---
kind: "section"
citation: "42 U.S.C. § 300gg–112"
title: "42"
title_heading: "The Public Health and Welfare"
number: "300gg–112"
heading: "Ending surprise air ambulance bills"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/300gg-112"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter XXV — Requirements Relating to Health Insurance Coverage"
  - "Part D — Additional Coverage Provisions"
---

# §300gg–112. Ending surprise air ambulance bills

- (a) **In general—** In the case of a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee who is in a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) and who receives air ambulance [services](/usc/42/201.md?p=a) from a nonparticipating [provider](/usc/42/299b–21.md?p=8) (as defined in [section 300gg–111(a)(3)(G) of this title](/usc/42/300gg–111.md?p=a-3-G)) with respect to such plan or coverage, if such [services](/usc/42/201.md?p=a) would be covered if provided by a participating [provider](/usc/42/299b–21.md?p=8) (as defined in such section) with respect to such plan or coverage—
  - (1) the cost-sharing requirement with respect to such [services](/usc/42/201.md?p=a) shall be the same requirement that would apply if such [services](/usc/42/201.md?p=a) were provided by such a participating [provider](/usc/42/299b–21.md?p=8), and any coinsurance or deductible shall be based on rates that would apply for such [services](/usc/42/201.md?p=a) if they were furnished by such a participating [provider](/usc/42/299b–21.md?p=8);
  - (2) such cost-sharing amounts shall be counted towards the in-network deductible and in-network out-of-pocket maximum amount under the plan or coverage for the plan year (and such in-network deductible shall be applied) with respect to such items and [services](/usc/42/201.md?p=a) so furnished in the same manner as if such cost-sharing payments were with respect to items and [services](/usc/42/201.md?p=a) furnished by a participating [provider](/usc/42/299b–21.md?p=8); and
  - (3) the [group health plan](/usc/42/300bb–8.md?p=1) or [health insurance issuer](/usc/42/300gg–91.md?p=b-2), respectively, shall—
    - (A) not later than 30 calendar days after the bill for such [services](/usc/42/201.md?p=a) is transmitted by such [provider](/usc/42/299b–21.md?p=8), send to the [provider](/usc/42/299b–21.md?p=8), an initial payment or notice of denial of payment; and
    - (B) pay a total plan or coverage payment, in accordance with, if applicable, [subsection (b)(6)](#b-6), directly to such [provider](/usc/42/299b–21.md?p=8) furnishing such [services](/usc/42/201.md?p=a) to such [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee that is, with application of any initial payment under [subparagraph (A)](#a-3-A), equal to the amount by which the out-of-network rate (as defined in [section 300gg–111(a)(3)(K) of this title](/usc/42/300gg–111.md?p=a-3-K)) for such [services](/usc/42/201.md?p=a) and year involved exceeds the cost-sharing amount imposed under the plan or coverage, respectively, for such [services](/usc/42/201.md?p=a) (as determined in accordance with paragraphs [(1)](#a-1) and [(2)](#a-2)).
- (b) **Determination of out-of-network rates to be paid by health plans; independent dispute resolution process—**
  - (1) **Determination through open negotiation—**
    - (A) **In general—** With respect to air ambulance [services](/usc/42/201.md?p=a) furnished in a year by a nonparticipating [provider](/usc/42/299b–21.md?p=8), with respect to a [group health plan](/usc/42/300bb–8.md?p=1) or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5), and for which a payment is required to be made by the plan or coverage pursuant to [subsection (a)(3)](#a-3), the [provider](/usc/42/299b–21.md?p=8) or plan or coverage may, during the 30-day period beginning on the day the [provider](/usc/42/299b–21.md?p=8) receives an initial payment or a notice of denial of payment from the plan or coverage regarding a claim for payment for such [service](/usc/42/201.md?p=a), initiate open negotiations under this paragraph between such [provider](/usc/42/299b–21.md?p=8) and plan or coverage for purposes of determining, during the open negotiation period, an amount agreed on by such [provider](/usc/42/299b–21.md?p=8), and such plan or coverage for payment (including any cost-sharing) for such [service](/usc/42/201.md?p=a). For purposes of this subsection, the open negotiation period, with respect to air ambulance [services](/usc/42/201.md?p=a), is the 30-day period beginning on the date of initiation of the negotiations with respect to such [services](/usc/42/201.md?p=a).
