Transparent PRICE Act

I 118TH CONGRESS 1ST SESSION H. R. 3281 To promote hospital and insurer price transparency. IN THE HOUSE OF REPRESENTATIVES MAY 15, 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 02:45 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3281.IH H3281 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3281 IH ‘‘(1) IN GENERAL.—Each hospital’’; 1 (2) by inserting ‘‘, without subscription and 2 free of charge, in a single machine-readable file,’’ 3 after ‘‘a list’’; 4 (3) by inserting ‘‘and a list, in plain language 5 and without subscription and free of charge, in a 6 consumer-friendly format, of the hospital’s standard 7 charges for as many of the 70 Centers for Medicare 8 & Medicaid Services-specified shoppable services that 9 are provided by the hospital, and as many additional 10 hospital-selected shoppable services (or all such addi- 11 tional services, if such hospital provides fewer than 12 300 shoppable services) as may be necessary for a 13 combined total of at least 300 shoppable services’’ 14 after ‘‘Social Security Act’’; and 15 (4) by adding at the end the following: ‘‘Such 16 lists shall be updated not less frequently than annu- 17 ally. Beginning January 1, 2024, each hospital shall 18 include in its lists of standard charges, along with 19 such additional information as the Secretary may re- 20 quire with respect to such charges for purposes of 21 promoting public awareness of hospital pricing in 22 advance of receiving a hospital item or service, the 23 following: 24 VerDate Sep 11 2014 02:45 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3281.IH H3281 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3281 IH ‘‘(A) A plain language description of each 1 item or service included on such list, including, 2 as applicable, the Healthcare Common Proce- 3 dure Coding System (HCPCS) code, the Diag- 4 nosis Related Group (DRG), the National Drug 5 Code (NDC), or other payer identifier used or 6 approved by the Centers for Medicare & Med- 7 icaid Services for such item or service. 8 ‘‘(B) The gross charge, expressed as a dol- 9 lar amount, for each such item or service, when 10 provided in, as applicable, the hospital inpatient 11 setting and outpatient department setting. 12 ‘‘(C) Any current payer-specific negotiated 13 charges, clearly associated with the name of the 14 third party payer and plan and expressed as a 15 dollar amount, that applies to each such item or 16 service when provided in, as applicable, the hos- 17 pital inpatient setting and outpatient depart- 18 ment setting. 19 ‘‘(D) The de-identified maximum and min- 20 imum negotiated charges for each such item or 21 service. 22 ‘‘(E) The discounted cash price, expressed 23 as a dollar amount, for each such item or serv- 24 ice when provided in, as applicable, the hospital 25 VerDate Sep 11 2014 02:45 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3281.IH H3281 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3281 IH inpatient setting and outpatient department 1 setting. If the discounted cash price is a per- 2 centage of another value provided, the cal- 3 culated value must be entered as a dollar 4 amount. If the discounted cash price equates to 5 the gross charge, the gross charge shall be re- 6 entered to indicate that no cash discount is 7 available. 8 ‘‘(2) DEEMED COMPLIANCE WITH SHOPPABLE 9 SERVICES REQUIREMENT FOR CERTAIN YEARS.— 10 With respect to a year before 2025, a hospital shall 11 be deemed to meet the requirement of paragraph (1) 12 that such hospital make available a list of standard 13 charges for shoppable services if the hospital main- 14 tains an internet-based price estimator tool that 15 meets the following requirements: 16 ‘‘(A) The tool provides estimates for as 17 many of the 70 Centers for Medicare & Med- 18 icaid Services specified shoppable services that 19 are provided by the hospital, and as many addi- 20 tional hospital-selected shoppable services (or 21 all such additional services, if such hospital pro- 22 vides fewer than 300 shoppable services) as 23 may be necessary for a combined total of at 24 least 300 shoppable services. 25 VerDate Sep 11 2014 02:45 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3281.IH H3281 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3281 IH ‘‘(B) The tool allows health care con- 1 sumers to, at the time they use the tool, obtain 2 an estimate of the amount they will be obligated 3 to pay the hospital for the shoppable service. 