Sec. 302. Honest billing requirements applicable to providers
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Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–111 et seq.) is amended by adding at the end the following: A group health plan or health insurance issuer offering group or individual health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b))) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10. .
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: A group health plan or health insurance issuer offering group health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b)) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act. .
The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by inserting after the item relating to section 725 the following new item: Sec. 726. Honest billing requirements applicable to plans and issuers. . Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following: A group health plan may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b)) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act. .
The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item: Sec. 9826. Honest billing requirements applicable to plans. . Part E of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–131 et seq.) is amended by adding at the end the following: For items and services furnished, on or after January 1, 2026, at an off-campus outpatient department of a provider to a participant, beneficiary, or enrollee with benefits under a group health plan or group or individual health insurance coverage offered by a health insurance issuer, a health care provider or facility may not submit a claim to the group health plan or health insurance issuer, bill the participant, beneficiary, or enrollee, or hold liable the participant, beneficiary, or enrollee, unless— such provider or facility obtains a separate unique health identifier established for such department pursuant to section 1173(b) of the Social Security Act; and such items and services are billed using the separate unique health identifier established for such department pursuant to paragraph (1).
The term off-campus outpatient department of a provider means a department of a provider (as defined in section 413.65(a)(2) of title 42 of the Code of Federal Regulations, as in effect on the date of the enactment of the Bipartisan Primary Care and Health Workforce Act ) that is not located— on the campus (as defined in such section 413.65(a)(2)) of such provider; or within the distance (described in such definition of campus) from a remote location of a hospital (as defined in such section 413.65(a)(2)).
The Secretary shall establish a process under which a suspected violation of this section may be reported to such Secretary. The Secretary may assess a civil monetary penalty against a hospital for a violation under this section in an amount— 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 the Bipartisan Primary Care and Health Workforce Act (or any successor regulations)), not to exceed $300 per day that the violation is ongoing, as determined by the Secretary; and in the case of a hospital with more than 30 beds (as so determined), not to exceed $5,500 per day that the violation is ongoing, as determined by the Secretary. .
Section 2799B–4(a)(1) of the Public Health Service Act (42 U.S.C. 300gg–134(a)(1)) is amended by inserting (other than section 2799B–10) after this part .
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- 42 USC 300gg–111
- 42 USC 300gg–131
- 42 USC 300gg–134(a)(1)
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Sec. 302
Honest billing requirements applicable to providers
Cite42 USC 300gg–111
Cite42 USC 300gg–131
Cite42 USC 300gg–134(a)(1)
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