    - (B) **Accessing independent dispute resolution process in case of failed negotiations—** In the case of open negotiations pursuant to [subparagraph (A)](#b-1-A), with respect to air ambulance [services](/usc/42/201.md?p=a), that do not result in a determination of an amount of payment for such [services](/usc/42/201.md?p=a) by the last day of the open negotiation period described in such subparagraph with respect to such [services](/usc/42/201.md?p=a), the [provider](/usc/42/299b–21.md?p=8) or [group health plan](/usc/42/300bb–8.md?p=1) or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) that was party to such negotiations may, during the 4-day period beginning on the day after such open negotiation period, initiate the independent dispute resolution process under [paragraph (2)](#b-2) with respect to such item or [service](/usc/42/201.md?p=a). The independent dispute resolution process shall be initiated by a party pursuant to the previous sentence by submission to the other party and to the [Secretary](/usc/42/201.md?p=c) of a notification (containing such information as specified by the [Secretary](/usc/42/201.md?p=c)) and for purposes of this subsection, the date of initiation of such process shall be the date of such submission or such other date specified by the [Secretary](/usc/42/201.md?p=c) pursuant to [regulations](/usc/42/201.md?p=d) that is not later than the date of receipt of such notification by both the other party and the [Secretary](/usc/42/201.md?p=c).
  - (2) **Independent dispute resolution process available in case of failed open negotiations—**
    - (A) **Establishment—** Not later than 1 year after December 27, 2020, the [Secretary](/usc/42/201.md?p=c), jointly with the [Secretary](/usc/42/201.md?p=c) of Labor and the [Secretary](/usc/42/201.md?p=c) of the Treasury, shall establish by regulation one independent dispute resolution process (referred to in this subsection as the “IDR process”) under which, in the case of air ambulance [services](/usc/42/201.md?p=a) with respect to which a [provider](/usc/42/299b–21.md?p=8) or [group health plan](/usc/42/300bb–8.md?p=1) or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) submits a notification under [paragraph (1)(B)](#b-1-B) (in this subsection referred to as a “qualified IDR air ambulance [services](/usc/42/201.md?p=a)”), a certified IDR entity under [paragraph (4)](#b-4) determines, subject to [subparagraph (B)](#b-2-B) and in accordance with the succeeding provisions of this subsection, the amount of payment under the plan or coverage for such [services](/usc/42/201.md?p=a) furnished by such [provider](/usc/42/299b–21.md?p=8).
    - (B) **Authority to continue negotiations—** Under the independent dispute resolution process, in the case that the parties to a determination for qualified IDR air ambulance [services](/usc/42/201.md?p=a) agree on a payment amount for such [services](/usc/42/201.md?p=a) during such process but before the date on which the entity selected with respect to such determination under [paragraph (4)](#b-4) makes such determination under [paragraph (5)](#b-5), such amount shall be treated for purposes of [section 300gg–111(a)(3)(K)(ii) of this title](/usc/42/300gg–111.md?p=a-3-K-ii) as the amount agreed to by such parties for such [services](/usc/42/201.md?p=a). In the case of an agreement described in the previous sentence, the independent dispute resolution process shall provide for a method to determine how to allocate between the parties to such determination the payment of the compensation of the entity selected with respect to such determination.
    - (C) **Clarification—** A nonparticipating [provider](/usc/42/299b–21.md?p=8) may not, with respect to an item or [service](/usc/42/201.md?p=a) furnished by such [provider](/usc/42/299b–21.md?p=8), submit a notification under [paragraph (1)(B)](#b-1-B) if such [provider](/usc/42/299b–21.md?p=8) is exempt from the requirement under subsection (a) of [section 300gg–132 of this title](/usc/42/300gg–132.md) with respect to such item or [service](/usc/42/201.md?p=a) pursuant to [subsection (b)](/usc/42/300gg–132.md?p=b) of such section.
  - (3) **Treatment of batching of services—** The provisions of [section 300gg–111(c)(3) of this title](/usc/42/300gg–111.md?p=c-3) shall apply with respect to a notification submitted under this subsection with respect to air ambulance [services](/usc/42/201.md?p=a) in the same manner and to the same extent such provisions apply with respect to a notification submitted under [section 300gg–111(c) of this title](/usc/42/300gg–111.md?p=c) with respect to items and [services](/usc/42/201.md?p=a) described in such section.
  - (4) **IDR entities—**
    - (A) **Eligibility—** An IDR entity certified under this subsection is an IDR entity certified under [section 300gg–111(c)(4) of this title](/usc/42/300gg–111.md?p=c-4).
