119-s2420

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2420 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 2420

 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, health insurance 
 issuers, and nonparticipating providers or facilities for practices 
 that violate balance billing requirements, and for other purposes.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 July 23, 2025

 Mr. Marshall (for himself and Mr. Bennet) introduced the following 
 bill; which was read twice and referred to the Committee on Health, 
 Education, Labor, and Pensions

_______________________________________________________________________

 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, health insurance 
 issuers, and nonparticipating providers or facilities 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 ``No Surprises Act Enforcement 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 violation)'' 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 per 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)'' 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'';
            (C) in subparagraph
        (A) , as so inserted, by adding 
 at the end the following new sentence: ``In the case 
 such determination is an amount less than the sum of 
 the initial payment for such item or service and any 
 cost sharing required to be paid by the individual 
 receiving such item or service, the nonparticipating 
 provider or facility furnishing such item or service 
 shall pay to such plan or coverage the difference 
 between such determination and such sum not later than 
 30 days after the date on which such determination is 
 made.''; and
            (D) by adding at the end the following new 
 subparagraphs:
 ``
        (B) Notification.--In the case of a plan or 
 coverage, or a nonparticipating provider or facility, 
 required to make a payment pursuant to a determination 
 described in subparagraph
        (A) , such plan or coverage or 
 nonparticipating provider or facility 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, or a nonparticipating provider or 
 facility, 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 or nonparticipating provider or 
 facility shall also pay to the nonparticipating 
 provider or facility or plan or coverage (as 
 applicable) 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.--A late payment penalty 
 under clause
            (i) 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'';
            (C) in subparagraph
        (A) , as so inserted, by adding 
 at the end the following new sentence: ``In the case 
 such determination is an amount less than the sum of 
 the initial payment for such item or service and any 
 cost sharing required to be paid by the individual 
 receiving such item or service, the nonparticipating 
 provider or facility furnishing such item or service 
 shall pay to such plan or coverage the difference 
 between such determination and such sum not later than 
 30 days after the date on which such determination is 
 made.''; and
            (D) by adding at the end the following new 
 subparagraphs:
 ``
        (B) Notification.--In the case of a plan or 
 coverage, or a nonparticipating provider or facility, 
 required to make a payment pursuant to a determination 
 described in subparagraph
        (A) , such plan or coverage or 
 nonparticipating provider or facility 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, or a nonparticipating provider or 
 facility, 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 or nonparticipating provider or 
 facility shall also pay to the nonparticipating 
 provider or facility or plan or coverage (as 
 applicable) 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.--A late payment penalty 
 under clause
            (i) 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'';
            (C) in subparagraph
        (A) , as so inserted, by adding 
 at the end the following new sentence: ``In the case 
 such determination is an amount less than the sum of 
 the initial payment for such item or service and any 
 cost sharing required to be paid by the individual 
 receiving such item or service, the nonparticipating 
 provider or facility furnishing such item or service 
 shall pay to such plan or coverage the difference 
 between such determination and such sum not later than 
 30 days after the date on which such determination is 
 made.''; and
            (D) by adding at the end the following new 
 subparagraphs:
 ``
        (B) Notification.--In the case of a plan or 
 coverage, or a nonparticipating provider or facility, 
 required to make a payment pursuant to a determination 
 described in subparagraph
        (A) , such plan or coverage or 
 nonparticipating provider or facility 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, or a nonparticipating provider or 
 facility, 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 or nonparticipating provider or 
 facility shall also pay to the nonparticipating 
 provider or facility or plan or coverage (as 
 applicable) 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.--A late payment penalty 
 under clause
            (i) 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'';
            (C) in subparagraph
        (A) , as so inserted, by adding 
 at the end the following new sentence: ``In the case 
 such determination is an amount less than the sum of 
 the initial payment for such item or service and any 
 cost sharing required to be paid by the individual 
 receiving such item or service, the nonparticipating 
 provider or facility furnishing such item or service 
 shall pay to such plan or coverage the difference 
 between such determination and such sum not later than 
 30 days after the date on which such determination is 
 made.''; and
            (D) by adding at the end the following new 
 subparagraphs:
 ``
        (B) Notification.--In the case of a plan or 
 coverage, or a nonparticipating provider or facility, 
 required to make a payment pursuant to a determination 
 described in subparagraph
        (A) , such plan or coverage or 
 nonparticipating provider or facility 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, or a nonparticipating provider or 
 facility, 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 or nonparticipating provider or 
 facility shall also pay to the nonparticipating 
 provider or facility or plan or coverage (as 
 applicable) 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.--A late payment penalty 
 under clause
            (i) 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'';
            (C) in subparagraph
        (A) , as so inserted, by adding 
 at the end the following new sentence: ``In the case 
 such determination is an amount less than the sum of 
 the initial payment for such item or service and any 
 cost sharing required to be paid by the individual 
 receiving such item or service, the nonparticipating 
 provider or facility furnishing such item or service 
 shall pay to such plan the difference between such 
 determination and such sum not later than 30 days after 
 the date on which such determination is made.''; and
            (D) by adding at the end the following new 
 subparagraphs:
 ``
        (B) Notification.--In the case of a plan, or a 
 nonparticipating provider or facility, required to make 
 a payment pursuant to a determination described in 
 subparagraph
        (A) , such plan or nonparticipating 
 provider or facility 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 a nonparticipating provider or facility, 
 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 nonparticipating 
 provider or facility shall also pay to the 
 nonparticipating provider or facility or plan 
 (as applicable) 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.--A late payment penalty 
 under clause
            (i) 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'';
            (C) in subparagraph
        (A) , as so inserted, by adding 
 at the end the following new sentence: ``In the case 
 such determination is an amount less than the sum of 
 the initial payment for such item or service and any 
 cost sharing required to be paid by the individual 
 receiving such item or service, the nonparticipating 
 provider or facility furnishing such item or service 
 shall pay to such plan the difference between such 
 determination and such sum not later than 30 days after 
 the date on which such determination is made.''; and
            (D) by adding at the end the following new 
 subparagraphs:
 ``
        (B) Notification.--In the case of a plan, or a 
 nonparticipating provider or facility, required to make 
 a payment pursuant to a determination described in 
 subparagraph
        (A) , such plan or nonparticipating 
 provider or facility 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 a nonparticipating provider or facility, 
 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 nonparticipating 
 provider or facility shall also pay to the 
 nonparticipating provider or facility or plan 
 (as applicable) 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 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).
 ``
            (ii) Interest.--A late payment penalty 
 under clause
            (i) shall also be subject to 
 interest in a manner specified by the 
 Secretary.''.

