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..