This bill would change the Employee Retirement Income Security Act of 1974 (ERISA) to require hospitals to use and report a separate unique health identifier for any off-campus outpatient department when they submit claims to group health plans or group health insurance issuers. A group health plan or issuer could not pay a claim from a hospital for services at an off-campus outpatient department unless the claim includes that separate department identifier. The bill also says a hospital may not submit such a claim or hold the patient liable unless the department has obtained the identifier and the claim includes it.
The bill defines "off-campus outpatient department" by referring to the definition in 42 C.F.R. §413.65. It directs the Secretary to set up a process, within one year of enactment, for reporting suspected violations. The labor Secretary must implement the changes by rulemaking. The bill adds civil monetary penalties: up to $300 per day for hospitals with 30 beds or fewer, and up to $5,500 per day for hospitals with more than 30 beds. The rule changes take effect for plan years beginning on or after January 1, 2027.
No publicly available information on the bill's overall costs or savings to plans, hospitals, or taxpayers. The bill sets civil monetary penalties for violations: up to $300 per day for hospitals with 30 or fewer beds, and up to $5,500 per day for hospitals with more than 30 beds. The bill requires the Secretary to carry out rulemaking, but it does not include estimates of implementation costs.
The bill's text says it would require plans and issuers to only pay claims submitted by hospitals that have policies and procedures to ensure accurate billing practices and would require separate identifiers for off-campus outpatient departments. The sponsors introduced the bill to increase billing accuracy and transparency by linking payment to the use of department-specific identifiers.
No publicly available information.