[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9572 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 9572
To amend title XXVII of the Public Health Service Act, the Employee
Retirement Income Security Act of 1974, and the Internal Revenue Code
of 1986 to increase penalties for group health plans and health
insurance issuers for practices that violate balance billing
requirements, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 12, 2024
Mr. Murphy (for himself, Mr. Ruiz, Mr. Joyce of Pennsylvania, Ms.
Schrier, and Mr. Panetta) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committees on Ways and Means, and Education and the Workforce, 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 XXVII of the Public Health Service Act, the Employee
Retirement Income Security Act of 1974, and the Internal Revenue Code
of 1986 to increase penalties for group health plans and health
insurance issuers for practices that violate balance billing
requirements, 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 ``Enhanced Enforcement of Health
Coverage Act''.
SEC. 2. INCREASING PENALTIES FOR GROUP HEALTH PLANS AND HEALTH
INSURANCE ISSUERS FOR PRACTICES THAT VIOLATE BALANCE
BILLING REQUIREMENTS.
(a) PHSA.--Section 2723(b)(2)(C) of the Public Health Service Act
(42 U.S.C. 300gg-22(b)(2)(C)) is amended--
(1) in clause (i), by inserting ``(or, in the case of such
a failure with respect to a provision specified in clause (iv),
$10,000 per failure)'' after ``$100''; and
(2) by adding at the end the following new clause:
``(iv) Provisions specified.--For purposes
of clause (i), the provisions specified in this
clause are the following:
``(I) Subparagraphs (A) and (B) of
section 2799A-1(a)(1).
``(II) Clauses (i), (ii), (iii),
and (v) of section 2799A-1(a)(1)(C).
``(III) Subparagraphs (A), (B), and
(E) of section 2799A-1(b)(1).
``(IV) Paragraphs (1) and (2) of
section 2799A-2(a).''.
(b) ERISA.--Section 502 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1131) is amended--
(1) in subsection (a)(6), by striking ``or (9)'' and
inserting ``(9), or (12)'';
(2) in subsection (b)(3)--
(A) by inserting ``, (c)(12),'' after ``subsections
(c)(9)''; and
(B) by inserting ``or (c)(12)'' after ``under
subsection (c)(9)''; and
(3) in subsection (c), by adding at the end the following
new paragraph:
``(12) The Secretary may assess a civil penalty against any group
health plan or health insurance issuer offering group health insurance
coverage of not more than $10,000 for each violation for each
individual with respect to which such plan or coverage fails to comply
with one of the following provisions:
``(A) Subparagraphs (A) and (B) of section 716(a)(1).
``(B) Clauses (i), (ii), (iii), and (v) of section
716(a)(1)(C).
``(C) Subparagraphs (A), (B), and (E) of section 716(b)(1).
``(D) Paragraphs (1) and (2) of section 717(a).''.
(c) IRC.--Section 4980D(b) of the Internal Revenue Code of 1986 is
amended--
(1) in paragraph (1), by inserting ``(or, in the case of
such a failure with respect to a provision specified in
paragraph (4), $10,000 per failure)'' after ``$100''; and
(2) by adding at the end the following new paragraph:
``(4) Provisions specified.--For purposes of paragraph (1),
the provisions specified in this paragraph are the following:
``(A) Subparagraphs (A) and (B) of section
9816(a)(1).
``(B) Clauses (i), (ii), (iii), and (v) of section
9816(a)(1)(C).
``(C) Subparagraphs (A), (B), and (E) of section
9816(b)(1).
``(D) Paragraphs (1) and (2) of section 9817(a).''.
SEC. 3. ADDITIONAL PENALTIES FOR LATE PAYMENT OR NON-PAYMENT AFTER IDR
ENTITY PAYMENT DETERMINATION.