    - (B) **Selection of certified IDR entity—** The provisions of subparagraph (F) of [section 300gg–111(c)(4) of this title](/usc/42/300gg–111.md?p=c-4) shall apply with respect to selecting an IDR entity certified pursuant to [subparagraph (A)](#b-4-A) with respect to the determination of the amount of payment under this subsection of air ambulance [services](/usc/42/201.md?p=a) in the same manner as such provisions apply with respect to selecting an IDR entity certified under such section with respect to the determination of the amount of payment under [section 300gg–111(c) of this title](/usc/42/300gg–111.md?p=c) of an item or [service](/usc/42/201.md?p=a). An entity selected pursuant to the previous sentence to make a determination described in such sentence shall be referred to in this subsection as the “certified IDR entity” with respect to such determination.
  - (5) **Payment determination—**
    - (A) **In general—** Not later than 30 days after the date of selection of the certified IDR entity with respect to a determination for qualified IDR ambulance [services](/usc/42/201.md?p=a), the certified IDR entity shall—
      - (i) taking into account the considerations specified in [subparagraph (C)](#b-5-C), select one of the offers submitted under [subparagraph (B)](#b-5-B) to be the amount of payment for such [services](/usc/42/201.md?p=a) determined under this subsection for purposes of [subsection (a)(3)](#a-3); and
      - (ii) notify the [provider](/usc/42/299b–21.md?p=8) or facility and the [group health plan](/usc/42/300bb–8.md?p=1) or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) party to such determination of the offer selected under [clause (i)](#b-5-A-i).
    - (B) **Submission of offers—** Not later than 10 days after the date of selection of the certified IDR entity with respect to a determination for qualified IDR air ambulance [services](/usc/42/201.md?p=a), the [provider](/usc/42/299b–21.md?p=8) and the [group health plan](/usc/42/300bb–8.md?p=1) or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) party to such determination—
      - (i) shall each submit to the certified IDR entity with respect to such determination—
        - (I) an offer for a payment amount for such [services](/usc/42/201.md?p=a) furnished by such [provider](/usc/42/299b–21.md?p=8); and
        - (II) such information as requested by the certified IDR entity relating to such offer; and
      - (ii) may each submit to the certified IDR entity with respect to such determination any information relating to such offer submitted by either party, including information relating to any circumstance described in [subparagraph (C)(ii)](#b-5-C-ii).
    - (C) **Considerations in determination—**
      - (i) **In general—** In determining which offer is the payment to be applied pursuant to this paragraph, the certified IDR entity, with respect to the determination for a qualified IDR air ambulance [service](/usc/42/201.md?p=a) shall consider—
        - (I) the qualifying payment amounts (as defined in [section 300gg–111(a)(3)(E) of this title](/usc/42/300gg–111.md?p=a-3-E)) for the applicable year for items or [services](/usc/42/201.md?p=a) that are comparable to the qualified IDR air ambulance [service](/usc/42/201.md?p=a) and that are furnished in the same geographic region (as defined by the [Secretary](/usc/42/201.md?p=c) for purposes of such subsection) as such qualified IDR air ambulance [service](/usc/42/201.md?p=a); and
        - (II) subject to [clause (iii)](#b-5-C-iii), information on any circumstance described in [clause (ii)](#b-5-C-ii), such information as requested in [subparagraph (B)(i)(II)](#b-5-B-i-II), and any additional information provided in [subparagraph (B)(ii)](#b-5-B-ii).
      - (ii) **Additional circumstances—** For purposes of [clause (i)(II)](#b-5-C-i-II), the circumstances described in this clause are, with respect to air ambulance [services](/usc/42/201.md?p=a) included in the notification submitted under [paragraph (1)(B)](#b-1-B) of a nonparticipating [provider](/usc/42/299b–21.md?p=8), [group health plan](/usc/42/300bb–8.md?p=1), or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) the following:
        - (I) The quality and outcomes measurements of the [provider](/usc/42/299b–21.md?p=8) that furnished such [services](/usc/42/201.md?p=a).
        - (II) The acuity of the individual receiving such [services](/usc/42/201.md?p=a) or the complexity of furnishing such [services](/usc/42/201.md?p=a) to such individual.
        - (III) The training, experience, and quality of the medical personnel that furnished such [services](/usc/42/201.md?p=a).
        - (IV) Ambulance vehicle type, including the clinical capability level of such vehicle.
        - (V) Population density of the pick up location (such as urban, suburban, rural, or frontier).
        - (VI) Demonstrations of good faith efforts (or lack of good faith efforts) made by the nonparticipating [provider](/usc/42/299b–21.md?p=8) or nonparticipating facility or the plan or issuer to enter into network agreements and, if applicable, contracted rates between the [provider](/usc/42/299b–21.md?p=8) and the plan or issuer, as applicable, during the previous 4 plan years.
