H.R.5817

            I 

116TH CONGRESS 
2D SESSION H. R. 5817 

To amend title XXVII of the Public Health Service Act, the Internal Revenue 
Code of 1986, and the Employee Retirement Income Security Act of 
1974 to require health plans to provide to participants, beneficiaries, 
and enrollees an advanced explanation of benefits with respect to items 
and services scheduled to be received from providers and facilities and 
to amend title XI of the Social Security Act to require health care 
providers and health care facilities to provide good faith estimates of 
the expected charges for furnishing such items and services. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 7, 2020 
Mr. NUNES (for himself and Mr. PASCRELL) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 
addition to the Committees on Ways and Means, and Education and 
Labor, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 

A BILL 
To amend title XXVII of the Public Health Service Act, 

the Internal Revenue Code of 1986, and the Employee 
Retirement Income Security Act of 1974 to require 
health plans to provide to participants, beneficiaries, and 
enrollees an advanced explanation of benefits with re-
spect to items and services scheduled to be received from 
providers and facilities and to amend title XI of the 
Social Security Act to require health care providers and 
health care facilities to provide good faith estimates of 

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•HR 5817 IH

the expected charges for furnishing such items and serv-
ices. 

Be it enacted by the Senate and House of Representa-1

tives of the United States of America in Congress assembled, 2

SECTION 1. SHORT TITLE. 3

This Act may be cited as the ‘‘Fair and Honest Ad-4

vance Cost Estimate for Patients Act of 2020’’. 5

SEC. 2. ADVANCED EXPLANATION OF BENEFITS. 6

(a) HEALTH PLAN REQUIREMENTS.— 7

(1) PUBLIC HEALTH SERVICE ACT AMEND-8

MENT.—Subpart II of part A of title XXVII of the 9

Public Health Service Act (42 U.S.C. 300gg–11 et 10

seq.) is amended by adding at the end the following 11

new section: 12

‘‘SEC. 2730. ADVANCED EXPLANATION OF BENEFITS. 13

‘‘(a) IN GENERAL.—Beginning on January 1, 2022, 14

each health plan shall, with respect to a notification sub-15

mitted under section 1128A(t)(1)(B) of the Social Secu-16

rity Act by a health care provider or health care facility, 17

respectively, to the health plan for a participant, bene-18

ficiary, or enrollee under such health plan scheduled to 19

receive an item or service from the provider or facility, 20

not later than 1 business day (or, in the case such item 21

or service was so scheduled at least 10 business days be-22

fore such item or service is to be furnished (or in the case 23

such notification was made pursuant to a request by such 24

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•HR 5817 IH

participant, beneficiary, or enrollee), 3 business days) 1

after the date on which the health plan receives such noti-2

fication, provide to the participant, beneficiary, or enrollee 3

(through mail or electronic means, as requested by the 4

participant, beneficiary, or enrollee) a notification includ-5

ing the following: 6

‘‘(1) Whether or not the provider or facility is 7

a participating provider or a participating facility 8

with respect to the health plan with respect to the 9

furnishing of such item or service and— 10

‘‘(A) in the case the provider or facility is 11

a participating provider or facility with respect 12

to the health plan with respect to the furnishing 13

of such item or service, the contracted rate 14

under such plan for such item or service; and 15

‘‘(B) in the case the provider or facility is 16

a nonparticipating provider or facility with re-17

spect to such plan, a description of how such 18

participant, beneficiary, or enrollee may obtain 19

information on providers and facilities that, 20

with respect to such health plan, are partici-21

pating providers and facilities. 22

‘‘(2) The good faith estimate included in the 23

notification received from the provider or facility. 24

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•HR 5817 IH

‘‘(3) A good faith estimate of the amount the 1

health plan is responsible for paying for items and 2

services included in the estimate described in para-3

graph (2). 4

‘‘(4) A good faith estimate of the amount of 5

any cost-sharing (including with respect to the de-6

ductible and any copayment or coinsurance obliga-7

tion) for which the participant, beneficiary, or en-8

rollee would be responsible for such item or service 9

(as of the date of such notification). 10

‘‘(5) A good faith estimate of the amount that 11

the participant, beneficiary, or enrollee has incurred 12

toward meeting the limit of the financial responsi-13

bility (including with respect to deductibles and out- 14

of-pocket maximums) under the health plan (as of 15

the date of such notification). 16

‘‘(6) In the case such item or service is subject 17

to a medical management technique (including con-18

current review, prior authorization, and step-therapy 19

or fail-first protocols) for coverage under the health 20

plan, a disclaimer that coverage for such item or 21

service is subject to such medical management tech-22

nique. 23

‘‘(7) A disclaimer that the information provided 24

in the notification is only an estimate based on the 25

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•HR 5817 IH

