PATIENT Act of 2023

I 118TH CONGRESS 1ST SESSION H. R. 3561 To promote hospital and insurer price transparency, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MAY 22, 2023 Mrs. RODGERS of Washington (for herself and Mr. PALLONE) introduced the following bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committees on Ways and Means, and Edu- cation and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall with- in the jurisdiction of the committee concerned A BILL To promote hospital and insurer price transparency, and for other purposes. 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 ‘‘Promoting Access to 4 Treatments and Increasing Extremely Needed Trans- 5 parency Act of 2023’’ or the ‘‘PATIENT Act of 2023’’. 6 VerDate Sep 11 2014 01:34 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3561.IH H3561 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3561 IH TITLE I—INCREASING PRICE 1 TRANSPARENCY TO LOWER 2 COSTS 3 SEC. 101. PRICE TRANSPARENCY REQUIREMENTS. 4 (a) IN GENERAL.—Section 2718(e) of the Public 5 Health Service Act (42 U.S.C. 300gg–18(e)) is amend- 6 ed— 7 (1) by striking ‘‘Each hospital’’ and inserting 8 the following: 9 ‘‘(1) IN GENERAL.—Each hospital’’; 10 (2) by inserting ‘‘, without subscription and 11 free of charge, in a single machine-readable file,’’ 12 after ‘‘a list’’; 13 (3) by inserting ‘‘and a list, in plain language 14 and without subscription and free of charge, in a 15 consumer-friendly format, of the hospital’s standard 16 charges for as many of the 70 Centers for Medicare 17 & Medicaid Services-specified shoppable services that 18 are provided by the hospital, and as many additional 19 hospital-selected shoppable services (or all such addi- 20 tional services, if such hospital provides fewer than 21 300 shoppable services) as may be necessary for a 22 combined total of at least 300 shoppable services’’ 23 after ‘‘Social Security Act’’; and 24 VerDate Sep 11 2014 01:34 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3561.IH H3561 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3561 IH (4) by adding at the end the following: ‘‘Such 1 lists shall be updated not less frequently than annu- 2 ally. Beginning January 1, 2024, each hospital shall 3 include in its lists of standard charges, along with 4 such additional information as the Secretary may re- 5 quire with respect to such charges for purposes of 6 promoting public awareness of hospital pricing in 7 advance of receiving a hospital item or service, the 8 following: 9 ‘‘(A) A plain language description of each 10 item or service included on such list, including, 11 as applicable, the Healthcare Common Proce- 12 dure Coding System (HCPCS) code, the Diag- 13 nosis Related Group (DRG), the National Drug 14 Code (NDC), or other payer identifier used or 15 approved by the Centers for Medicare & Med- 16 icaid Services for such item or service. 17 ‘‘(B) The gross charge, expressed as a dol- 18 lar amount, for each such item or service, when 19 provided in, as applicable, the hospital inpatient 20 setting and outpatient department setting. 21 ‘‘(C) Any current payer-specific negotiated 22 charges, clearly associated with the name of the 23 third party payer and plan and expressed as a 24 dollar amount, that applies to each such item or 25 VerDate Sep 11 2014 01:34 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3561.IH H3561 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3561 IH service when provided in, as applicable, the hos- 1 pital inpatient setting and outpatient depart- 2 ment setting. 3 ‘‘(D) The de-identified maximum and min- 4 imum negotiated charges for each such item or 5 service. 6 ‘‘(E) The discounted cash price, expressed 7 as a dollar amount, for each such item or serv- 8 ice when provided in, as applicable, the hospital 9 inpatient setting and outpatient department 10 setting. If the discounted cash price is a per- 11 centage of another value provided, the cal- 12 culated value must be entered as a dollar 13 amount. If the discounted cash price equates to 14 the gross charge, the gross charge shall be re- 15 entered to indicate that no cash discount is 16 available. 17 ‘‘(2) DEEMED COMPLIANCE WITH SHOPPABLE 18 SERVICES REQUIREMENT FOR CERTAIN YEARS.— 19 With respect to a year before 2025, a hospital shall 20 be deemed to meet the requirement of paragraph (1) 21 that such hospital make available a list of standard 22 charges for shoppable services if the hospital main- 23 tains an internet-based price estimator tool that 24 meets the following requirements: 25 VerDate Sep 11 2014 01:34 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3561.IH H3561 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3561 IH ‘‘(A) The tool provides estimates for as 1 many of the 70 Centers for Medicare & Med- 2 icaid Services specified shoppable services that 3 are provided by the hospital, and as many addi- 4 tional hospital-selected shoppable services (or 5 all such additional services, if such hospital pro- 6 vides fewer than 300 shoppable services) as 7 may be necessary for a combined total of at 8 least 300 shoppable services. 