Transparent PRICE Act

I 118TH CONGRESS 1ST SESSION H. R. 2691 To promote hospital and insurer price transparency. IN THE HOUSE OF REPRESENTATIVES APRIL 18, 2023 Mrs. RODGERS of Washington (for herself and Mr. PALLONE) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To promote 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 ‘‘Transparent Prices 4 Required to Inform Consumer and Employers Act’’ or the 5 ‘‘Transparent PRICE Act’’. 6 SEC. 2. PRICE TRANSPARENCY REQUIREMENTS. 7 (a) IN GENERAL.—Section 2718(e) of the Public 8 Health Service Act (42 U.S.C. 300gg–18(e)) is amend- 9 ed— 10 (1) by striking ‘‘Each hospital’’ and inserting 11 the following: 12 VerDate Sep 11 2014 04:16 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 2691 IH ‘‘(1) IN GENERAL.—Each hospital’’; 1 (2) by inserting ‘‘, in plain language without 2 subscription and free of charge, in a consumer- 3 friendly, machine-readable format,’’ after ‘‘a list’’; 4 and 5 (3) by adding at the end the following: ‘‘Begin- 6 ning January 1, 2024, each hospital shall include in 7 its list of standard charges, along with such addi- 8 tional information as the Secretary may require with 9 respect to such charges for purposes of promoting 10 public awareness of hospital pricing in advance of 11 receiving a hospital item or service, as applicable, 12 the following: 13 ‘‘(A) A description of each item or service 14 provided by the hospital, accompanied by, as 15 applicable, the Current Procedural Terminology 16 (CPT) code, the Healthcare Common Procedure 17 Coding System (HCPCS) code, the Diagnosis 18 Related Group (DRG), the National Drug Code 19 (NDC), or other payer identifier used or ap- 20 proved by the Centers for Medicare & Medicaid 21 Services. 22 ‘‘(B) The gross charge, expressed as a dol- 23 lar amount, for each such item or service, when 24 VerDate Sep 11 2014 04:16 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 2691 IH provided in, as applicable, the hospital inpatient 1 setting and outpatient department setting. 2 ‘‘(C) Any current payer-specific negotiated 3 charges, clearly associated with the name of the 4 third party payer and plan and expressed as a 5 dollar amount, that applies to each item or 6 service when provided in, as applicable, the hos- 7 pital inpatient setting and outpatient depart- 8 ment setting. 9 ‘‘(D) The discounted cash price, expressed 10 as a dollar amount, for each such item or serv- 11 ice when provided in, as applicable, the hospital 12 inpatient setting and outpatient department 13 setting. If the discounted cash price is a per- 14 centage of another value provided, the cal- 15 culated value must be entered as a dollar 16 amount. If the discounted cash price equates to 17 the gross charge, the gross charge shall be re- 18 entered to indicate that no cash discount is 19 available. 20 ‘‘(E) The average negotiated rate and ac- 21 quisition cost paid by the hospital for each drug 22 or biological product— 23 ‘‘(i) for which payment would be made 24 under part B of title XVIII of the Social 25 VerDate Sep 11 2014 04:16 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 2691 IH Security Act if the individual administered 1 such drug or biological product were en- 2 rolled under such part B; and 3 ‘‘(ii) that is administered by the hos- 4 pital or an entity with a direct financial re- 5 lationship to the hospital during the pre- 6 vious year, 7 which, in the case of such a drug or biological 8 product that is first administered in the hos- 9 pital during the previous 12-month period, shall 10 be included in such list of standard charges be- 11 ginning not later than 30 days after the date of 12 such first administration. 13 ‘‘(2) DELIVERY METHODS AND USE.— 14 ‘‘(A) IN GENERAL.—Each hospital shall 15 make public the standard charges described in 16 paragraph (1) for as many of the 70 Centers 17 for Medicare & Medicaid Services-specified 18 shoppable services that are provided by the hos- 19 pital, and as many additional hospital-selected 20 shoppable services as may be necessary for a 21 combined total of at least 300 shoppable serv- 22 ices, including the rate at which a hospital pro- 23 vides and bills for that shoppable service. If a 24 hospital does not provide 300 shoppable services 25 VerDate Sep 11 2014 04:16 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 2691 IH in accordance with the previous sentence, the 1 hospital shall make public the information spec- 2 ified under paragraph (1) for as many 3 shoppable services as it provides. 4 ‘‘(B) DETERMINATION BY CMS.