items and services reasonably expected, at the time 1

of scheduling (or requesting) the item or service, to 2

be furnished and is subject to change. 3

‘‘(8) Any other information or disclaimer the 4

health plan determines appropriate that is consistent 5

with information and disclaimers required under this 6

section. 7

‘‘(b) HEALTH PLAN DEFINED.—In this section, the 8

term ‘health plan’ means a group health plan and health 9

insurance coverage offered by a heath insurance issuer in 10

the group or individual market and includes a grand-11

fathered health plan (as defined in section 1251(e) of the 12

Patient Protection and Affordable Care Act).’’. 13

(2) INTERNAL REVENUE CODE OF 1986 AMEND-14

MENT.— 15

(A) IN GENERAL.—Subchapter B of chap-16

ter 100 of the Internal Revenue Code of 1986 17

is amended by adding at the end the following 18

new section: 19

‘‘SEC. 9816. ADVANCED EXPLANATION OF BENEFITS. 20

‘‘(a) IN GENERAL.—Beginning on January 1, 2022, 21

each health plan shall, with respect to a notification sub-22

mitted under section 1128A(t)(1)(B) of the Social Secu-23

rity Act by a health care provider or health care facility, 24

respectively, to the health plan for a participant or bene-25

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•HR 5817 IH

ficiary under such health plan scheduled to receive an item 1

or service from the provider or facility, not later than 1 2

business day (or, in the case such item or service was so 3

scheduled at least 10 business days before such item or 4

service is to be furnished (or in the case such notification 5

was made pursuant to a request by such participant or 6

beneficiary), 3 business days) after the date on which the 7

health plan receives such notification, provide to the par-8

ticipant or beneficiary (through mail or electronic means, 9

as requested by the participant or beneficiary) a notifica-10

tion including the following: 11

‘‘(1) Whether or not the provider or facility is 12

a participating provider or a participating facility 13

with respect to the health plan with respect to the 14

furnishing of such item or service and— 15

‘‘(A) in the case the provider or facility is 16

a participating provider or facility with respect 17

to the health plan with respect to the furnishing 18

of such item or service, the contracted rate 19

under such plan for such item or service; and 20

‘‘(B) in the case the provider or facility is 21

a nonparticipating provider or facility with re-22

spect to such plan, a description of how such 23

participant or beneficiary may obtain informa-24

tion on providers and facilities that, with re-25

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•HR 5817 IH

spect to such health plan, are participating pro-1

viders and facilities. 2

‘‘(2) The good faith estimate included in the 3

notification received from the provider or facility. 4

‘‘(3) A good faith estimate of the amount the 5

health plan is responsible for paying for items and 6

services included in the estimate described in para-7

graph (2). 8

‘‘(4) A good faith estimate of the amount of 9

any cost-sharing (including with respect to the de-10

ductible and any copayment or coinsurance obliga-11

tion) for which the participant or beneficiary would 12

be responsible for such item or service (as of the 13

date of such notification). 14

‘‘(5) A good faith estimate of the amount that 15

the participant or beneficiary has incurred toward 16

meeting the limit of the financial responsibility (in-17

cluding with respect to deductibles and out-of-pocket 18

maximums) under the health plan (as of the date of 19

such notification). 20

‘‘(6) In the case such item or service is subject 21

to a medical management technique (including con-22

current review, prior authorization, and step-therapy 23

or fail-first protocols) for coverage under the health 24

plan, a disclaimer that coverage for such item or 25

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•HR 5817 IH

service is subject to such medical management tech-1

nique. 2

‘‘(7) A disclaimer that the information provided 3

in the notification is only an estimate based on the 4

items and services reasonably expected, at the time 5

of scheduling (or requesting) the item or service, to 6

be furnished and is subject to change. 7

‘‘(8) Any other information or disclaimer the 8

health plan determines appropriate that is consistent 9

with information and disclaimers required under this 10

section. 11

‘‘(b) HEALTH PLAN DEFINED.—In this section, the 12

term ‘health plan’ means a group health plan, including 13

any group health plan that is a grandfathered health plan 14

(as defined in section 1251(e) of the Patient Protection 15

and Affordable Care Act).’’. 16

(B) CONFORMING AMENDMENT.—Section 17

9815(a) of the Internal Revenue Code of 1986 18

is amended— 19

(i) in paragraph (1), by striking ‘‘(as 20

amended by the Patient Protection and Af-21

fordable Care Act)’’ and inserting ‘‘(other 22

than the provisions of section 2730 of such 23

Act)’’; and 24

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9 

•HR 5817 IH

(ii) in paragraph (2), by inserting 1

‘‘(other than the provisions of section 2730 2

of such Act)’’ after ‘‘a provision of such 3

part A’’. 4

(C) CLERICAL AMENDMENT.—The table of 5

sections for such subchapter is amended by 6

adding at the end the following new item: 7

‘‘Sec. 9816. Advanced explanation of benefits.’’. 

