HOUSE BILL NO. 3152 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE CHRIST.
4168H.01I JOSEPH ENGLER, Chief Clerk
AN ACT To amend chapter 191, RSMo, by adding thereto one new section relating to payment for health care services, with penalty provisions.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 191, RSMo, is amended by adding thereto one new section, to be 2 known as section 191.2299, to read as follows: 191.2299. 1. This section shall be known and may be cited as the "Honest Billing 2 Act". 3 2. As used in this section, the following terms shall mean: 4 (1) "Campus", the same meaning as in 42 CFR 413.65(a), as may be amended 5 from time to time; 6 (2) "Enrollee", the same meaning as is ascribed to such term in section 376.1350; 7 (3) "Facility", the same meaning as is ascribed to such term in section 376.1350; 8 (4) "Health care service", the same meaning as is ascribed to such term in 9 section 376.1350; 10 (5) "Health carrier" or "carrier", the same meaning as is ascribed to such term 11 in section 376.1350; 12 (6) "National provider identifier" or "NPI", the standard, unique health 13 identifier for health care providers that is issued by the National Plan and Provider 14 Enumeration System in accordance with 45 CFR Part 162; 15 (7) "Off-campus outpatient department of a facility", a location:
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. HB 3152 2
16 (a) Whose operations are directly or indirectly owned or controlled by, in whole 17 or in part, or affiliated with, a hospital, regardless of whether the operations are under 18 the same governing body as the hospital; 19 (b) That is located more than two hundred fifty yards from the hospital's main 20 campus; 21 (c) That provides services that are organizationally and functionally integrated 22 with the hospital; and 23 (d) That is an outpatient facility providing preventive, diagnostic, treatment, or 24 emergency services. 25 3. Except as otherwise specified in this section, this section shall apply to all 26 facilities licensed and operating in this state and to all health carriers doing business in 27 this state. This section shall apply to claims submitted after December 31, 2026. 28 4. Irrespective of 45 CFR 162.410(a)(1), each off-campus outpatient department 29 of a facility shall apply for, obtain, and use, on all claims filed after the date specified in 30 subsection 3 of this section, for reimbursement or payment for health care services 31 provided in that department, a unique NPI that is distinct from the NPI used by the 32 main campus of the facility and any other off-campus location of the facility. 33 5. (1) No facility, or entity on behalf of a facility, shall, with respect to health 34 care services furnished to an enrollee at an off-campus outpatient department of a 35 facility, submit a claim for such health care services to a health carrier, or hold the 36 enrollee liable for such health care services, unless those health care services are billed 37 using the separate unique NPI established for the off-campus outpatient department 38 and on a CMS 1500 form or a HIPAA X12 837P electronic claims transaction or a 39 successor form or transaction. 40 (2) No health carrier shall be responsible to reimburse claims for health care 41 services furnished to an enrollee at an off-campus outpatient department of a facility if 42 such claims are not billed in accordance with this subsection. 43 6. A facility, or entity on behalf of a facility, that does not bill for health care 44 services rendered to an enrollee at an off-campus outpatient department of a facility in 45 accordance with this section shall not hold the enrollee liable to pay for the health care 46 services. A violation of this subsection shall constitute a violation of the Missouri 47 merchandising practices act, sections 407.010 to 407.130, subject to enforcement by the 48 attorney general. 49 7. A facility applying for a license or license renewal by the state shall 50 demonstrate that it has obtained one or more NPIs as required under this section as a 51 condition of receiving licensure, and shall use its unique NPI or NPIs on every claim for 52 payment in the manner required under this section. HB 3152 3
53 8. The department of health and senior services may, in accordance with chapter 54 536, impose penalties on any licensee violating any of the provisions of this section by 55 taking any or all of the following actions, separately or in combination: 56 (1) Imposing an administrative fine of one thousand dollars for each violation of 57 this section; 58 (2) Recovering reasonable investigative fees and costs incurred as a consequence 59 of the violation or violations; 60 (3) Suspending, revoking, or denying the issuance or renewal of a license; 61 (4) Placing conditions on a license; 62 (5) Placing a licensee on probation; 63 (6) Referring a licensee to the attorney general for investigation; and 64 (7) Requiring the provider to post information about these penalties on the main 65 page of its website. 66 9. The director of the department of commerce and insurance shall have 67 authority to refer any violation of this section to the department of health and senior 68 services. The attorney general shall have authority to enforce the provisions of this 69 section. 70 10. The director of the department of commerce and insurance may promulgate 71 rules as necessary for the implementation of this section. Any rule or portion of a rule, 72 as that term is defined in section 536.010, that is created under the authority delegated 73 in this section shall become effective only if it complies with and is subject to all of the 74 provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 75 536 are nonseverable and if any of the powers vested with the general assembly 76 pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul 77 a rule are subsequently held unconstitutional, then the grant of rulemaking authority 78 and any rule proposed or adopted after August 28, 2026, shall be invalid and void. ✔
Statutes affected: