An Act amending the act of July 19, 1979 (P.L.130, No.48), known as the Health Care Facilities Act, providing for health care site neutrality.

PRINTER'S NO. 2967
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2268
Session of
2026
INTRODUCED BY WEBSTER, PROBST, CONKLIN, GUENST, SANCHEZ, WAXMAN,
HILL-EVANS, MAYES, HADDOCK, INGLIS, CEPEDA-FREYTIZ, CERRATO,
HOHENSTEIN, NEILSON AND STEELE, MARCH 6, 2026
REFERRED TO COMMITTEE ON HEALTH, MARCH 9, 2026
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 health care site
neutrality.
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-D
HEALTH CARE SITE NEUTRALITY
Section 801-D. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
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"Applicable services." Any of the following:
(1) Services provided in an off-campus health care
facility.
(2) Outpatient evaluation and management services.
(3) Any outpatient, diagnostic or imaging service
identified by the department under section 804-D.
"Campus." Any of the following:
(1) The primary buildings of a health care facility.
(2) The physical area immediately adjacent to the
primary buildings or other areas or structures not strictly
contiguous to the primary buildings of a health care facility
that are located within 250 yards of the main buildings.
(3) Any other area determined on an individual basis by
the Centers for Medicare and Medicaid Services to be part of
the campus of a health care facility.
"Council." The Health Care Cost Containment Council
established under the act of July 8, 1986 (P.L.408, No.89),
known as the Health Care Cost Containment Act.
"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; and
(3) irrespective of the modality through which the
health care service was provided.
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"Health benefit plan." A plan, policy, contract, certificate
or agreement entered into, offered or issued by a health
insurance carrier or third-party administrator acting on behalf
of a plan sponsor to provide, deliver, arrange for, pay for or
reimburse any of the costs of health care services and includes
non-Federal governmental plans as defined in 29 U.S.C. §
1002(32) (relating to definitions). The term does not include
any plans, programs of coverage or benefits administered under
42 U.S.C. Ch. 7 Subch. XVIII (relating to health insurance for
aged and disabled).
"Health care contract." A contract, agreement or
understanding, either orally or in writing, entered into,
amended, restated or renewed between a health care provider and
any of the following for the delivery of health care services to
an enrollee of a health benefit plan:
(1) a health insurance carrier;
(2) one or more third-party administrators;
(3) a plan sponsor; or
(4) the health care provider's contractor or agent.
"Health care facility." For purposes of this chapter, a
health care facility includes, but is not limited to, a general,
chronic disease or other type of hospital, a home health care
agency, a home care agency, a hospice, a long-term care nursing
facility, cancer treatment centers using radiation therapy on an
ambulatory basis, an ambulatory surgical facility, a birth
center regardless of whether such health care facility is
operated for profit, nonprofit or by an agency of the
Commonwealth or local government. The department shall have the
authority to license other health care facilities as may be
necessary due to emergence of new modes of health care. When the
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department so finds, it shall transmit notice of its intention
to license a particular type of health care facility to the
Legislative Reference Bureau for publication in the next
available issue of the Pennsylvania Bulletin in accordance with
the act of June 25, 1982 (P.L.633, No.181), known as the
Regulatory Review Act. The term does not include an office used
primarily for the private practice of a health care
practitioner, a program which renders treatment or care for drug
or alcohol abuse or dependence unless located within a health
facility or a facility providing treatment solely on the basis
of prayer or spiritual means. The term does not apply to a
facility which is conducted by a religious organization for the
purpose of providing health care services exclusively to
clergymen or other persons in a religious profession who are
members of a religious denomination.
"Health insurance carrier." An entity licensed by the
department that offers, issues or renews an individual or group
health insurance policy that is offered or governed under any of
the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including section 630 and
Article XXIV of that act.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
"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.
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"Off-campus health care facility." A facility that is not
located on the campus of a health care facility.
"Participating provider." A provider under contract with a
health benefit plan, or one of its delegates, who has agreed
under the contract to provide health care services to the health
benefit plan's beneficiaries with an expectation of receiving
payment, other than coinsurance, copayments or deductibles from
the beneficiary, solely from the health care entity under the
terms of the contract.