(3) EMPLOYEE RETIREMENT INCOME SECURITY 8

ACT OF 1974 AMENDMENT.— 9

(A) IN GENERAL.—Subpart B of part 7 of 10

subtitle B of title I of the Employee Retirement 11

Income Security Act of 1974 (29 U.S.C. 1185 12

et seq.) is amended by adding at the end the 13

following new section: 14

‘‘SEC. 716. ADVANCED EXPLANATION OF BENEFITS. 15

‘‘(a) IN GENERAL.—Beginning on January 1, 2022, 16

each health plan shall, with respect to a notification sub-17

mitted under section 1128A(t)(1)(B) of the Social Secu-18

rity Act by a health care provider or health care facility, 19

respectively, to the health plan for a participant or bene-20

ficiary under such health plan scheduled to receive an item 21

or service from the provider or facility, not later than 1 22

business day (or, in the case such item or service was so 23

scheduled at least 10 business days before such item or 24

service is to be furnished (or in the case such notification 25

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10 

•HR 5817 IH

was made pursuant to a request by such participant or 1

beneficiary), 3 business days) after the date on which the 2

health plan receives such notification, provide to the par-3

ticipant or beneficiary (through mail or electronic means, 4

as requested by the participant or beneficiary) a notifica-5

tion including the following: 6

‘‘(1) Whether or not the provider or facility is 7

a participating provider or a participating facility 8

with respect to the health plan with respect to the 9

furnishing of such item or service and— 10

‘‘(A) in the case the provider or facility is 11

a participating provider or facility with respect 12

to the health plan with respect to the furnishing 13

of such item or service, the contracted rate 14

under such plan for such item or service; and 15

‘‘(B) in the case the provider or facility is 16

a nonparticipating provider or facility with re-17

spect to such plan, a description of how such 18

participant or beneficiary may obtain informa-19

tion on providers and facilities that, with re-20

spect to such health plan, are participating pro-21

viders and facilities. 22

‘‘(2) The good faith estimate included in the 23

notification received from the provider or facility. 24

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11 

•HR 5817 IH

‘‘(3) A good faith estimate of the amount the 1

health plan is responsible for paying for items and 2

services included in the estimate described in para-3

graph (2). 4

‘‘(4) A good faith estimate of the amount of 5

any cost-sharing (including with respect to the de-6

ductible and any copayment or coinsurance obliga-7

tion) for which the participant or beneficiary would 8

be responsible for such item or service (as of the 9

date of such notification). 10

‘‘(5) A good faith estimate of the amount that 11

the participant or beneficiary has incurred toward 12

meeting the limit of the financial responsibility (in-13

cluding with respect to deductibles and out-of-pocket 14

maximums) under the health plan (as of the date of 15

such notification). 16

‘‘(6) In the case such item or service is subject 17

to a medical management technique (including con-18

current review, prior authorization, and step-therapy 19

or fail-first protocols) for coverage under the health 20

plan, a disclaimer that coverage for such item or 21

service is subject to such medical management tech-22

nique. 23

‘‘(7) A disclaimer that the information provided 24

in the notification is only an estimate based on the 25

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12 

•HR 5817 IH

items and services reasonably expected, at the time 1

of scheduling (or requesting) the item or service, to 2

be furnished and is subject to change. 3

‘‘(8) Any other information or disclaimer the 4

health plan determines appropriate that is consistent 5

with information and disclaimers required under this 6

section. 7

‘‘(b) HEALTH PLAN DEFINED.—In this section, the 8

term ‘health plan’ means a group health plan and health 9

insurance coverage offered by a health insurance issuer 10

in the group market and includes a grandfathered health 11

plan (as defined in section 1251(e) of the Patient Protec-12

tion and Affordable Care Act) that is such a plan or cov-13

erage.’’. 14

