Sec. 501. Ensuring access to emergency services without excessive charges for out-of-network services
644 words·~3 min read·
/bill/114/s/2985/is/section-501·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1867 of the Social Security Act ( 42 U.S.C. 1395dd ) is amended— in subsection (d), by adding at the end the following new paragraph: A hospital, physician, or other entity that violates the requirements of subsection (j)(1) with respect to the furnishing of items and services is subject to a civil money penalty of not more than $25,000 for each such violation. The provisions of section 1128A (other than subsections
(a)and (b)) shall apply to a civil money penalty under this paragraph in the same manner as such provisions apply with respect to a penalty or proceeding under section 1128A(a). ; and by adding at the end the following new subsection: If items or services to screen or treat an emergency medical condition are furnished under this section in a participating hospital with respect to an individual and the individual has not, directly or through a health insurance issuer, group health plan, or other third party, negotiated a payment rate for such items and services, subject to paragraph (2), the charges imposed for such items and services may not be in excess of the following: For physicians’ services or services of a health care provider to which section 223(f)(9) of the Internal Revenue Code of 1986 applies (and including drugs and biologicals furnished in conjunction with and billed as part of such services), the lesser of— the cash price for such services posted pursuant to such section; or 85 percent of the usual, customary, and reasonable
(UCR)charge for such services, as determined under rules established by the department of insurance for the State in which the services are furnished. For inpatient and outpatient hospital services for which payment rates are established under this title (and including drugs and biologicals furnished in conjunction with and billed as part of such services), the lesser of— the cash price for such services posted pursuant to section 223(f)(9) of the Internal Revenue Code of 1986; or 110 percent of the payment rate applicable to such services in the case of an individual entitled to benefits under part A and enrolled under part B. For drugs and other pharmaceuticals furnished to which a previous subparagraph does not apply, the lesser of— twice the acquisition cost to the hospital or other provider for the dose involved; or the acquisition cost to the hospital or other provider plus $250. The dollar amount in clause
(ii)shall be increased from year to year (beginning with the year after the first year in which this subsection applies) by the same percentage as the percentage increase in the consumer price index for all urban consumers (all items; U.S. city average) for the year involved (as determined by the Secretary). Any such dollar amount as so increased that is not a multiple of $5 shall be rounded to the nearest multiple of $5 (or, if a multiple of $2.50, to the next highest multiple of $5). For any other items or services, the lesser of— the cash price for such items and services posted pursuant to section 223(f)(9) of the Internal Revenue Code of 1986; or 110 percent of the payment basis that would be applicable to payment for such items and services under this title in the case of an individual entitled to benefits under part A and enrolled under part B. In the case of items and services for which there is a single price for a group or bundle of such items and services, the maximum charge permitted under paragraph
(1)may not exceed the lesser of— the price charged for such bundled services; or the aggregate of the maximum charges permitted under paragraph
(1)with respect to items and services included in such bundle. . The amendments made by this section shall apply to charges imposed for items and services furnished on or after January 1, 2017.
Connectionstraces to 1
Traces to 1 document
Citation graph
cites case law
Sec. 501
Ensuring access to emergency services without excessive charges for out-of-network services
Cites 1Cited by 0 across 0 sources