4 ‘‘(C) The tool is prominently displayed on 5 the hospital’s website and easily accessible to 6 the public, without subscription, fee, or having 7 to submit personal identifying information, and 8 searchable by service description, billing code, 9 and payer. 10 The Secretary may not deem the establishment of an 11 internet-based price estimator tool that meets the re- 12 quirements of this paragraph to constitute compli- 13 ance with the requirement of paragraph (1) that 14 such hospital make available a list of standard 15 charges for shoppable services for 2025 or a subse- 16 quent year. 17 ‘‘(3) UNIFORM METHOD AND FORMAT.—Not 18 later than January 1, 2025, the Secretary shall im- 19 plement a standard, uniform method and format for 20 hospitals to use in order to satisfy the requirements 21 of this subsection for disclosing directly to the public 22 charge and price information. Such method and for- 23 mat may be similar to any template established by 24 the Centers for Medicare & Medicaid Services as of 25 VerDate Sep 11 2014 02:45 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3281.IH H3281 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 3281 IH the date of the enactment of this paragraph for re- 1 porting such information under this subsection and 2 shall meet such standards as determined appropriate 3 by the Secretary. 4 ‘‘(4) MONITORING OF PRICING INFORMATION.— 5 The Secretary, in consultation with the Inspector 6 General of the Department of Health and Human 7 Services, shall, through notice and comment rule- 8 making, establish a process to regularly monitor the 9 accuracy and validity of pricing information dis- 10 played by each hospital pursuant to paragraph (1). 11 ‘‘(5) DEFINITIONS.—Notwithstanding any other 12 provision of law, for the purpose of paragraphs (1) 13 and (2): 14 ‘‘(A) DE-IDENTIFIED MAXIMUM NEGO- 15 TIATED CHARGE.—The term ‘de-identified max- 16 imum negotiated charge’ means the highest 17 charge that a hospital has negotiated with all 18 third party payers for an item or service. 19 ‘‘(B) DE-IDENTIFIED MINIMUM NEGO- 20 TIATED CHARGE.—The term ‘de-identified min- 21 imum negotiated charge’ means the lowest 22 charge that a hospital has negotiated with all 23 third party payers for an item or service. 24 VerDate Sep 11 2014 02:45 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3281.IH H3281 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 3281 IH ‘‘(C) DISCOUNTED CASH PRICE.—The 1 term ‘discounted cash price’ means the charge 2 that applies to an individual who pays cash, or 3 cash equivalent, for a hospital item or service. 4 Hospitals that do not offer self-pay discounts 5 may display the hospital’s undiscounted gross 6 charges as found in the hospital chargemaster. 7 ‘‘(D) GROSS CHARGE.—The term ‘gross 8 charge’ means the charge for an individual item 9 or service that is reflected on a hospital’s 10 chargemaster, absent any discounts. 11 ‘‘(E) PAYER-SPECIFIC NEGOTIATED 12 CHARGE.—The term ‘payer-specific negotiated 13 charge’ means the charge that a hospital has 14 negotiated with a third party payer for an item 15 or service. 16 ‘‘(F) SHOPPABLE SERVICE.—The term 17 ‘shoppable service’ means a service that can be 18 scheduled by a health care consumer in ad- 19 vance. 20 ‘‘(G) 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 02:45 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3281.IH H3281 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 3281 IH ‘‘(6) ENFORCEMENT.— 1 ‘‘(A) IN GENERAL.—Subject to subpara- 2 graph (C), in the case of a hospital that fails 3 to comply with this subsection— 4 ‘‘(i) the Secretary shall notify such 5 hospital of such failure not later than 30 6 days after the date on which the Secretary 7 determines such failure exists; and 8 ‘‘(ii) not later than 45 days after the 9 date of such notification, the hospital shall 10 complete a corrective action plan to comply 11 with such requirements. 12 ‘‘(B) CIVIL MONETARY PENALTY.— 13 ‘‘(i) IN GENERAL.