[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1531 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                S. 1531

   To amend the Public Health Service Act to provide protections for 
           health insurance consumers from surprise billing.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 16, 2019

   Mr. Cassidy (for himself, Mr. Bennet, Mr. Young, Ms. Hassan, Ms. 
Murkowski, Mr. Carper, Mr. Sullivan, Mr. Brown, Mr. Cramer, Mr. Cardin, 
 Mr. Kennedy, and Mr. Casey) introduced the following bill; which was 
 read twice and referred to the Committee on Health, Education, Labor, 
                              and Pensions

_______________________________________________________________________

                                 A BILL


 
   To amend the Public Health Service Act to provide protections for 
           health insurance consumers from surprise billing.

    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 ``Stopping The Outrageous Practice of 
Surprise Medical Bills Act of 2019'' or the ``STOP Surprise Medical 
Bills Act of 2019''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Consumers frequently struggle to determine when and how 
        much they will pay for a medical service or procedure. A 
        majority of consumers say health care providers rarely, if 
        ever, discuss costs of recommended treatments and whether these 
        treatments are covered by health insurance. Almost 70 percent 
        of patients who receive bills from out-of-network providers did 
        not realize the provider was out-of-network at the time of 
        treatment. Patients using in-network facilities still receive 
        claims from out-of- network providers at high rates, over 15 
        percent of inpatient admissions and 5 percent of outpatient 
        service days. Even when patients try to schedule an in-network 
        procedure at an in-network hospital and try to ensure that all 
        providers who administer treatment will be in-network, they may 
        be sent a balance bill by an out-of-network provider after 
        receiving care. If providers accepted the same health plans as 
        the facilities at which they practice and administer care, out-
        of-network surprise medical bills would not be a complication 
        for consumers scheduling elective procedures.
            (2) Surprise medical bills affect a sizeable portion of the 
        insured population. Approximately 30 percent of individuals 
        covered by private health insurance have received a surprise 
        medical bill within the past year. Almost 20 percent of 
        inpatient admissions by enrollees in large employer plans 
        include at least 1 claim from an out-of-network provider, while 
        8 percent of outpatient service days include an out-of-network 
        claim.
            (3) Surprise medical bills are an issue of particular 
        concern to consumers. A majority of Americans feel that 
        softening the impact of surprise medical bills should be a 
        priority for the current Congress. Eighty-six percent of 
        Americans think it is important to protect individuals from 
        surprise medical bills.
            (4) Surprise medical bills for emergency care are 
        frequently unavoidable due to the emergent and serious nature 
        of the patient's condition at the time of treatment. One in 5 
        cases of inpatient hospital admissions that originate within 
        the emergency department result in a surprise medical bill. For 
        inpatient admissions, those that include an emergency room 
        claim are much more likely to include a claim from an out-of-
        network provider than admissions without an emergency room 
        claim. This is true whether or not enrollees use in-network 
        facilities. Most cases of surprise medical billing occur when 
        privately insured individuals involuntarily see out-of-network 
        providers during medical emergencies.
            (5) The financial implications of surprise medical bills 
        can be devastating for American consumers and can prevent them 
        from seeking timely follow-up care or from accessing necessary 
        services. Approximately 20 percent of insured Americans 
        struggle to pay their medical bills. Almost a third of 
        consumers who report they are struggling to pay a medical bill 
        also report this bill was due to charges from an out-of-network 
        provider that were not covered or were only partially covered 
        by their insurer. Consumers with outstanding medical bills 
        report delaying or skipping needed health care at rates 2 to 3 
        times higher than consumers without outstanding bills. Over 60 
        percent of consumers with outstanding medical bills report 
        difficulties paying other bills (including necessities such as 
        food, heat, or housing costs) as a result of their medical 
        bills.

SEC. 3. PROHIBITION ON SURPRISE BALANCE BILLING AND INDEPENDENT DISPUTE 
              RESOLUTION WITH RESPECT TO OUT-OF-NETWORK HEALTH CARE 
              SERVICES.

    (a) In General.--Subpart II of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg et seq.) is amended by adding at 
the end the following:

``SEC. 2729A. GENERAL PROHIBITION ON SURPRISE BALANCE BILLING.

