2024 -- S 2721

========

LC004257

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

____________

A N   A C T

RELATING TO HEALTH AND SAFETY -- NATIONAL PROVIDER IDENTIFIER OFF-

CAMPUS LOCATIONS

     Introduced By: Senators Miller, DiMario, Lauria, DiPalma, Valverde, Ujifusa, and
Pearson

     Date Introduced: March 05, 2024

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Legislative findings.

     The general assembly hereby finds and declares that:

     (1) Health care spending accounts for over seventeen percent (17%) of the United States

economy;

     (2) Health care costs in Rhode Island continue to increase, and spending on health care is

growing faster than the economy as a whole;

     (3) More accountability for and transparency in health care system costs is needed in order

that consumers can make better health care decisions and policymakers can find ways to address

rising health care costs;

     (4) According to the Rhode Island office of the health insurance commissioner (OHIC), as

the result of rising premium and cost-sharing, an estimated thirty-one cents ($0.31) of every

additional dollar earned by Rhode Island families between 2017 and 2019 went to health care;

     (5) Hospitals and other organization health care providers have expanded to create a

number of off-campus or separate physical locations for delivering health care ("off-campus

locations"), which include freestanding emergency departments.

     (6) When consumers seek nonemergency care for common conditions at freestanding

emergency departments, delivery of that level of care in that setting can increase costs in the overall

health care system;

     (7) Rhode Islanders deserve to have information about the costs associated with seeking

services at off-campus locations, including freestanding emergency departments;

     (8) In many cases, off-campus locations share the same identifier for billing purposes as

their affiliated hospital or organization health care provider, and because the costs associated with

care delivered at off-campus locations are not transparent, it may be impossible for consumers to

understand the basis for charges and for policymakers to evaluate the effects of these costs on

overall system costs;

     (9) Under federal regulations, an organization health care provider that has separate

physical locations, referred to as "subparts" of the organization provider, may obtain a unique

identifier for each subpart, which facilitates identifying the types of health care services and the

location where the services are provided; and

     (10) It is therefore the intent of the general assembly, through the passage of this act, to

require each off-campus location of a hospital and each subpart of an organization health care

provider to have a unique identification number in order that the costs associated with those

facilities are transparent and accountable.

     SECTION 2. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

amended by adding thereto the following chapter:

CHAPTER 17.29

NATIONAL PROVIDER IDENTIFIER OFF-CAMPUS LOCATIONS ACT

     23-17.29-1. Short Title.

     This chapter shall be known and may be cited as the "National Provider Identifier -- Off-

Campus Locations Act."

     23-17.29-2. Definitions.

     As used in this section:

     (1) "Health care clearinghouse" has the same meaning as set forth in 45 CFR § 160.103.

     (2) "NPI" or "national provider identifier" means the standard, unique health identifier for

health care providers that is issued by the national provider system in accordance with 45 CFR §

162.408.

     (3) "Off-campus location" means a facility:

     (i) Whose operations are directly or indirectly owned or controlled by, in whole or in part,

or affiliated with a hospital, regardless of whether the operations are under the same governing

body as the hospital;

     (ii) That is located more than two hundred fifty (250) yards from the hospital's main

campus;

LC004257 - Page 2 of 5

     (iii) That provides services that are organizationally and functionally integrated with the

hospital; and

     (iv) That is an outpatient facility providing preventive, diagnostic, treatment, or emergency

services.

     (4) "Organization health care provider" means a provider that is not an individual and

includes a hospital.

     (5) "Subpart" has the same meaning as that term used in 45 CFR § 162.410 and means a

component or separate physical location of an organization health care provider that may be

separately licensed or certified by the state.

     23-17.29-3. Providers to obtain unique NPI.

     (a) An off-campus location of a hospital shall apply for, obtain, and use on all claims for

reimbursement or payment for health care services provided at the off-campus location submitted

on or after January 1, 2025, a unique National Provider Identifier (NPI) that is separate and distinct

from the hospital's NPI. The off-campus location's unique NPI shall be included on any claim for

reimbursement or payment for health care services provided at the off-campus location, regardless

of whether the claim is filed or submitted by or through a central office of the hospital or a health

care clearinghouse.

     (b) Each organization health care provider and each subpart that is required or eligible to

obtain an NPI pursuant to 45 CFR § 162.410 shall apply for, obtain, and use on all claims for

payment for medical care, services, or goods, a unique NPI for each site at which the organization

health care provider or its subparts deliver medical care, services, or goods.

     (c) Each organization health care provider and each subpart that is required or eligible to

obtain an NPI pursuant to 45 CFR § 162.410 shall apply for, obtain, and use on all claims for

payment for medical care, services, or goods a unique NPI for each provider type under which the

organization health care provider or its subparts deliver medical care, services, or goods.

     (d) An organization health care provider or subpart submitting a claim for payment for

medical care, services, or goods shall include on the claim the unique NPI that identifies both the

site where the medical care, services, or goods were provided and the provider type regardless of

whether the claim is filed or submitted by or through a central office of the organization health care

provider or a health care clearinghouse.

     (e) For an organization health care provider that is a licensed or certified hospital

contracting for services, the hospital shall obtain and use a unique, separate, and distinct NPI for:

     (1) Its main campus;

     (2) Each off-campus location of the hospital; and

LC004257 - Page 3 of 5

     (3) Each provider types when the hospital delivers medical care, services, or goods at either

the hospital's main campus or at an off-campus location.

     (f) A hospital submitting a claim for payment for medical care, services, or goods shall

include on the claim the unique NPI that identifies both the site where the medical care, services,

or goods were provided and the provider type, regardless of whether the claim is filed or submitted

by or through a central office of the hospital or a health care clearinghouse.

     (g) Commencing January 1, 2025, an organization health care provider applying to enroll

as a new provider shall demonstrate that it has obtained one or more NPIs as required by this section

and, upon enrollment, shall use its unique NPI on every claim for payment in the manner required

by this section.

     (h) Commencing January 1, 2025, an organization health care provider enrolled and

applying for revalidation as a provider shall demonstrate that it has obtained one or more NPIs as

required by this section as a condition of receiving revalidation, and upon receiving revalidation as

a provider, shall use its unique NPI on every claim for payment in the manner required by this

section.

     SECTION 3. This act shall take effect upon passage.

========

LC004257

========

LC004257 - Page 4 of 5

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- NATIONAL PROVIDER IDENTIFIER OFF-

CAMPUS LOCATIONS

***

     This act would require each off-campus location of a hospital and each subpart of an

organization health care provider to have a unique identification number in order that the costs

associated with those facilities are transparent and accountable.

     This act would take effect upon passage.

========

LC004257

========

LC004257 - Page 5 of 5