HR4509-118

1. Short title This Act may be cited as the Transparency in Billing Act.

2. Honest billing requirements Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following new section: A group health plan or health insurance issuer offering group health insurance coverage may not pay a claim for items and services furnished to an individual at an off-campus outpatient department of a provider (as defined in section 901(c)) submitted by a hospital (as defined in section 1861(e) of the Social Security Act) unless such claim submitted by such hospital includes the separate unique health identifier for the department where items and services were furnished, in accordance with section 901. The table of contents of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 note) is amended by adding after the item relating to section 725 the following: The amendments made by this section shall take effect with respect to plan years beginning on or after January 1, 2024. 726.Honest billing requirementsA group health plan or health insurance issuer offering group health insurance coverage may not pay a claim for items and services furnished to an individual at an off-campus outpatient department of a provider (as defined in section 901(c)) submitted by a hospital (as defined in section 1861(e) of the Social Security Act) unless such claim submitted by such hospital includes the separate unique health identifier for the department where items and services were furnished, in accordance with section 901.. 726. Banning dishonest billing..

726. Honest billing requirements A group health plan or health insurance issuer offering group health insurance coverage may not pay a claim for items and services furnished to an individual at an off-campus outpatient department of a provider (as defined in section 901(c)) submitted by a hospital (as defined in section 1861(e) of the Social Security Act) unless such claim submitted by such hospital includes the separate unique health identifier for the department where items and services were furnished, in accordance with section 901.

3. Regulation of honest billing Subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1021 et seq.) is amended by adding at the end the following new part: A hospital may not, with respect to items and services furnished to an individual at an off-campus outpatient department of a provider, submit a claim for such items and services to a group health plan or health insurance issuer, and may not hold such individual liable for such items and services, unless— such hospital obtains a separate unique health identifier established for such department pursuant to section 1173(b) of the Social Security Act; and the claim for such items and services includes such separate unique health identifier for such department where such items and services were furnished. Not later than one year after the date of enactment of this section, the Secretary shall establish a process under which a suspected violation of this section may be reported to such Secretary. For purposes of this paragraph, the term off-campus outpatient department of a provider means a department of a provider (as defined in section 413.65 of title 42, Code of Federal Regulations, or any successor regulation) that is not located— on the campus (as defined in such section) of such provider; or within the distance (described in such definition of campus) from a remote location of a hospital facility (as defined in such section). The table of contents of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 note) is amended by inserting after the item relating to section 804 the following new item: 9Billing Requirements with Respect to Group Health Plans and Coverage901.Honest billing requirements(a)In generalA hospital may not, with respect to items and services furnished to an individual at an off-campus outpatient department of a provider, submit a claim for such items and services to a group health plan or health insurance issuer, and may not hold such individual liable for such items and services, unless—(1)such hospital obtains a separate unique health identifier established for such department pursuant to section 1173(b) of the Social Security Act; and(2)the claim for such items and services includes such separate unique health identifier for such department where such items and services were furnished.(b)Process for reporting suspected violationsNot later than one year after the date of enactment of this section, the Secretary shall establish a process under which a suspected violation of this section may be reported to such Secretary.(c)Off-Campus outpatient department of a provider definedFor purposes of this paragraph, the term off-campus outpatient department of a provider means a department of a provider (as defined in section 413.65 of title 42, Code of Federal Regulations, or any successor regulation) that is not located—(1)on the campus (as defined in such section) of such provider; or(2)within the distance (described in such definition of campus) from a remote location of a hospital facility (as defined in such section).. Part 9—Regulation of Hospitals901. Hospital billing requirements..

901. Honest billing requirements A hospital may not, with respect to items and services furnished to an individual at an off-campus outpatient department of a provider, submit a claim for such items and services to a group health plan or health insurance issuer, and may not hold such individual liable for such items and services, unless— such hospital obtains a separate unique health identifier established for such department pursuant to section 1173(b) of the Social Security Act; and the claim for such items and services includes such separate unique health identifier for such department where such items and services were furnished. Not later than one year after the date of enactment of this section, the Secretary shall establish a process under which a suspected violation of this section may be reported to such Secretary. For purposes of this paragraph, the term off-campus outpatient department of a provider means a department of a provider (as defined in section 413.65 of title 42, Code of Federal Regulations, or any successor regulation) that is not located— on the campus (as defined in such section) of such provider; or within the distance (described in such definition of campus) from a remote location of a hospital facility (as defined in such section).

5. Implementation The Secretary of Labor shall implement the amendments made by this Act by rulemaking.