(B) CONFORMING AMENDMENT.—Section 15

715(a) of the Employee Retirement Income Se-16

curity Act of 1974 (29 U.S.C. 1185d(a)) is 17

amended— 18

(i) in paragraph (1), by striking ‘‘(as 19

amended by the Patient Protection and Af-20

fordable Care Act)’’ and inserting ‘‘(other 21

than the provisions of section 2730 of such 22

Act)’’; and 23

(ii) in paragraph (2), by inserting 24

‘‘(other than the provisions of section 2730 25

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13 

•HR 5817 IH

of such Act)’’ after ‘‘a provision of such 1

part A’’. 2

(C) CLERICAL AMENDMENT.—The table of 3

contents in section 1 of the Employee Retire-4

ment Income Security Act of 1974 is amended 5

by inserting after the item relating to section 6

714 the following new items: 7

‘‘Sec. 715. Additional market reforms. 
‘‘Sec. 716. Advanced explanation of benefits.’’. 

(b) HEALTH CARE PROVIDERS AND FACILITIES.— 8

Section 1128A of the Social Security Act (42 U.S.C. 9

1320a–7a) is amended by adding at the end the following 10

new subsection: 11

‘‘(t)(1) Each health care provider and health care fa-12

cility shall, beginning January 1, 2022, in the case of an 13

individual who schedules an item or service to be furnished 14

to such individual by such provider or facility at least 3 15

business days before the date such item or service is to 16

be so furnished, not later than 1 business day after the 17

date of such scheduling (or, in the case of such an item 18

or service scheduled at least 10 business days before the 19

date such item or service is to be so furnished (or if re-20

quested by the individual), not later than 3 business days 21

after the date of such scheduling or such request)— 22

‘‘(A) inquire if such individual is enrolled in a 23

group health plan, group or individual health insur-24

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•HR 5817 IH

ance coverage offered by a health insurance issuer, 1

or a Federal health care program (and if is so en-2

rolled in such plan or coverage, seeking to have a 3

claim for such item or service submitted to such 4

plan or coverage); and 5

‘‘(B) provide a notification of the good faith es-6

timate of the expected charges for furnishing such 7

item or service (including any item or service that is 8

reasonably expected to be provided in conjunction 9

with such scheduled item or service) to— 10

‘‘(i) in the case the individual is enrolled in 11

such a plan or such coverage (and is seeking to 12

have a claim for such item or service submitted 13

to such plan or coverage), such plan or issuer 14

of such coverage; and 15

‘‘(ii) in the case the individual is not de-16

scribed in clause (i) and not enrolled in a Fed-17

eral health care program, the individual. 18

‘‘(2) Each health care provider or health care facility 19

that fails to provide the estimate as required under para-20

graph (1) shall be subject to a civil monetary penalty in 21

an amount not to exceed $10,000 for each such failure. 22

The provisions of this section (other than subsection (a), 23

subsection (b), the first sentence of subsection (c)(1), and 24

subsection (o)) shall apply to a civil monetary penalty im-25

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posed under the preceding sentence in the same manner 1

as such provisions apply to a penalty or proceeding under 2

subsection (a). 3

‘‘(3) In this subsection— 4

‘‘(A) the terms ‘health insurance issuer’, ‘group 5

health plan’, ‘group health insurance coverage’, and 6

‘individual health insurance coverage’ have the 7

meaning given such terms, respectively, in section 8

2791 of the Public Health Service Act; and 9

‘‘(B) the term ‘Federal health care program’ 10

has the meaning given such term in section 11

1128B(f).’’. 12

Æ 

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  /PDFX3Check false
  /PDFXCompliantPDFOnly true
  /PDFXNoTrimBoxError false
  /PDFXTrimBoxToMediaBoxOffset [
    0.00000
    0.00000
    0.00000
    0.00000
  ]
  /PDFXSetBleedBoxToMediaBox true
  /PDFXBleedBoxToTrimBoxOffset [
    0.00000
    0.00000
    0.00000
    0.00000
  ]
  /PDFXOutputIntentProfile (U.S. Web Coated \050SWOP\051 v2)
  /PDFXOutputConditionIdentifier (CGATS TR 001)
  /PDFXOutputCondition ()
  /PDFXRegistryName (http://www.color.org)
  /PDFXTrapped /False

