Health Care PRICE Transparency Act

II 116TH CONGRESS 2D SESSION S. 4106 To amend the Public Health Service Act to provide for hospital and insurer price transparency. IN THE SENATE OF THE UNITED STATES JUNE 30, 2020 Mr. BRAUN (for himself, Mr. KENNEDY, Mrs. LOEFFLER, Mr. GRASSLEY, Mr. ENZI, Ms. ERNST, and Mr. BARRASSO) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions A BILL To amend the Public Health Service Act to provide for hospital and insurer price transparency. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Health Care Prices 4 Revealed and Information to Consumers Explained Trans- 5 parency Act’’ or the ‘‘Health Care PRICE Transparency 6 Act’’. 7 VerDate Sep 11 2014 05:55 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4106.IS S4106 kjohnson on DSK79L0C42PROD with BILLS 2 •S 4106 IS SEC. 2. PRICE TRANSPARENCY REQUIREMENTS. 1 (a) HOSPITALS.—Section 2718(e) of the Public 2 Health Service Act (42 U.S.C. § 300gg–18(e)) is amend- 3 ed— 4 (1) by striking ‘‘Each hospital’’ and inserting 5 the following: 6 ‘‘(1) IN GENERAL.—Each hospital’’; 7 (2) by inserting ‘‘, in a machine-readable for- 8 mat, via open application program interfaces 9 (APIs)’’ after ‘‘a list’’; 10 (3) by inserting ‘‘, along with such additional 11 information as the Secretary may require with re- 12 spect to such charges for purposes of promoting 13 public awareness of hospital pricing in advance of 14 receiving a hospital item or service’’ before the pe- 15 riod; and 16 (4) by adding at the end the following: 17 ‘‘(2) DEFINITION OF STANDARD CHARGES.— 18 Notwithstanding any other provision of law, for pur- 19 poses of paragraph (1), the term ‘standard charges’ 20 means the rates hospitals, including providers or en- 21 tities that contract with or practice at a hospital, 22 charge for all items and services at a minimum, 23 chargemaster rates, rates that hospitals negotiate 24 with third party payers across all plans, including 25 those related to a patient’s specific plan, discounted 26 VerDate Sep 11 2014 05:55 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4106.IS S4106 kjohnson on DSK79L0C42PROD with BILLS 3 •S 4106 IS cash prices, and other rates determined by the Sec- 1 retary. 2 ‘‘(3) ENFORCEMENT.—In addition to any other 3 enforcement actions or penalties that may apply 4 under subsection (b)(3) or another provision of law, 5 a hospital that fails to provide the information re- 6 quired by this subsection and has not completed a 7 corrective action plan to comply with the require- 8 ments of such subsection shall be subject to a civil 9 monetary penalty of an amount not to exceed $300 10 per day that the violation is ongoing as determined 11 by the Secretary. Such penalty shall be imposed and 12 collected in the same manner as civil money pen- 13 alties under subsection (a) of section 1128A of the 14 Social Security Act are imposed and collected.’’. 15 (b) TRANSPARENCY IN COVERAGE.—Section 16 1311(e)(3) of the Patient Protection and Affordable Care 17 Act (42 U.S.C. 18031(e)(3)) is amended— 18 (1) in subparagraph (A)— 19 (A) in clause (vii), by inserting before the 20 period the following: ‘‘, including, for all items 21 and services covered under the plan, aggregate 22 information on specific payments the plan has 23 made to out-of-network health care providers on 24 behalf of plan enrollees’’; and 25 VerDate Sep 11 2014 05:55 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4106.IS S4106 kjohnson on DSK79L0C42PROD with BILLS 4 •S 4106 IS (B) by designating clause (ix) as clause 1 (x); and 2 (C) by inserting after clause (viii), the fol- 3 lowing: 4 ‘‘(ix) Information on the specific nego- 5 tiated payment rates between the plan and 6 health care providers for all items and 7 services covered under the plan.’’; 8 (2) in subparagraph (B)— 9 (A) in the heading, by striking ‘‘USE’’ and 10 inserting ‘‘DELIVERY METHODS AND USE’’; 11 (B) by inserting ‘‘, as applicable,’’ after 12 ‘‘English proficiency’’; and 13 (C) by inserting after the second sentence, 14 the following: ‘‘The Secretary shall establish 15 standards for electronic delivery and access to 16 such information by individuals, free of charge, 17 in machine readable format, through an inter- 18 net website and via open APIs.’’; 19 (3) in subparagraph (C)— 20 (A) in the first sentence, by inserting ‘‘or 21 out-of-network provider’’ after ‘‘item or service 22 by a participating provider’’; 23 (B) in the second sentence, by striking 24 ‘‘through an internet website’’ and inserting 25 VerDate Sep 11 2014 03:59 Jul 10, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4106.IS S4106 kjohnson on DSK79L0C42PROD with BILLS 5 •S 4106 IS ‘‘free of charge, in machine readable format, 1 through an internet website, and via open APIs, 2 in accordance with standards established by the 3 Secretary,’’; and 4 (C) by adding at the end the following: 5 ‘‘Such information shall include specific nego- 6 tiated rates that allow for comparison between 7 providers and across plans, and related to a pa- 8 tient’s specific plan, including after an enrollee 9 has exceeded their deductible responsibility.’’; 10 and 11 (4) in subparagraph (D) by striking ‘‘subpara- 12 graph (A)’’ and inserting ‘‘subparagraphs (A), (B), 13 and (C)’’. 14 Æ VerDate Sep 11 2014 05:55 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\S4106.IS S4106 kjohnson on DSK79L0C42PROD with BILLS