      - (iii) **Prohibition on consideration of certain factors—** In determining which offer is the payment amount to be applied with respect to qualified IDR air ambulance [services](/usc/42/201.md?p=a) furnished by a [provider](/usc/42/299b–21.md?p=8), the certified IDR entity with respect to such determination shall not consider usual and customary charges, the amount that would have been billed by such [provider](/usc/42/299b–21.md?p=8) with respect to such [services](/usc/42/201.md?p=a) had the provisions of [section 300gg–135 of this title](/usc/42/300gg–135.md) not applied, or the payment or reimbursement rate for such [services](/usc/42/201.md?p=a) furnished by such [provider](/usc/42/299b–21.md?p=8) payable by a public payor, including under the Medicare [program](/usc/42/274l–1.md?p=4) under title XVIII of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq.], under the Medicaid [program](/usc/42/274l–1.md?p=4) under title XIX of such Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.], under the Children’s Health Insurance [Program](/usc/42/274l–1.md?p=4) under title XXI of such Act [[42 U.S.C. 1397aa](/usc/42/1397aa.md) et seq.], under the TRICARE [program](/usc/42/274l–1.md?p=4) under [chapter 55](/usc/10/chstA/ptII/ch55.md) of title 10, or under chapter 17 of title 38.
    - (D) **Effects of determination—** The provisions of [section 300gg–111(c)(5)(E) of this title](/usc/42/300gg–111.md?p=c-5-E) shall apply with respect to a determination of a certified IDR entity under [subparagraph (A)](#b-5-A), the notification submitted with respect to such determination, the [services](/usc/42/201.md?p=a) with respect to such notification, and the parties to such notification in the same manner as such provisions apply with respect to a determination of a certified IDR entity under [section 300gg–111(c)(5)(E) of this title](/usc/42/300gg–111.md?p=c-5-E), the notification submitted with respect to such determination, the items and [services](/usc/42/201.md?p=a) with respect to such notification, and the parties to such notification.
    - (E) **Costs of independent dispute resolution process—** The provisions of [section 300gg–111(c)(5)(F) of this title](/usc/42/300gg–111.md?p=c-5-F) shall apply to a notification made under this subsection, the parties to such notification, and a determination under [subparagraph (A)](#b-5-A) in the same manner and to the same extent such provisions apply to a notification under [section 300gg–111(c) of this title](/usc/42/300gg–111.md?p=c), the parties to such notification and a determination made under [section 300gg–111(c)(5)(A) of this title](/usc/42/300gg–111.md?p=c-5-A).
  - (6) **Timing of payment—** The total plan or coverage payment required pursuant to [subsection (a)(3)](#a-3), with respect to qualified IDR air ambulance [services](/usc/42/201.md?p=a) for which a determination is made under [paragraph (5)(A)](#b-5-A) or with respect to an air ambulance [service](/usc/42/201.md?p=a) for which a payment amount is determined under open negotiations under [paragraph (1)](#b-1), shall be made directly to the nonparticipating [provider](/usc/42/299b–21.md?p=8) not later than 30 days after the date on which such determination is made.
  - (7) **Publication of information relating to the IDR process—**
    - (A) **In general—** For each calendar quarter in 2022 and each calendar quarter in a subsequent year, the [Secretary](/usc/42/201.md?p=c) shall publish on the public website of the Department of Health and Human [Services](/usc/42/201.md?p=a)—
      - (i) the number of notifications submitted under the IDR process during such calendar quarter;
      - (ii) the number of such notifications with respect to which a final determination was made under [paragraph (5)(A)](#b-5-A);
      - (iii) the information described in [subparagraph (B)](#b-7-B) with respect to each notification with respect to which such a determination was so made.[^1]
      - (iv) the number of times the payment amount determined (or agreed to) under this subsection exceeds the qualifying payment amount;
      - (v) the amount of expenditures made by the [Secretary](/usc/42/201.md?p=c) during such calendar quarter to carry out the IDR process;
      - (vi) the total amount of fees paid under [paragraph (8)](#b-8) during such calendar quarter; and
      - (vii) the total amount of compensation paid to certified IDR entities under [paragraph (5)(E)](#b-5-E) during such calendar quarter.
    - (B) **Information with respect to requests—** For purposes of [subparagraph (A)](#b-7-A), the information described in this subparagraph is, with respect to a notification under the IDR process of a nonparticipating [provider](/usc/42/299b–21.md?p=8), [group health plan](/usc/42/300bb–8.md?p=1), or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5)—
      - (i) a description of each air ambulance [service](/usc/42/201.md?p=a) included in such notification;
      - (ii) the geography in which the [services](/usc/42/201.md?p=a) included in such notification were provided;
