H.R. 3023 — Preventing Hospital Overbilling of Medicare Act

This section revises Medicare payment rules for off-campus outpatient departments (OPDs) of hospitals (i.e., provider-based facilities not on the hospital's main campus or within specified distances from a remote hospital location) to promote site-neutral payments (i.e., reimbursing services at physician office rates rather than higher hospital outpatient rates), effective January 1, 2026, by (1) redefining off-campus OPDs under SSA section 1833(t)(21)(B) to remove prior exceptions tied to 2015 regulations; (2) limiting the site-neutral payment exception for dedicated off-campus emergency departments to services furnished before January 1, 2026; and (3) authorizing the Secretary of Health and Human Services to implement site-neutral policies, including preventing hospitals from billing off-campus OPD services as on-campus. The section further requires, by January 1, 2026, (1) separate National Provider Identifiers (NPIs) for off-campus OPDs under HIPAA standards (SSA section 1173(b)); (2) Medicare provider agreements to bill off-campus OPD services using the separate NPI on specified forms (SSA section 1866(a)(1)); and (3) off-campus OPDs to bill group health plans and health insurance issuers using the separate NPI on those forms, with no patient liability otherwise (new PHS Act section 2799B-10). Finally, this section directs the Secretary to request that the National Association of Insurance Commissioners develop, within six months of enactment, a model state act or regulation to reject improperly billed off-campus OPD claims, modeled on Colorado House Bill 18-1282.