SITE Act

II 118TH CONGRESS 1ST SESSION S. 1869 To amend title XVIII of the Social Security Act and title XXVII of the Public Health Service Act to ensure fair billing practice for items and services furnished by off-campus hospital locations, to amend such title XVIII to provide for payments for graduate nursing education costs, and for other purposes. IN THE SENATE OF THE UNITED STATES JUNE 7, 2023 Mr. BRAUN (for himself, Ms. HASSAN, and Mr. KENNEDY) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act and title XXVII of the Public Health Service Act to ensure fair billing practice for items and services furnished by off- campus hospital locations, to amend such title XVIII to provide for payments for graduate nursing education costs, and for other purposes. 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 ‘‘Site-based Invoicing 4 and Transparency Enhancement Act’’ or the ‘‘SITE Act’’. 5 VerDate Sep 11 2014 23:26 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1869.IS S1869 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •S 1869 IS SEC. 2. ENSURING FAIR BILLING PRACTICE FOR ITEMS 1 AND SERVICES FURNISHED BY OFF-CAMPUS 2 HOSPITAL LOCATIONS. 3 (a) PROMOTING MEDICARE SITE-NEUTRAL PAY- 4 MENTS.—Section 1833(t)(21) of the Social Security Act 5 (42 U.S.C. 1395l(t)(21)) is amended— 6 (1) by redesignating subparagraph (E) as sub- 7 paragraph (G); and 8 (2) by inserting after subparagraph (D) the fol- 9 lowing new subparagraphs: 10 ‘‘(E) SUNSET OF CERTAIN EXCEPTIONS.— 11 The provisions of clauses (ii) and (iv) of sub- 12 paragraph (B) shall not apply with respect to 13 applicable items and services furnished on or 14 after January 1, 2025. 15 ‘‘(F) SPECIAL PAYMENT RULE FOR NON- 16 APPLICABLE ITEMS AND SERVICES FURNISHED 17 AT CERTAIN OFF-CAMPUS DEDICATED EMER- 18 GENCY DEPARTMENTS.— 19 ‘‘(i) IN GENERAL.—In the case of cov- 20 ered OPD services furnished by an applica- 21 ble dedicated emergency department dur- 22 ing 2025 or a subsequent year, the pay- 23 ment amount for such service that would 24 otherwise be determined under this sub- 25 section (without regard to the application 26 VerDate Sep 11 2014 23:26 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1869.IS S1869 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •S 1869 IS of this subparagraph) for such year shall 1 be reduced by 30 percent. 2 ‘‘(ii) APPLICABLE DEDICATED EMER- 3 GENCY DEPARTMENT.—In clause (i), the 4 term ‘applicable dedicated emergency de- 5 partment’ means a dedicated emergency 6 department (as defined in section 7 489.24(b) of title 42 of the Code of Fed- 8 eral Regulations) that— 9 ‘‘(I) is an off-campus outpatient 10 department of a provider (as defined 11 in subparagraph (B)); and 12 ‘‘(II) is located 6 or fewer miles 13 from another hospital, critical access 14 hospital, or rural emergency hospital, 15 including the parent hospital of such 16 emergency department.’’. 17 (b) ENSURING SEPARATE NPIS FOR OFF-CAMPUS 18 OUTPATIENT DEPARTMENTS OF A PROVIDER.— 19 (1) IN GENERAL.—Section 1173(b) of the So- 20 cial Security Act (42 U.S.C. 1320d–2(b)) is amend- 21 ed by adding at the end the following new para- 22 graph: 23 ‘‘(3) ENSURING SEPARATE NPIS FOR OFF-CAM- 24 PUS OUTPATIENT DEPARTMENTS OF A PROVIDER.— 25 VerDate Sep 11 2014 23:26 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1869.IS S1869 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •S 1869 IS The standards specified under paragraph (1) shall 1 ensure that, not later than January 1, 2025, each 2 off-campus outpatient department of a provider (as 3 defined in section 1833(t)(21)(B)) is assigned a sep- 4 arate unique health identifier from such provider.’’. 5 (2) TREATMENT OF CERTAIN DEPARTMENTS AS 6 SUBPARTS OF A HOSPITAL.—Not later than January 7 1, 2025, the Secretary of Health and Human Serv- 8 ices shall revise sections 162.408 and 162.410 of 9 title 45, Code of Federal Regulations, to ensure that 10 each off-campus outpatient department of a provider 11 (as defined in section 1833(t)(21)(B) of the Social 12 Security Act (42 U.S.C. 1395l(t)(21)(B))) is treated 13 as a subpart (as described in such sections) of such 14 provider and assigned a unique health identifier pur- 15 suant to section 1173(b)(3) of such Act (as added 16 by paragraph (1)). 17 (c) BILLING REQUIREMENTS FOR OFF-CAMPUS OUT- 18 PATIENT DEPARTMENTS OF A PROVIDER.— 19 (1) MEDICARE.