    ``(a) Surprise Medical Bill.--In this title, the term `surprise 
medical bill' means a balance bill, as described in subsection (b), 
that an enrollee receives for services provided to the enrollee where 
such services were--
            ``(1) emergency services provided by an out-of-network 
        health care professional or at an out-of-network facility;
            ``(2) health care services that were provided--
                    ``(A) at an in-network facility (including the use 
                of equipment, devices, telemedicine services, or other 
                treatments or services); and
                    ``(B) by an out-of-network health care 
                professional; or
            ``(3) additional health care services required in the case 
        of an enrollee who initially enters a hospital through the 
        emergency room for emergency services, and then receives 
        nonemergency services from an out-of-network health care 
        professional or at an out-of-network hospital or facility after 
        the enrollee has been stabilized (as defined in section 
        2719A(b)(2)(C)), as determined by the treating physician.
Paragraph (3) shall not apply in the case of an enrollee who is 
stabilized and able to travel in nonmedical transport, and the enrollee 
(or designee of the enrollee where the enrollee is not able to 
comprehend the information to be provided or make related decisions) 
has been provided with clear, written notification that the 
professional or facility is an out-of-network health care professional 
or facility, has been given a cost estimate for services provided by 
the out-of-network professional or facility, and has assumed, in 
writing, full responsibility for out-of-pocket costs associated with 
such out-of-network care.
    ``(b) Balance Bill.--In subsection (a), the term `balance bill' 
refers to a claim for payment for services provided to an enrollee that 
is in an amount equal to the difference between the actual amount 
charged with respect to services or care described in subsection (a) 
and the expected in-network cost-sharing required by the enrollee under 
the plan or coverage involved.
    ``(c) Prohibition on Balance Billing.--
            ``(1) Prohibition.--
                    ``(A) In general.--A group health plan, a health 
                insurance issuer in connection with group or individual 
                health insurance coverage, or a health care provider 
                shall not engage in balance billing practices 
                prohibited under this section.
                    ``(B) Application of provisions.--Subparagraph (A) 
                shall apply--
                            ``(i) to all services provided at 
                        hospitals, emergency rooms, State-accredited 
                        free-standing emergency departments, hospital 
                        outpatient departments, and ambulatory surgery 
                        centers; and
                            ``(ii) with respect to subsection (a)(2), 
                        to the health care provider's offices and 
                        related services (including laboratory and 
                        imaging services ordered by an in-network 
                        provider and provided by an out-of-network 
                        provider or laboratory).
            ``(2) Enrollee liability.--With respect to the services and 
        care described in subsection (a), an enrollee shall only be 
        liable for the in-network cost-sharing amount provided for in 
        their plan or coverage. For purposes of this section, such 
        payments by the enrollee shall count toward the in-network 
        deductible under the plan or coverage as well as toward the 
        enrollee's out-of-pocket maximum limitation.
            ``(3) Penalty.--Violations of this section shall subject 
        the violator to a civil monetary penalty as provided for in 
        this title. Such provisions shall not apply to a health care 
        provider, group health plan, or health insurance issuer that 
        unknowingly balance bills an enrollee and reimburses such 
        enrollee within 30 calendar days of such billing.

``SEC. 2729B. OUT-OF-NETWORK BILLING.

