HB 2268 — An Act amending the act of July 19, 1979 (P.L.130, No.48), known as the Health Care Facilities Act, providing for health care site neutrality.

PRINTER'S NO.   2967

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 2268
                                                Session of
                                                  2026

     INTRODUCED BY WEBSTER, PROBST, CONKLIN, GUENST, SANCHEZ, WAXMAN,
        HILL-EVANS, MAYES, HADDOCK, INGLIS, CEPEDA-FREYTIZ, CERRATO,
        HOHENSTEIN, NEILSON AND STEELE, MARCH 6, 2026

     REFERRED TO COMMITTEE ON HEALTH, MARCH 9, 2026


                                      AN ACT
 1   Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An
 2      act relating to health care; prescribing the powers and
 3      duties of the Department of Health; establishing and
 4      providing the powers and duties of the State Health
 5      Coordinating Council, health systems agencies and Health Care
 6      Policy Board in the Department of Health, and State Health
 7      Facility Hearing Board in the Department of Justice;
 8      providing for certification of need of health care providers
 9      and prescribing penalties," providing for health care site
10      neutrality.
11      The General Assembly of the Commonwealth of Pennsylvania
12   hereby enacts as follows:
13      Section 1.    The act of July 19, 1979 (P.L.130, No.48), known
14   as the Health Care Facilities Act, is amended by adding a
15   chapter to read:
16                                CHAPTER 8-D
17                        HEALTH CARE SITE NEUTRALITY
18   Section 801-D.    Definitions.
19      The following words and phrases when used in this chapter
20   shall have the meanings given to them in this section unless the
21   context clearly indicates otherwise:
 1      "Applicable services."    Any of the following:
 2          (1)     Services provided in an off-campus health care
 3      facility.
 4          (2)     Outpatient evaluation and management services.
 5          (3)     Any outpatient, diagnostic or imaging service
 6      identified by the department under section 804-D.
 7      "Campus."    Any of the following:
 8          (1)     The primary buildings of a health care facility.
 9          (2)     The physical area immediately adjacent to the
10      primary buildings or other areas or structures not strictly
11      contiguous to the primary buildings of a health care facility
12      that are located within 250 yards of the main buildings.
13          (3)     Any other area determined on an individual basis by
14      the Centers for Medicare and Medicaid Services to be part of
15      the campus of a health care facility.
16      "Council."    The Health Care Cost Containment Council
17   established under the act of July 8, 1986 (P.L.408, No.89),
18   known as the Health Care Cost Containment Act.
19      "Current procedural terminology."    The codes, descriptions
20   and guidelines as included in the current procedural terminology
21   manual published by the American Medical Association in effect
22   at the time of the effective date of this section.
23      "Facility fee."    Any fee charged or billed by a health care
24   provider for outpatient services provided in an off-campus
25   health care facility that is:
26          (1)     intended to compensate the health care provider for
27      the operational expenses of the health care provider;
28          (2)     separate and distinct from a professional fee; and
29          (3)     irrespective of the modality through which the
30      health care service was provided.

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 1      "Health benefit plan."    A plan, policy, contract, certificate
 2   or agreement entered into, offered or issued by a health
 3   insurance carrier or third-party administrator acting on behalf
 4   of a plan sponsor to provide, deliver, arrange for, pay for or
 5   reimburse any of the costs of health care services and includes
 6   non-Federal governmental plans as defined in 29 U.S.C. §
 7   1002(32) (relating to definitions). The term does not include
 8   any plans, programs of coverage or benefits administered under
 9   42 U.S.C. Ch. 7 Subch. XVIII (relating to health insurance for
10   aged and disabled).
11      "Health care contract."   A contract, agreement or
12   understanding, either orally or in writing, entered into,
13   amended, restated or renewed between a health care provider and
14   any of the following for the delivery of health care services to
15   an enrollee of a health benefit plan:
16          (1)   a health insurance carrier;
17          (2)   one or more third-party administrators;
18          (3)   a plan sponsor; or
19          (4)   the health care provider's contractor or agent.
20      "Health care facility."   For purposes of this chapter, a
21   health care facility includes, but is not limited to, a general,
22   chronic disease or other type of hospital, a home health care
23   agency, a home care agency, a hospice, a long-term care nursing
24   facility, cancer treatment centers using radiation therapy on an
25   ambulatory basis, an ambulatory surgical facility, a birth
26   center regardless of whether such health care facility is
27   operated for profit, nonprofit or by an agency of the
28   Commonwealth or local government. The department shall have the
29   authority to license other health care facilities as may be
30   necessary due to emergence of new modes of health care. When the

