118 HR 4509 RH: Transparency in Billing Act of 2023
U.S. House of Representatives
2023-11-01
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Union Calendar No. 208
118th CONGRESS
1st Session
H. R. 4509
[Report No. 118–258]
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.
1.

Short title
This Act may be cited as the “Transparency in Billing Act of 2023”.
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:
“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.
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:
“9

Billing Requirements with Respect to Group Health Plans and Coverage
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.”.
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.”.
5.

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