—Section 1866(a)(1) of the So- 20 cial Security Act (42 U.S.C. 1395cc(a)(1)) is 21 amended— 22 (A) in subparagraph (X), by striking 23 ‘‘and’’ at the end; 24 VerDate Sep 11 2014 23:26 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1869.IS S1869 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •S 1869 IS (B) in subparagraph (Y)(ii)(V), by striking 1 the period and inserting ‘‘, and’’; and 2 (C) by inserting after subparagraph (Y) 3 the following new subparagraph: 4 ‘‘(Z) in the case of a hospital with an off-cam- 5 pus outpatient department of a provider (as defined 6 in section 1833(t)(21)(B)), with respect to items 7 and services furnished at such department of a pro- 8 vider on or after January 1, 2025, to include in any 9 claim form submitted under this title (including 10 under part C of this title) for such items and serv- 11 ices the unique health identifier established for such 12 department of a provider pursuant to section 13 1173(b)(3).’’. 14 (2) OTHER PROVIDERS.—Part E of title XXVII 15 of the Public Health Service Act (42 U.S.C. 300gg– 16 131 et seq.) is amended by adding at the end the 17 following new section: 18 ‘‘SEC. 2799B–10. BILLING REQUIREMENTS FOR OFF-CAMPUS 19 DEPARTMENTS OF A PROVIDER OR FACILITY. 20 ‘‘A health care provider or facility may not, with re- 21 spect to items and services furnished to an individual at 22 an off-campus outpatient department of a provider (as de- 23 fined in section 1833(t)(21)(B) of the Social Security Act) 24 on or after January 1, 2025, submit a claim for such items 25 VerDate Sep 11 2014 23:26 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1869.IS S1869 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •S 1869 IS and services to a group health plan or health insurance 1 issuer, and may not bill such an individual or hold such 2 individual liable for such items and services, unless such 3 items and services are billed— 4 ‘‘(1) using the separate unique health identifier 5 established for such department pursuant to section 6 1173(b)(3) of such Act; and 7 ‘‘(2) on a HIPAA X12 837P transaction form 8 or CMS 1500 form (or a successor transaction or 9 form).’’. 10 (3) EFFECTIVE DATE.—The amendment made 11 by paragraph (1) shall apply with respect to claims 12 submitted for items and services furnished on or 13 after January 1, 2025. 14 SEC. 3. PAYMENTS FOR GRADUATE NURSING EDUCATION 15 COSTS. 16 (a) IN GENERAL.—Title XVIII of the Social Security 17 Act (42 U.S.C. 1395 et seq.) is amended by adding at 18 the end the following new section: 19 ‘‘SEC. 1899C. PAYMENTS FOR GRADUATE NURSING EDU- 20 CATION COSTS. 21 ‘‘(a) IN GENERAL.—The Secretary shall provide for 22 payments for qualified training costs in accordance with 23 this section. Such payments shall be made from the Fed- 24 VerDate Sep 11 2014 23:26 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1869.IS S1869 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •S 1869 IS eral Supplementary Medical Insurance Trust Fund under 1 section 1841. 2 ‘‘(b) ESTABLISHMENT OF HUB STRUCTURE.— 3 ‘‘(1) APPLICATION.—An eligible hospital seek- 4 ing to operate as a Graduate Nursing Education 5 Hub (in this section referred to as a ‘Hub’) shall 6 submit an application to the Secretary at such time, 7 in such manner, and containing such information as 8 the Secretary may specify. 9 ‘‘(2) SELECTION OF ELIGIBLE HOSPITALS TO 10 OPERATE AS HUB.— 11 ‘‘(A) ESTABLISHMENT OF REGIONS.—The 12 Secretary shall establish regions for Hubs based 13 on hospital referral regions. 14 ‘‘(B) SELECTION OF ELIGIBLE HOS- 15 PITALS.—For each hospital referral region, the 16 Secretary shall select not more than one eligible 17 hospital to operate as a Hub. 18 ‘‘(C) LIMITATION.—An eligible hospital 19 may not be selected to operate, or participate as 20 an eligible partner of, more than one Hub 21 under this section. 22 ‘‘(D) ADJACENT REGIONS.—An eligible 23 hospital may be selected to operate as a Hub 24 for one or more adjacent hospital referral re- 25 VerDate Sep 11 2014 23:26 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1869.IS S1869 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •S 1869 IS gions if no other qualifying eligible hospital sub- 1 mits an application for such regions, in which 2 case the eligible hospital shall operate as a sin- 3 gle Hub for such regions. 4 ‘‘(E) MULTIPLE APPLICATIONS.—If more 5 than one eligible hospital submits an application 6 to operate as a Hub for a hospital referral re- 7 gion, the Secretary shall consider each applica- 8 tion submitted, giving special consideration to 9 the following: 10 ‘‘(i) The application of the eligible 11 hospital that includes the greatest number 12 of applicable schools of nursing that have 13 an advanced practice registered nurse edu- 14 cation program in the region (or in an ad- 15 jacent region if an eligible hospital has not 16 been selected to operate as a Hub for such 17 region and the eligible hospital is submit- 18 ting an application to operate as a single 19 Hub for both regions). 20 ‘‘(ii) The application of the eligible 21 hospital that includes the greatest number 22 of advanced practice registered nurses that 23 have graduated from participating applica- 24 VerDate Sep 11 2014 23:26 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1869.IS S1869 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •S 1869 IS ble schools of nursing over the preceding 3 1 years. 