,i #aahth ,,congress #ast ,session ,h4 ,r4 #bhfc ,,in ,,the ,,house ,,of ,,representatives ,april #be1 #bjbc,mrs4 ,spartz introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act and title ,,xxvii of the ,public ,health ,service ,act to address incorrect billing by off-campus hospital locations1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,preventing ,hospital ,overbilling of ,medicare ,act4 #b4 ,addressing incorrect billing by off-campus hospital locations 7a7 ,promoting ,medicare site-,neutral payments 7#a7 ,removing certain exceptions to the definition of an off-campus outpatient department of a provider 7,a7 ,in general ,section #ahcc7t77#ba77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#ba77;,b77 is amended to read as follows3 7,b7 ,off-campus outpatient department of a provider ,for purposes of paragraph 7#a77;,b77v7 and this paragraph1 the term off-campus outpatient department of a provider means a department of a provider 7as defined in section #dac4fe7;a77#b7 of title #db of the ,code of ,federal ,regulations1 as in effect as of the date of the enactment of the ,bipartisan ,budget ,act of #bjae7 that is not located-- 7i7 on the campus 7as defined in such section #dac4fe7;a77#b77 of such provider2 or 7ii7 within the distance 7described in such definition of campus7 from a remote location of a hospital facility 7as defined in such section #dac4fe7;a77#b774 4 7,b7 ,effective date ,the amendment made by subparagraph 7,a7 shall apply with respect to items and services furnished on or after ,january #a1 #bjbd4 7#b7 ,removing site-neutral exception for off-campus emergency departments ,section #ahcc7t77#ba77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#ba77;,a77 is amended by inserting before ,january #a1 #bjbd after furnished4 7#c7 ,clarifying ,secretarial authority to promote site-neutral payments ,section #ahcc7t77#b77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#b77;,f77 is amended by adding at the end the following new sentence3 ,such method may include actions determined appropriate by the ,secretary to promote site-neutral payment policies to reduce expenditures attributable to items and services furnished under this part1 such as actions to prevent hospitals from billing for items and services furnished at an off-campus outpatient department of a provider as if such items and services were furnished at such hospital44 7b7 ,ensuring separate ,n,p,is for off-,campus outpatient departments of a provider 7#a7 ,in general ,section #aagc7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;d-#b7;b77 is amended by adding at the end the following new paragraph3 7#c7 ,ensuring separate ,n,p,is for off-campus outpatient departments of a provider ,the standards specified under paragraph 7#a7 shall ensure that1 not later than ,january #a1 #bjbd1 each off-campus outpatient department of a provider 7as defined in section #ahcc7t77#ba77;,b77 is assigned a separate unique health identifier from such provider4 4 7#b7 ,treatment of certain departments as subparts of a hospital ,not later than ,january #a1 #bjbd1 the ,secretary of ,health and ,human ,services shall revise sections #afb4djh and #afb4daj of title #de1 ,code of ,federal ,regulations1 to ensure that each off-campus outpatient department of a provider 7as defined in section #ahcc7t77#ba77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#ba77;,b777 is treated as a subpart 7as described in such sections7 of such provider and assigned a unique health identifier pursuant to section #aagc7;b77#c7 of such ,act 7as added by paragraph 7#a774 7c7 ,off-,campus departments of a provider billing requirements 7#a7 ,medicare ,section #ahff7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is amended-- 7,a7 in subparagraph 7,x71 by striking and at the end2 7,b7 in subparagraph 7,y77ii77,v71 by striking the period and inserting 1 and2 and 7,c7 by inserting after subparagraph 7,y7 the following new subparagraph3 7,z7 in the case of a hospital with an off-campus outpatient department of a provider 7as defined in section #ahcc7t77#ba77;,b771 with respect to items and services furnished at such department of a provider on or after ,january #a1 #bjbd1 to bill under this title 7including under part ,c of this title7 for such items and services using the unique health identifier established for such department of a provider pursuant to section #aagc7;b77#c7 on a ,,hipaa ,x#ab #hcg,p transaction or ,,cms #aejj form 7or a successor transaction or form74 4 7#b7 ,other providers ,part ,e of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aca et seq47 is amended by adding at the end the following new section3 #bgii;,b-#aj4 ,billing requirements for off-campus departments of a provider ,a health care provider may not1 with respect to items and services furnished to an individual at an off-campus outpatient department of a provider 7as defined in section #ahcc7t77#ba77;,b7 of the ,social ,security ,act71 submit a claim for such items and services to a group health plan or health insurance issuer1 and may not hold such individual liable for such items and services1 unless such items and services are billed-- 7#a7 using the separate unique health identifier established for such department pursuant to section #aagc7;b77#c7 of such ,act2 and 7#b7 on a ,,hipaa ,x#ab #hcg,p transaction or ,,cms #aejj form 7or a successor transaction or form74 4 7#c7 ,effective date ,the amendment made by paragraph 7#a7 shall apply with respect to claims submitted for items and services furnished on or after ,january #a1 #bjbd4 7d7 ,,naic model ,act or regulation ,the ,secretary of ,health and ,human ,services shall request that1 not later than #f months after the date of the enactment of this ,act1 the ,national ,association of ,insurance ,commissioners establish a model ,act or regulation designed to address the issue of hospitals inappropriately billing for items and services furnished at off-campus outpatient departments of a provider 7as defined in section #ahcc7t77#ba77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aicel7t77#ba77;,b777 by allowing health insurance issuers and group health plans 7as such terms are defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia77 to reject such claims unless such department of a provider bills in accordance with the provisions of section #bgii;,b-#aj of such ,act4 ,the ,secretary shall request that such model ,act or regulation include requirements similar to those found in ,colorado ,house ,bill #ah-abhb4