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:

     SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

amended by adding thereto the following chapter:

CHAPTER 17.31

PREVENTING UNWARRANTED FACILITY FEES

     23-17.31-1. Definitions.

     For the purposes of this chapter:

     (1) "Campus" means:

     (i) The hospital's main buildings, the physical area immediately adjacent to a hospital's

main buildings and other areas and structures that are not strictly contiguous to the main buildings

but are located within two hundred fifty yards (250 yds.) of the main buildings or as may otherwise

be defined under federal law or regulation including 42 CFR § 413.65(a)(2) (or successor

regulations) or any other area that has been determined on an individual case basis by the Centers

for Medicare and Medicaid Services to be part of a hospital's campus.

     (ii) "Off-site from a hospital campus" or "off-campus location" means any location that is

not located:

     (A) On the "campus" as defined in this section; or

     (B) Within the distance described in the definition of "campus".

     (iii) Services provided via telecommunications or telemedicine are deemed to be rendered

off-site from a hospital campus for the purposes of this section.

     (2) "Facility fee" means any fee that is:

     (i) Intended to compensate the hospital, healthcare facility, or health system for the

operational, administrative, or overhead expenses of the hospital or health system; and

     (ii) Separate and distinct from a professional fee.

     (3) "Healthcare facility" has the meaning as set forth in § 23-17-2.

     (4) "Healthcare clearinghouse" has the same meaning as set forth in 45 CFR § 160.103.

     (5) "Healthcare provider" means any person, group, professional corporation, or other

organization that is licensed or otherwise authorized in this state to furnish a healthcare service or

provides the services of such individuals, groups, corporations, or organization including, but not

limited to, a medical clinic, a medical group, a home health care agency, a health infusion center,

an urgent care center, and an emergent care center.

     (6) "Health system" means:

     (i) A parent corporation of one or more hospitals and any entity affiliated with such parent

corporation through ownership, governance, membership or other means; or

     (ii) A hospital and any entity affiliated with such hospital through ownership, governance,

membership or other means.

     (7) "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.

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

component or separate physical location of a health system that may be separately licensed or

certified by the state.

     23-17.31-2. Enhanced consumer protections from facility fees.

     (a) A healthcare facility, hospital-based facility, healthcare provider, or health system, shall

not bill, charge, collect, or seek compensation, remuneration, or reimbursement, for a facility fee

for services provided off-site from a hospital campus, and shall not submit, and no payer shall be

required to reimburse, an institutional claim, including a claim submitted on a UB-40 or any

successor or substantially similar form, or to include other claims code reserved for or indicating

services were provided on a hospital campus, for the services.

     (b) An off-site entity may be required to submit claims for professional services by billing

via a claim form that reflects professional services only, such as CMS-1500, or any successor or

substantially similar form, and reimbursement shall be limited to the applicable professional fee.

     (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.

     23-17.31-3. 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, 2027, 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 health system 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 health system or its subparts deliver

medical care, services, or goods.

     (c) Each health system 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 health system or its

subparts deliver medical care, services, or goods.

     (d) A health system 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 health system or a health care clearinghouse.

     (e) For a health system 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

     (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, 2027, a health system applying to enroll as a new provider

shall demonstrate that it has obtained or applied 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

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this section.

     (h) Commencing January 1, 2027, a health system enrolled and applying for revalidation

as a provider shall demonstrate that it has obtained or applied 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.

     (i) Federal alignment. If the office of the health insurance commissioner determines that

federal law or rules from CMS provide a substantially similar alternative requirement or process,

then the office shall report to the speaker of the house and president of the senate as soon as practical

whether amendments to the above section are advisable.

     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

rendered on a hospital campus, and require each off-campus location of a hospital to have a unique

identification number in order that the charges associated with those facilities are transparent and

accountable.

     This act would take effect upon passage.

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