"Plan sponsor." Any of the following:
(1) The employer in the case of a benefit plan
established or maintained by a single employer.
(2) The employee organization in the case of a benefit
plan established or maintained by an employee organization,
provided that "employee organization" shall mean any labor
union or any organization of any kind, or any agency or
employee representation committee, association, group or
plan, in which employees participate and that exists for the
purpose, in whole or in part, of dealing with employers
concerning an employee benefit plan or other matters
incidental to employment relationships or any employees'
beneficiary association organized for the purpose, in whole
or in part, of establishing a plan.
(3) In the case of a benefit plan established or
maintained by two or more employers or jointly by one or more
employers and one or more employee organizations, the
association, committee, joint board of trustees or other
similar group of representatives of the parties who establish
or maintain the benefit plan.
"Professional fee." Any fee charged or billed by a provider
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for professional medical services provided in a health care
facility.
"Third-party administrator." A health plan administrator who
acts on behalf of a plan sponsor to administer a health benefit
plan.
Section 802-D. Prohibited fees and provider reimbursement.
(a) Prohibited fees.--A health care provider may not charge,
bill or collect a facility fee for any applicable service.
(b) Participating provider reimbursement rates.--A health
care provider that enters into a health care contract to be a
participating provider with a health benefit plan shall offer to
accept as payment in full for applicable services rates that
shall not exceed 150% of the amount paid by Medicare for the
same services.
(c) Health care provider reimbursement rates.--
(1) A health care provider may not charge, bill or
accept payment for an applicable service that exceeds the
lesser of:
(i) 150% of the amount paid by Medicare; or
(ii) the negotiated rate agreed upon by the health
care provider and the health benefit plan.
(2) Paragraph (1) shall apply to any individual or
entity that reimburses for applicable services, including
self-pay individuals and health benefit plans that do not
have an existing contract with the health care provider.
(d) Contract provisions.--A health care contract entered
into with a health care provider shall include provisions
requiring that:
(1) the health benefit plan shall not reimburse a health
care provider for any applicable services in amounts in
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excess of the rates specified in subsections (b) and (c) or
for facility fees prohibited by subsection (a); and
(2) a beneficiary or self-pay individual shall not be
liable to any health care provider for any amounts in excess
of the rates specified in subsections (b) and (c) or for
facility fees prohibited under subsection (a), including any
copayments, deductibles or coinsurance for any portion of the
prohibited rates.
Section 803-D. Duties of health care provider.
(a) Notice requirement.--A health care provider shall
provide written notice 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 of:
(1) the dollar amount of the patient's potential
financial liability, if known; or
(2) 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; and
(3) 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.
(b) Method of notice.--
(1) A health care provider must provide written notice
required under subsection (a) in a method that the patient
can understand.
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(2) A health care provider must provide the notice
required under subsection (a) 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.
(3) A health care provider must provide the notice
required under subsection (a) 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.
(c) Provider-based status notice.--A health care provider
shall provide written notice 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).
Section 804-D. Identification of medical services.
The department shall annually identify medical services
subject to the limitations on facility fees provided in section
802-D and submit the list of identified medical services to the
Legislative Reference Bureau for publication in the next
available issue of the Pennsylvania Bulletin.
Section 805-D. Reporting requirements.
(a) Submissions.--Each health care provider shall submit to
the council an annual report concerning facility fees billed
during the preceding calendar year. The report under this
paragraph shall be in a format as determined by the council. The
council shall submit the report to the Legislative Reference
Bureau for publication in the next available issue of the
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Pennsylvania Bulletin.
(b) Report content.--A report under subsection (a) shall
include the following:
(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 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 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
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
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on patient volume, including the gross and net revenue totals
received for each such procedure or service.
(7) Any other information related to facility fees the
council may require.
Section 806-D. Regulatory authorization.
The council may promulgate regulations necessary to implement
this chapter, 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-D. Enforcement.
(a) Compliance enforcement.--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 data
required under section 805-A may be subject to the penalty under
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 facility fee was charged,
billed or collected.
Section 2. This act shall take effect in 60 days.
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