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 1   department so finds, it shall transmit notice of its intention
 2   to license a particular type of health care facility to the
 3   Legislative Reference Bureau for publication in the next
 4   available issue of the Pennsylvania Bulletin in accordance with
 5   the act of June 25, 1982 (P.L.633, No.181), known as the
 6   Regulatory Review Act. The term does not include an office used
 7   primarily for the private practice of a health care
 8   practitioner, a program which renders treatment or care for drug
 9   or alcohol abuse or dependence unless located within a health
10   facility or a facility providing treatment solely on the basis
11   of prayer or spiritual means. The term does not apply to a
12   facility which is conducted by a religious organization for the
13   purpose of providing health care services exclusively to
14   clergymen or other persons in a religious profession who are
15   members of a religious denomination.
16      "Health insurance carrier."    An entity licensed by the
17   department that offers, issues or renews an individual or group
18   health insurance policy that is offered or governed under any of
19   the following:
20          (1)   The act of May 17, 1921 (P.L.682, No.284), known as
21      The Insurance Company Law of 1921, including section 630 and
22      Article XXIV of that act.
23          (2)   The act of December 29, 1972 (P.L.1701, No.364),
24      known as the Health Maintenance Organization Act.
25          (3)   40 Pa.C.S. Ch. 61 (relating to hospital plan
26      corporations) or 63 (relating to professional health services
27      plan corporations).
28      "Medical service."    As defined in section 2 of the act of
29   December 20, 1985 (P.L.457, No.112), known as the Medical
30   Practice Act of 1985.

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 1      "Off-campus health care facility."    A facility that is not
 2   located on the campus of a health care facility.
 3      "Participating provider."   A provider under contract with a
 4   health benefit plan, or one of its delegates, who has agreed
 5   under the contract to provide health care services to the health
 6   benefit plan's beneficiaries with an expectation of receiving
 7   payment, other than coinsurance, copayments or deductibles from
 8   the beneficiary, solely from the health care entity under the
 9   terms of the contract.
10      "Plan sponsor."   Any of the following:
11          (1)   The employer in the case of a benefit plan
12      established or maintained by a single employer.
13          (2)   The employee organization in the case of a benefit
14      plan established or maintained by an employee organization,
15      provided that "employee organization" shall mean any labor
16      union or any organization of any kind, or any agency or
17      employee representation committee, association, group or
18      plan, in which employees participate and that exists for the
19      purpose, in whole or in part, of dealing with employers
20      concerning an employee benefit plan or other matters
21      incidental to employment relationships or any employees'
22      beneficiary association organized for the purpose, in whole
23      or in part, of establishing a plan.
24          (3)   In the case of a benefit plan established or
25      maintained by two or more employers or jointly by one or more
26      employers and one or more employee organizations, the
27      association, committee, joint board of trustees or other
28      similar group of representatives of the parties who establish
29      or maintain the benefit plan.
30      "Professional fee."   Any fee charged or billed by a provider

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 1   for professional medical services provided in a health care
 2   facility.
 3      "Third-party administrator."        A health plan administrator who
 4   acts on behalf of a plan sponsor to administer a health benefit
 5   plan.
 6   Section 802-D.        Prohibited fees and provider reimbursement.
 7      (a)   Prohibited fees.--A health care provider may not charge,
 8   bill or collect a facility fee for any applicable service.
 9      (b)   Participating provider reimbursement rates.--A health
10   care provider that enters into a health care contract to be a
11   participating provider with a health benefit plan shall offer to
12   accept as payment in full for applicable services rates that
13   shall not exceed 150% of the amount paid by Medicare for the
14   same services.
15      (c)   Health care provider reimbursement rates.--
16            (1)   A health care provider may not charge, bill or
17      accept payment for an applicable service that exceeds the
18      lesser of:
19                  (i)    150% of the amount paid by Medicare; or
20                  (ii)    the negotiated rate agreed upon by the health
21            care provider and the health benefit plan.
22            (2)   Paragraph (1) shall apply to any individual or
23      entity that reimburses for applicable services, including
24      self-pay individuals and health benefit plans that do not
25      have an existing contract with the health care provider.
26      (d)   Contract provisions.--A health care contract entered
27   into with a health care provider shall include provisions
28   requiring that:
29            (1)   the health benefit plan shall not reimburse a health
30      care provider for any applicable services in amounts in

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 1      excess of the rates specified in subsections (b) and (c) or
 2      for facility fees prohibited by subsection (a); and
 3            (2)   a beneficiary or self-pay individual shall not be
 4      liable to any health care provider for any amounts in excess
 5      of the rates specified in subsections (b) and (c) or for
 6      facility fees prohibited under subsection (a), including any
 7      copayments, deductibles or coinsurance for any portion of the
 8      prohibited rates.
 9   Section 803-D.    Duties of health care provider.
10      (a)   Notice requirement.--A health care provider shall
11   provide written notice to the patient at least 48 hours before
12   the performance of medical services, including diagnosis, care
13   or treatment in an off-campus health care facility of:
14            (1)   the dollar amount of the patient's potential
15      financial liability, if known; or
16            (2)   if the diagnosis and the extent of medical services
17      is unknown within the 48-hour period, a statement advising
18      the patient or the patient's authorized representative that
19      the patient may incur a financial liability to the health
20      care facility that the patient would not incur if the patient
21      was receiving medical services and treatment on the campus of
22      the health care facility; and
23            (3)   a statement advising the patient, or the patient's
24      authorized representative, that the patient's actual
25      financial liability is based on the medical services rendered
26      by the health care facility.
27      (b)   Method of notice.--
28            (1)   A health care provider must provide written notice
29      required under subsection (a) in a method that the patient
30      can understand.

