[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4092 Introduced in House (IH)]






108th CONGRESS
  2d Session
                                H. R. 4092

 To amend title XIX of the Social Security Act to require fair billing 
for hospital services provided to uninsured patients as a condition of 
                    Medicaid funding for a hospital.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 31, 2004

  Mr. Hefley introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend title XIX of the Social Security Act to require fair billing 
for hospital services provided to uninsured patients as a condition of 
                    Medicaid funding for a hospital.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as ``Hospital Billing Fairness Act of 2004''.

SEC. 2. REQUIREMENT FOR FAIR HOSPITAL BILLING FOR THE UNINSURED.

    (a) In General.--Section 1903 of the Social Security Act (42 U.S.C. 
1396b) is amended--
            (1) in subsection (i), by inserting after paragraph (8) the 
        following new paragraph:
            ``(9) with respect to any amount expended for care or 
        services furnished under the plan by a hospital unless the 
        hospital has in effect with the Secretary a certification of 
        fair billing practices described in subsection (h)(1); or''; 
        and
            (2) by inserting after subsection (g) the following new 
        subsection:
    ``(h)(1) For purposes of subsection (i)(9), a certification of fair 
billing practices of a hospital under this paragraph is a 
certification, in a form and manner specified by the Secretary, that 
the hospital does not bill or collect from any uninsured individual (as 
defined in paragraph (3)) for care or services furnished by the 
hospital an amount that exceeds 125 percent of the full payment amount 
(including any deductibles, coinsurance, or other cost-sharing) that 
would be recognized and permitted under title XVIII with respect to 
such care or services furnished to an individual entitled to benefits 
under part A of such title and enrolled under part B of such title. The 
Secretary shall specify the method for computing such full payment 
amount in the case of care and services for which there is not a full 
payment amount computed for purposes of such title.
    ``(2)(A) In the case of a hospital that has in effect a 
certification under paragraph (1) and that collects any amount in 
excess of the amount permitted to be charged or billed under such 
certification, the hospital shall refund such excess amount on a timely 
basis (as defined by the Secretary consistent with time period 
described in section 1848(g)(1)(C)).
    ``(B) In the case of a hospital with such a certification that 
fails to provide a refund required under subparagraph (A), the hospital 
is subject to imposition of a civil money penalty in an amount equal to 
three times the amount of such excess. The provisions of section 1128A 
(other than subsections (a) and (b)) shall apply to civil money 
penalties under this subparagraph in the same manner as they apply to a 
penalty or proceeding under section 1128A(a). The Secretary shall 
provide for payment to the uninsured individual involved of the portion 
of such civil money penalty collected that represents the excess amount 
collected with respect to that individual.
    ``(3) For purposes of this subsection, the term `uninsured 
individual' means, with respect to care and services furnished by a 
hospital to the individual, an individual who does not have insurance 
or other third-party contractual benefits that provides payment for 
costs incurred for such care and services. In applying the previous 
sentence, an individual shall not be treated as having insurance or 
contractual benefits for care and services if benefits for such care 
and services are not payable under such insurance or benefits by virtue 
of application of a deductible or if such contractual benefits consist 
only of payment from a medical or health savings account or similar 
mechanism.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
first apply to payment amounts for care and services furnished after 
the end of the 60-day period beginning on the date of the enactment of 
this Act, but shall not apply to inpatient hospital services that are 
part of an admission that began before the end of such period.
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