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SECOND REGULAR SESSION
HOUSE BILL NO. 3152
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE CHRIST .
4168H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o 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 fr om time to time;
6 (2) "Enr ollee", 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 pro vider identifier" or "NPI", the standard, unique health
13 identifier for health care prov iders that is issued by the National Plan and Pr ovider
14 Enumeration System in accordance with 45 CFR Part 162;
15 (7) "Off-campus outpatient department of a facility", a location:
EXPLANA TION — 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.
16 (a) Whose operations are dir ectly or indirectl y owned or controlled by , in whole
17 or in part, or affiliated with, a hospital, r egardless of whether the operations are under
18 the same governing body as the hospital;
19 (b) That is located mor e than two hundred fifty yards fr om the hospital's main
20 campus;
21 (c) That prov ides services that ar e organizationally and functionally integrated
22 with the hospital; and
23 (d) That is an outpatient facility provi ding pr eventive, diagnostic, tr eatment, 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. Irr espective 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 r eimbursement or payment for health care services
31 pr ovided in that department, a unique NPI that is distinct fro m 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 r espect to health
34 car e services furnished to an enr ollee 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 enr ollee liable for such health car e services, unless those health car e 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 HIP AA X12 837P electr onic claims transaction or a
39 successor form or transaction.
40 (2) No health carrier shall be r esponsible to reim burse claims for health car e
41 services furnished to an enr ollee 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 car e
44 services r endere d to an enro llee at an off-campus outpatient department of a facility in
45 accordance with this section shall not hold the enr ollee liable to pay for the health car e
46 services. A violation of this subsection shall constitute a violation of the Missouri
47 mer chandising practices act, sections 407.010 to 407.130, subject to enforcem ent by the
48 attorney general.
49 7. A facility applying for a license or license renewa l by the state shall
50 demonstrate that it has obtained one or mor e NPIs as re quir ed under this section as a
51 condition of receivi ng licensur e, and shall use its unique NPI or NPIs on every claim for
52 payment in the manner r equir ed under this section.
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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 pro visions 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 reas onable investigative fees and costs incurr ed as a consequence
59 of the violation or violations;
60 (3) Suspending, revo king, or denying the issuance or r enewal of a license;
61 (4) Placing conditions on a license;
62 (5) Placing a licensee on pr obation;
63 (6) Referring a licensee to the attorney general for investigation; and
64 (7) Requiring the pr ovider to post information about these penalties on the main
65 page of its website.
66 9. The director of the department of commer ce and insurance shall have
67 authority to re fer any violation of this section to the department of health and senior
68 services. The attorney general shall have authority to enfor ce the pr ovisions of this
69 section.
70 10. The dir ector of the department of commer ce and insurance may pr omulgate
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 creat ed under the authority delegated
73 in this section shall become effective only if it complies with and is subject to all of the
74 pr ovisions 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 revi ew , to delay the effective date, or to disappr ove and annul
77 a rule are subsequently held unconstitutional, then the grant of rulemaking authority
78 and any rule prop osed or adopted after August 28, 2026, shall be invalid and void.
✔
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