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S. 1607: Medical Billing Fairness Act of 2019

The text of the bill below is as of May 22, 2019 (Introduced).



1st Session

S. 1607


May 22, 2019

introduced the following bill; which was read twice and referred to the Committee on Finance


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.


Short title

This Act may be cited as the Medical Billing Fairness Act of 2019.


Additional conditions of participation for hospitals under the Medicare program with respect to scheduling of non-emergency procedures at in-network hospitals


In general

Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended—


by moving the indentation of subparagraph (W) 2 ems to the left;


in subparagraph (X)—


by moving the indentation 2 ems to the left; and


by striking and at the end;


in subparagraph (Y), by striking the period at the end and inserting , and; and


by inserting after subparagraph (Y) the following new subparagraph:


in the case of a hospital, with respect to a non-emergency procedure scheduled by a patient in the hospital where the hospital is in-network for the patient—


to provide to the patient at the time of scheduling the opportunity to inform the hospital that they would like in-network treatment only for the procedure; and


if such treatment is not available at the time of the procedure despite the patient informing the hospital that they would like such treatment at the time of scheduling, to provide for payment by the hospital of any additional cost to the patient, group health plan, or group or individual health insurance coverage for the procedure as a result of any treatment that is not in-network.


For purposes of this subparagraph, the term non-emergency procedure means examination or treatment for a medical condition (other than an emergency medical condition, as defined in section 1867(e)(1)).



Effective date

The amendments made by subsection (a) shall take effect on the date of the enactment of this Act and apply to contracts entered into or renewed on or after the date that is six months after such date of enactment.