Researcher: AR Page 1 4/3/23
OLR Bill Analysis
sHB 6634
AN ACT CONCERNING SITE OF SERVICE REIMBURSEMENTS.
SUMMARY
Beginning January 1, 2024, this bill requires a hospital-based facility
that is located away from a hospital campus (“off-site”) to submit with
each claim the facility’s national provider identifier (NPI) and federal
tax identification number. The NPI and tax identification number must
be:
1. separate from those issued to the hospital campus and
2. included in any reimbursement claim for services the facility
provided, regardless of whether the facility or the hospital or
another facility submits the claim.
Under the bill, health carriers are not required to reimburse or pay a
health care provider for a claim for a service or item provided to a
covered person at an off-site hospital-based facility unless the provider
submits the claim using the separate NPI or tax identification number
as described above. Off-site hospital-based facilities, or their designees,
that do not file claims in this way cannot hold the covered person liable
for payment.
Under the bill and existing law, a “hospital-based facility” is a facility
that is at least partly owned or operated by a hospital or health system
(e.g., a hospital’s parent corporation) that provides hospital or
professional medical services. A “campus” is the physical area
immediately adjacent to a hospital’s main building and other related
structures within 250 yards, as well as any area the federal Centers for
Medicare and Medicaid Services determines to be part of the hospital’s
campus. 2023HB-06634-R000357-BA.DOCX
Researcher: AR Page 2 4/3/23
Additionally, starting January 1, 2024, the bill prohibits off-site
hospital based facilities in Connecticut from charging a facility fee,
unless it is mutually agreed to in a contract between a health carrier and
the hospital.
Lastly, the bill authorizes the commissioner to adopt implementing
regulations.
EFFECTIVE DATE: October 1, 2023
BACKGROUND
Related Bill
sSB 1116, reported favorably by the Insurance and Real Estate
Committee, contains similar provisions requiring reimbursement and
payment for off-site hospital-based facilities.
COMMITTEE ACTION
Insurance and Real Estate Committee
Joint Favorable Substitute
Yea 12 Nay 0 (03/16/2023)