I
118THCONGRESS
1
STSESSION 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
MAY17, 2023
Mr. H
ERN(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 provi-
sions as fall within the jurisdiction of the committee concerned
A BILL
To ensure fair billing practices for items and services fur-
nished by off-campus outpatient departments of a pro-
vider.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Facilitating Account-4
ability In Reimbursements Act’’ or the ‘‘FAIR Act’’. 5
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SEC. 2. ENSURING FAIR BILLING PRACTICES FOR ITEMS 1
AND SERVICES FURNISHED BY OFF-CAMPUS 2
OUTPATIENT DEPARTMENTS OF A PROVIDER. 3
(a) S
EPARATENPIS FOROFF-CAMPUSOUTPATIENT 4
D
EPARTMENTS OF APROVIDER.— 5
(1) I
N GENERAL.—Section 1173(b) of the So-6
cial Security Act (42 U.S.C. 1320d–2(b)) is amend-7
ed by adding at the end the following new para-8
graph: 9
‘‘(3) E
NSURING SEPARATE NPIS FOR OFF -CAM-10
PUS OUTPATIENT DEPARTMENTS OF A PROVIDER .— 11
The standards specified under paragraph (1) shall 12
ensure that, not later than January 1, 2025, each 13
off-campus outpatient department of a provider (as 14
defined in section 1833(t)(21)(B)) is assigned a sep-15
arate unique health identifier from such provider.’’. 16
(2) T
REATMENT OF CERTAIN DEPARTMENTS AS 17
SUBPARTS OF A HOSPITAL .—Not later than January 18
1, 2025, the Secretary of Health and Human Serv-19
ices shall revise sections 162.408 and 162.410 of 20
title 45, Code of Federal Regulations, to ensure that 21
each off-campus outpatient department of a provider 22
(as defined in section 1833(t)(21)(B) of the Social 23
Security Act (42 U.S.C. 1395l(t)(21)(B))) is treated 24
as a subpart (as described in such sections) of such 25
provider and assigned a unique health identifier pur-26
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suant to section 1173(b)(3) of such Act (as added 1
by paragraph (1)). 2
(b) O
FF-CAMPUSDEPARTMENTS OF A PROVIDER 3
B
ILLINGREQUIREMENTS.— 4
(1) M
EDICARE.— 5
(A) I
N GENERAL.—Section 1866(a)(1) of 6
the Social Security Act (42 U.S.C. 7
1395cc(a)(1)) is amended— 8
(i) in subparagraph (X), by striking 9
‘‘and’’ at the end; 10
(ii) in subparagraph (Y)(ii)(V), by 11
striking the period and inserting ‘‘, and’’; 12
and 13
(iii) by inserting after subparagraph 14
(Y) the following new subparagraph: 15
‘‘(Z) in the case of a hospital with an off-cam-16
pus outpatient department of a provider (as defined 17
in section 1833(t)(21)(B)), with respect to items 18
and services furnished at such department of a pro-19
vider on or after January 1, 2025, to bill under this 20
title (including under part C of this title) for such 21
items and services using the unique health identifier 22
established for such department of a provider pursu-23
ant to section 1173(b)(3) on a HIPAA X12 837P 24
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transaction or CMS 1500 form (or a successor 1
transaction or form).’’. 2
(B) C
OMPLIANCE REVIEWS .—In con-3
ducting any regular reviews of off-campus out-4
patient departments of a provider (as defined in 5
section 1833(t)(21)(B) of the Social Security 6
Act (42 U.S.C. 1395l(t)(21)(B))) for purposes 7
of determining whether such departments are 8
compliant with the requirements of section 9
413.65 of title 42, Code of Federal Regulations 10
(or any successor regulation), the Secretary of 11
Health and Human Services shall prioritize re-12
viewing such departments that, prior to billing 13
for covered OPD services (as defined in section 14
1833(t) of such Act (42 U.S.C. 1395l(t))) 15
under part B of title XVIII of such Act (42 16
U.S.C. 1395j et seq.), were furnishing items 17
and services billed solely by individual practi-18
tioners or group practices under such part and 19
that are not located in a rural area (as defined 20
in section 1886(d)(2)(D) of such Act (42 21
U.S.C. 1395ww(d)(2)(D))). 22
(2) O
THER PROVIDERS.—Part E of title XXVII 23
of the Public Health Service Act (42 U.S.C. 300gg– 24
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131 et seq.) is amended by adding at the end the 1
following new section: 2
‘‘SEC. 2799B–10. BILLING REQUIREMENTS FOR OFF-CAMPUS 3
DEPARTMENTS OF A PROVIDER. 4
‘‘A health care provider may not, with respect to 5
items and services furnished to an individual at an off- 6
campus outpatient department of a provider (as defined 7
in section 1833(t)(21)(B) of the Social Security Act), sub-8
mit a claim for such items and services to a group health 9
plan or health insurance issuer, and may not hold such 10
individual liable for such items and services, unless such 11
items and services are billed— 12
‘‘(1) using the separate unique health identifier 13
established for such department pursuant to section 14
1173(b)(3) of such Act; and 15
‘‘(2) on a HIPAA X12 837P transaction or 16
CMS 1500 form (or a successor transaction or 17
form).’’. 18
(3) E
FFECTIVE DATE.—The amendment made 19
by paragraph (1) shall apply with respect to claims 20
submitted for items and services furnished on or 21
after January 1, 2025. 22
Æ
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