PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congressional Research Service
No official summary is available in the imported record yet.
People & committees
Rep. Pallone, Frank [D-NJ-6] · D–NJ
Legislative record
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Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Oct 16, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2026-10-09 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The bill would shift specified out-of-network medical payments to a calculated payment benchmark beginning in 2028, affecting health plans, insurers, providers and facilities. Related changes would cover air ambulance services. It would set a 30-day payment deadline where that benchmark applies, revise how it is calculated, and require updated federal rules. It would also expand audit and reporting requirements.
(II) with respect to items and services furnished on or after January 1, 2028, the qualifying payment amount (as defined in subparagraph (E) for such year and determined in accordance with rulemaking described in paragraph (2)(B)) for such item or service; or
(or, with respect to such services for which the out-of-network rate is the qualifying payment amount for such services, not later than 30 days after the bill for such services is transmitted by such provider or facility)
(B) Air ambulance services Section 2799A–2 of the Public Health Service Act (42 U.S.C. 300gg–112) is amended—
shall update the rules issued under clause (i) to revise the methodology the group health plan or health insurance issuer offering group or individual health insurance coverage shall use to determine the qualifying payment amount for an item or service furnished during 2028 or a subsequent year.
(bb) with respect to 2028 and each subsequent year, of a sample with respect to such year of claims data from not less than 25 group health plans and health insurance issuers offering group or individual health insurance coverage;
by inserting (and, beginning for 2028, shall make publicly available) after submit to Congress
Section 1 would name the legislation the Lower Premiums, Faster Payments Act. That title does not establish that premiums would fall.
1. Short title This Act may be cited as the Lower Premiums, Faster Payments Act.
Section 2 would make parallel changes across three federal laws governing health coverage: the Public Health Service Act, the Internal Revenue Code and the Employee Retirement Income Security Act.
2. Adjusting surprise medical billing requirements (a) Amendments to the Public Health Service Act
(b) Amendments to the Internal Revenue Code of 1986
(c) Amendments to the Employee Retirement Income Security Act of 1974
The bill would phase out the specified independent dispute resolution provisions—the process for resolving payment disagreements—by limiting their year references to years ending on or before December 31, 2027. It would also limit specified existing payment procedures to services furnished before January 1, 2028.
(1) Eliminating independent dispute resolution process
(iii) in subsection (c)— (I) in paragraph (1)(A), by inserting ending on or before December 31, 2027, after in a year; and (II) in paragraph (7)— (aa) in subparagraph (A), by inserting ending on or before December 31, 2027 after subsequent year; and (bb) in subparagraph (C), by inserting ending on or before December 31, 2027 after subsequent year.
(I) in subparagraph (C), by inserting with respect to such services furnished before January 1, 2028, before not later than
For items and services furnished on or after January 1, 2028, the amended branch of the out-of-network rate definition would use the qualifying payment amount—a payment benchmark calculated under federal rules. The supplied amendments do not reproduce the other branches of that definition.
(II) in paragraph (3)(K)(ii)—
(II) with respect to items and services furnished on or after January 1, 2028, the qualifying payment amount (as defined in subparagraph (E) for such year and determined in accordance with rulemaking described in paragraph (2)(B)) for such item or service; or
such services for which the out-of-network rate is the qualifying payment amount for such services
Where the out-of-network rate equals the qualifying payment amount, the bill would require payment no later than 30 days after the provider or facility transmits the bill.
(or, with respect to such services for which the out-of-network rate is the qualifying payment amount for such services, not later than 30 days after the bill for such services is transmitted by such provider or facility)
The air ambulance amendments would add the same conditional 30-day payment deadline and December 31, 2027 cutoff for the specified dispute resolution provisions.
