AB343 - Makes revisions relating to health care. (BDR 40-988)

- 83rd Session (2025) Assembly Bill No. 343–Assemblymember Yeager CHAPTER.......... AN ACT relating to health care; requiring hospitals to publish certain information relating to the pricing of goods and services; prohibiting a hospital from collecting medical debt that accrued while the hospital was out of compliance with that requirement; prescribing a procedure for the correction of violations of that requirement; authorizing certain investigations, civil actions and the imposition of certain administrative sanctions; providing for the publication of certain information relating to violations; requiring certain health care entities to provide certain information before taking any action to collect a medical debt; providing a penalty; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing federal regulations require a hospital to publish: (1) a list of standard charges for all items and services provided by the hospital; and (2) a consumer- friendly list of standard charges for a limited set of shoppable services, which are services provided by a hospital that can be scheduled by a consumer in advance. (45 C.F.R. §§ 180.20, 180.40-180.60) Sections 13-15 of this bill codify similar requirements into Nevada law. Specifically, section 13 requires a hospital to compile, publish and update annually a list of standard charges for all items and services provided by the hospital. Section 14 requires a hospital to maintain an online price-estimator tool or compile, publish and update annually: (1) a list of shoppable services provided by the hospital; and (2) a list of the shoppable services that appear on a list of certain shoppable services specified by the Federal Government and that the hospital does not provide. Section 15 requires a hospital to publish the most current version of each list required by sections 13 and 14 on the most prominent publicly available Internet website maintained by the hospital. Section 15 prescribes certain requirements governing the manner in which those lists must be published. Section 16 of this bill requires a hospital to annually report to the Department of Health and Human Services concerning facility fees for outpatient services provided in off-campus facilities. Section 16 requires the Department to publish those reports on a publicly available Internet website. Section 17 of this bill prohibits a hospital from taking certain actions to collect a medical debt for goods or services provided to a patient while the hospital is not in compliance with the requirements of sections 13-15 or the corresponding federal requirements. Section 17 provides that such prohibited actions, when taken knowingly, constitute deceptive trade practices, thereby subjecting a hospital that commits such a violation to the civil and criminal penalties that may be imposed for deceptive trade practices generally. (Chapter 598 of NRS) Section 17 also authorizes a medical debtor who is aggrieved by such a prohibited action to file a claim with the Bureau of Consumer Protection in the Office of the Attorney General. Section 24.5 of this bill requires the Governor’s Consumer Health Advocate to assist patients with the filing of such claims. If the Bureau determines that a hospital has taken an action prohibited by section 17 to collect a medical debt, section 17 requires the hospital to cancel the debt and refund any portion of the debt that has been paid. – 2 – - 83rd Session (2025) Sections 18-21 of this bill provide for the administrative enforcement of sections 2-21. Specifically, section 18: (1) authorizes any person or entity to file a complaint against a hospital that fails to comply with sections 2-21; and (2) requires the Department to monitor the compliance of hospitals with sections 2-21. Section 19 prescribes a procedure for the correction of a violation of sections 2-21, and section 20 requires the Department to impose administrative penalties against a hospital that commits such a violation. Section 21 provides for the publication of certain documents relating to violations of sections 2-21. Sections 21 and 25 of this bill provide that a complaint alleging such a violation and certain initial investigatory documents are confidential. Section 22 of this bill requires certain health care entities, before taking any action to collect a medical debt, to provide: (1) the patient with an itemized statement of the medical debt and certain other information; and (2) the medical debtor with a receipt for each payment made on the debt. Section 22 authorizes a patient or medical debtor who is aggrieved by a violation of those requirements to file a claim with the Bureau of Consumer Protection in the Office of the Attorney General. Section 24.5 requires the Governor’s Consumer Health Advocate to assist patients with the filing of such claims. If the Bureau determines that a health care entity has taken an action to collect a medical debt where prohibited by section 22, section 22 requires the health care entity to cancel the debt and refund any portion of the debt that has been paid. Section 22 also provides that attempting to collect a debt under such prohibited circumstances constitutes a deceptive trade practice. Sections 3-12 of this bill define certain terms, and section 2 of this bill establishes the applicability of those definitions. Sections 23 and 27 of this bill make conforming changes to clarify the applicability of an existing definition. EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 439B of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 22, inclusive, of this act. Sec. 2. As used in sections 2 to 22, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 3 to 12, inclusive, of this act have the meanings ascribed to them in those sections. Sec. 3. “Diagnosis-related group” means groupings of medical diagnostic categories used as a basis for hospital payment schedules by Medicare and other health benefit plans offered by third parties. Sec. 4. “Healing art” means any system, treatment, operation, diagnosis, prescription or practice for the ascertainment, cure, relief, palliation, adjustment or correction of any human disease, ailment, deformity, injury or unhealthy or abnormal physical or mental condition for the practice of which long periods of specialized education and training and a degree of – 3 – - 83rd Session (2025) specialized knowledge of an intellectual as well as physical nature are required. Sec. 5. “Health benefit plan” means a policy, contract, certificate or agreement offered or issued by a third party to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services. Sec. 5.5. “Health care entity” means: 1. Any facility licensed pursuant to chapter 449 of NRS; 2. A practitioner group practice; 3. An entity that provides staffing or services of practitioners; or 4. Any other entity that provides health care specified by regulation of the Department. Sec. 6. (Deleted by amendment.) Sec. 7. “Medical debt” means an obligation or alleged