    ``(a) Prohibition.--
            ``(1) In general.--An enrollee may not be billed in excess 
        of the in-network cost-sharing amount for services or care 
        provided under section 2729A (a surprise medical bill 
        situation).
            ``(2) Automatic payment.--
                    ``(A) In general.--A group health plan, or health 
                insurance issuer in connection with group or individual 
                health insurance coverage, shall pay the median in-
                network rate under the plan or coverage, less the 
                applicable enrollee in-network cost-sharing, directly 
                to the health care provider as provided for in this 
                section.
                    ``(B) Request for alternative rate.--Upon payment 
                under subparagraph (A), the plan or issuer shall 
                provide to the health care provider information about 
                how the provider may initiate independent dispute 
                resolution under such subsection with respect to such 
                payment. The plan, issuer, or provider may negotiate an 
                alternative amount or initiate independent dispute 
                resolution under subsection (b) during the 30-day 
                period beginning on the date on which the automatic 
                payment is made under this subsection.
    ``(b) Establishment of IDR Process; Certification of Entities.--
            ``(1) Establishment.--Not later than 1 year after the date 
        of enactment of this section, the Secretary, in consultation 
        with the Secretary of Labor, shall establish a process for 
        resolving payment disputes between group health plans, or 
        health insurance issuers offering health insurance coverage in 
        the group market, and out-of-network health care providers in 
        surprise medical bill situations in accordance with this 
        section (referred to in this section as the `IDR process').
            ``(2) Certification of entities.--An entity wishing to 
        participate in the IDR process under this subsection shall 
        request certification from the Secretary. The Secretary, in 
        consultation with the Secretary of Labor, shall determine 
        eligibility of applicant entities, taking into consideration 
        whether the entity is unbiased and unaffiliated with health 
        plans and providers and free of conflicts of interest, in 
        accordance with the Secretary's rulemaking on determining 
        criteria for conflicts of interest.
            ``(3) IDR entity.--Under the process established under 
        paragraph (1), the parties in the independent dispute 
        resolution process shall jointly agree upon an independent 
        dispute resolution entity. In the event that parties cannot 
        agree, one will be selected at random jointly by the Department 
        of Health and Human Services and the Department of Labor.
    ``(c) Applicable Claims.--
            ``(1) In general.--The IDR process shall be with respect to 
        one or more Current Procedural Terminology (`CPT') codes.
            ``(2) Batching of claims.--Health care facilities and 
        providers and group health plans or health insurance issuers 
        may batch claims if such claims--
                    ``(A) involve identical plan or issuer and provider 
                or facility parties;
                    ``(B) involve claims with the same or related 
                current procedural terminology codes relevant to a 
                particular procedure; and
                    ``(C) involve claims that occur within 30 days of 
                each other.
    ``(d) Independent Dispute Resolution Process.--
            ``(1) Timing.--An independent dispute resolution entity 
        that receives a request under this section shall, not later 
        than 30 days after receiving such request, determine the amount 
        the group health plan, or health insurance issuer offering 
        health insurance coverage in the group market, is required to 
        pay the out-of-network health care provider. Such amount shall 
        be--
                    ``(A) the amount determined by the parties through 
                a settlement under paragraph (2); or
                    ``(B) the amount determined reasonable by the 
                entity in accordance with paragraph (3).
            ``(2) Settlement.--
                    ``(A) In general.--If the independent dispute 
                resolution entity determines, based on the amounts 
                indicated in the request under this section, that a 
                settlement between the group health plan, or health 
                insurance issuer offering health insurance coverage in 
                the group market, and the out-of-network health care 
                provider is likely, the independent dispute resolution 
                entity may direct the parties to attempt, for a period 
                not to exceed 10 days, a good faith negotiation for a 
                settlement.
                    ``(B) Timing.--The period for a settlement 
                described in subparagraph (A) shall accrue towards the 
                30-day period required under paragraph (1).
            ``(3) Determination of amount.--
                    ``(A) Final offers.--In the absence of a settlement 
                under paragraph (2), the group health plan, or health 
                insurance issuer offering health insurance coverage in 
                the group market, and the out-of-network health care 
                provider shall each submit to the independent dispute 
                resolution entity their final offer. Such entity shall 
                determine which of the 2 amounts is more reasonable 
                based on the factors described in subparagraph (D).
                    ``(B) Final decisions.--The amount that is 
                determined to be the more reasonable amount under 
                subparagraph (A) shall be the final decision of the 
                independent dispute resolution entity as to the amount 
                the group health plan, or health insurance issuer 
                offering health insurance coverage in the group market, 
                is required to pay the out-of-network health care 
                provider.
                    ``(C) Service units.--A final determination under 
                subparagraph (B) may include the resolution of disputes 
                for multiple items or services, if such determination 
                is in regard to items or services that are eligible for 
                independent dispute resolution under subsection (c)(2).
                    ``(D) Factors.--In determining which final offer to 
                select as the more reasonable amount under subparagraph 
                (A), the independent dispute resolution entity shall 
                consider relevant factors including--
                            ``(i) commercially reasonable rates for 
                        comparable services or items in the same 
                        geographic area (which shall take into 
                        consideration in-network rates for that 
                        geographic area and not charges); and
                            ``(ii) other factors that may be submitted 
                        at the discretion of either party, which may 
                        include--
                                    ``(I) the level of training, 
                                education, experience, and quality and 
                                outcomes measurements of the out-of-
                                network health care provider;
                                    ``(II) the circumstances and 
                                complexity of the particular dispute, 
                                including the time and place of the 
                                service;
                                    ``(III) the market share held by 
                                the out-of-network health care provider 
                                or that of the plan or issuer;
                                    ``(IV) demonstration of good faith 
                                efforts (or lack of good faith efforts) 
                                made by the out-of-network provider or 
                                the plan to contract and prior 
                                negotiated rates, if applicable; and
                                    ``(V) other relevant economic 
                                aspects of provider reimbursement for 
                                the same specialty within the same 
                                geographic area.
                    ``(E) Effect of determination.--A final 
                determination of an independent dispute resolution 
                entity under subparagraph (B)--
                            ``(i) shall be binding; and
                            ``(ii) shall not be subject to judicial 
                        review, except in cases comparable to those 
                        described in section 10(a) of title 9, United 
                        States Code, as determined by the Secretary in 
                        consultation with the Secretary of Labor, and 
                        cases in which information submitted by one 
                        party was determined to be fraudulent.
            ``(4) Privacy laws.--An independent dispute resolution 
        entity shall, in conducting an independent dispute resolution 
        process under this subsection, comply with all applicable 
        Federal and State privacy laws.
            ``(5) Public availability.--The reasonable amount 
        determined by an independent dispute resolution entity under 
        this subsection with respect to any claim shall not be 
        confidential, except that information submitted to the 
        independent dispute entity shall be kept confidential. 
        Independent dispute entities may consider past decisions 
        awarded by independent dispute entities during the independent 
        dispute resolution process.
            ``(6) Costs of independent dispute resolution process.--The 
        nonprevailing party shall be responsible for paying all fees 
        charged by the independent dispute resolution entity. If the 
        parties reach a settlement prior to completion of the 
        independent dispute resolution process, the costs of the 
        independent dispute resolution process shall be divided equally 
        between the parties.
            ``(7) Payment.--Group health plans and health insurance 
        issuers with respect to group health coverage shall pay 
        directly to the health care provider amounts determined by the 
        independent dispute resolution entity within 30 days of the 
        date on which the entity makes a determination with respect to 
        such amount. A plan or issuer that fails to comply with this 
        paragraph shall be subject to the penalties described in 
        section 2729A(c)(3).''.
    (b) Emergency Services.--Section 2719A(b)(1)(C)(ii)(II) of the 
Public Health Service Act (42 U.S.C. 300gg-19a(b)(1)(C)(ii)(II)) is 
amended by inserting ``, deductible amount,'' after ``copayment 
amount''.