(a) PHSA.--
(1) Emergency and nonemergency services.--Section 2799A-
1(c)(6) of the Public Health Service Act (42 U.S.C. 300gg-
111(c)(6)) is amended--
(A) in the paragraph heading, by inserting ``;
penalty for late payment or non-payment'' after
``payment'';
(B) by striking ``The total plan'' and inserting
the following:
``(A) Timing of payment.--The total plan''; and
(C) by adding at the end the following new
subparagraphs:
``(B) Notification.--In the case of a plan or
coverage required to make a payment pursuant to a
determination described in subparagraph (A), such plan
or coverage shall submit to the Secretary a
notification of such payment as of the date such
payment is made in a manner specified by the Secretary.
``(C) Penalty for late payment or non-payment.--
``(i) In general.--In the case of a plan or
coverage that has not made the required payment
described in subparagraph (A) with respect to
an item or service in the time period described
in such subparagraph, in addition to making
such payment, such plan or coverage shall also
pay to the nonparticipating provider or
facility an amount that is three times the
difference between--
``(I) the initial payment (or, in
the case of a notice of denial of
payment, $0) described in subsection
(a)(1)(C)(iv)(I) or (b)(1)(C), as
applicable; and
``(II) the out-of-network rate (as
defined in subsection (a)(3)(K)) for
such item or service (less any cost
sharing required to be paid by the
individual receiving such item or
service).
``(ii) Interest.--Such late payment or non-
payment (as applicable) shall also be subject
to interest in a manner specified by the
Secretary.''.
(2) Air ambulance services.--Section 2799A-2(b)(6) of the
Public Health Service Act (42 U.S.C. 300gg-112(b)(6)) is
amended--
(A) in the paragraph heading, by inserting ``;
penalty for late payment or non-payment'' after
``payment'';
(B) by striking ``The total plan'' and inserting
the following:
``(A) Timing of payment.--The total plan''; and
(C) by adding at the end the following new
subparagraphs:
``(B) Notification.--In the case of a plan or
coverage required to make a payment pursuant to a
determination described in subparagraph (A), such plan
or coverage shall submit to the Secretary a
notification of such payment as of the date such
payment is made in a manner specified by the Secretary.
``(C) Penalty for late payment or non-payment.--
``(i) In general.--In the case of a plan or
coverage that has not made the required payment
described in subparagraph (A) with respect to
an item or service in the time period described
in such subparagraph, in addition to making
such payment, such plan or coverage shall also
pay to the nonparticipating provider an amount
that is three times the difference between--
``(I) the initial payment (or, in
the case of a notice of denial of
payment, $0) described in subsection
(a)(3)(A); and
``(II) the out-of-network rate (as
defined in section 2799-1(a)(3)(K)) for
such item or service (less any cost
sharing required to be paid by the
individual receiving such item or
service).
``(ii) Interest.--Such late payment or non-
payment (as applicable) shall also be subject
to interest in a manner specified by the
Secretary.''.
(b) ERISA.--
(1) Emergency and nonemergency services.--Section 716(c)(6)
of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185e(c)(6)) is amended--
(A) in the paragraph heading, by inserting ``;
penalty for late payment or non-payment'' after
``payment'';
(B) by striking ``The total plan'' and inserting
the following:
``(A) Timing of payment.--The total plan''; and
(C) by adding at the end the following new
subparagraphs:
``(B) Notification.--In the case of a plan or
coverage required to make a payment pursuant to a
determination described in subparagraph (A), such plan
or coverage shall submit to the Secretary a
notification of such payment as of the date such
payment is made in a manner specified by the Secretary.
``(C) Penalty for late payment or non-payment.--
``(i) In general.--In the case of a plan or
coverage that has not made the required payment
described in subparagraph (A) with respect to
an item or service in the time period described
in such subparagraph, in addition to making
such payment, such plan or coverage shall also
pay to the nonparticipating provider or
facility an amount that is three times the
difference between--
``(I) the initial payment (or, in
the case of a notice of denial of
payment, $0) described in subsection
(a)(1)(C)(iv)(I) or (b)(1)(C), as
applicable; and
``(II) the out-of-network rate (as
defined in subsection (a)(3)(K)) for
such item or service (less any cost
sharing required to be paid by the
individual receiving such item or
service).
