SPONSOR: Christ
This bill creates the "Honest Billing Act", which requires off- campus outpatient departments of medical facilities, as defined in the bill, to apply for, obtain, and use a national provider identifier ("NPI") that is distinct from the NPI used by the main campus of the facility. This unique NPI must be used on all claims submitted to health carriers on or after January 1, 2026.
No facility, or entity on behalf of a facility, can submit a claim for a health care service provided at an off-campus outpatient department of a facility, or hold an enrollee liable for the service, unless the service is billed using the unique NPI and on specified forms. A Health carrier is not required to reimburse claims that are not billed in accordance with this requirement.
Facilities, and entities acting on behalf of facilities, cannot hold enrollees liable for health care services that are not billed as provided in the bill. Any violation of this requirement is a violation of the Missouri Merchandising Practices Act subject to enforcement by the Attorney General.
A facility applying for a license or license renewal by the state must demonstrate it has obtained one or more NPIs as a condition of receiving licensure, and must use its unique NPI on every claim for payment in the manner required.
The bill specifies penalties that may be imposed by the Department of Health and Senior Services after an administrative hearing as provided by law, and the Department of Commerce and Insurance has the authority to refer violations of the these provisions to the Department of Health and Senior Services. The Attorney General also has the authority to enforce the provisions of the bill.
This bill is similar to HB 1943 (2024) and SB 610 (2023).
Statutes affected: