I 

108TH CONGRESS 

2D SESSION H. R. 4092 

To amend title XIX of the Social Security Act to require fair billing for 

hospital services provided to uninsured patients as a condition of Medicaid funding for a hospital. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 31, 2004 

Mr. HEFLEY introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to require 

fair billing for hospital services provided to uninsured 

patients as a condition of Medicaid funding for a hospital. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as ‘‘Hospital Billing Fairness 

5 Act of 2004’’. 
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1 SEC. 2. REQUIREMENT FOR FAIR HOSPITAL BILLING FOR 

2 THE UNINSURED. 

3 (a) IN GENERAL.—Section 1903 of the Social Secu4 rity Act (42 U.S.C. 1396b) is amended— 

5 (1) in subsection (i), by inserting after para6 graph (8) the following new paragraph: 

7 ‘‘(9) with respect to any amount expended for 

8 care or services furnished under the plan by a hos9 pital unless the hospital has in effect with the Sec10 retary a certification of fair billing practices de11 scribed in subsection (h)(1); or’’; and 

12 (2) by inserting after subsection (g) the fol13 lowing new subsection: 

14 ‘‘(h)(1) For purposes of subsection (i)(9), a certifi15 cation of fair billing practices of a hospital under this 

16 paragraph is a certification, in a form and manner speci17 fied by the Secretary, that the hospital does not bill or 

18 collect from any uninsured individual (as defined in para19 graph (3)) for care or services furnished by the hospital 

20 an amount that exceeds 125 percent of the full payment 

21 amount (including any deductibles, coinsurance, or other 

22 cost-sharing) that would be recognized and permitted 

23 under title XVIII with respect to such care or services fur24 nished to an individual entitled to benefits under part A 

25 of such title and enrolled under part B of such title. The 

26 Secretary shall specify the method for computing such full 
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1 payment amount in the case of care and services for which 

2 there is not a full payment amount computed for purposes 

3 of such title. 

4 ‘‘(2)(A) In the case of a hospital that has in effect 

5 a certification under paragraph (1) and that collects any 

6 amount in excess of the amount permitted to be charged 

7 or billed under such certification, the hospital shall refund 

8 such excess amount on a timely basis (as defined by the 

9 Secretary consistent with time period described in section 

10 1848(g)(1)(C)). 

11 ‘‘(B) In the case of a hospital with such a certifi12 cation that fails to provide a refund required under sub13 paragraph (A), the hospital is subject to imposition of a 

14 civil money penalty in an amount equal to three times the 

15 amount of such excess. The provisions of section 1128A 

16 (other than subsections (a) and (b)) shall apply to civil 

17 money penalties under this subparagraph in the same 

18 manner as they apply to a penalty or proceeding under 

19 section 1128A(a). The Secretary shall provide for payment 

20 to the uninsured individual involved of the portion of such 

21 civil money penalty collected that represents the excess 

22 amount collected with respect to that individual. 

23 ‘‘(3) For purposes of this subsection, the term ‘unin24 sured individual’ means, with respect to care and services 

25 furnished by a hospital to the individual, an individual who 
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1 does not have insurance or other third-party contractual 

2 benefits that provides payment for costs incurred for such 

3 care and services. In applying the previous sentence, an 

4 individual shall not be treated as having insurance or con5 tractual benefits for care and services if benefits for such 

6 care and services are not payable under such insurance 

7 or benefits by virtue of application of a deductible or if 

8 such contractual benefits consist only of payment from a 

9 medical or health savings account or similar mechanism.’’. 

10 (b) EFFECTIVE DATE.—The amendments made by 

11 subsection (a) shall first apply to payment amounts for 

12 care and services furnished after the end of the 60-day 

13 period beginning on the date of the enactment of this Act, 

14 but shall not apply to inpatient hospital services that are 

15 part of an admission that began before the end of such 

16 period. 

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