FAIR Act

I 118TH CONGRESS 1ST SESSION 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 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 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 VerDate Sep 11 2014 00:11 Jun 02, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3417.IH H3417 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 3417 IH SEC. 2. ENSURING FAIR BILLING PRACTICES FOR ITEMS 1 AND SERVICES FURNISHED BY OFF-CAMPUS 2 OUTPATIENT DEPARTMENTS OF A PROVIDER. 3 (a) SEPARATE NPIS FOR OFF-CAMPUS OUTPATIENT 4 DEPARTMENTS OF A PROVIDER.— 5 (1) IN 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) ENSURING 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) TREATMENT 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 VerDate Sep 11 2014 00:11 Jun 02, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3417.IH H3417 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 3417 IH suant to section 1173(b)(3) of such Act (as added 1 by paragraph (1)). 2 (b) OFF-CAMPUS DEPARTMENTS OF A PROVIDER 3 BILLING REQUIREMENTS.— 4 (1) MEDICARE.— 5 (A) IN 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 VerDate Sep 11 2014 00:11 Jun 02, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3417.IH H3417 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 3417 IH transaction or CMS 1500 form (or a successor 1 transaction or form).’’. 2 (B) COMPLIANCE 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) OTHER PROVIDERS.—Part E of title XXVII 23 of the Public Health Service Act (42 U.S.C. 300gg– 24 VerDate Sep 11 2014 00:11 Jun 02, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3417.IH H3417 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 3417 IH 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) EFFECTIVE 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 VerDate Sep 11 2014 00:11 Jun 02, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H3417.IH H3417 kjohnson on DSK79L0C42PROD with BILLS