Us Congress 2023-2024 Regular Session

Us Congress House Bill HB3417 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	I
2	2	118THCONGRESS
3	3	1
4	4	STSESSION H. R. 3417
5	5	To ensure fair billing practices for items and services furnished by off-
6	6	campus outpatient departments of a provider.
7	7	IN THE HOUSE OF REPRESENTATIVES
8	8	MAY17, 2023
9	9	Mr. H
10	10	ERN(for himself and Ms. KUSTER) introduced the following bill; which
11	11	was referred to the Committee on Energy and Commerce, and in addition
12	12	to the Committee on Ways and Means, for a period to be subsequently
13	13	determined by the Speaker, in each case for consideration of such provi-
14	14	sions as fall within the jurisdiction of the committee concerned
15	15	A BILL
16	16	To ensure fair billing practices for items and services fur-
17	17	nished by off-campus outpatient departments of a pro-
18	18	vider.
19	19	Be it enacted by the Senate and House of Representa-1
20	20	tives of the United States of America in Congress assembled, 2
21	21	SECTION 1. SHORT TITLE. 3
22	22	This Act may be cited as the ‘‘Facilitating Account-4
23	23	ability In Reimbursements Act’’ or the ‘‘FAIR Act’’. 5
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26	26	•HR 3417 IH
27	27	SEC. 2. ENSURING FAIR BILLING PRACTICES FOR ITEMS 1
28	28	AND SERVICES FURNISHED BY OFF-CAMPUS 2
29	29	OUTPATIENT DEPARTMENTS OF A PROVIDER. 3
30	30	(a) S
31	31	EPARATENPIS FOROFF-CAMPUSOUTPATIENT 4
32	32	D
33	33	EPARTMENTS OF APROVIDER.— 5
34	34	(1) I
35	35	N GENERAL.—Section 1173(b) of the So-6
36	36	cial Security Act (42 U.S.C. 1320d–2(b)) is amend-7
37	37	ed by adding at the end the following new para-8
38	38	graph: 9
39	39	‘‘(3) E
40	40	NSURING SEPARATE NPIS FOR OFF -CAM-10
41	41	PUS OUTPATIENT DEPARTMENTS OF A PROVIDER .— 11
42	42	The standards specified under paragraph (1) shall 12
43	43	ensure that, not later than January 1, 2025, each 13
44	44	off-campus outpatient department of a provider (as 14
45	45	defined in section 1833(t)(21)(B)) is assigned a sep-15
46	46	arate unique health identifier from such provider.’’. 16
47	47	(2) T
48	48	REATMENT OF CERTAIN DEPARTMENTS AS 17
49	49	SUBPARTS OF A HOSPITAL .—Not later than January 18
50	50	1, 2025, the Secretary of Health and Human Serv-19
51	51	ices shall revise sections 162.408 and 162.410 of 20
52	52	title 45, Code of Federal Regulations, to ensure that 21
53	53	each off-campus outpatient department of a provider 22
54	54	(as defined in section 1833(t)(21)(B) of the Social 23
55	55	Security Act (42 U.S.C. 1395l(t)(21)(B))) is treated 24
56	56	as a subpart (as described in such sections) of such 25
57	57	provider and assigned a unique health identifier pur-26
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60	60	•HR 3417 IH
61	61	suant to section 1173(b)(3) of such Act (as added 1
62	62	by paragraph (1)). 2
63	63	(b) O
64	64	FF-CAMPUSDEPARTMENTS OF A PROVIDER 3
65	65	B
66	66	ILLINGREQUIREMENTS.— 4
67	67	(1) M
68	68	EDICARE.— 5
69	69	(A) I
70	70	N GENERAL.—Section 1866(a)(1) of 6
71	71	the Social Security Act (42 U.S.C. 7
72	72	1395cc(a)(1)) is amended— 8
73	73	(i) in subparagraph (X), by striking 9
74	74	‘‘and’’ at the end; 10
75	75	(ii) in subparagraph (Y)(ii)(V), by 11
76	76	striking the period and inserting ‘‘, and’’; 12
77	77	and 13
78	78	(iii) by inserting after subparagraph 14
79	79	(Y) the following new subparagraph: 15
80	80	‘‘(Z) in the case of a hospital with an off-cam-16
81	81	pus outpatient department of a provider (as defined 17
82	82	in section 1833(t)(21)(B)), with respect to items 18
83	83	and services furnished at such department of a pro-19
84	84	vider on or after January 1, 2025, to bill under this 20
85	85	title (including under part C of this title) for such 21
86	86	items and services using the unique health identifier 22
87	87	established for such department of a provider pursu-23
88	88	ant to section 1173(b)(3) on a HIPAA X12 837P 24
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91	91	•HR 3417 IH
92	92	transaction or CMS 1500 form (or a successor 1
93	93	transaction or form).’’. 2
94	94	(B) C
95	95	OMPLIANCE REVIEWS .—In con-3
96	96	ducting any regular reviews of off-campus out-4
97	97	patient departments of a provider (as defined in 5
98	98	section 1833(t)(21)(B) of the Social Security 6
99	99	Act (42 U.S.C. 1395l(t)(21)(B))) for purposes 7
100	100	of determining whether such departments are 8
101	101	compliant with the requirements of section 9
102	102	413.65 of title 42, Code of Federal Regulations 10
103	103	(or any successor regulation), the Secretary of 11
104	104	Health and Human Services shall prioritize re-12
105	105	viewing such departments that, prior to billing 13
106	106	for covered OPD services (as defined in section 14
107	107	1833(t) of such Act (42 U.S.C. 1395l(t))) 15
108	108	under part B of title XVIII of such Act (42 16
109	109	U.S.C. 1395j et seq.), were furnishing items 17
110	110	and services billed solely by individual practi-18
111	111	tioners or group practices under such part and 19
112	112	that are not located in a rural area (as defined 20
113	113	in section 1886(d)(2)(D) of such Act (42 21
114	114	U.S.C. 1395ww(d)(2)(D))). 22
115	115	(2) O
116	116	THER PROVIDERS.—Part E of title XXVII 23
117	117	of the Public Health Service Act (42 U.S.C. 300gg– 24
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120	120	•HR 3417 IH
121	121	131 et seq.) is amended by adding at the end the 1
122	122	following new section: 2
123	123	‘‘SEC. 2799B–10. BILLING REQUIREMENTS FOR OFF-CAMPUS 3
124	124	DEPARTMENTS OF A PROVIDER. 4
125	125	‘‘A health care provider may not, with respect to 5
126	126	items and services furnished to an individual at an off- 6
127	127	campus outpatient department of a provider (as defined 7
128	128	in section 1833(t)(21)(B) of the Social Security Act), sub-8
129	129	mit a claim for such items and services to a group health 9
130	130	plan or health insurance issuer, and may not hold such 10
131	131	individual liable for such items and services, unless such 11
132	132	items and services are billed— 12
133	133	‘‘(1) using the separate unique health identifier 13
134	134	established for such department pursuant to section 14
135	135	1173(b)(3) of such Act; and 15
136	136	‘‘(2) on a HIPAA X12 837P transaction or 16
137	137	CMS 1500 form (or a successor transaction or 17
138	138	form).’’. 18
139	139	(3) E
140	140	FFECTIVE DATE.—The amendment made 19
141	141	by paragraph (1) shall apply with respect to claims 20
142	142	submitted for items and services furnished on or 21
143	143	after January 1, 2025. 22
144	144	Æ
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