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 1            (2)   A health care provider must provide the notice
 2      required under subsection (a) to the patient's authorized
 3      representative at least 48 hours prior to the delivery of
 4      medical services to the patient if the patient is
 5      unconscious, under significant duress or otherwise unable to
 6      read, comprehend or act on the patient's own behalf.
 7            (3)   A health care provider must provide the notice
 8      required under subsection (a) as soon as possible after the
 9      existence of an emergency has been ruled out or the emergency
10      condition has been stabilized in situations where an off-
11      campus health care facility provides examination or
12      treatment.
13      (c)   Provider-based status notice.--A health care provider
14   shall provide written notice to a patient or the patient's
15   authorized representative under 42 CFR 413.65(g)(7)(iii)
16   (relating to requirements for a determination that a facility or
17   an organization has provider-based status).
18   Section 804-D.    Identification of medical services.
19      The department shall annually identify medical services
20   subject to the limitations on facility fees provided in section
21   802-D and submit the list of identified medical services to the
22   Legislative Reference Bureau for publication in the next
23   available issue of the Pennsylvania Bulletin.
24   Section 805-D.    Reporting requirements.
25      (a)   Submissions.--Each health care provider shall submit to
26   the council an annual report concerning facility fees billed
27   during the preceding calendar year. The report under this
28   paragraph shall be in a format as determined by the council. The
29   council shall submit the report to the Legislative Reference
30   Bureau for publication in the next available issue of the

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 1   Pennsylvania Bulletin.
 2      (b)   Report content.--A report under subsection (a) shall
 3   include the following:
 4            (1)   The name and full address of each health care
 5      facility owned or operated by the health care provider that
 6      provides medical services for which a facility fee is charged
 7      or billed.
 8            (2)   The number of patient visits at each health care
 9      facility for which a facility fee was charged or billed.
10            (3)   The number, total amount and types of allowable
11      facility fees paid at each health care facility by Medicare,
12      Medicaid and private insurance.
13            (4)   For each health care facility and the health care
14      provider, the total amount billed and the total revenue
15      received from facility fees.
16            (5)   The 10 most frequent procedures or services,
17      identified by current procedural terminology category I
18      codes, provided by the health care provider that generated
19      the largest amount of facility fee gross revenue, including:
20                  (i)    The volume of each procedure or service under
21            this paragraph.
22                  (ii)    The gross and net revenue totals for each
23            procedure or service under this paragraph.
24                  (iii)    The total net amount of revenue received by
25            the health care provider derived from facility fees for
26            each procedure or service under this paragraph.
27            (6)   The 10 most frequent procedures or services,
28      identified by current procedural terminology category I
29      codes, based on patient volume, provided by the health care
30      provider for which facility fees are billed or charged based

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 1      on patient volume, including the gross and net revenue totals
 2      received for each such procedure or service.
 3            (7)   Any other information related to facility fees the
 4      council may require.
 5   Section 806-D.    Regulatory authorization.
 6      The council may promulgate regulations necessary to implement
 7   this chapter, specify the format and content of reports and
 8   impose penalties for noncompliance consistent with the council's
 9   authority under 35 Pa.C.S. Ch. 33 (relating to health care cost
10   containment).
11   Section 807-D.    Enforcement.
12      (a)   Compliance enforcement.--Except as provided in
13   subsection (b), the department shall enforce the provisions of
14   this chapter and shall adopt and promulgate regulations to carry
15   out the provisions of this chapter.
16      (b)   Penalty.--A health care provider or health care facility
17   that fails to provide notice under section 803-A and supply data
18   required under section 805-A may be subject to the penalty under
19   35 Pa.C.S. § 3310(b) (relating to enforcement and penalty).
20      (c)   Audit.--The department, or a designee, may audit any
21   health care provider for compliance with the requirements of
22   this chapter. Each health care provider shall make available,
23   upon written request of the department or a designee, a copy of
24   any books, documents, records or data necessary for the audit
25   under this subsection for a period of four years after the
26   furnishing of any services for which a facility fee was charged,
27   billed or collected.
28      Section 2.    This act shall take effect in 60 days.




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