Connecticut State Office of Health Strategy

 

Facility Fees Charged/Billed by a Hospital or Health System

Connecticut’s Hospitals (C.G.S. §19a-490) and Health Systems (C.G.S. § 19a-486i (a)(4)) must now report information regarding facility fees charged or billed during the preceding calendar year.

 

What is the statutory authority for this filing requirement and when is it due?

Effective October 1, 2015, C.G.S. §§ 19a-508(c) (k) and (m) require the filing of this information no later than July 1, 2016 and annually thereafter.

 

Section 19a-508(c)(m)(1)(from Public Act 23-171) states that for CY 2022 only, filings are due on October 1, 2023 and thereafter on July 1st, each year.  There are also requirements of data for separate off campus and on campus activity, data on gross charges, and data on payers other than Medicare, Medicaid, and Private Insurance.

 

C.G.S. §19a-508c(l)(2) (from Public Act 23-171) states that on and after July 1, 2024, no hospital or health  system shall collect a facility fee for outpatient health care services that use a current procedural terminology evaluation and management (CPT E/M) code or assessment and management (CPT A/M) code and are provided on the hospital campus. The provisions of this subdivision shall not apply to (A) an emergency department located on a hospital campus, or (B) observation stays on a hospital campus and (CPT E/M) and (CPT A/M) codes when billed for the following services: (i) Wound care, (ii) orthopedics, (iii) anticoagulation, (iv) oncology, (v) obstetrics, and (vi) solid organ transplant.

 

C.G.S. § 19a-906(h) states that no telehealth provider or hospital shall charge a facility fee for telehealth services. Such prohibition shall apply to hospital telehealth services whether provided on campus or otherwise.

 

What are Facility Fees for purposes of this submission?

C.G.S. §19a-508c(a)(3) defines “Facility fee” as any fee charged or billed by a hospital or health system for outpatient hospital services provided in a hospital-based facility that is:

(A) Intended to compensate the hospital or health system for the operational expenses of the hospital or health system, and

(B) separate and distinct from a professional fee

 

What is a Hospital-Based Facility?

C.G.S. §19a-508c(a)(7) defines a "Hospital-based facility" as a facility that is owned or operated, in whole or in part, by a hospital or health system where hospital or professional medical services are provided.

 

What is a hospital campus for purposes of this submission?

Only a facility located outside a hospital campus is included in this data submission. 

C.G.S. § 19a-508c(a)(2) defines a hospital campus as:

(A) 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 of the main buildings, or

(B) 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

 

What is a Tagline?

C.G.S. §Section 19a-508(c)(a)(13) defines a tagline as a short statement written in a non-English language that indicates the availability of language assistance services free of charge.

     

    How should information be filed?

    1. Complete both Table 1 and Table 2 which can be found at this link using these instructions. (For a hospital system, the higher level system parent is the reporting entity and the contact person is an in-state representative of the system. Report on only business entities operating in Connecticut.)
    2. Upload the completed Tables 1 and 2 as both an Excel and PDF file.
    3. By October 1st, provide a copy of the written notice, with tag lines, that are in locations that are readily accessible to and visible by patients. (Submit as a PDF file.)
    4. By October 15th, provide a sample of a billing statement. The billing statement should not include any patient identifying information and should also include tag lines. (Submit as a PDF file.)
    5. Find the Facility Fee Billing Affidavit at this link. (All hospitals/health systems must complete this affidavit even if they do not charge/bill facility fees at any on-campus or off-campus hospital-based facility.)
    6. Find the Facility Fee Notification Affidavit at this link. (Only hospitals/health systems that charge facility fees at any on-campus or off-campus hospital-based facility need to complete this affidavit.)
    7. All documents should be uploaded to the following portal https://ohsnotificationandfilings.ct.gov/Filing/Index.
    8. Find the Hospital Facility Fee Notice template that complies with C.G.S. § 19a-508c(k) at this link.
    9. Portal instructions for uploading all required information are at this link.
    10. For any questions on Facility Fees, email questions to OHS@ct.gov and put Facility Fees in the subject line.

     

    Useful resources

    1. Powerpoint presentation on Facility Fee Filing Changes Calendar Year 2022 Reporting at this link.
    2. Zoom recording on Facility Fee Filing Changes Calendar Year 2022 Reporting at this link.
     

    How to access Facility Fee Filings

    To access facility fee information for reporting entities use the “Other Required Filings” and ‘Facility Fees” tabs at: