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SECOND REGULAR SESSION
SENATE BILL NO. 1664
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR COLEMAN.
6974S.01I KRISTINA MARTIN, Secretary
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 1
one new section, to be known as section 191.2299, to read as 2
follows:3
191.2299. 1. This section shall be known and may be 1
cited as the "Honest Billing Act". 2
2. As used in this section, the following terms shall 3
mean: 4
(1) "Campus", the same meaning as in 42 CFR 413.65(a), 5
as may be amended from time to time; 6
(2) "Enrollee", the same meaning as is ascribed to 7
such term in section 376.1350; 8
(3) "Facility", the same meaning as is ascribed to 9
such term in section 376.1350; 10
(4) "Health care service", the same meaning as is 11
ascribed to such term in section 376.1350; 12
(5) "Health carrier" or "carrier", the same meaning as 13
is ascribed to such term in section 376.1350; 14
(6) "National provider identifier" or "NPI", the 15
standard, unique health identifier for health care providers 16
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that is issued by the National Plan and Provider Enumeration 17
System in accordance with 45 CFR 162; 18
(7) "Off-campus outpatient department of a facility", 19
a location: 20
(a) Whose operations are directly or indirectly owned 21
or controlled by, in whole or in part, or affiliated with, a 22
hospital, regardless of whether the operations are under the 23
same governing body as the hospital; 24
(b) That is located more than two hundred fifty yards 25
from the hospital's main campus; 26
(c) That provides services that are organizationally 27
and functionally integrated with the hospital; and 28
(d) That is an outpatient facility providing 29
preventive, diagnostic, treatment, or emergency services. 30
3. Except as otherwise specified in this section, this 31
section shall apply to all facilities licensed and operating 32
in this state and to all health carriers doing business in 33
this state. This section shall apply to claims submitted 34
after December 31, 2026. 35
4. Irrespective of 45 CFR 162.410(a)(1), each off- 36
campus outpatient department of a facility shall apply for, 37
obtain, and use, on all claims filed after the date 38
specified in subsection 3 of this section, for reimbursement 39
or payment for health care services provided in that 40
department, a unique NPI that is distinct from the NPI used 41
by the main campus of the facility and any other off-campus 42
location of the facility. 43
5. (1) No facility, or entity on behalf of a 44
facility, shall, with respect to health care services 45
furnished to an enrollee at an off-campus outpatient 46
department of a facility, submit a claim for such health 47
care services to a health carrier, or hold the enrollee 48
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liable for such health care services, unless those health 49
care services are billed using the separate unique NPI 50
established for the off-campus outpatient department and on 51
a CMS 1500 form or a HIPAA X12 837P electronic claims 52
transaction or a successor form or transaction. 53
(2) No health carrier shall be responsible to 54
reimburse claims for health care services furnished to an 55
enrollee at an off-campus outpatient department of a 56
facility if such claims are not billed in accordance with 57
this subsection. 58
6. A facility, or entity on behalf of a facility, that 59
does not bill for health care services rendered to an 60
enrollee at an off-campus outpatient department of a 61
facility in accordance with this section shall not hold the 62
enrollee liable to pay for the health care services. A 63
violation of this subsection shall constitute a violation of 64
the Missouri merchandising practices act, sections 407.010 65
to 407.130, subject to enforcement by the attorney general. 66
7. A facility applying for a license or license 67
renewal by the state shall demonstrate that it has obtained 68
one or more NPIs as required under this section as a 69
condition of receiving licensure, and shall use its unique 70
NPI or NPIs on every claim for payment in the manner 71
required under this section. 72
8. The department of health and senior services may, 73
in accordance with chapter 536, impose penalties on any 74
licensee violating any of the provisions of this section by 75
taking any or all of the following actions, separately or in 76
combination: 77
(1) Imposing an administrative fine of one thousand 78
dollars for each violation of this section; 79
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(2) Recovering reasonable investigative fees and costs 80
incurred as a consequence of the violation or violations; 81
(3) Suspending, revoking, or denying the issuance or 82
renewal of a license; 83
(4) Placing conditions on a license; 84
(5) Placing a licensee on probation; 85
(6) Referring a licensee to the attorney general for 86
investigation; and 87
(7) Requiring the provider to post information about 88
these penalties on the main page of its website. 89
9. The director of the department of commerce and 90
insurance shall have authority to refer any violation of 91
this section to the department of health and senior 92
services. The attorney general shall have authority to 93
enforce the provisions of this section. 94
10. The director of the department of commerce and 95
insurance may promulgate rules as necessary for the 96
implementation of this section. Any rule or portion of a 97
rule, as that term is defined in section 536.010, that is 98
created under the authority delegated in this section shall 99
become effective only if it complies with and is subject to 100
all of the provisions of chapter 536 and, if applicable, 101
section 536.028. This section and chapter 536 are 102
nonseverable and if any of the powers vested with the 103
general assembly pursuant to chapter 536 to review, to delay 104
the effective date, or to disapprove and annul a rule are 105
subsequently held unconstitutional, then the grant of 106
rulemaking authority and any rule proposed or adopted after 107
August 28, 2026, shall be invalid and void. 108
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