[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4185 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 4185

To establish an independent dispute resolution process for surprise air 
                ambulance bills, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              July 2, 2020

  Mr. Wicker introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To establish an independent dispute resolution process for surprise air 
                ambulance bills, 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 Medical Bills for Air 
Ambulances Act of 2020''.

SEC. 2. ENDING SURPRISE AIR AMBULANCE BILLS.

    Part A of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg et seq.) is amended by inserting after section 2719A the 
following:

``SEC. 2719B. AIR AMBULANCE SURPRISE MEDICAL BILL DISPUTE RESOLUTION.

    ``(a) Establishment of Independent Dispute Resolution Process.--
            ``(1) Establishment.--Not later than 30 days after the date 
        of enactment of this section, the Secretary, in consultation 
        with the Secretary of Transportation, shall establish an 
        independent dispute resolution process for resolving balance 
        bills between a health plan or a health insurance issuer 
        offering health insurance coverage (in this section 
        collectively referred to as a `health insurance issuer') and an 
        out-of-network air ambulance providers in accordance with this 
        section (referred to in this section as the `IDR process').
            ``(2) Independent dispute resolution entity.--Under the IDR 
        process, the Secretary in coordination with the Secretary of 
        Transportation, shall establish a list of qualified entities to 
        serve as Independent Dispute Resolution Entities. In 
        establishing this list of qualified entities, the Secretary 
        shall require that the qualified entities have arbitrators who 
        have--
                    ``(A) a minimum of 10 years of experience in health 
                care litigation but whom have not represented a health 
                insurance issuer or an air ambulance provider in the 
                preceding 5 years; or
                    ``(B) a minimum of 15 years of experience in 
                providing mediation and arbitration services.
            ``(3) Arbitration parameters.--The IDR process shall 
        require an arbitrator to do the following:
                    ``(A) Render a written decision resolving all 
                disputes that designates 1 party as the `prevailing 
                party'.
                    ``(B) Use the following factors in determining the 
                reasonable value of the services provided:
                            ``(i) The nature of the services provided 
                        and equipment used, including the care 
                        capability and scope of practice of the out-of-
                        network air ambulance provider.
                            ``(ii) A comprehensive accounting of the 
                        out-of-network air ambulance provider's costs, 
                        payor mix, revenue mix, and other economic 
                        factors of the out-of-network air ambulance 
                        provider's service.
                            ``(iii) Amounts paid (in- and out-of-
                        network) to the out-of-network provider.
                            ``(iv) Amounts paid (in- and out-of-
                        network) to similar out-of-network air 
                        ambulance providers in the same geographic 
                        region if such data is available.
                            ``(v) Information provided by Federal data 
                        collection and reporting requirements, when 
                        available.
                            ``(vi) If available for the geographic area 
                        in which the flight took place, the median in-
                        network rate.
                    ``(C) Not take into consideration bill charges when 
                considering the amount to award.
            ``(4) Process requirements.--The IDR process shall require 
        an arbitrator and parties adhere to the following process and 
        timelines:
                    ``(A) The parties shall submit written submissions 
                to the arbitrator on or before the 30th day after 
                initiating the IDR process.
                    ``(B) The arbitrator's decision shall include 
                written findings and be issued within 45 days after 
                receipt of the parties' written submissions.
                    ``(C) Any amount awarded by the arbitrator shall be 
                paid within 20 days of the arbitrator's final decision.
                    ``(D) All proceedings and the arbitrator's 
                decisions made under the IDR process shall be 
                confidential in nature and not subject to any 
                disclosure requirements.
                    ``(E) The nonprevailing party shall be responsible 
                for paying all fees charged by the arbitrator.
            ``(5) Other considerations.--The IDR process shall allow 
        the arbitrator in making the arbitrator's final decision to 
        take into consideration the number of previous instances in 
        which the parties involved have had to undergo the IDR process.
    ``(b) Independent Dispute Resolution Process.--
            ``(1) In general.--When an out-of-network air ambulance 
        provider bills a health insurance issuer for an air ambulance 
        service provided to a participant, beneficiary, or enrollee of 
        the issuer, the health insurance issuer shall pay the billed 
        amount or determine that the health insurance issuer considers 
        some or all of the claim to be disputed within 30 days from 
        receipt of the bill. If a claim is disputed, the health 
        insurance issuer shall notify--
                    ``(A) the out-of-network air ambulance provider in 
                writing within 30 days of receipt of the bill why the 
                claim is disputed (in this subsection referred to as 
                the `notice of dispute'); and
                    ``(B) the patient who received the out-of-network 
                air ambulance transport that the bill is disputed, that 
                the health insurance issuer, and not the patient, is 
                responsible for the disputed bill, and that the 
                disputed bill will be resolved through the IDR process.
            ``(2) Resolution process.--The health insurance issuer and 
        the out-of-network air ambulance provider have 90 days from the 
        date on which the provider receives a notice of dispute from 
        the issuer to come to a settlement agreement for the disputed 
        bill.
            ``(3) Arbitrator selection.--If the health insurance issuer 
        and the air ambulance provider do not come to an agreement 
        under paragraph (2) within such 90-day period, the issuer and 
        provider shall enter into the IDR process with an Independent 
        Dispute Resolution Entity selected at random from the list 
        established under subsection (a)(2). Within 5 business days of 
        being selected, the Independent Dispute Resolution Entity shall 
        assign an arbitrator to make a determination in the matter.
    ``(c) Effect of Determination.--A final determination of the 
arbitrator assigned under subparagraph (b)(3) shall be binding on the 
issuer and provider.
    ``(d) Privacy Laws.--An arbitrator shall comply with all applicable 
Federal and State privacy laws in conducting an IDR process under this 
section.
    ``(e) Public Availability.--The amount determined with respect to 
any claim by an arbitrator conducting an IDR process under this section 
shall be confidential, except that an arbitrator may access the amounts 
determined in any previous claims involving the health insurance issuer 
or the out-of-network air ambulance provider that was resolved through 
the IDR process.
    ``(f) Air Ambulance Enforcement.--The Secretary of Transportation 
shall require all air ambulance providers to participate in good faith 
in the IDR process. If an air ambulance provider fails to abide by the 
timelines established in this section during the IDR process, the 
Secretary of Transportation shall issue a fine of $20,000 against the 
air ambulance provider unless the provider's failure to abide by the 
timelines is attributable to the actions or inactions of the health 
insurance issuer.
    ``(g) Insurers Enforcement.--The Secretary shall require all health 
insurance issuers to participate in good faith in the IDR process. If 
an insurer fails to abide by the timelines established in this section 
during the IDR process, the Secretary shall issue a fine of $20,000 
against the health insurance issuer unless the issuer's failure to 
abide by the timelines is attributable to the actions or inactions of 
the air ambulance provider.
    ``(h) Reevaluation.--Not later than 3 years after the establishment 
of the IDR process, the Secretary and the Secretary of Transportation 
jointly shall--
            ``(1) conduct an evaluation of the process; and
            ``(2) based on the results of such evaluation, determine 
        whether to continue or terminate the IDR process (after 
        resolution of all disputed claims that are pending on the date 
        the determination to terminate the process is made).
    ``(i) Definition.--For purposes of this section, the term `air 
ambulance service' means medical transport by helicopter or airplane 
for patients.''.
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