SEC. 4. TRANSPARENCY REPORTING REQUIREMENTS.

    (a) PHSA.--

Section 2799A-1

    (a)

    (2)
        (A)
            (iii) of the Public Health 
Service Act (42 U.S.C. 300gg-111

    (a)

    (2)
        (A)
            (iii) ) is amended to read as 
follows:
 ``
            (iii) Reporting.--
 ``
            (I) Initial reporting.--Beginning 
 for 2022 and ending on December 31 of 
 the calendar year in which the No 
 Surprises Act Enforcement Act is 
 enacted, the Secretary shall annually 
 submit to Congress a report on the 
 number of plans and issuers with 
 respect to which audits were conducted 
 during such year pursuant to this 
 subparagraph.
 ``
            (II) Subsequent reporting.--
 ``

    (aa) In general.--With 
 respect to the first calendar 
 year following the date of the 
 enactment of the No Surprises 
 Act Enforcement Act, not later 
 than February 1 of such year, 
 and every 6 months thereafter, 
 the Secretary, in coordination 
 with the Secretary of Labor and 
 the Secretary of the Treasury, 
 shall submit to the Committee 
 on Ways and Means, the 
 Committee on Energy and 
 Commerce, and the Committee on 
 Education and the Workforce of 
 the House of Representatives, 
 and the Committee on Finance 
 and the Committee on Health, 
 Education, Labor and Pensions 
 of the Senate, a report on any 
 audits conducted pursuant to 
 this subparagraph during the 
 applicable reporting period, 
 and any enforcement actions 
 taken during such period in 
 accordance with the provisions 
 of this part, including--

