Title I, SEC. 1406. HEALTH PLAN ARRANGEMENTS WITH PROVIDERS. 
      (a) Requirement. Each health plan must enter into such agreements with 
    health care providers or have such other arrangements as may be necessary 
    to assure the provision of all services covered by the comprehensive 
    benefit package to eligible individuals enrolled with the plan. 

      (b) Emergency and Urgent Care Services. 

        (1) In general. Each health plan must cover emergency and urgent care 
      services provided to enrollees, without regard to whether or not the 
      provider furnishing such services has a contractual (or other) 
      arrangement with the plan to provide items or services to enrollees of 
      the plan. 

        (2) Payment amounts. In the case of  emergency and urgent care provided 
      to an enrollee outside of a health plan's service area, the payment 
      amounts of the plan shall be based on the fee for service rate schedule 
      established by the regional alliance for the alliance area where the 
      services were provided. 

      (c) Application of Fee Schedule. 

        (1) In general. Subject to paragraph (2), each regional alliance health 
      plan or corporate alliance health plan that provides for payment for 
      services on a fee-for-service basis shall make such payment in the 
      amounts provided under the fee schedule established by the regional 
      alliance under section 1322(c) (or, in the case of a plan offered in a 
      State that has established a Statewide fee schedule under section 
      1322(c)(3), under such Statewide fee schedule). 

        (2) Reduction for providers voluntarily reducing charges. If a provider 
      under a health plan voluntarily agrees to reduce the amount charged to an 
      individual enrolled under the plan, the plan shall reduce the amount 
      otherwise determined under the fee schedule applicable under paragraph 
      (1) by the proportion of the reduction in such amount charged. 

        (3) Reduction for noncomplying plan. Each regional alliance health plan 
      that is a noncomplying plan shall provide for reductions in payments 
      under the fee schedule to providers that are not participating providers 
      in accordance with section 6012(b). 

      (d) Prohibition Against Balance Billing; Requirement of Direct Billing. 

        (1) Prohibition of balance billing. A provider may not charge or 
      collect from an enrollee a fee in excess of the applicable payment amount 
      under the applicable fee schedule under subsection (c), and the health 
      plan and its enrollees are not legally responsible for payment of any 
      amount in excess of such applicable payment amount for items and services 
      covered under the comprehensive benefits package. 

        (2) Direct billing. A provider may not charge or collect from an 
      enrollee amounts that are payable by the health plan (including any cost 
      sharing reduction assistance payable by the plan) and shall submit 
      charges to such plan in accordance with any applicable requirements of 
      part 1 of subtitle B of title V (relating to health information systems). 

        (3) Coverage under agreements with plans. The agreements or other 
      arrangements entered into under subsection (a) between a health plan and 
      the health care providers providing the comprehensive benefit package to 
      individuals enrolled with the plan shall prohibit a provider from 
      engaging in balance billing described in paragraph (1). 

      (e) Imposition of Participating Provider Assessment in Case of a 
    Noncomplying Plan. Each health plan shall provide that if the plan is a 
    noncomplying plan for a year under section 6012, payments to participating 
    providers shall be reduced by the applicable network reduction percentage 
    under such section.