wa-law.org > bill > 2023-24 > HB 2378 > Original Bill
An affiliated health care provider may not charge, bill, or collect a facility fee except for services provided to a patient when the patient is on a hospital's campus.
Prior to the delivery of nonemergency services, a provider-based clinic that charges a facility fee shall provide a notice to any patient that the clinic is licensed as part of the hospital and the patient may receive a separate charge or billing for the facility component, which may result in a higher out-of-pocket expense. The notice must include the amount of the facility fee that will be charged. The notice must be provided to a patient at the time the appointment is scheduled and at the time that the health care service is rendered.
Each provider-based clinic that charges a facility fee must post prominently in locations easily accessible to and visible by patients, including its website, a statement that the provider-based clinic is licensed as part of the hospital and the patient may receive a separate charge or billing for the facility, which may result in a higher out-of-pocket expense.
Beginning January 1, 2025, each initial billing statement that includes a facility fee must:
Clearly identify the fee as a facility fee that is billed in addition to, or separately from, any professional fee billed by the provider;
Include a statement that the facility fee is intended to cover the hospital's or health system's operational expenses;
Inform the patient that the patient's financial liability may have been less if the services had been provided at a facility not owned or operated by the hospital or health system; and
Include written notice of the patient's right to request a reduction in the facility fee or any other portion of the bill and a telephone number that the patient may use to request such a reduction without regard to whether the patient qualifies for, or is likely to be granted, any reduction.
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A provider-based clinic that is newly affiliated with or owned by a hospital or health system on or after January 1, 2025, shall provide written notice to each patient receiving services within the 12-month period immediately preceding the affiliation or change of ownership that the provider-based clinic is part of a hospital or health system. The notice must include:
The name, business address, and phone number of the hospital or health system that is the purchaser of the provider-based clinic or with which the provider-based clinic is affiliated;
A statement that the provider-based clinic bills, or is likely to bill, patients a facility fee that may be in addition to and separate from any professional fee billed by a health care provider at the provider-based clinic; and
A statement that, prior to seeking services at the provider-based clinic, a patient covered by a health insurance policy or health benefit plan should contact the patient's health insurer for additional information regarding the provider-based clinic's facility fees, including the patient's potential financial liability, if any, for the facility fees.
A hospital, health system, or health facility may not collect a facility fee for health care services provided by a health care provider affiliated with or owned by a hospital or health system that is subject to any provisions of this section from the date of the transaction until at least 30 days after the written notice required by this subsection (5) has been sent to the relevant patients.
A provider-based clinic must apply for, obtain, and use on all claims for reimbursement or payment for health care services provided at the provider-based clinic submitted on or after January 1, 2025, a unique national provider identifier that is separate and distinct from the national provider identifier of the hospital that owns or operates the clinic. The provider-based clinic's unique national provider identifier must be included on any claim for reimbursement or payment for health care services provided at the provider-based clinic, regardless of whether the claim is filed or submitted by or through a central office of the hospital.
As part of the year-end financial reports submitted to the department of health pursuant to RCW 43.70.052, all hospitals with provider-based clinics that bill a separate facility fee shall report:
The number of provider-based clinics owned or operated, in whole or in part, by the hospital that charge or bill a separate facility fee;
The number of patient visits at each provider-based clinic for which a facility fee was charged or billed for the year;
The medicaid, medicare, and commercial health plan revenue received by the hospital for the year by means of facility fees at each provider-based clinic;
The range of allowable facility fees paid by medicaid, medicare, and commercial health plan payers at each provider-based clinic; and
Any additional information that the department requires.
The department may impose sanctions on a hospital in accordance with RCW 70.41.130 for failure to comply with the requirements of this section.
The department may adopt rules to implement the provisions of this section.
For the purposes of this section:
"Affiliated health care provider" means an individual, entity, corporation, person, or organization, whether for profit or nonprofit, that furnishes, bills, or is paid for health care service delivery in the normal course of business, and includes, but is not limited to, health systems, hospitals, and provider-based clinics.
"Campus" means:
A hospital's main buildings; and
The physical area immediately adjacent to a hospital's main buildings and other areas and structures, including a provider-based clinic, that are not strictly contiguous to the main buildings, but are located within 250 yards of the main buildings.
"Facility fee" means any separate charge or billing by a provider-based clinic in addition to a professional fee for physicians' services that is intended to cover building, electronic medical records systems, billing, and other administrative and operational expenses, regardless of the modality through which the health care services were provided.
"National provider identifier" means the standard, unique health identifier for affiliated health care providers that is issued by the national provider system in accordance with 45 C.F.R. part 162.
"Provider-based clinic" means the site of a clinic or provider office that is owned or operated, in whole or in part, by a hospital licensed under chapter 70.41 RCW or a health system that operates one or more hospitals licensed under chapter 70.41 RCW, is licensed as part of the hospital, and is primarily engaged in providing diagnostic and therapeutic care including medical history, physical examinations, assessment of health status, and treatment monitoring. This does not include facilities designated as rural health clinics, critical access hospitals, or sole community hospitals.