AN ACT RELATING TO HEALTH AND SAFETY -- PREVENTING UNWARRANTED FACILITY FEES (Prohibits the addition of facility fees when healthcare services are not rendered on a hospital campus.)

H7937

2026 -- H 7937
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LC005432
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
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A N A C T
RELATING TO HEALTH AND SAFETY -- PREVENTING UNWARRANTED FACILITY
FEES

Introduced By:
Representatives Potter, Kislak, Giraldo, Handy, McGaw, Tanzi,
Donovan, Morales, Cotter, and Bennett

Date Introduced:
February 27, 2026

Referred To:
House Health & Human Services
It is enacted by the General Assembly as follows:
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SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby
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amended by adding thereto the following chapter:
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CHAPTER 17.31
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PREVENTING UNWARRANTED FACILITY FEES
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23-17.31-1. Definitions.
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For the purposes of this chapter:
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(1) "Campus" means:
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(i) The hospital's main buildings, the physical area immediately adjacent to a hospital's
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main buildings and other areas and structures that are not strictly contiguous to the main buildings
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but are located within two hundred fifty yards (250 yds.) of the main buildings or as may otherwise
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be defined under federal law or regulation including 42 CFR § 413.65(a)(2) (or successor
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regulations) or any other area that has been determined on an individual case basis by the Centers
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for Medicare and Medicaid Services to be part of a hospital's campus.
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(ii) "Off-site from a hospital campus" or "off-campus location" means any location that is
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not located:
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(A) On the "campus" as defined in this section; or
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(B) Within the distance described in the definition of "campus".
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(iii) Services provided via telecommunications or telemedicine are deemed to be rendered

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off-site from a hospital campus for the purposes of this section.
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(2) "Facility fee" means any fee that is:
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(i) Intended to compensate the hospital, healthcare facility, or health system for the
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operational, administrative, or overhead expenses of the hospital or health system; and
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(ii) Separate and distinct from a professional fee.
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(3) "Healthcare facility" has the meaning as set forth in § 23-17-2.
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(4) "Healthcare clearinghouse" has the same meaning as set forth in 45 CFR § 160.103.
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(5) "Healthcare provider" means any person, group, professional corporation, or other
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organization that is licensed or otherwise authorized in this state to furnish a healthcare service or
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provides the services of such individuals, groups, corporations, or organization including, but not
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limited to, a medical clinic, a medical group, a home health care agency, a health infusion center,
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an urgent care center, and an emergent care center.
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(6) "Health system" means:
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(i) A parent corporation of one or more hospitals and any entity affiliated with such parent
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corporation through ownership, governance, membership or other means; or
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(ii) A hospital and any entity affiliated with such hospital through ownership, governance,
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membership or other means.
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(7) "NPI" or "national provider identifier" means the standard, unique health identifier for
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health care providers that is issued by the national provider system in accordance with 45 CFR
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§162.408.
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(8) "Subpart" has the same meaning as that term used in 45 CFR § 162.410 and means a
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component or separate physical location of a health system that may be separately licensed or
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certified by the state.
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23-17.31-2. Enhanced consumer protections from facility fees.
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(a) A healthcare facility, hospital-based facility, healthcare provider, or health system, shall
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not bill, charge, collect, or seek compensation, remuneration, or reimbursement, for a facility fee
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for services provided off-site from a hospital campus, and shall not submit, and no payer shall be
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required to reimburse, an institutional claim, including a claim submitted on a UB-40 or any
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successor or substantially similar form, or to include other claims code reserved for or indicating
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services were provided on a hospital campus, for the services.
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(b) An off-site entity may be required to submit claims for professional services by billing
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via a claim form that reflects professional services only, such as CMS-1500, or any successor or
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substantially similar form, and reimbursement shall be limited to the applicable professional fee.
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(c) Any claim for outpatient services shall include the physical address where the services

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were furnished and a unique site identifier required by § 23-17.31-3.
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23-17.31-3. Providers to obtain unique NPI.
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(a) An off-campus location of a hospital shall apply for, obtain, and use on all claims for
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reimbursement or payment for health care services provided at the off-campus location submitted
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on or after January 1, 2027, a unique National Provider Identifier (NPI) that is separate and distinct
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from the hospital's NPI. The off-campus location's unique NPI shall be included on any claim for
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reimbursement or payment for health care services provided at the off-campus location, regardless
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of whether the claim is filed or submitted by or through a central office of the hospital or a health
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care clearinghouse.
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(b) Each health system and each subpart that is required or eligible to obtain an NPI
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pursuant to 45 CFR § 162.410 shall apply for, obtain, and use on all claims for payment for medical
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care, services, or goods, a unique NPI for each site at which the health system or its subparts deliver
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medical care, services, or goods.
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(c) Each health system and each subpart that is required or eligible to obtain an NPI
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pursuant to 45 CFR § 162.410 shall apply for, obtain, and use on all claims for payment for medical
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care, services, or goods a unique NPI for each provider type under which the health system or its
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subparts deliver medical care, services, or goods.
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(d) A health system or subpart submitting a claim for payment for medical care, services,
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or goods shall include on the claim the unique NPI that identifies both the site where the medical
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care, services, or goods were provided and the provider type regardless of whether the claim is filed
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or submitted by or through a central office of the health system or a health care clearinghouse.
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(e) For a health system that is a licensed or certified hospital contracting for services, the
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hospital shall obtain and use a unique, separate, and distinct NPI for:
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(1) Its main campus;
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(2) Each off-campus location of the hospital; and
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(3) Each provider types when the hospital delivers medical care, services, or goods at either
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the hospital's main campus or at an off-campus location.
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(f) A hospital submitting a claim for payment for medical care, services, or goods shall
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include on the claim the unique NPI that identifies both the site where the medical care, services,
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or goods were provided and the provider type, regardless of whether the claim is filed or submitted
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by or through a central office of the hospital or a health care clearinghouse.
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(g) Commencing January 1, 2027, a health system applying to enroll as a new provider
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shall demonstrate that it has obtained or applied one or more NPIs as required by this section and,
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upon enrollment, shall use its unique NPI on every claim for payment in the manner required by

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this section.
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(h) Commencing January 1, 2027, a health system enrolled and applying for revalidation
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as a provider shall demonstrate that it has obtained or applied one or more NPIs as required by this
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section as a condition of receiving revalidation, and upon receiving revalidation as a provider, shall
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use its unique NPI on every claim for payment in the manner required by this section.
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(i) Federal alignment. If the office of the health insurance commissioner determines that
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federal law or rules from CMS provide a substantially similar alternative requirement or process,
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then the office shall report to the speaker of the house and president of the senate as soon as practical
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whether amendments to the above section are advisable.
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SECTION 2. This act shall take effect upon passage.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO HEALTH AND SAFETY -- PREVENTING UNWARRANTED FACILITY
FEES
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This act would prohibit the addition of facility fees when health care services are not
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rendered on a hospital campus, and require each off-campus location of a hospital to have a unique
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identification number in order that the charges associated with those facilities are transparent and
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accountable.
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This act would take effect upon passage.
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