SEC. 4. NOTIFICATION OF NEW INSURANCE PRODUCTS TO IN-NETWORK PROVIDERS.

    Subpart II of part A of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg et seq.), as amended by section 3, is further 
amended by adding at the end the following:

``SEC. 2729C. NOTIFICATION OF NEW INSURANCE PRODUCTS TO IN-NETWORK 
              PROVIDERS.

    ``If a health care provider has a contract to provide in-network 
services to enrollees in a group health plan or health insurance 
coverage offered by a health insurance issuer, the plan or issuer shall 
notify the in-network provider within 7 days of offering any new 
insurance product for which the in-network provider would be eligible 
to enroll as an in-network provider.''.

SEC. 5. TRANSPARENCY REGARDING IN-NETWORK AND OUT-OF-NETWORK 
              DEDUCTIBLES.

    Subpart II of part A of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg et seq.), as amended by section 4, is further 
amended by adding at the end the following:

``SEC. 2729D. TRANSPARENCY REGARDING IN-NETWORK AND OUT-OF-NETWORK 
              DEDUCTIBLES.

    ``(a) In General.--A group health plan or a health insurance issuer 
offering group or individual health insurance coverage and providing or 
covering any benefit with respect to items or services shall include, 
in clear writing, on any plan or insurance identification card issued 
to enrollees in the plan or coverage the amount of the in-network and 
out-of-network deductibles and the out-of-pocket maximum limitation 
that apply to such plan or coverage.
    ``(b) Guidance.--The Secretary, in consultation with the Secretary 
of Labor, shall issue guidance to implement subsection (a).''.

SEC. 6. ENSURING ENROLLEE ACCESS TO COST-SHARING INFORMATION.

