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H 7937Medical Services

Health and Safety - Preventing Unwarranted Facility Fees

Prohibits hospitals from charging extra facility fees for services provided at off-campus locations and requires unique location identifiers on claims.

Held for study
Population
Affected
65
Email Legislator
Introduced Feb 27, 2026Committee House Health & Human Services

Plain-English Summary

This bill prohibits hospitals and healthcare systems from charging "facility fees" for medical services provided at locations separate from the main hospital campus. It defines a campus as the main buildings and areas within 250 yards. Telemedicine is considered off-campus. Additionally, it requires healthcare providers to obtain and use unique National Provider Identifiers (NPIs) for each specific off-campus location and provider type on insurance claims starting January 1, 2027. This ensures billing clearly identifies where services were rendered and prevents hospitals from billing institutional fees for doctor's office visits.

For younger readers

When you go to the doctor, sometimes hospitals add an extra charge just for using the building, called a "facility fee." This bill says that if you go to a doctor's office that isn't actually at the big hospital building, the hospital cannot charge this extra fee. It also says that doctors and hospitals must use special ID numbers on their bills so everyone knows exactly where the doctor saw you. This helps make sure people aren't paying extra money for a regular doctor's visit just because a hospital owns the office.

Who & Where It Applies

Impacted groups
PatientsHospitalsHealth Insurance CompaniesOff-site Medical ClinicsHealthcare Systems
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
None
Estimated revenue
None

Bill Analysis

Both viewpoints
For Progressives
  • Reduces out-of-pocket healthcare costs for working families and the poor by eliminating hidden fees often attached to routine medical visits.
  • Increases transparency in the healthcare system, preventing large corporate hospital systems from exploiting patients through confusing billing practices.
  • Promotes fair access to care by ensuring that community-based clinics are not priced the same as expensive hospital emergency rooms.
  • May reduce revenue for non-profit safety-net hospitals, potentially threatening their ability to subsidize care for underserved and uninsured communities.
  • Could discourage hospitals from opening or maintaining satellite clinics in rural or low-income neighborhoods if they cannot cover overhead costs without the fees.
  • Might lead to market consolidation where hospitals close off-site locations and force patients to travel to the main campus to receive care.
For Conservatives
  • Promotes free-market principles by ensuring billing reflects the actual service provided rather than the ownership structure of the facility.
  • Reduces healthcare costs for private businesses and insurers by eliminating unnecessary surcharges on employee health claims.
  • Prevents large hospital monopolies from artificially inflating prices for routine services, allowing smaller private practices to compete fairly.
  • Imposes heavy government regulations on private healthcare businesses regarding how they structure their billing and operations.
  • Creates significant administrative burdens and compliance costs by mandating new unique provider identifiers for every location.
  • Interferes with the free market by dictating what fees a private business is legally allowed to charge for its services.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 91 additions

SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby amended by adding thereto the following chapter: 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 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 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.