``(ii) Interest.--Such late payment or non-
payment (as applicable) shall also be subject
to interest in a manner specified by the
Secretary.''.
(2) Air ambulance services.--Section 717(b)(6) of the
Employee Retirement Income Security Act of 1974 (29 U.S.C.
1185f(b)(6)) is amended--
(A) in the paragraph heading, by inserting ``;
penalty for late payment or non-payment'' after
``payment'';
(B) by striking ``The total plan'' and inserting
the following:
``(A) Timing of payment.--The total plan''; and
(C) by adding at the end the following new
subparagraphs:
``(B) Notification.--In the case of a plan or
coverage required to make a payment pursuant to a
determination described in subparagraph (A), such plan
or coverage shall submit to the Secretary a
notification of such payment as of the date such
payment is made in a manner specified by the Secretary.
``(C) Penalty for late payment or non-payment.--
``(i) In general.--In the case of a plan or
coverage that has not made the required payment
described in subparagraph (A) with respect to
an item or service in the time period described
in such subparagraph, in addition to making
such payment, such plan or coverage shall also
pay to the nonparticipating provider an amount
that is three times the difference between--
``(I) the initial payment (or, in
the case of a notice of denial of
payment, $0) described in subsection
(a)(3)(A); and
``(II) the out-of-network rate (as
defined in section 716(a)(3)(K)) for
such item or service (less any cost
sharing required to be paid by the
individual receiving such item or
service).
``(ii) Interest.--Such late payment or non-
payment (as applicable) shall also be subject
to interest in a manner specified by the
Secretary.''.
(c) IRC.--
(1) Emergency and nonemergency services.--Section
9816(c)(6) of the Internal Revenue Code of 1986 is amended--
(A) in the paragraph heading, by inserting ``;
penalty for late payment or non-payment'' after
``payment'';
(B) by striking ``The total plan'' and inserting
the following:
``(A) Timing of payment.--The total plan''; and
(C) by adding at the end the following new
subparagraphs:
``(B) Notification.--In the case of a plan required
to make a payment pursuant to a determination described
in subparagraph (A), such plan shall submit to the
Secretary a notification of such payment as of the date
such payment is made in a manner specified by the
Secretary.
``(C) Penalty for late payment or non-payment.--
``(i) In general.--In the case of a plan
that has not made the required payment
described in subparagraph (A) with respect to
an item or service in the time period described
in such subparagraph, in addition to making
such payment, such plan shall also pay to the
nonparticipating provider or facility an amount
that is three times the difference between--
``(I) the initial payment (or, in
the case of a notice of denial of
payment, $0) described in subsection
(a)(1)(C)(iv)(I) or (b)(1)(C), as
applicable; and
``(II) the out-of-network rate (as
defined in subsection (a)(3)(K)) for
such item or service (less any cost
sharing required to be paid by the
individual receiving such item or
service).
``(ii) Interest.--Such late payment or non-
payment (as applicable) shall also be subject
to interest in a manner specified by the
Secretary.''.
(2) Air ambulance services.--Section 9817(b)(6) of the
Internal Revenue Code of 1986 is amended--
(A) in the paragraph heading, by inserting ``;
penalty for late payment or non-payment'' after
``payment'';
(B) by striking ``The total plan'' and inserting
the following:
``(A) Timing of payment.--The total plan''; and
(C) by adding at the end the following new
subparagraphs:
``(B) Notification.--In the case of a plan required
to make a payment pursuant to a determination described
in subparagraph (A), such plan shall submit to the
Secretary a notification of such payment as of the date
such payment is made in a manner specified by the
Secretary.
``(C) Penalty for late payment or non-payment.--
``(i) In general.--In the case of a plan
that has not made the required payment
described in subparagraph (A) with respect to
an item or service in the time period described
in such subparagraph, in addition to making
such payment, such plan shall also pay to the
nonparticipating provider an amount that is
three times the difference between--
``(I) the initial payment (or, in
the case of a notice of denial of
payment, $0) described in subsection
(a)(3)(A); and