—With re- 5 spect to a year before 2025, a hospital shall be 6 deemed by the Centers for Medicare & Medicaid 7 Services to meet the requirements of subpara- 8 graph (A) if the hospital maintains an internet- 9 based price estimator tool that meets the fol- 10 lowing requirements: 11 ‘‘(i) The tool provides estimates for as 12 many of the 70 specified shoppable services 13 that are provided by the hospital, and as 14 many additional hospital-selected 15 shoppable services as may be necessary for 16 a combined total of at least 300 shoppable 17 services. 18 ‘‘(ii) The tool allows health care con- 19 sumers to, at the time they use the tool, 20 obtain an estimate of the amount they will 21 be obligated to pay the hospital for the 22 shoppable service. 23 ‘‘(iii) The tool is prominently dis- 24 played on the hospital’s website and easily 25 VerDate Sep 11 2014 04:16 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 2691 IH accessible to the public, without subscrip- 1 tion, fee, or having to submit personal 2 identifying information (PII), and search- 3 able by service description, billing code, 4 and payer. 5 ‘‘(3) UNIFORM METHOD AND FORMAT.—Not 6 later than January 1, 2025, the Secretary shall im- 7 plement a standard, uniform method and format for 8 hospitals to use in order to satisfy the requirements 9 of this subsection for disclosing directly to the public 10 charge and price information. Such method and for- 11 mat may be similar to any template established by 12 the Centers for Medicare & Medicaid Services as of 13 the date of the enactment of this paragraph for re- 14 porting such information under this subsection and 15 shall meet such standards as determined appropriate 16 by the Secretary. 17 ‘‘(4) MONITORING OF PRICING INFORMATION.— 18 The Secretary, in consultation with the Inspector 19 General of the Department of Health and Human 20 Services, shall, through notice and comment rule- 21 making, establish a process to regularly monitor the 22 accuracy and validity of pricing information dis- 23 played by each hospital pursuant to paragraph (1). 24 VerDate Sep 11 2014 04:16 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 2691 IH ‘‘(5) DEFINITIONS.—Notwithstanding any other 1 provision of law, for the purpose of paragraphs (1) 2 and (2): 3 ‘‘(A) DE-IDENTIFIED MAXIMUM NEGO- 4 TIATED CHARGE.—The term ‘de-identified max- 5 imum negotiated charge’ means the highest 6 charge that a hospital has negotiated with all 7 third party payers for an item or service. 8 ‘‘(B) DE-IDENTIFIED MINIMUM NEGO- 9 TIATED CHARGE.—The term ‘de-identified min- 10 imum negotiated charge’ means the lowest 11 charge that a hospital has negotiated with all 12 third party payers for an item or service. 13 ‘‘(C) DISCOUNTED CASH PRICE.—The 14 term ‘discounted cash price’ means the charge 15 that applies to an individual who pays cash, or 16 cash equivalent, for a hospital item or service. 17 Hospitals that do not offer self-pay discounts 18 may display the hospital’s undiscounted gross 19 charges as found in the hospital chargemaster. 20 ‘‘(D) GROSS CHARGE.—The term ‘gross 21 charge’ means the charge for an individual item 22 or service that is reflected on a hospital’s 23 chargemaster, absent any discounts. 24 VerDate Sep 11 2014 04:16 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 2691 IH ‘‘(E) PAYER-SPECIFIC NEGOTIATED 1 CHARGE.—The term ‘payer-specific negotiated 2 charge’ means the charge that a hospital has 3 negotiated with a third party payer for an item 4 or service. 5 ‘‘(F) SHOPPABLE SERVICE.—The term 6 ‘shoppable service’ means a service that can be 7 scheduled by a health care consumer in ad- 8 vance. 9 ‘‘(G) STANDARD CHARGES.—The term 10 ‘standard charges’ means the regular rate es- 11 tablished by the hospital for an item or service, 12 including both individual items and services and 13 service packages, provided to a specific group of 14 paying patients, including the gross charge, the 15 payer-specific negotiated charge, the discounted 16 cash price, the de-identified minimum nego- 17 tiated charge, the de-identified maximum nego- 18 tiated charge, and other rates determined by 19 the Secretary. 20 ‘‘(H) THIRD PARTY PAYER.—The term 21 ‘third party payer’ means an entity that is, by 22 statute, contract, or agreement, legally respon- 23 sible for payment of a claim for a health care 24 item or service. 25 VerDate Sep 11 2014 04:16 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 2691 IH ‘‘(6) ENFORCEMENT.— 1 ‘‘(A) IN GENERAL.