Sec. 3. Additional penalties for late payment or non-payment after IDR entity payment determination
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Section 2799A–1(c)(6) of the Public Health Service Act ( 42 U.S.C. 300gg–111(c)(6) ) is amended— in the paragraph heading, by inserting after ; penalty for late payment or non-payment ; payment by striking The total plan and inserting the following: The total plan ; and by adding at the end the following new subparagraphs: 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.
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— 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 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). Such late payment or non-payment (as applicable) shall also be subject to interest in a manner specified by the Secretary. . Section 2799A–2(b)(6) of the Public Health Service Act ( 42 U.S.C. 300gg–112(b)(6) ) is amended— in the paragraph heading, by inserting after ; penalty for late payment or non-payment ; payment by striking The total plan and inserting the following: The total plan ; and by adding at the end the following new subparagraphs: 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. 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— the initial payment (or, in the case of a notice of denial of payment, $0) described in subsection (a)(3)(A); and 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). Such late payment or non-payment (as applicable) shall also be subject to interest in a manner specified by the Secretary. . Section 716(c)(6) of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185e(c)(6) ) is amended— in the paragraph heading, by inserting after ; penalty for late payment or non-payment ; payment by striking The total plan and inserting the following: The total plan ; and by adding at the end the following new subparagraphs: 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. 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— 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 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). Such late payment or non-payment (as applicable) shall also be subject to interest in a manner specified by the Secretary. . Section 717(b)(6) of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185f(b)(6) ) is amended— in the paragraph heading, by inserting after ; penalty for late payment or non-payment ; payment by striking The total plan and inserting the following: The total plan ; and by adding at the end the following new subparagraphs: 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. 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— the initial payment (or, in the case of a notice of denial of payment, $0) described in subsection (a)(3)(A); and 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). Such late payment or non-payment (as applicable) shall also be subject to interest in a manner specified by the Secretary. . Section 9816(c)(6) of the Internal Revenue Code of 1986 is amended— in the paragraph heading, by inserting after ; penalty for late payment or non-payment ; payment by striking The total plan and inserting the following: The total plan ; and by adding at the end the following new subparagraphs: 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. 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— 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 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). Such late payment or non-payment (as applicable) shall also be subject to interest in a manner specified by the Secretary. . Section 9817(b)(6) of the Internal Revenue Code of 1986 is amended— in the paragraph heading, by inserting after ; penalty for late payment or non-payment ; payment by striking The total plan and inserting the following: The total plan ; and by adding at the end the following new subparagraphs: 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. 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— the initial payment (or, in the case of a notice of denial of payment, $0) described in subsection (a)(3)(A); and the out-of-network rate (as defined in section 9816(a)(3)(K)) for such item or service (less any cost sharing required to be paid by the individual receiving such item or service). Such late payment or non-payment (as applicable) shall also be subject to interest in a manner specified by the Secretary. .
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- 42 USC 300gg–111(c)(6)
- 42 USC 300gg–112(b)(6)
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Sec. 3
Additional penalties for late payment or non-payment after IDR entity payment determination
Cite42 USC 300gg–111(c)(6)
Cite42 USC 300gg–112(b)(6)
Cites 4Cited by 0 across 0 sources