Regular Session 2021-2022 House Bill 1723 P.N. 1952

PRINTER'S NO. 1952

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

1723

Session of

2021

INTRODUCED BY FRANKEL, SANCHEZ, D. WILLIAMS, FREEMAN, GUENST,

VITALI, HOHENSTEIN, WEBSTER, SIMS, GALLOWAY, MADDEN,

INNAMORATO, DELLOSO, DeLUCA, ISAACSON, CIRESI, DRISCOLL,

McCLINTON, ROZZI, CONKLIN, KINKEAD, LONGIETTI, McNEILL,

A. DAVIS, HENNESSEY AND FITZGERALD, JULY 19, 2021

REFERRED TO COMMITTEE ON HEALTH, JULY 19, 2021

AN ACT

Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An

act relating to health care; prescribing the powers and

duties of the Department of Health; establishing and

providing the powers and duties of the State Health

Coordinating Council, health systems agencies and Health Care

Policy Board in the Department of Health, and State Health

Facility Hearing Board in the Department of Justice;

providing for certification of need of health care providers

and prescribing penalties," providing for off-campus facility

fees.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. The act of July 19, 1979 (P.L.130, No.48), known

as the Health Care Facilities Act, is amended by adding a

chapter to read:

CHAPTER 8-A

OFF-CAMPUS FACILITY FEES

Section 801-A. Definitions.

The following words and phrases when used in this chapter

shall have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Campus." The following:

(1) the main buildings of a health care facility;

(2) the physical area immediately adjacent to the main

buildings or other areas or structures not strictly

contiguous to the main buildings of a health care facility

that are located within 250 yards of the main buildings; or

(3) any other area determined on an individual case

basis by the Centers for Medicare & Medicaid Services to be

part of the campus of a health care facility.

"Council." The Health Care Cost Containment Council.

"COVID-19." The novel coronavirus as identified in the

Governor's proclamation of disaster emergency issued on March 6,

2020, published at 50 Pa.B. 1644 (March 21, 2020).

"COVID-19 fee." Any fee charged or billed by a health care

provider for additional personal protective equipment, cleaning

supplies or cleaning services utilized as a result of the SARS-

CoV-2 pandemic.

"Current procedural terminology." The codes, descriptions

and guidelines as included in the current procedural terminology

manual published by the American Medical Association in effect

at the time of the effective date of this section.

"Facility fee." Any fee charged or billed by a health care

provider for outpatient services provided in an off-campus

health care facility that is:

(1) Intended to compensate the health care provider for

the operational expenses of the health care provider.

(2) Separate and distinct from a professional fee.

(3) Irrespective of the modality through which the

health care service was provided.

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"Medical service." As defined in section 2 of the act of

December 20, 1985 (P.L.457, No.112), known as the Medical

Practice Act of 1985.

"Off-campus health care facility." A facility that is not

located on the campus of a health care facility.

"Professional fee." Any fee charged or billed by a provider

for professional medical services provided in a health care

facility.

Section 802-A. Prohibited fees.

A health care provider may not charge, bill or collect the

following fees:

(1) A COVID-19 fee; or

(2) A facility fee for:

(i) services provided in an off-campus health care

facility;

(ii) outpatient evaluation and management services;

(iii) any outpatient, diagnostic or imaging service

identified by the department under section 804-A.

Section 803-A. Duties of health care provider.

A health care provider shall provide written notice:

(1) To a patient or the patient's authorized

representative under 42 CFR § 413.65(g)(7)(iii) (relating to

requirements for a determination that a facility or an

organization has provider-based status).

(2) To the patient at least 48 hours before the

performance of medical services, including diagnosis, care or

treatment in an off-campus health care facility. The notice

under this paragraph shall include:

(i) The dollar amount of the patient's potential

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financial liability, if known; or

(ii) If the diagnosis and the extent of medical

services is unknown within the 48-hour period, a

statement advising the patient or the patient's

authorized representative that the patient may incur a

financial liability to the health care facility that the

patient would not incur if the patient was receiving

medical services and treatment on the campus of the

health care facility.

(iii) A statement advising the patient, or the

patient's authorized representative, that the patient's

actual financial liability is based on the medical

services rendered by the health care facility.

(3) In a method that the patient can understand.

(4) To the patient's authorized representative at least

48 hours prior to the delivery of medical services to the

patient if the patient is unconscious, under significant

duress or otherwise unable to read, comprehend or act on the

patient's own behalf.

(5) As soon as possible after the existence of an

emergency has been ruled out or the emergency condition has

been stabilized in situations where an off-campus health care

facility provides examination or treatment.

Section 804-A. Identification of medical services.

The department shall annually identify medical services

subject to the limitations on facility fees provided in section

802-A and submit the list of identified medical services to the

Legislative Reference Bureau for publication in the Pennsylvania

Bulletin.

Section 805-A. Reporting requirements.

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(a) Submissions.--Each health care provider shall submit the

following reports to the council:

(1) A report enumerating the COVID-19 fees associated

with care and treatment of COVID-19 charged and billed by the

health care provider prior to the effective date of this

section. The report under this paragraph may be included in

the report required under paragraph (2).

(2) An annual report concerning facility fees billed

during the preceding calendar year. The report under this

paragraph shall be in the format specified by the council.

The council shall submit the report to the Legislative

Reference Bureau for publication in the Pennsylvania

Bulletin.

(b) Report content.--The reports under subsection (a) shall

include:

(1) The name and full address of each health care

facility owned or operated by the health care provider that

provides medical services for which a COVID-19 fee or

facility fee is charged or billed.

(2) The number of patient visits at each health care

facility for which a facility fee was charged or billed.

(3) The number, total amount and types of allowable

facility fees paid at each health care facility by Medicare,

Medicaid and private insurance.

(4) For each health care facility and the health care

provider, the total amount billed and the total revenue

received from COVID-19 fees and facility fees.

(5) The 10 most frequent procedures or services,

identified by current procedural terminology category I

codes, provided by the health care provider that generated

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the largest amount of facility fee gross revenue, including:

(i) The volume of each procedure or service under

this paragraph.

(ii) The gross and net revenue totals for each

procedure or service under this paragraph.

(iii) The total net amount of revenue received by

the health care provider derived from facility fees for

each procedure or service under this paragraph.

(6) The 10 most frequent procedures or services,

identified by current procedural terminology category I

codes, based on patient volume, provided by the health care

provider for which facility fees are billed or charged based

on patient volume, including the gross and net revenue totals

received for each such procedure or service.

(7) Any other information related to COVID-19 fees and

facility fees the council may require.

Section 806-A. Regulatory authorization.

The council may promulgate regulations necessary to implement

this section, specify the format and content of reports and

impose penalties for noncompliance consistent with the council's

authority under 35 Pa.C.S. Ch. 33 (relating to health care cost

containment).

Section 807-A. Enforcement.

(a) General rule.--Except as provided in subsection (b), the

department shall enforce the provisions of this chapter and

shall adopt and promulgate regulations to carry out the

provisions of this chapter.

(b) Penalty.--A health care provider or health care facility

that fails to provide notice under section 803-A and supply the

data under section 805-A may be subject to the penalty under

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section 35 Pa.C.S. § 3310(b) (relating to enforcement and

penalty).

health care provider for compliance with the requirements of

this chapter. Each health care provider shall make available,

upon written request of the department or a designee, a copy of

any books, documents, records or data necessary for the audit

under this subsection for a period of four years after the

furnishing of any services for which a COVID-19 fee or facility

fee was charged, billed or collected.

Section 2. This act shall take effect in 60 days.

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