S.Amdt. 2555

SA 2555. Mr. ENZI submitted an amendment intended to be proposed to
amendment SA 2499 proposed by Mr. McConnell to the bill S. 178, to
condemn gross human rights violations of

[[Page S4868]]

ethnic Turkic Muslims in Xinjiang, and calling for an end to arbitrary
detention, torture, and harassment of these communities inside and
outside China; which was ordered to lie on the table; as follows:

At the appropriate place, insert the following:

SEC. __. TIMELY BILLS FOR PATIENTS.

(a) In General.--
(1) Amendment.--Part C of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-91 et seq.), is amended--
(A) by redesignating the second section 2794 (42 U.S.C.
300gg-95) (relating to uniform fraud and abuse referral
format), as added by section 6603 of the Patient Protection
and Affordable Care Act (Public Law 111-148), as section
2795; and
(B) by adding at the end the following:

``SEC. 2796. PROVIDER PROVISION OF TIMELY BILLS FOR PATIENTS.

``(a) In General.--The Secretary shall require--
``(1) health care facilities, or in the case of
practitioners providing services outside of such a facility,
practitioners, to provide to a patient a list of services
rendered to such patient during the visit to such facility or
practitioner, and, in the case of a facility, the name of the
practitioner for each such service, upon discharge or end of
the visit or by postal or electronic communication as soon as
practicable and not later than 15 calendar days after
discharge or date of visit; and
``(2) subject to subsection (e), health care facilities and
practitioners to furnish all bills reflecting claims
adjudicated between the relevant provider and group health
plan or health insurance issuer offering group or individual
health insurance coverage, to the patient as soon as
practicable, but not later than 90 calendar days after
discharge or date of visit.
``(b) Adjudication of Bills.--For purposes of meeting the
requirements of subsection (a), in the case of services
provided to an individual covered by a group health plan or
group or individual health insurance coverage--
``(1) the health care facility, or in the case of a
practitioner providing services outside of such a facility,
the practitioner, shall submit to the applicable group health
plan or health insurance issuer the bill with respect to such
services not later than 30 calendar days after discharge or
date of visit of the individual;
``(2) a group health plan or health insurance issuer
receiving a bill as described in paragraph (1) shall, not
later than 30 calendar days after such bill is transmitted by
the facility or practitioner, complete adjudication of the
bill and send such adjudicated bill to the facility or
practitioner, as applicable under paragraph (1); and
``(3) the health care facility or practitioner, as
applicable under paragraph (1), shall, not later than 30
calendar days after transmission of the adjudicated bill as
described in paragraph (2), send such bill to the individual.
``(c) Payment After Billing.--No patient may be required to
pay a bill for health care services any earlier than 45 days
after the postmark date of a bill for such services.
``(d) Effect of Violation.--
``(1) Notification and refund requirements.--
``(A) Provider lists.--If a facility or practitioner fails
to provide a patient a list as required under subsection
(a)(1), such facility or practitioner shall report such
failure to the Secretary.
``(B) Billing.--If a facility or practitioner bills a
patient after the 60-calendar-day period described in
subsection (a)(2), such facility or practitioner shall--
``(i) report such bill to the Secretary; and
``(ii) refund the patient for the full amount paid in
response to such bill with interest, at a rate determined by
the Secretary.
``(2) Civil monetary penalties.--
``(A) In general.--The Secretary may impose civil monetary
penalties of up to $10,000 on any facility or practitioner as
follows:
``(i) In the case of a facility or practitioner that fails
to provide a list required under subsection (a)(1) 10 or more
times, such penalties may be imposed, with respect to each
such failure. Such penalties may be imposed, with respect to
each such failure, for each day, beginning on the date of the
tenth failure and ending on the day on which the facility or
practitioner provides the relevant list.
``(ii) In the case of a facility or practitioner that
submits 10 or more bills outside of the period described in
subsection (a)(2), such penalties may be imposed with respect
to each such bill, each day, beginning on the date on which
such facility or practitioner sends each such bill and ending
on the date such facility or practitioner withdraws such
bill.
``(iii) In the case of a facility or practitioner that
fails to report to the Secretary any failure to provide lists
as required under paragraph (1)(A), such penalties may be
imposed, each day, beginning on the date that is 60 calendar
days after the date of discharge or visit, as applicable, and
ending on the date of reporting.
``(iv) In the case of a facility or practitioner that fails
to send any bill as required under subsection (a)(2), such
penalties may be imposed, each day, beginning on the date
that is 60 calendar days after the date of discharge or
visit, as applicable, and ending on the date of sending such
bill.
``(v) In the case of a facility or practitioner that
requires a patient to pay a bill for health care services
earlier than 45 days after the postmark date of such bill,
such penalties may be imposed for each bill issued in
violation of subsection (b).
``(B) Procedure.--The provisions of section 1128A of the
Social Security Act, other than subsections (a) and (b) and
the first sentence of subsection (c)(1) of such section,
shall apply to civil money penalties under this subsection in
the same manner as such provisions apply to a penalty or
proceeding under section 1128A of the Social Security Act.
``(3) Exemptions.--The Secretary may exempt a practitioner
or facility from the penalties under paragraph (2)(A) or
extend the period of time specified in subsection (a)(2) for
compliance with such subsection if a practitioner or
facility--
``(A) makes a good-faith attempt to send a bill within the
period of time specified in subsection (a)(2) but is unable
to do so because of an incorrect address; or
``(B) experiences extenuating circumstances (as defined by
the Secretary), such as a hurricane or cyberattack, that may
reasonably delay delivery of a timely bill.
``(e) Rule of Construction.--Nothing in this section shall
be construed to limit applicability of the appeals process
under section 2719 to coverage determinations or claims
subject to the requirements of this section. The periods
described in subsections (a)(2), (b), and (c) shall be tolled
during any period during which a claim is subject to an
appeal under section 2719, provided that, in the case of such
an appeal by the provider, the patient is informed of such
appeal.''.
(2) Rulemaking.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Health and Human
Services shall promulgate final regulations to implement
section 2796 of the Public Health Service Act, as added by
paragraph (1). Such regulations shall include--
(A) a definition of the term ``extenuating circumstance''
for purposes of subsection (d)(3)(B) of such section 2796;
and
(B) a definition of the term ``date of service'' for
purposes of subsection (b)(1), with respect to providers
submitting global packages for services provided on multiple
visits.
(b) Group Health Plan and Health Insurance Issuer
Requirements.--
(1) PHSA.--Part A of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg) is amended by adding at the end
the following:

