I 
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 Com-
mittee 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 incor-
rect billing by off-campus hospital locations, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives 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’’. 
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SEC. 2. ADDRESSING INCORRECT BILLING BY OFF-CAMPUS 
HOSPITAL LOCATIONS. 
(a) PROMOTING MEDICARE SITE-NEUTRAL PAY-
MENTS.— 
(1) REMOVING CERTAIN EXCEPTIONS TO THE 
DEFINITION OF AN OFF-CAMPUS OUTPATIENT DE-
PARTMENT 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
DEPART-
MENT OF A PROVIDER.—For purposes of para-
graph (1)(B)(v) and this paragraph, the term 
‘off-campus outpatient department of a pro-
vider’ means a department of a provider (as de-
fined 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)).’’. 
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(B) EFFECTIVE
DATE.—The amendment 
made by subparagraph (A) shall apply with re-
spect 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 ex-
penditures attributable to items and services fur-
nished under this part, such as actions to prevent 
hospitals from billing for items and services fur-
nished 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.— 
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(1) IN GENERAL.—Section 1173(b) of the So-
cial Security Act (42 U.S.C. 1320d–2(b)) is amend-
ed by adding at the end the following new para-
graph: 
‘‘(3) ENSURING SEPARATE NPIS FOR OFF-CAM-
PUS 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 sep-
arate 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 Serv-
ices 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 pur-
suant to section 1173(b)(3) of such Act (as added 
by paragraph (1)). 
(c) OFF-CAMPUS DEPARTMENTS
OF
A PROVIDER 
BILLING REQUIREMENTS.— 
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(1) MEDICARE.—Section 1866(a)(1) of the So-
cial 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-cam-
pus 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 pro-
vider 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 pursu-
ant 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: 
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‘‘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), sub-
mit 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 Sec-
retary 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 Com-
missioners establish a model Act or regulation designed 
to address the issue of hospitals inappropriately billing for 
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items and services furnished at off-campus outpatient de-
partments 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. 
Æ 
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