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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
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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;
or
(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).
(c) Audit.--The department or a designee may audit any
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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