1. Short title This Act may be cited as the Air Ambulance Affordability Act of 2019 . 2. Prohibiting surprise billing with respect to air ambulance services (a) Air ambulance services (1) In general Section 2719A of the Public Health Service Act ( 42 U.S.C. 300gg–19a ) is amended by adding at the end the following new subsections: (e) Air ambulance services (1) In general Subject to paragraph (2), in the case of air ambulance services furnished to a participant, beneficiary, or enrollee of a health plan (as defined in paragraph (3)(A)) by a nonparticipating provider (as defined in paragraph (3)(C)), the plan— (A) shall not impose on such participant, beneficiary, or enrollee a cost-sharing amount (expressed as a copayment amount or coinsurance rate) for such services so furnished that is greater than the cost-sharing amount that would apply under such plan had such services been furnished by a participating provider; (B) shall calculate such cost-sharing amount as if the negotiated rate that would have been charged by such participating provider for such services were equal to the amount determined in accordance with subsection (f) for such services (or, in the case of such services furnished in a State described in paragraph (3)(E)(i), the amount determined by such State for such services in accordance with the method described in such paragraph); (C) shall pay to such provider furnishing such services to such participant, beneficiary, or enrollee the amount by which the recognized amount (as defined in paragraph (3)(E)) for such services exceeds the cost-sharing amount imposed for such services (as determined in accordance with subparagraphs (A) and (B))