 ``

    (AA) the total 
 number of audits 
 conducted under this 
 subparagraph;

 ``

    (BB) the number 
 of audits conducted 
 pursuant to clause
            (ii) 
            (I) ;

 ``
            (CC) the number 
 of complaints submitted 
 by providers and by 
 participants, 
 beneficiaries, and 
 enrollees with respect 
 to a violation of this 
 part;

 ``
            (DD) any 
 enforcement actions 
 taken as a result of a 
 complaint submitted by 
 a provider or by a 
 participant, a 
 beneficiary, or an 
 enrollee, with respect 
 to the provisions of 
 this part;

 ``

    (EE) the total 
 number of, and the 
 aggregate dollar amount 
 of, any civil monetary 
 penalties issued in 
 accordance with this 
 part;

 ``

    (FF) a summary of 
 any non-monetary 
 corrective action taken 
 against a group health 
 plan or health 
 insurance issuer 
 offering group or 
 individual health 
 insurance coverage for 
 a violation of this 
 part; and

 ``

    (GG) a 
 description of the 3 
 most commonly reported 
 violations of this 
 part.

 ``

    (bb) Applicable reporting 
 period.--For purposes of this 
 subclause, the term `applicable 
 reporting period' means the 6 
 month period prior to each 
 report submitted under item

    (aa) .''.

    (b) IRC.--

Section 9816

    (a)

    (2)
        (A)
            (iii) of the Internal Revenue Code 
of 1986 is amended to read as follows:
 ``
            (iii) Reporting.--
 ``
            (I) Initial reporting.--Beginning 
 for 2022 and ending on December 31 of 
 the calendar year in which the No 
 Surprises Act Enforcement Act is 
 enacted, the Secretary shall annually 
 submit to Congress a report on the 
 number of plans with respect to which 
 audits were conducted during such year 
 pursuant to this subparagraph.
 ``
            (II) Subsequent reporting.--
 ``

    (aa) In general.--With 
 respect to the first calendar 
 year following the date of the 
 enactment of the No Surprises 
 Act Enforcement Act, not later 
 than February 1 of such year, 
 and every 6 months thereafter, 
 the Secretary, in coordination 
 with the Secretary of Labor and 
 the Secretary of Health and 
 Human Services, shall submit to 
 the Committee on Ways and 
 Means, the Committee on Energy 
 and Commerce, and the Committee 
 on Education and Workforce of 
 the House of Representatives, 
 and the Committee on Finance 
 and the Committee on Health, 
 Education, Labor and Pensions 
 of the Senate, a report on 
 audits performed pursuant to 
 this subparagraph during the 
 applicable reporting period, 
 and any enforcement actions 
 taken during such period in 
 accordance with the provisions 
 of an applicable section, 
 including--

 ``

    (AA) the total 
 number of audits 
 conducted under this 
 subparagraph;

 ``

    (BB) the number 
 of audits conducted 
 pursuant to clause
            (ii) 
            (I) ;

 ``
            (CC) the number 
 of complaints submitted 
 by providers and by 
 participants and 
 beneficiaries with 
 respect to a violation 
 of an applicable 
 section;

 ``
            (DD) any 
 enforcement actions 
 taken pursuant to a 
 violation of an 
 applicable section;

 ``

    (EE) the total 
 number of, and the 
 aggregate dollar amount 
 of, any civil monetary 
 penalties issued in 
 accordance with an 
 applicable section;

 ``

    (FF) a summary of 
 any non-monetary 
 corrective action taken 
 against a group health 
 plan for a violation of 
 an applicable section; 
 and

 ``

    (GG) a 
 description of the 3 
 most commonly reported 
 violations of an 
 applicable section.

 ``

    (bb) 

=== Definitions. ===
-In 
 this subclause:

 ``

    (AA) Applicable 
 reporting period.--The 
 term `applicable 
 reporting period' means 
 the 6 month period 
 prior to each report 
 submitted under item

    (aa) .

 ``

    (BB) Applicable 
 section.--The term 
 `applicable section' 
 means this section and 
 each of sections 9817 
 through 9825.''.

 <all>