains from the
individual the consent described in paragraph (3).
``(2) Information included in notice.--The notice described
in paragraph (1)(A) shall include, with respect to an
individual with health benefits coverage described in paragraph
(1) who seeks to be furnished items or services or is to be
furnished items or services by a hospital or critical access
hospital (including by a provider of services or supplier that
furnishes items or services at the hospital or critical access
hospital), a notification of each of the following:
``(A) Whether the hospital or critical access
hospital is not within the health care provider network
or otherwise a participating provider of services or
supplier with respect to such health benefits coverage
of such individual.
``(B) If the hospital or critical access hospital
is not within such network or otherwise such a
participating provider or supplier, the estimated
amount that the hospital or critical access hospital
will charge the individual for such items and services
in excess of any cost sharing obligations that the
individual would otherwise have under such health
benefits coverage for such items and services if the
hospital or critical access hospital were within such
network or otherwise participating in such coverage.
``(C) Whether any of the providers of services or
suppliers furnishing items or services at the hospital
or critical access hospital who will furnish the items
or services to the individual are not within the health
care provider network or otherwise a participating
provider of services or supplier with respect to such
health benefits coverage of such individual.
``(D) If any of such providers of services or
suppliers are not within such network or otherwise such
a participating provider or supplier, the estimated
amount that such providers of services or suppliers
will charge the individual for such items and services
in excess of any cost sharing obligations that the
individual would otherwise have for such items and
services if the providers of services or suppliers were
within the such network or otherwise participating in
such coverage.
``(3) Consent described.--For purposes of paragraph (1)(B),
the consent described in this paragraph, with respect to an
individual with health benefits coverage described in paragraph
(1) who is to be furnished items or services by a hospital or
critical access hospital (or provider of services or supplier
furnishing services at such hospital or critical access
hospital) that is not within the health care provider network
or otherwise a participating provider of services or supplier
with respect to such health benefits coverage of such
individual, is a document specified by the Secretary through
rulemaking that is signed by the individual (or by a
representative of the individual) not less than 24 hours prior
to the individual being furnished such items or services by
such hospital, critical access hospital, provider of services,
or supplier, respectively, and that--
``(A) acknowledges that the individual has been--
``(i) provided with a written estimate of
the charge that the individual will be assessed
for the items or services anticipated to be
furnished to the individual by the hospital,
critical access hospital, provider of services,
or supplier that is not within such network or
otherwise such a participating provider of
services or supplier; and
``(ii) informed that the payment of such
charge by the individual will not accrue toward
any limitation that the health benefits
coverage places upon the annual out-of-pocket
expenses to be paid by the individual or upon
the in-network deductible to be paid by the
individual; and
``(B) documents the consent of the individual to--
``(i) be furnished with such items or
services by such hospital, critical access
hospital, provider of services, or supplier, as
applicable; and
``(ii) in the case that the individual is
so furnished such items or services, be charged
an amount approximate to the estimated charge
described in subparagraph (A)(i) with respect
to such items or services.
``(4) Limitations on payment by individual.--For purposes
of subsection (a)(1)(Z), the requirements under this paragraph
are the following:
``(A) In case of noncompliance by hospitals and
critical access hospitals.--In the case of an
individual with health benefits coverage described in
paragraph (1) who is furnished items or services by a
hospital or critical access hospital (or provider of
services or supplier furnishing services at such
hospital or critical access hospital) that is not
within the health care provider network or otherwise a
participating provider of services or supplier with
respect to such health benefits coverage of such
individual, if the hospital or critical access hospital
does not comply with the requirements of paragraph (1)
with respect to the furnishing of such items or
services to such individual, the hospital or critical
access hospital (or, as applicable, the provider of
services or supplier furnishing such items or services
to such individual) may not charge the individual more
than the amount that the individual would have been
required to pay in cost sharing if such items or
services had been furnished by a hospital or critical
access hospital, as applicable (or by a provider of
services or supplier, as applicable) that is within
such network or that is otherwise such a participating
provider of services or supplier.
``(B) In case of same-day emergency services.--In
the case of an individual with health benefits coverage
described in paragraph (1) who is furnished items or
services by a hospital or critical access hospital (or
provider of services or supplier furnishing services at
such hospital or critical access hospital) that is not
within the health care provider network or otherwise a
participating provider of services or supplier with
respect to such health benefits coverage of such
individual on the same date on which the individual
makes an appointment for such items or services (or
otherwise presents at the hospital or critical access
hospital for such services such as in the case of items
and services furnished with respect to an emergency
medical condition, as defined in section 1867(e)), the
hospital or critical access hospital (or, as
applicable, the provider of services or supplier
furnishing such items or services to such individual)
may not charge the individual more than the amount that
the individual would have been required to pay in cost
sharing if such items or services had been furnished by
a hospital or critical access hospital, as applicable
(or by a provider of services or supplier, as
applicable) that is within such network or that is
otherwise such a participating provider of services or
supplier.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply with respect to agreements under section 1866(a)(1) of the Social
Security Act (42 U.S.C. 1395cc(a)(1)) that are filed with the Secretary
of Health and Human Services on a date that is not less than 12 months
after the date of the enactment of this Act.
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