; (B) shall calculate such cost-sharing amount as if the contracted rate for such services if furnished by a participating provider were equal to the recognized amount for such items and services; (C) shall pay to such provider furnishing such items and services to such participant or beneficiary the amount by which the out-of-network rate for such items and services exceeds the cost-sharing amount imposed under the plan for such items and services (as determined in accordance with subparagraphs (A) and (B)); and (D) shall apply the deductible or out-of-pocket maximum, if any, that would apply if such services were furnished by a participating provider. (2) Exception Paragraph (1) shall not apply to a health plan in the case of items or services furnished to a participant or beneficiary of a health plan by a nonparticipating provider during a visit (as so defined by the Secretary in accordance with subsection (k)(2)) at a participating facility if the requirement described in paragraph (1) of section 1150C(b) of the Social Security Act does not apply with respect to such provider and such items and services due to the application of paragraph (2) of such section. . (2) Effective date The amendments made by paragraph (1) shall apply with respect to plan years beginning on or after January 1, 2022. 4. Consumer protections through application of health plan external review in cases of certain surprise medical bills Section 2719(b)(1) of the Public Health Service Act ( 42 U.S.C. 300gg–19(b)(1) ) is amended— (1) by striking at a minimum, includes and inserting at a minimum— (A) includes ; (2) by striking at the end or and inserting and