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II
116TH CONGRESS
1ST SESSION
S. 1607
To amend title XVIII of the Social Security Act to provide protections
for patients scheduling non-emergency procedures at in-network hospitals,
and for other purposes.
IN THE SENATE OF THE UNITED STATES
MAY 22, 2019
Mr. KENNEDY introduced the following bill; which was read twice and referred
to the Committee on Finance
A BILL
To amend title XVIII of the Social Security Act to provide
protections for patients scheduling non-emergency proce-
dures at in-network hospitals, and for other purposes.
Be it enacted by the Senate and House of Representa-
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tives of the United States of America in Congress assembled,
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SECTION 1. SHORT TITLE.
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This Act may be cited as the ‘‘Medical Billing Fair-
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ness Act of 2019’’.
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•S 1607 IS
SEC. 2. ADDITIONAL CONDITIONS OF PARTICIPATION FOR
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HOSPITALS UNDER THE MEDICARE PRO-
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GRAM WITH RESPECT TO SCHEDULING OF
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NON-EMERGENCY PROCEDURES AT IN-NET-
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WORK HOSPITALS.
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(a) IN GENERAL.—Section 1866(a)(1) of the Social
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Security Act (42 U.S.C. 1395cc(a)(1)) is amended—
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(1) by moving the indentation of subparagraph
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(W) 2 ems to the left;
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(2) in subparagraph (X)—
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(A) by moving the indentation 2 ems to
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the left; and
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(B) by striking ‘‘and’’ at the end;
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(3) in subparagraph (Y), by striking the period
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at the end and inserting ‘‘, and’’; and
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(4) by inserting after subparagraph (Y) the fol-
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lowing new subparagraph:
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‘‘(Z)(i) in the case of a hospital, with respect to
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a non-emergency procedure scheduled by a patient in
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the hospital where the hospital is in-network for the
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patient—
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‘‘(I) to provide to the patient at the time
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of scheduling the opportunity to inform the hos-
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pital that they would like in-network treatment
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only for the procedure; and
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•S 1607 IS
‘‘(II) if such treatment is not available at
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the time of the procedure despite the patient in-
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forming the hospital that they would like such
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treatment at the time of scheduling, to provide
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for payment by the hospital of any additional
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cost to the patient, group health plan, or group
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or individual health insurance coverage for the
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procedure as a result of any treatment that is
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not in-network.
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‘‘(ii) For purposes of this subparagraph, the
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term ‘non-emergency procedure’ means examination
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or treatment for a medical condition (other than an
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emergency medical condition, as defined in section
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1867(e)(1)).’’.
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(b) EFFECTIVE DATE.—The amendments made by
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subsection (a) shall take effect on the date of the enact-
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ment of this Act and apply to contracts entered into or
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renewed on or after the date that is six months after such
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date of enactment.
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Æ
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