2 ‘‘(c) HUB REQUIREMENTS.— 3 ‘‘(1) CONTRACTS.—Each Hub selected pursu- 4 ant to subsection (b)(2) must enter into a written 5 agreement with each eligible partner of the Hub that 6 meets contents and terms, as determined by the Sec- 7 retary, and sets out, at a minimum, the following: 8 ‘‘(A) PARTNER OBLIGATIONS.—The obliga- 9 tions of the eligible partner with respect to the 10 provision of qualified training. 11 ‘‘(B) REIMBURSEMENT.—The obligation of 12 the Hub to reimburse the eligible partner (in a 13 timely manner as the Secretary may specify) for 14 the costs of qualified training for which pay- 15 ment is made under this section that are attrib- 16 utable to such partner. 17 ‘‘(C) GOVERNANCE STRUCTURE.—A gov- 18 ernance structure that includes the Hub and 19 one or more applicable schools of nursing in the 20 leadership and an oversight process that is de- 21 veloped and approved by the Hub, participating 22 applicable schools of nursing, and other Hub 23 partners, in accordance with requirements es- 24 tablished by the Secretary. 25 VerDate Sep 11 2014 23:26 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1869.IS S1869 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •S 1869 IS ‘‘(D) COORDINATION.—The maintenance 1 of an adequate system for coordination of clin- 2 ical education sites and preceptors. The Sec- 3 retary may specify standards for such system. 4 ‘‘(E) PRECEPTOR TRAINING.—A system 5 for the Hub to provide at least 4 hours of pre- 6 ceptor training to each preceptor each year. 7 ‘‘(F) PUBLIC HEALTH NEEDS.—A process 8 for taking into consideration local, State, and 9 regional workforce needs to ensure public 10 health. 11 ‘‘(d) PAYMENTS.— 12 ‘‘(1) AMOUNT OF PAYMENT.—The amount of 13 payment to a Hub under this section for qualified 14 training costs during a year shall be equal to the 15 product of— 16 ‘‘(A) the annual per student payment 17 amount determined under paragraph (2) for the 18 Hub for the year; and 19 ‘‘(B) the total number of positions distrib- 20 uted to the Hub under subsection (f), as deter- 21 mined by the Secretary. 22 ‘‘(2) DETERMINATION OF HUB-SPECIFIC AN- 23 NUAL PER STUDENT PAYMENT AMOUNT.—The Sec- 24 retary shall determine, for each Hub, an annual per 25 VerDate Sep 11 2014 23:26 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1869.IS S1869 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •S 1869 IS student payment amount for each year (beginning 1 with 2026). Such amount shall be equal to the 2 unadjusted per student amount determined under 3 paragraph (3), as adjusted for geographic variation 4 in wages in a budget neutral manner, as determined 5 appropriate by the Secretary. 6 ‘‘(3) UNADJUSTED PER STUDENT AMOUNT.— 7 The unadjusted per student amount determined 8 under this paragraph for a year is equal to the prod- 9 uct of— 10 ‘‘(A) 750 hours; and 11 ‘‘(B) the median hourly wage for a nurse 12 practitioner in the United States, according to 13 the Occupational Employment and Wage Statis- 14 tics of the Bureau of Labor Statistics for the 15 most recent year for which such data is avail- 16 able (or an appropriate successor measure), in- 17 creased or decreased by the percentage change 18 in the consumer price index for all urban con- 19 sumers (all items; United States city average) 20 from June of the most recent year for which 21 such data is available to the June preceding the 22 year involved. 23 VerDate Sep 11 2014 23:26 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1869.IS S1869 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •S 1869 IS ‘‘(4) PERMISSIBLE USES OF PAYMENT.—A Hub 1 may use payments provided under this section only 2 for payment of the costs of qualified training. 3 ‘‘(e) NUMBER OF TRAINING POSITIONS AVAIL- 4 ABLE.—The maximum number of positions for which pay- 5 ment made be made under this section for a year shall 6 be equal to— 7 ‘‘(1) for each of 2026 and 2027, 10,000 ad- 8 vanced practice registered nurse students; 9 ‘‘(2) for each of 2028 and 2029, 15,000 ad- 10 vanced practice registered nurse students; 11 ‘‘(3) for each of 2030 and 2031: 20,000 ad- 12 vanced practice registered nurse students; and 13 ‘‘(4) for 2032 and subsequent years, the greater 14 of— 15 ‘‘(A) 20,000 advanced practice registered 16 nurse students; or 17 ‘‘(B) the number of advanced practice reg- 18 istered nurse students needed to ensure the 19 ratio of such students to the number of bene- 20 ficiaries under the program under this title, the 21 Medicaid program under title XIX, and the 22 CHIP program under title XXI during the year 23 is the same as such ratio for 2031. 24 ‘‘(f) DISTRIBUTION O [Text truncated for display. 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