SB 986 - This act creates the "Honest Billing Act", which requires off-campus outpatient departments of medical facilities, as defined in the act, to apply for, obtain, and use a national provider identifier ("NPI") that is distinct from the NPI used by the main campus of the facility. This unique NPI shall be used on all claims submitted to health carriers on or after January 1, 2025. No facility, or entity on behalf of a facility, shall submit a claim for a health care service provided at an off-campus outpatient department of a facility, or hold an enrollee liable for the service, unless the service is billed using the unique NPI and in a form specified in the act. Health carriers shall not be required to reimburse claims that are not billed in accordance with this requirement.
Facilities, and entities acting on behalf of facilities, shall not hold enrollees liable for health care services that are not billed as provided in the act. Violations of this requirement shall be a violation of the Missouri Merchandising Practices Act subject to enforcement by the Attorney General.
A facility applying for a license or license renewal by the state shall demonstrate it has obtained one or more NPIs as a condition of receiving licensure, and shall use its unique NPI on every claim for payment in the manner required under the act.
The act specifies penalties that may be imposed by the Department of Health and Senior Services after an administrative hearing as provided by law, and the Department of Commerce and insurance shall have authority to refer violations of the act to the Department of Health and Senior Services. The Attorney General shall also have authority to enforce the act.
This act is identical to SB 610 (2023).
ERIC VANDER WEERD