    (a) In General.--Subpart II of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-11 et seq.), as amended by section 
5, is further amended by adding at the end the following:

``SEC. 2729E. PROVISION OF COST-SHARING INFORMATION.

    ``(a) Cost-Sharing Disclosure for Medical Services.--
            ``(1) Provider disclosures.--A group health plan or a 
        health insurance issuer offering group or individual health 
        insurance coverage shall not contract with a health care 
        provider with respect to the plan or coverage unless the 
        provider agrees to provide an enrollee in the plan or coverage, 
        at the time of scheduling an elective health care service, or 
        not later than 48 hours of the enrollee requesting such 
        information, the expected enrollee cost-sharing for the 
        provision of a particular health care service involved 
        (including any service that is reasonably expected to be 
        provided in conjunction with such specific service, such as 
        expected cost-sharing of laboratory services).
            ``(2) Insurer disclosures.--A group health plan or a health 
        insurance issuer offering group or individual health insurance 
        coverage shall provide an enrollee in the plan or coverage with 
        a good faith estimate of the enrollee's cost-sharing (including 
        deductibles, copayments, and coinsurance) for which the 
        enrollee would be responsible for paying with respect to a 
        specific elective health care service (including any service 
        that is reasonably expected to be provided in conjunction with 
        such specific service such as expected cost-sharing of 
        laboratory services), not later than 48 hours after receiving a 
        request for such information by an enrollee.
    ``(b) Electronically Available Price Information.--A group health 
plan or a health insurance issuer offering group or individual health 
insurance coverage shall provide to enrollees the out-of-pocket costs 
and benefits information at all sites of care and for all providers 
included in the plan network. Such information shall be made available 
to enrollees through an internet website or an application. Information 
about the availability of such price information through such means 
shall be provided to each enrollee upon enrollment, or renewal, in the 
health plan or health insurance coverage.''.
    (b) Effective Dates.--
            (1) Cost-sharing disclosures.--Subsection (a)(1) of section 
        2729E of the Public Health Service Act, as added by subsection 
        (a), shall apply with respect to plan years beginning on or 
        after January 1, 2020.
            (2) Availability of information.--Subsection (b) of section 
        2729E of the Public Health Service Act, as added by subsection 
        (a), shall apply with respect to plan years beginning on or 
        after January 1, 2021.

SEC. 7. MEDICAL LOSS RATIO.

    Section 2718(a)(1) of the Public Health Service Act (42 U.S.C. 
300gg-18(a)(1)) is amended by inserting before the period the 
following: ``(including, in the case of group health plans, the amount 
of independent dispute process expenses incurred by the plan)''.

SEC. 8. TRANSPARENCY REQUIREMENTS ON HOSPITALS.

    Section 2718 of the Public Health Service Act (42 U.S.C. 300gg-18) 
is amended by adding at the end the following:
    ``(f) Transparency Requirements on Hospitals.--
            ``(1) Requirements for hospitals and physician groups.--
        Each hospital operating within the United States shall for each 
        year disclose on its internet website and in printed materials, 
        any financial relationship or profit-sharing agreement the 
        hospital maintains with a physician group.
            ``(2) Required information.--
                    ``(A) In general.--Each hospital operating within 
                the United States shall include ancillary services 
                provided by individuals such as phlebotomists, 
                laboratory technicians, and echocardiogram technicians 
                within each hospital bill that is provided to patients.
                    ``(B) Study.--Not later than 1 year after the date 
                of enactment of this Act, the Secretary shall conduct a 
                study on the feasibility of hospitals and hospital-
                based provider groups providing to patients a single, 
                unified bill for all services provided within an 
                episode of care.''.

SEC. 9. TRANSPARENCY REQUIREMENTS ON INSURANCE.

    (a) Group Health Plan Reporting.--Part C of title XXVII of the 
Public Health Service Act (42 U.S.C. 300gg-91 et seq.) is amended by 
adding at the end the following:

``SEC. 2795. TRANSPARENCY REQUIREMENTS FOR GROUP HEALTH PLANS.