  /CreateJDFFile false
  /Description <<
    /ARA 
    /BGR 
    /CHS 
    /CHT 
    /CZE 
    /DAN 
    /DEU 
    /ESP 
    /ETI 
    /FRA 
    /GRE 
    /HEB 
    /HRV 
    /HUN 
    /ITA (Utilizzare queste impostazioni per creare documenti Adobe PDF che devono essere conformi o verificati in base a PDF/X-1a:2001, uno standard ISO per lo scambio di contenuto grafico. Per ulteriori informazioni sulla creazione di documenti PDF compatibili con PDF/X-1a, consultare la Guida dell'utente di Acrobat. I documenti PDF creati possono essere aperti con Acrobat e Adobe Reader 4.0 e versioni successive.)
    /JPN 
    /KOR 
    /LTH 
    /LVI 
    /NLD (Gebruik deze instellingen om Adobe PDF-documenten te maken die moeten worden gecontroleerd of moeten voldoen aan PDF/X-1a:2001, een ISO-standaard voor het uitwisselen van grafische gegevens. Raadpleeg de gebruikershandleiding van Acrobat voor meer informatie over het maken van PDF-documenten die compatibel zijn met PDF/X-1a. De gemaakte PDF-documenten kunnen worden geopend met Acrobat en Adobe Reader 4.0 en hoger.)
    /NOR 
    /POL 
    /PTB 
    /RUM 
    /RUS 
    /SKY 
    /SLV 
    /SUO 
    /SVE 
    /TUR 
    /UKR 
    /ENU (Use these settings to create Adobe PDF documents that are to be checked or must conform to PDF/X-1a:2001, an ISO standard for graphic content exchange.  For more information on creating PDF/X-1a compliant PDF documents, please refer to the Acrobat User Guide.  Created PDF documents can be opened with Acrobat and Adobe Reader 4.0 and later.)
  >>
  /Namespace [
    (Adobe)
    (Common)
    (1.0)
  ]
  /OtherNamespaces [
    <<
      /AsReaderSpreads false
      /CropImagesToFrames true
      /ErrorControl /WarnAndContinue
      /FlattenerIgnoreSpreadOverrides false
      /IncludeGuidesGrids false
      /IncludeNonPrinting false
      /IncludeSlug false
      /Namespace [
        (Adobe)
        (InDesign)
        (4.0)
      ]
      /OmitPlacedBitmaps false
      /OmitPlacedEPS false
      /OmitPlacedPDF false
      /SimulateOverprint /Legacy
    >>
    <<
      /AddBleedMarks false
      /AddColorBars false
      /AddCropMarks false
      /AddPageInfo false
      /AddRegMarks false
      /ConvertColors /ConvertToCMYK
      /DestinationProfileName ()
      /DestinationProfileSelector /DocumentCMYK
      /Downsample16BitImages true
      /FlattenerPreset <<
        /PresetSelector /HighResolution
      >>
      /FormElements false
      /GenerateStructure false
      /IncludeBookmarks false
      /IncludeHyperlinks false
      /IncludeInteractive false
      /IncludeLayers false
      /IncludeProfiles false
      /MultimediaHandling /UseObjectSettings
      /Namespace [
        (Adobe)
        (CreativeSuite)
        (2.0)
      ]
      /PDFXOutputIntentProfileSelector /DocumentCMYK
      /PreserveEditing true
      /UntaggedCMYKHandling /LeaveUntagged
      /UntaggedRGBHandling /UseDocumentProfile
      /UseDocumentBleed false
    >>
  ]
>> setdistillerparams
<<
  /HWResolution [2400 2400]
  /PageSize [612.000 792.000]
>> setpagedevice



		Superintendent of Documents
	2020-02-21T07:46:03-0500
	US GPO, Washington, DC 20401
	Superintendent of Documents
	GPO attests that this document has not been altered since it was disseminated by GPO