; and (ii) the estimated amount that such provider may charge the participant, beneficiary, or enrollee for such items and services involved; (B) has been provided by the plan or coverage, prior to the provision of any post-stabilization, out-of-network service at such facility, with— (i) paper and electronic notification that the practitioner or facility is an out-of-network health care provider and the out-of-network rate of the provider, as applicable, and the option to affirmatively consent to receiving services from such practitioner or facility; (ii) a list of in-network practitioners or facilities that could provide the same services, and an option for a referral to such providers; and (iii) information about whether prior authorization or other care management limitations may be required in advance of receiving in-network care at the facility; and (C) has acknowledged that the out-of-network treatment may not be covered or may be covered at an out-of-network cost-sharing amount, requiring higher cost-sharing obligations of the enrollee than if the service were provided at an in-network facility, and has assumed, in writing, full responsibility of out-of-pocket costs associated with services furnished after the enrollee has been stabilized, from the out-of-network practitioner or facility, as applicable. (2) Requirements of notice The notice under paragraph (1) shall be in a format determined by the Secretary to give a reasonable layperson clear comprehension of the terms of the agreement, including all possible financial responsibilities, including the requirements that the notice— (A) does not exceed one page in length; (B) is readily identifiable for its purpose and as a contract of consent; (C) clearly states that consent is optional; (D) includes an estimate of the amount that such provider will charge the participant, beneficiary, or enrollee for such items and services involved