``SEC. 2729A. TIMELY BILLS FOR PATIENTS.

``(a) In General.--A group health plan or health insurance
issuer offering group or individual health insurance coverage
shall have in place business practices with respect to in-
network facilities and practitioners to ensure that claims
are adjudicated between the provider and the plan or issuer
in order to facilitate facility and practitioner compliance
with the requirements under section 2796(a).
``(b) Clarification.--Nothing in subsection (a) prohibits a
provider and a group health plan or health insurance issuer
from establishing in a contract the timeline for submission
by either party to the other party of billing information,
adjudication, sending of remittance information, or any other
coordination required between the provider and the plan or
issuer necessary for meeting the deadline described in
section 2796(a)(2).
``(c) Rules of Construction.--Nothing in this section shall
be construed to limit applicability of the appeals process
under section 2719 to coverage determinations or claims
subject to the requirements of this section. Any timeline
established under subsection (b) shall be tolled during any
period during which a claim is subject to an appeal under
section 2719, provided that, in the case of such an appeal by
the provider, the patient is informed of such appeal. A group
health plan or health insurance issuer that knows or should
have known that denials of a claim would lead to
noncompliance by providers with section 2799B-10 may be found
to be in violation of this part.''.
(2) ERISA.--Subpart B of part 7 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185 et seq.) is amended by adding at the end the
following:

``SEC. 716. TIMELY BILLS FOR PATIENTS.

``(a) In General.--A group health plan (or health insurance
coverage offered in connection with such a plan) shall have
in place business practices with respect to in-network
facilities and practitioners to ensure that claims are
adjudicated between the provider and the plan or issuer in
order to facilitate facility and practitioner compliance with
the requirements under section 2796(a) of the Public Health
Service Act.
``(b) Clarification.--Nothing in subsection (a) prohibits a
provider and a group health plan (or health insurance
coverage offered in connection with such a plan) from
establishing in a contract the timeline for submission by
either party to the other party of billing information,
adjudication, sending of remittance information, or any other
coordination required between the provider and the plan or
issuer necessary for meeting the deadline described in
section 2796(a)(2) of the Public Health Service Act.
``(c) Rules of Construction.--Nothing in this section shall
be construed to limit applicability of the appeals process
under section 2719 of the Public Health Service Act to
coverage determinations or claims subject to the requirements
of this section. Any timeline established under subsection
(b)

[[Page S4869]]

shall be tolled during any period during which a claim is
subject to an appeal under section 2719 of the Public Health
Service Act, provided that, in the case of such an appeal by
the provider, the patient is informed of such appeal. A group
health plan or health insurance issuer that knows or should
have known that denials of a claim would lead to
noncompliance by providers with section 2796 of the Public
Health Service Act may be found to be in violation of this
subpart.''.
(3) IRC.--Subchapter B of chapter 100 of the Internal
Revenue Code of 1986 is amended by adding at the end the
following:

``SEC. 9816. TIMELY BILLS FOR PATIENTS.

``(a) In General.--A group health plan shall have in place
business practices with respect to in-network facilities and
practitioners to ensure that claims are adjudicated between
the provider and the plan in order to facilitate facility and
practitioner compliance with the requirements under section
2796(a) of the Public Health Service Act.
``(b) Clarification.--Nothing in subsection (a) prohibits a
provider and a group health plan from establishing in a
contract the timeline for submission by either party to the
other party of billing information, adjudication, sending of
remittance information, or any other coordination required
between the provider and the plan necessary for meeting the
deadline described in section 2796(a)(2) of the Public Health
Service Act.
``(c) Rules of Construction.--Nothing in this section shall
be construed to limit applicability of the appeals process
under section 2719 of the Public Health Service Act to
coverage determinations or claims subject to the requirements
of this section. Any timeline established under subsection
(b) shall be tolled during any period during which a claim is
subject to an appeal under section 2719 of the Public Health
Service Act, provided that, in the case of such an appeal by
the provider, the patient is informed of such appeal. A group
health plan that knows or should have known that denials of a
claim would lead to noncompliance by providers with section
2796 of the Public Health Service Act may be found to be in
violation of this chapter.''.
(4) Clerical amendments.--
(A) ERISA.--The table of contents in section 1 of the
Employee Retirement Income Security Act of 1974 (29 U.S.C.
1001 et seq.), as amended by the previous sections, is
further amended by inserting after the item relating to
section 715 the following new item:

``716. Timely bills for patients.''.
(B) IRC.--The table of sections for subchapter B of chapter
100 of the Internal Revenue Code of 1986 is amended by adding
at the end the following new item:

``9816. Timely bills for patients.''.
(c) Effective Date.--The amendments made by subsections (a)
and (b) shall apply beginning 6 months after the date of
enactment of this Act.
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