      - (iii) the amount of the offer submitted under [paragraph (2)](#b-2) by the [group health plan](/usc/42/300bb–8.md?p=1) or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) (as applicable) and by the nonparticipating [provider](/usc/42/299b–21.md?p=8) expressed as a percentage of the qualifying payment amount;
      - (iv) whether the offer selected by the certified IDR entity under [paragraph (5)](#b-5) to be the payment applied was the offer submitted by such plan or issuer (as applicable) or by such [provider](/usc/42/299b–21.md?p=8) and the amount of such offer so selected expressed as a percentage of the qualifying payment amount;
      - (v) ambulance vehicle type, including the clinical capability level of such vehicle;
      - (vi) the identity of the [group health plan](/usc/42/300bb–8.md?p=1) or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) or air ambulance [provider](/usc/42/299b–21.md?p=8) with respect to such notification;
      - (vii) the length of time in making each determination;
      - (viii) the compensation paid to the certified IDR entity with respect to the settlement or determination; and
      - (ix) any other information specified by the [Secretary](/usc/42/201.md?p=c).
    - (C) **IDR entity requirements—** For 2022 and each subsequent year, an IDR entity, as a condition of certification as an IDR entity, shall submit to the [Secretary](/usc/42/201.md?p=c) such information as the [Secretary](/usc/42/201.md?p=c) determines necessary for the [Secretary](/usc/42/201.md?p=c) to carry out the provisions of this paragraph.
    - (D) **Clarification—** The [Secretary](/usc/42/201.md?p=c) shall ensure the public reporting under this paragraph does not contain information that would disclose privileged or confidential information of a [group health plan](/usc/42/300bb–8.md?p=1) or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) or of a [provider](/usc/42/299b–21.md?p=8) or facility.
  - (8) **Administrative fee—**
    - (A) **In general—** Each party to a determination under [paragraph (5)](#b-5) to which an entity is selected under [paragraph (4)](#b-4) in a year shall pay to the [Secretary](/usc/42/201.md?p=c), at such time and in such manner as specified by the [Secretary](/usc/42/201.md?p=c), a fee for participating in the IDR process with respect to such determination in an amount described in [subparagraph (B)](#b-8-B) for such year.
    - (B) **Amount of fee—** The amount described in this subparagraph for a year is an amount established by the [Secretary](/usc/42/201.md?p=c) in a manner such that the total amount of fees paid under this paragraph for such year is estimated to be equal to the amount of expenditures estimated to be made by the [Secretary](/usc/42/201.md?p=c) for such year in carrying out the IDR process.
  - (9) **Waiver authority—** The [Secretary](/usc/42/201.md?p=c) may modify any deadline or other timing requirement specified under this subsection (other than the establishment date for the IDR process under [paragraph (2)(A)](#b-2-A) and other than under [paragraph (6)](#b-6)) in cases of extenuating circumstances, as specified by the [Secretary](/usc/42/201.md?p=c), or to ensure that all claims that occur during a 90-day period applied through [paragraph (5)(D)](#b-5-D), but with respect to which a notification is not permitted by reason of such paragraph to be submitted under [paragraph (1)(B)](#b-1-B) during such period, are eligible for the IDR process.
- (c) **Definitions—** For purposes of this section:
  - (1) **Air ambulance service—** The term “air ambulance [service](/usc/42/201.md?p=a)” means medical transport by helicopter or airplane for patients.
  - (2) **Qualifying payment amount—** The term “qualifying payment amount” has the meaning given such term in [section 300gg–111(a)(3) of this title](/usc/42/300gg–111.md?p=a-3).
  - (3) **Nonparticipating provider—** The term “nonparticipating [provider](/usc/42/299b–21.md?p=8)” has the meaning given such term in [section 300gg–111(a)(3) of this title](/usc/42/300gg–111.md?p=a-3).

## Footnotes

[^1]: So in original. The period probably should be a semicolon.

## Source credit

(July 1, 1944, ch. 373, title XXVII, § 2799A–2, as added Pub. L. 116–260, div. BB, title I, § 105(a)(1), Dec. 27, 2020, 134 Stat. 2831.)

## Notes

### Editorial Notes

### References in Text

The Social Security Act, referred to in subsec. (b)(5)(C)(iii), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XVIII, XIX, and XXI of the Act are classified generally to subchapters XVIII (§ 1395 et seq.), XIX (§ 1396 et seq.), and XXI (§ 1397aa et seq.), respectively, of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.

### Statutory Notes and Related Subsidiaries

### Effective Date

Section applicable with respect to plan years beginning on or after Jan. 1, 2022, see section 105(a)(4) of div. BB of Pub. L. 116–260, set out as a note under section 9817 of Title 26, Internal Revenue Code.