(B) Air ambulance services Section 2799A–2 of the Public Health Service Act (42 U.S.C. 300gg–112) is amended— (i) in subsection (a)(3)— (I) in subparagraph (A), by inserting with respect to such services furnished before January 1, 2028, before not later than; and (II) in subparagraph (B), by inserting (or, with respect to such services for which the out-of-network rate is the qualifying payment amount for such services, not later than 30 days after the bill for such services is transmitted by such provider) after subsection (b)(6); and (ii) in subsection (b)— (I) in paragraph (1)(A), by inserting ending on or before December 31, 2027, after in a year; and (II) in paragraph (7)— (aa) in subparagraph (A), by inserting ending on or before December 31, 2027 after subsequent year; and (bb) in subparagraph (C), by inserting ending on or before December 31, 2027 after subsequent year.
For 2028, the benchmark would start with the median—the middle value—of contracted rates recognized by the particular plan or coverage on January 31, 2019. The comparison would use the same or a similar service, the same provider specialty and the geographic region where the service is furnished.
for an item or service furnished during 2028, the median of the contracted rates recognized by the plan or issuer, respectively (determined only with respect to such plan or such coverage)
on January 31, 2019, for the same or a similar item or service that is provided by a provider in the same specialty and provided in the geographic region in which the item or service is furnished, consistent with the methodology established by the Secretary under paragraph (2)
The contracted-rate calculation would include the patient's share, the plan or insurer's share, and average expected incentive payments or later adjustments, including risk-sharing payments, bonuses and penalties.
as the total payment (including the cost-sharing amount imposed for such item or service and the amount to be paid by the plan or issuer, respectively, and the average expected amount of any incentive-based or retroactive payments or payment adjustments, including risk-sharing payments, bonuses, and penalties)
The 2028 calculation would exclude a provider's contracted rate if that provider did not furnish the item or service during the plan year containing January 31, 2019.
excluding any such rate in effect with a provider that did not furnish such item or service during the plan year containing January 31, 2019
The 2028 benchmark would increase the historical rate using annual increases in the Consumer Price Index for All Urban Consumers, a measure of consumer prices, for 2019 through 2027. Starting in 2029, it would increase the previous year's benchmark by the index's percentage increase over that previous year.
increased by the percentage increase in the consumer price index for all urban consumers (United States city average) over 2019 and such percentage increase for each of years 2020 through 2027
(IV) for an item or service furnished during 2029 or a subsequent year, the qualifying payment amount determined under this clause for such an item or service furnished in the previous year, increased by the percentage increase in the consumer price index for all urban consumers (United States city average) over such previous year.
For plans or coverage offered in 2028 or later that the sponsor or insurer did not offer in 2019, the first-year benchmark would follow a methodology established by the responsible Secretary. Later years would use the previous year's benchmark adjusted by the specified consumer price index.
(II) with respect to a sponsor of a group health plan or health insurance issuer offering group or individual health insurance coverage in 2028 or a subsequent year that such sponsor or issuer, respectively, did not offer during 2019— (aa) for the first year in which such group health plan, group health insurance coverage, or individual health insurance coverage, respectively, is offered, a rate (determined in accordance with a methodology established by the Secretary) for items and services that are covered by such plan or coverage and furnished during such first year; and (bb) for each subsequent year such group health plan, group health insurance coverage, or individual health insurance coverage, respectively, is offered, the qualifying payment amount determined under this clause for such items and services furnished in the previous year, increased by the percentage increase in the consumer price index for all urban consumers (United States city average) over such previous year.
A special calculation would apply when the statutory 'first sufficient information year' is 2028 or later. It would use the first day of that year in place of January 31, 2019 and omit the historical inflation increase. For years after that first year, the bill would apply the annual adjustment rule. The supplied text does not fully define when information becomes sufficient.
(bb) in the case that such first sufficient information year is 2028 or a subsequent year, has the meaning given the term qualifying payment amount in clause (i)(III), except that in applying such clause to such item or service, the reference to furnished during 2028 shall, for first sufficient information years subsequent to 2028, be treated as a reference to furnished during such first sufficient information year, the reference to January 31, 2019 shall be treated as a reference to the first day of such first sufficient information year, and the increase described in such clause shall not be applied
(bb) in the case that such first sufficient information year is 2028 or a subsequent year, has the meaning given such term in clause (i)(IV), except that in applying such clause to such item or service, the reference to furnished during 2029 or a subsequent year shall, for first sufficient information years subsequent to 2028, be treated as a reference to furnished during the year after such first sufficient information year or a subsequent year.