obligation owed by a consumer of health care to pay money to a health care entity or its assignee for medical services, products or devices, regardless of whether the obligation is past due. The term includes, without limitation, any amount which has been paid toward the partial or total satisfaction of the debt. Sec. 8. “Medical debtor” means a natural person who: 1. Owes a medical debt; or 2. Is the guarantor of a natural person who owes a medical debt. Sec. 9. “National Drug Code” means the numerical code assigned to a prescription drug by the United States Food and Drug Administration. Sec. 10. “Practitioner group practice” means any business entity organized for the purpose of the practice of one or more healing arts by more than one practitioner. Sec. 11. “Small practitioner group practice” means a practitioner group practice consisting of a number of practitioners less than or equal to the maximum number of practitioners established by regulation of the Department for a small practitioner group practice. Sec. 12. “Third party” means any insurer, governmental entity or other organization providing health coverage or benefits in accordance with state or federal law. Sec. 13. 1. A hospital shall compile, publish in accordance with section 15 of this act and update annually a list of: (a) Each item or service provided by the hospital for which the hospital has established a standard charge, including, where applicable: – 4 – - 83rd Session (2025) (1) A fee for: (I) Supplies and procedures; (II) Room and board; or (III) The services of physicians and other practitioners employed by the hospital; and (2) A fee for the use of the hospital or an item; and (b) For each item or service described in paragraph (a): (1) A description of the item or service; (2) The amount, in dollars, of the charge for the item or service that is reflected on the charge master maintained pursuant to NRS 449.490, absent any discount; (3) The amount, in dollars, of the highest charge that the hospital has negotiated with a third party for the item or service, listed without identifying the third party; (4) The amount, in dollars, of the lowest charge that the hospital has negotiated with a third party for the item or service, listed without identifying the third party; (5) The amount, in dollars, that the hospital charges a natural person who pays immediately in cash for the item or service; (6) Except as otherwise provided in subsection 4, the amount, in dollars, of each charge negotiated with a third party for an item or service, listed in a manner that clearly associates the negotiated charge with the third party and any applicable health benefit plan offered by the third party; and (7) Any code or similar identifier that the hospital uses for the purpose of accounting or billing for the item or service, which may include, without limitation: (I) The code set forth in Current Procedural Terminology published by the American Medical Association; (II) The code set forth in the Healthcare Common Procedure Coding System published by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services; (III) The diagnosis-related group; and (IV) The National Drug Code. 2. If a hospital operates multiple facilities in this State, the hospital shall compile a separate list pursuant to subsection 1 for each facility. 3. A hospital is not required to include the information described in subparagraph (6) of paragraph (b) of subsection 1 as part of the list compiled pursuant to subsection 1 if such information is not required to be included in the information – 5 – - 83rd Session (2025) published pursuant to 42 U.S.C. § 300gg-18(e) and the regulations adopted pursuant thereto. 4. As used in this section, “standard charge” means the regular rate established by a hospital for an item or service provided to a specific group of patients. The term includes, without limitation: (a) A charge that is reflected on the charge master maintained pursuant to NRS 449.490, absent any discount; (b) A charge negotiated with a third party; and (c) The amount charged to a natural person who pays immediately in cash for the item or service. Sec. 14. 1. Except as otherwise provided in subsection 7, a hospital shall compile, publish in accordance with section 15 of this act and update annually: (a) A list of shoppable services provided by the hospital and, for each such shoppable service, the information required by subsection 3. The list must include at least 300 shoppable services or, if the hospital provides fewer than 300 shoppable services, each shoppable service that the hospital provides. Such shoppable services must include, without limitation, each shoppable service provided by the hospital that appears on the list of 70 shoppable services specified by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services pursuant to 45 C.F.R. § 180.60. (b) A list of each shoppable service that appears on the list of 70 shoppable services specified by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services pursuant to 45 C.F.R. § 180.60 that is not offered by the hospital. 2. In deciding whether to include a shoppable service on the list compiled pursuant to paragraph (a) of subsection 1, a hospital shall: (a) Consider the frequency with which the hospital provides the shoppable service and the rate that the hospital charges for the shoppable service; and (b) Prioritize for inclusion on the list the shoppable services that the hospital most frequently provides. 3. The list compiled pursuant to paragraph (a) of subsection 1 must include, for each shoppable service: (a) A description, in plain language, of the shoppable service; (b) Except as otherwise provided in subsection 6, the amount, in dollars, of each charge negotiated with a third party for the shoppable service and any services ancillary to the shoppable – 6 – - 83rd Session (2025) service, listed in a manner that clearly associates the negotiated charge with the third party and any applicable health benefit plan offered by the third party; (c) The amount, in dollars, that the hospital charges a natural person who pays immediately in cash for the shoppable service and any services ancillary to the shoppable service; (d) The amount, in dollars, of the highest charge that the hospital has negotiated with a third party for the shoppable service and any services ancillary to the shoppable service, listed without identifying the third party; (e) The amount, in dollars, of the lowest charge that the hospital has negotiated with a third party for the shoppable service and any services ancillary to the shoppable service, listed without identifying the third party; (f) Any code or similar identifier that the hospital uses for the purpose of accounting or billing for the shoppable service, which may include, without limitation: (1) The code set forth in Current Procedural Terminology published by the American Medical Association; (2) The code set forth in the Healt [Text truncated for display. 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