—In the case of a hos- 2 pital that fails to provide the information re- 3 quired by this subsection— 4 ‘‘(i) the Secretary shall notify such 5 hospital of such failure not later than 30 6 days after the date on which the Secretary 7 determines such failure exists; and 8 ‘‘(ii) not later than 90 days after the 9 date of such notification, the hospital shall 10 complete a corrective action plan to comply 11 with such requirements. 12 ‘‘(B) CIVIL MONETARY PENALTY.— 13 ‘‘(i) IN GENERAL.—In addition to any 14 other enforcement actions or penalties that 15 may apply under subsection (b)(3) or an- 16 other provision of law, a hospital that has 17 received a notification under subparagraph 18 (A)(i) and fails to satisfy the requirement 19 under subparagraph (A)(ii) or otherwise 20 comply with the requirements of this sub- 21 section not later than 90 days after such 22 notification, shall be subject to a civil mon- 23 etary penalty of an amount— 24 VerDate Sep 11 2014 04:16 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 2691 IH ‘‘(I) in the case the hospital pro- 1 vides not more than 30 beds (as de- 2 termined under section 3 180.90(c)(2)(ii)(D) of title 45, Code 4 of Federal Regulations, as in effect on 5 the date of the enactment of this 6 paragraph), not to exceed $300 per 7 day that the violation is ongoing as 8 determined by the Secretary; and 9 ‘‘(II) in the case the hospital pro- 10 vides more than 30 beds (as so deter- 11 mined), equal to— 12 ‘‘(aa) subject to item (bb), 13 $10 per bed per day that the vio- 14 lation is ongoing as determined 15 by the Secretary, but for viola- 16 tions occurring before January 1, 17 2024, not to exceed $5,500 per 18 each such day; or 19 ‘‘(bb) in the case such hos- 20 pital has failed to satisfy the re- 21 quirement under subparagraph 22 (A)(ii) or otherwise comply with 23 the requirements of this sub- 24 section for any continuous 1-year 25 VerDate Sep 11 2014 04:16 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 2691 IH period beginning on or after Jan- 1 uary 1, 2024, and the amount 2 otherwise imposed under item 3 (aa) for such failure for such pe- 4 riod would be less than 5 $5,000,000, an amount not less 6 than $5,000,000. 7 ‘‘(ii) INCREASE AUTHORITY.—In ap- 8 plying this subparagraph with respect to 9 violations occurring in 2025 or a subse- 10 quent year, the Secretary may through no- 11 tice and comment rulemaking increase any 12 dollar amount applied under this subpara- 13 graph by an amount specified by the Sec- 14 retary. 15 ‘‘(iii) APPLICATION OF CERTAIN PRO- 16 VISIONS.—The provisions of section 1128A 17 of the Social Security Act (other than sub- 18 sections (a) and (b) of such section) shall 19 apply to a civil monetary penalty imposed 20 under clause (i) in the same manner as 21 such provisions apply to a civil monetary 22 penalty imposed under subsection (a) of 23 such section.’’. 24 (b) PUBLICATION OF LIST OF HOSPITALS.— 25 VerDate Sep 11 2014 04:16 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 2691 IH (1) LIST OF HOSPITALS.—Beginning not later 1 than 90 days after the date of enactment of this 2 Act, the Secretary of Health and Human Services 3 (referred to in this section as the ‘‘Secretary’’) shall 4 establish and maintain a publicly available list, on 5 the website of the Centers for Medicare & Medicaid 6 Services and updated in real time, of— 7 (A) each hospital that— 8 (i) is not in compliance with the hos- 9 pital price transparency rule implementing 10 section 2718(e) of the Public Health Serv- 11 ice Act (42 U.S.C. 300gg–18(e)), and that, 12 with respect to such noncompliance— 13 (I) has been issued a civil mone- 14 tary penalty; 15 (II) has received a warning no- 16 tice; or 17 (III) has received a request for a 18 corrective action plan; or 19 (ii) has received any written commu- 20 nication by the Secretary regarding poten- 21 tial noncompliance with such hospital price 22 transparency rule; and 23 (B) each hospital that is in compliance 24 with respect to such hospital price transparency 25 VerDate Sep 11 2014 04:16 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691 kjohnson on DSK79L0C42PROD with BILLS 13 •HR 2691 IH rule and has not received any written commu- 1 nication described in paragraph (1)(B). 2 (2) FOIA REQUESTS.—Any penalty, notice, re- 3 quest, or other communication described in sub- 4 section (a) shall be subject to public disclosure, in 5 full and without redaction, under section 552 of title 6 21, United States Code, notwithstanding any exemp- 7 tions or exclusions otherwise available under such 8 section 552. 9 [Text truncated for display. Full text available on Congress.gov.]