[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2863 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 2863
To amend title XVIII of the Social Security Act and title XXVII of the
Public Health Service Act to address incorrect billing by off-campus
hospital locations, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 25, 2023
Mrs. Spartz introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act and title XXVII of the
Public Health Service Act to address incorrect billing by off-campus
hospital locations, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Preventing Hospital Overbilling of
Medicare Act''.
SEC. 2. ADDRESSING INCORRECT BILLING BY OFF-CAMPUS HOSPITAL LOCATIONS.
(a) Promoting Medicare Site-Neutral Payments.--
(1) Removing certain exceptions to the definition of an
off-campus outpatient department of a provider.--
(A) In general.--Section 1833(t)(21)(B) of the
Social Security Act (42 U.S.C. 1395l(t)(21)(B)) is
amended to read as follows:
``(B) Off-campus outpatient department of a
provider.--For purposes of paragraph (1)(B)(v) and this
paragraph, the term `off-campus outpatient department
of a provider' means a department of a provider (as
defined in section 413.65(a)(2) of title 42 of the Code
of Federal Regulations, as in effect as of the date of
the enactment of the Bipartisan Budget Act of 2015)
that is not located--
``(i) on the campus (as defined in such
section 413.65(a)(2)) of such provider; or
``(ii) within the distance (described in
such definition of campus) from a remote
location of a hospital facility (as defined in
such section 413.65(a)(2)).''.
(B) Effective date.--The amendment made by
subparagraph (A) shall apply with respect to items and
services furnished on or after January 1, 2024.
(2) Removing site-neutral exception for off-campus
emergency departments.--Section 1833(t)(21)(A) of the Social
Security Act (42 U.S.C. 1395l(t)(21)(A)) is amended by
inserting ``before January 1, 2024'' after ``furnished''.
(3) Clarifying secretarial authority to promote site-
neutral payments.--Section 1833(t)(2)(F) of the Social Security
Act (42 U.S.C. 1395l(t)(2)(F)) is amended by adding at the end
the following new sentence: ``Such method may include actions
determined appropriate by the Secretary to promote site-neutral
payment policies to reduce expenditures attributable to items
and services furnished under this part, such as actions to
prevent hospitals from billing for items and services furnished
at an off-campus outpatient department of a provider as if such
items and services were furnished at such hospital.''.
(b) Ensuring Separate NPIs for Off-Campus Outpatient Departments of
a Provider.--
(1) In general.--Section 1173(b) of the Social Security Act
(42 U.S.C. 1320d-2(b)) is amended by adding at the end the
following new paragraph:
``(3) Ensuring separate npis for off-campus outpatient
departments of a provider.--The standards specified under
paragraph (1) shall ensure that, not later than January 1,
2024, each off-campus outpatient department of a provider (as
defined in section 1833(t)(21)(B)) is assigned a separate
unique health identifier from such provider.''.
(2) Treatment of certain departments as subparts of a
hospital.--Not later than January 1, 2024, the Secretary of
Health and Human Services shall revise sections 162.408 and
162.410 of title 45, Code of Federal Regulations, to ensure
that each off-campus outpatient department of a provider (as
defined in section 1833(t)(21)(B) of the Social Security Act
(42 U.S.C. 1395l(t)(21)(B))) is treated as a subpart (as
described in such sections) of such provider and assigned a
unique health identifier pursuant to section 1173(b)(3) of such
Act (as added by paragraph (1)).
(c) Off-Campus Departments of a Provider Billing Requirements.--
(1) Medicare.--Section 1866(a)(1) of the Social Security
Act (42 U.S.C. 1395cc(a)(1)) is amended--
(A) in subparagraph (X), by striking ``and'' at the
end;
(B) in subparagraph (Y)(ii)(V), by striking the
period and inserting ``, and''; and
(C) by inserting after subparagraph (Y) the
following new subparagraph:
``(Z) in the case of a hospital with an off-campus
outpatient department of a provider (as defined in section
1833(t)(21)(B)), with respect to items and services furnished
at such department of a provider on or after January 1, 2024,
to bill under this title (including under part C of this title)
for such items and services using the unique health identifier
established for such department of a provider pursuant to
section 1173(b)(3) on a HIPAA X12 837P transaction or CMS 1500
form (or a successor transaction or form).''.
(2) Other providers.--Part E of title XXVII of the Public
Health Service Act (42 U.S.C. 300gg-131 et seq.) is amended by
adding at the end the following new section:
``SEC. 2799B-10. BILLING REQUIREMENTS FOR OFF-CAMPUS DEPARTMENTS OF A
PROVIDER.
``A health care provider may not, with respect to items and
services furnished to an individual at an off-campus outpatient
department of a provider (as defined in section 1833(t)(21)(B) of the
Social Security Act), submit a claim for such items and services to a
group health plan or health insurance issuer, and may not hold such
individual liable for such items and services, unless such items and
services are billed--
``(1) using the separate unique health identifier
established for such department pursuant to section 1173(b)(3)
of such Act; and
``(2) on a HIPAA X12 837P transaction or CMS 1500 form (or
a successor transaction or form).''.
(3) Effective date.--The amendment made by paragraph (1)
shall apply with respect to claims submitted for items and
services furnished on or after January 1, 2024.
(d) NAIC Model Act or Regulation.--The Secretary of Health and
Human Services shall request that, not later than 6 months after the
date of the enactment of this Act, the National Association of
Insurance Commissioners establish a model Act or regulation designed to
address the issue of hospitals inappropriately billing for items and
services furnished at off-campus outpatient departments of a provider
(as defined in section 1833(t)(21)(B) of the Social Security Act (42
U.S.C. 1935l(t)(21)(B))) by allowing health insurance issuers and group
health plans (as such terms are defined in section 2791 of the Public
Health Service Act (42 U.S.C. 300gg-91)) to reject such claims unless
such department of a provider bills in accordance with the provisions
of section 2799B-10 of such Act. The Secretary shall request that such
model Act or regulation include requirements similar to those found in
Colorado House Bill 18-1282.
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