[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3417 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 3417
To ensure fair billing practices for items and services furnished by
off-campus outpatient departments of a provider.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 17, 2023
Mr. Hern (for himself and Ms. Kuster) 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 ensure fair billing practices for items and services furnished by
off-campus outpatient departments of a provider.
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 ``Facilitating Accountability In
Reimbursements Act'' or the ``FAIR Act''.
SEC. 2. ENSURING FAIR BILLING PRACTICES FOR ITEMS AND SERVICES
FURNISHED BY OFF-CAMPUS OUTPATIENT DEPARTMENTS OF A
PROVIDER.
(a) 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,
2025, 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, 2025, 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)).
(b) Off-Campus Departments of a Provider Billing Requirements.--
(1) Medicare.--
(A) In general.--Section 1866(a)(1) of the Social
Security Act (42 U.S.C. 1395cc(a)(1)) is amended--
(i) in subparagraph (X), by striking
``and'' at the end;
(ii) in subparagraph (Y)(ii)(V), by
striking the period and inserting ``, and'';
and
(iii) 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, 2025,
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).''.
(B) Compliance reviews.--In conducting any regular
reviews of off-campus outpatient departments of a
provider (as defined in section 1833(t)(21)(B) of the
Social Security Act (42 U.S.C. 1395l(t)(21)(B))) for
purposes of determining whether such departments are
compliant with the requirements of section 413.65 of
title 42, Code of Federal Regulations (or any successor
regulation), the Secretary of Health and Human Services
shall prioritize reviewing such departments that, prior
to billing for covered OPD services (as defined in
section 1833(t) of such Act (42 U.S.C. 1395l(t))) under
part B of title XVIII of such Act (42 U.S.C. 1395j et
seq.), were furnishing items and services billed solely
by individual practitioners or group practices under
such part and that are not located in a rural area (as
defined in section 1886(d)(2)(D) of such Act (42 U.S.C.
1395ww(d)(2)(D))).
(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, 2025.
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