The responsible federal departments would have to update the benchmark calculation rules within 180 days after enactment, consulting with one another. The updated methods would govern services furnished in 2028 and later.
Not later than 180 days after the date of enactment of this clause, the Secretary, in consultation with the Secretary of Labor and the Secretary of the Treasury, shall update the rules issued under clause (i) to revise the methodology the group health plan or health insurance issuer offering group or individual health insurance coverage shall use to determine the qualifying payment amount for an item or service furnished during 2028 or a subsequent year.
Not later than 180 days after the date of enactment of this clause, the Secretary, in consultation with the Secretary of Labor and the Secretary of Health and Human Services, shall update the rules issued under clause (i)
Not later than 180 days after the date of enactment of this clause, the Secretary, in consultation with the Secretary of the Treasury and the Secretary of Health and Human Services, shall update the rules issued under subparagraph (A)
The bill would permit, but would not require, use of an interim final rule as an expedited way to issue the updated rules.
(II) Expedited rulemaking The Secretary may promulgate an interim final rule to carry out this clause.
(ii) Expedited rulemaking The Secretary may promulgate an interim final rule to carry out this subparagraph.
The bill would prohibit judicial review—review by courts—of the federally established method for calculating the qualifying payment amount. This language addresses the methodology, rather than expressly barring every dispute about an individual payment.
(vi) Judicial review There shall be no judicial review of the methodology for determining the qualifying payment amount established under this subparagraph.
(D) Judicial review There shall be no judicial review of the methodology for determining the qualifying payment amount established under this paragraph.
Beginning in 2028, the Public Health Service Act audit provision would require an annual sample of claims data from at least 25 health plans and insurers offering group or individual coverage. The parallel tax-code provision would require claims data from at least 25 group health plans.
(C) Annual audits Section 2799A–1(a)(2)(A) of the Public Health Service Act (42 U.S.C. 300gg–111(a)(2)(A)) is amended—
(bb) with respect to 2028 and each subsequent year, of a sample with respect to such year of claims data from not less than 25 group health plans and health insurance issuers offering group or individual health insurance coverage;
(C) Annual audits Section 9816(a)(2)(A) of the Internal Revenue Code of 1986 is amended—
(bb) with respect to 2028 and each subsequent year, of a sample with respect to such year of claims data from not less than 25 group health plans;
In both amended audit provisions, the bill would replace 'may' with 'shall' in a separate subclause, changing permission to a requirement. The underlying subclause is not reproduced, so the supplied text does not fully describe the duty made mandatory.
(C) Annual audits Section 2799A–1(a)(2)(A) of the Public Health Service Act (42 U.S.C. 300gg–111(a)(2)(A)) is amended—
(C) Annual audits Section 9816(a)(2)(A) of the Internal Revenue Code of 1986 is amended—
(II) in subclause (II), by striking may and inserting shall
The amended audit reports to Congress would have to include the findings of each audit. Beginning for 2028, the reports would also have to be publicly available.
(ii) in clause (iii)— (I) by inserting (and, beginning for 2028, shall make publicly available) after submit to Congress; (II) by striking the period at the end and inserting ; and; (III) by striking on the number and inserting: on— (I) the number ; and (IV) by adding at the end the following new subclause: (II) the findings of each such audit.
The supplied official-actions snapshot, updated October 16, 2026, records introduction in the House on October 9, 2026 and referral that day to Energy and Commerce, Education and Workforce, and Ways and Means for provisions within their respective jurisdictions.
Source snapshot updated 2026-10-16T15:00:44Z.
2026-10-09: Introduced in House
2026-10-09: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
A closer look
Reviewed version: Introduced in House · 2026-10-09. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy rider attached to appropriations was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for particular recipients or places was identified in the complete supplied introduced text. This conclusion is limited to that version; formal earmark disclosures and accompanying materials are not supplied.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow preferential exemption, carve-out or special benefit was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials.
Full text preserved for this analysis. Legislative record snapshot: Oct 16, 2026. How PlainBill uses AI