Sec. 305. Timely bills for patients
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Part P of title III of the Public Health Service Act ( 42 U.S.C. 280g et seq.) is amended by adding at the end the following: The Secretary shall require— health care facilities, or in the case of practitioners providing services outside of such a facility, practitioners, to provide to patients a list of services rendered during the visit to such facility or practitioner, and, in the case of a facility, the name of the provider for each such service, upon discharge or by postal or electronic communication as soon as practicable and not later than 5 calendar days after discharge; and health care facilities and practitioners to send all adjudicated bills to the patient as soon as practicable, but not later than 45 calendar days after discharge.
No patient may be required to pay a bill for health care services any earlier than 30 calendar days after receipt of a bill for such services. 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. If a facility or practitioner bills a patient after the 45-calendar-day period described in subsection (a)(2), such facility or practitioner shall— report such bill to the Secretary; and refund the patient for the full amount paid in response to such bill with interest, at a rate determined by the Secretary.
The Secretary may impose civil monetary penalties of up to $10,000 a day on any facility or practitioner that— fails to provide a list required under subsection (a)(1) more than 10 times, beginning on the date of such tenth failure; submits more than 10 bills outside of the period described in subsection (a)(2), beginning on the date on which such facility or practitioner sends the tenth such bill; fails to report to the Secretary any failure to provide lists as required under paragraph (1)(A), beginning on the date that is 45 calendar days after discharge; or fails to send any bill as required under subsection (a)(2), beginning on the date that is 45 calendar days after the date of discharge or visit, as applicable.
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. The Secretary may exempt a practitioner or facility from the penalties under paragraph (2)(A) or extend the period of time specified under subsection (a)(2) for compliance with such subsection if a practitioner or facility— makes a good faith attempt to send a bill within 30 days but is unable to do so because of an incorrect address; or experiences extenuating circumstances (as defined by the Secretary), such as a hurricane or cyberattack, that may reasonably delay delivery of a timely bill. . Not later than 1 year after the date of enactment of this Act, the Secretary shall promulgate final regulations to define the term extenuating circumstance for purposes of section 399V–7(c)(3)(B) of the Public Health Service Act, as added by paragraph (1). Subpart II of part A of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–11 ), as amended by section 304, is further amended by adding to the end the following: 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 in order to facilitate facility and practitioner compliance with the requirements under section 399V–7(a). 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 399V–7(a)(2). . The amendments made by subsections
(a)and
(b)shall take effect 6 months after the date of enactment of this Act.
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- 42 USC 300gg–11
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