[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4509 Reported in House (RH)]

<DOC>





                                                 Union Calendar No. 208
118th CONGRESS
  1st Session
                                H. R. 4509

                          [Report No. 118-258]

To amend the Employee Retirement Income Security Act of 1974 to require 
 group health plans and health insurance issuers offering group health 
insurance coverage to only pay claims submitted by hospitals that have 
in place policies and procedures to ensure accurate billing practices, 
                        and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 10, 2023

    Ms. Foxx (for herself and Mr. Scott of Virginia) introduced the 
 following bill; which was referred to the Committee on Education and 
                             the Workforce

                            November 1, 2023

  Reported with an amendment, committed to the Committee of the Whole 
       House on the State of the Union, and ordered to be printed
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]
 [For text of introduced bill, see copy of bill as introduced on July 
                               10, 2023]


_______________________________________________________________________

                                 A BILL


 
To amend the Employee Retirement Income Security Act of 1974 to require 
 group health plans and health insurance issuers offering group health 
insurance coverage to only pay claims submitted by hospitals that have 
in place policies and procedures to ensure accurate billing practices, 
                        and for other purposes.


 


    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 the ``Transparency in Billing Act of 
2023''.

SEC. 2. HONEST BILLING REQUIREMENTS.

    (a) In General.--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:

``SEC. 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.''.
    (b) Clerical Amendment.--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:

``Sec. 726. Honest billing requirements.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect with respect to plan years beginning on or after January 1, 
2024.

SEC. 3. REGULATION OF HONEST BILLING.

    (a) In General.--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:

 ``PART 9--BILLING REQUIREMENTS WITH RESPECT TO GROUP HEALTH PLANS AND 
                                COVERAGE

``SEC. 901. HONEST BILLING REQUIREMENTS.

    ``(a) In General.--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--
            ``(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 Violations.--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.
    ``(c) Off-campus Outpatient Department of a Provider Defined.--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--
            ``(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).''.
    (b) Clerical Amendment.--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:

 ``Part 9--Billing Requirements With Respect to Group Health Plans and 
                                Coverage

``Sec. 901. Honest billing requirements.''.

SEC. 4. ENFORCEMENT.

    Section 502 of the Employee Retirement Income Security Act of 1974 
(29 U.S.C. 1132) is amended--
            (1) in subsection (a)(6), by striking ``or (9)'' and 
        inserting ``(9), or (13)''; and
            (2) in subsection (c), by adding at the end the following 
        new paragraph:
            ``(13) The Secretary may assess a civil monetary penalty 
        against a hospital for a violation under section 901 in an 
        amount--
                    ``(A) in the case of a hospital with not more than 
                30 beds (as determined under section 
                180.90(c)(2)(ii)(D) of title 45, Code of Federal 
                Regulations, as in effect on the date of the enactment 
                of this paragraph), not to exceed $300 per day that the 
                violation is ongoing, as determined by the Secretary; 
                and
                    ``(B) in the case of a hospital with more than 30 
                beds (as so determined), not to exceed $5,500 per each 
                such day.''.

SEC. 5. IMPLEMENTATION.

    The Secretary of Labor shall implement the amendments made by this 
Act by rulemaking.
                                                 Union Calendar No. 208

118th CONGRESS

  1st Session

                               H. R. 4509

                          [Report No. 118-258]

_______________________________________________________________________

                                 A BILL

To amend the Employee Retirement Income Security Act of 1974 to require 
 group health plans and health insurance issuers offering group health 
insurance coverage to only pay claims submitted by hospitals that have 
in place policies and procedures to ensure accurate billing practices, 
                        and for other purposes.

_______________________________________________________________________

                            November 1, 2023

  Reported with an amendment, committed to the Committee of the Whole 
       House on the State of the Union, and ordered to be printed