Preventing Hospital Overbilling of Medicare Act

Subjects: Health


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2863 Introduced in House (IH)]

&lt;DOC&gt;






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.
                                 &lt;all&gt;
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