FAIR Act

Subjects: Health


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3417 Introduced in House (IH)]

&lt;DOC&gt;






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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