—In addition to any 14 other enforcement actions or penalties that 15 may apply under subsection (b)(3) or an- 16 other provision of law, a hospital that has 17 received a notification under subparagraph 18 (A)(i) and fails to satisfy the requirement 19 under subparagraph (A)(ii) or otherwise 20 comply with the requirements of this sub- 21 section by the date that is 90 days after 22 such notification shall be subject to a civil 23 monetary penalty of an amount— 24 VerDate Sep 11 2014 02:45 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3281.IH H3281 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 3281 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 02:45 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3281.IH H3281 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 3281 IH period beginning on or after Jan- 1 uary 1, 2024, and the amount 2 otherwise imposed under item 3 (aa) for such failure for such pe- 4 riod would be less than 5 $5,000,000, an amount not less 6 than $5,000,000. 7 ‘‘(ii) INCREASE AUTHORITY.—In ap- 8 plying this subparagraph with respect to 9 violations occurring in 2025 or a subse- 10 quent year, the Secretary may through no- 11 tice and comment rulemaking increase any 12 dollar amount applied under this subpara- 13 graph by an amount specified by the Sec- 14 retary. 15 ‘‘(iii) APPLICATION OF CERTAIN PRO- 16 VISIONS.—The provisions of section 1128A 17 of the Social Security Act (other than sub- 18 sections (a) and (b) of such section) shall 19 apply to a civil monetary penalty imposed 20 under clause (i) in the same manner as 21 such provisions apply to a civil monetary 22 penalty imposed under subsection (a) of 23 such section. 24 VerDate Sep 11 2014 02:45 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3281.IH H3281 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 3281 IH ‘‘(C) OPTION TO FORGO NOTICE OF NON- 1 COMPLIANCE.—In the case that the Secretary 2 determines that a hospital has failed to comply 3 with this subsection and further determines 4 that such hospital has made no effort to comply 5 with such subsection, the Secretary may elect to 6 request a corrective action plan from such hos- 7 pital’’. 8 (b) PUBLICATION OF LIST OF HOSPITALS.— 9 (1) LIST OF HOSPITALS.—Beginning not later 10 than 90 days after the date of enactment of this 11 Act, the Secretary of Health and Human Services 12 (referred to in this section as the ‘‘Secretary’’) shall 13 establish and maintain a publicly available list on 14 the website of the Centers for Medicare & Medicaid 15 Services of each hospital with respect to which the 16 Secretary has conducted a review of such hospital’s 17 compliance with the provisions of section 2718(e) of 18 the Public Health Service Act (42 U.S.C. 300gg– 19 18(e)). Such list shall include, with respect to each 20 such hospital that was noncompliant with such pro- 21 visions, a specification as to whether such hospital— 22 (A) has been issued a civil monetary pen- 23 alty; 24 (B) has received a warning notice; or 25 VerDate Sep 11 2014 02:45 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3281.IH H3281 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 3281 IH (C) has submitted a corrective action plan. 1 (2) ADDITIONS AND UPDATES.—In the case of 2 a hospital not included on the list described in para- 3 graph (1) as of the date of the establishment of such 4 list and that is subject to a review of such hospital’s 5 compliance with the provisions described in such 6 paragraph after such date, the Secretary shall add 7 such hospital to such list, along with the specifica- 8 tions described in such paragraph, not later than 1 9 business day after such review occurs. The Secretary 10 shall update such specifications with respect to any 11 hospital included on such list— 12 (A) not later than 1 business day after any 13 subsequent review of such hospital’s compliance 14 with such provisions; and 15 (B) not later than 1 business day after any 16 penalty, notice, or request described in para- 17 graph (1) is made with respect to such hospital. 18 (3) FOIA REQUESTS.—Any penalty, notice, or 19 request described in paragraph (1) shall be subject 20 to public disclosure, in full and without redaction, 21 under section 552 of title 21, United States Code, 22 notwithstanding any exemptions or exclusions other- 23 wise available under such section 552. 24 VerDate Sep 11 2014 02:45 Jun 14, 2023 Jkt 039200 PO 00000 [Text truncated for display. Full text available on Congress.gov.]