    ``(a) In General.--Each group health plan and health insurance 
issuer offering group or individual health insurance coverage shall 
annually report to the Secretary of Health and Human Services and the 
Secretary of Labor, with respect to the applicable plan or coverage for 
the applicable plan year--
            ``(1) the total claims that were submitted by in-network 
        health care providers with respect to enrollees under the plan 
        or coverage, and the number of such claims that were paid and 
        the number of such claims that were denied;
            ``(2) the total claims that were submitted by out-of-
        network health care providers with respect to enrollees under 
        the plan or coverage, and the number of such claims that were 
        paid and the number of such claims that were denied;
            ``(3) with respect to each out-of-network claim, the out-
        of-pocket costs, including applicable cost-sharing amounts, to 
        the enrollee for the services, and the difference between the 
        billed charge and the amount the plan pays, adjusted by any 
        balance billing limitation through State and Federal regulatory 
        and statutory requirements that might apply;
            ``(4) the number of out-of-network claims reported under 
        paragraph (2) that are for emergency services; and
            ``(5) the number of out-of-network claims reported under 
        paragraph (2) that relate to care at in-network hospitals or 
        facilities provided by out-of-network providers.
    ``(b) Clarification.--The information required to be submitted 
under this section shall be in addition to the information required to 
be submitted under section 2715A.''.

SEC. 10. APPLICABILITY TO STATES WITH SURPRISE BILLING LAWS.

    (a) General Application.--
            (1) In general.--Nothing in this Act, or the amendments 
        made by this Act, shall be construed to prohibit a State from 
        enacting patient protections that are greater than those 
        provided for in such amendments.
            (2) Application to all plans.--In the case of a group 
        health plan, individual health plan, and non-Federal 
        governmental health plan offered in a State that has not 
        enacted a law to determine the payment resolution between 
        enrollees and health care facilities or professionals relating 
        to surprise medical bills, the procedures applicable to self-
        insured group health plans for the resolution of surprise 
        medical bills under this Act (including the amendments made by 
        this Act), shall apply to determine compensation with respect 
        to a surprise medical bill, until such time as the State enacts 
        a law providing for such a resolution methodology.
    (b) Provisions Applicable to ERISA.--Section 715 of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1185d) is amended by 
adding at the end the following:
    ``(c) Prohibitions on Balance Billing.--
            ``(1) Fully insured plans.--In the case of a fully insured 
        group health plan--
                    ``(A) a State may establish procedures for 
                determining the appropriate compensation applicable to 
                surprise medical bills between a participant or 
                beneficiary and a health care facility or professional 
                so long as the methodology used relies on the 
                definition of `surprise medical bill' and the 
                prohibitions contained in section 2729A of the Public 
                Health Service Act; and
                    ``(B) a State may enact laws relating to rate-
                setting, independent dispute resolution, an in-network 
                guarantee, or an alternative methodology that complies 
                with paragraph (1).
            ``(2) Self-insured plans.--In the case of a self-insured 
        group health plan, the resolution methodology provided for 
        under section 2729A of the Public Health Service Act, shall be 
        used to determine compensation with respect to a surprise 
        medical bill.''.
    (c) FEHBP.--In the case of a health plan under chapter 89 of title 
5, United States Code, the resolution methodology provided for under 
this Act (including the amendments made by this Act), shall be used to 
determine compensation with respect to a surprise medical bill.

SEC. 11. BALANCE BILLING STUDY.

    (a) In General.--Not later than 3 years after the date of enactment 
of this Act, the Secretary of Health and Human Services, in 
consultation with the Secretary of Labor, shall conduct a study of the 
effects of this Act (including the amendments made by this Act), and 
submit to Congress a report on the findings of such study, which shall 
include information and analysis on--
            (1) the financial impact on patient responsibility for 
        health care spending and overall health care spending;
            (2) the incidence and prevalence of the delivery of out-of-
        network health care services;
            (3) the adequacy of provider networks offered by health 
        plans and health insurance issuers (as such terms are defined 
        in section 2791 of the Public Health Service Act (42 U.S.C. 
        300gg-91));
            (4) the impact of connecting reimbursement to different 
        claims databases;
            (5) the number of bills that go to the independent dispute 
        resolution process; and
            (6) the administrative cost of the independent dispute 
        resolution process and estimated impact on health insurance 
        premiums and deductibles.
    (b) Information Requirements.--The information provided in the 
report under subsection (a) shall be--
            (1) disaggregated by State and according to the fully 
        insured and the self-insured markets; and
            (2) with respect to paragraphs (1) through (3) of such 
        subsection, made available to the public electronically in a 
        searchable database.
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