118th CONGRESS 1st Session |
To ensure fair billing practices for items and services furnished by off-campus outpatient departments of a provider.
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
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,
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.—
(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.