9 ‘‘(B) The tool allows health care con- 10 sumers to, at the time they use the tool, obtain 11 an estimate of the amount they will be obligated 12 to pay the hospital for the shoppable service. 13 ‘‘(C) The tool is prominently displayed on 14 the hospital’s website and easily accessible to 15 the public, without subscription, fee, or having 16 to submit personal identifying information, and 17 searchable by service description, billing code, 18 and payer. 19 The Secretary may not deem the establishment of an 20 internet-based price estimator tool that meets the re- 21 quirements of this paragraph to constitute compli- 22 ance with the requirement of paragraph (1) that 23 such hospital make available a list of standard 24 VerDate Sep 11 2014 01:34 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3561.IH H3561 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 3561 IH charges for shoppable services for 2025 or a subse- 1 quent year. 2 ‘‘(3) UNIFORM METHOD AND FORMAT.—Not 3 later than January 1, 2025, the Secretary shall im- 4 plement a standard, uniform method and format for 5 hospitals to use in order to satisfy the requirements 6 of this subsection for disclosing directly to the public 7 charge and price information. Such method and for- 8 mat may be similar to any template established by 9 the Centers for Medicare & Medicaid Services as of 10 the date of the enactment of this paragraph for re- 11 porting such information under this subsection and 12 shall meet such standards as determined appropriate 13 by the Secretary. 14 ‘‘(4) MONITORING OF PRICING INFORMATION.— 15 The Secretary, in consultation with the Inspector 16 General of the Department of Health and Human 17 Services, shall, through notice and comment rule- 18 making, establish a process to regularly monitor the 19 accuracy and validity of pricing information dis- 20 played by each hospital pursuant to paragraph (1). 21 ‘‘(5) DEFINITIONS.—Notwithstanding any other 22 provision of law, for the purpose of paragraphs (1) 23 and (2): 24 VerDate Sep 11 2014 01:34 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3561.IH H3561 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 3561 IH ‘‘(A) DE-IDENTIFIED MAXIMUM NEGO- 1 TIATED CHARGE.—The term ‘de-identified max- 2 imum negotiated charge’ means the highest 3 charge that a hospital has negotiated with all 4 third party payers for an item or service. 5 ‘‘(B) DE-IDENTIFIED MINIMUM NEGO- 6 TIATED CHARGE.—The term ‘de-identified min- 7 imum negotiated charge’ means the lowest 8 charge that a hospital has negotiated with all 9 third party payers for an item or service. 10 ‘‘(C) DISCOUNTED CASH PRICE.—The 11 term ‘discounted cash price’ means the charge 12 that applies to an individual who pays cash, or 13 cash equivalent, for a hospital item or service. 14 Hospitals that do not offer self-pay discounts 15 may display the hospital’s undiscounted gross 16 charges as found in the hospital chargemaster. 17 ‘‘(D) GROSS CHARGE.—The term ‘gross 18 charge’ means the charge for an individual item 19 or service that is reflected on a hospital’s 20 chargemaster, absent any discounts. 21 ‘‘(E) PAYER-SPECIFIC NEGOTIATED 22 CHARGE.—The term ‘payer-specific negotiated 23 charge’ means the charge that a hospital has 24 VerDate Sep 11 2014 01:34 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3561.IH H3561 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 3561 IH negotiated with a third party payer for an item 1 or service. 2 ‘‘(F) SHOPPABLE SERVICE.—The term 3 ‘shoppable service’ means a service that can be 4 scheduled by a health care consumer in ad- 5 vance. 6 ‘‘(G) THIRD PARTY PAYER.—The term 7 ‘third party payer’ means an entity that is, by 8 statute, contract, or agreement, legally respon- 9 sible for payment of a claim for a health care 10 item or service. 11 ‘‘(6) ENFORCEMENT.— 12 ‘‘(A) IN GENERAL.—In the case of a hos- 13 pital that fails to comply with this subsection— 14 ‘‘(i) the Secretary shall notify such 15 hospital of such failure not later than 30 16 days after the date on which the Secretary 17 determines such failure exists; and 18 ‘‘(ii) not later than 45 days after the 19 date of such notification, the hospital shall 20 complete a corrective action plan to comply 21 with such requirements. 22 ‘‘(B) CIVIL MONETARY PENALTY.— 23 ‘‘(i) IN GENERAL.—In addition to any 24 other enforcement actions or penalties that 25 VerDate Sep 11 2014 01:34 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3561.IH H3561 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 3561 IH may apply under subsection (b)(3) or an- 1 other provision of law, a hospital that has 2 received a notification under subparagraph 3 (A)(i) and fails to satisfy the requirement 4 under subparagraph (A)(ii) or otherwise 5 comply with the requirements of this sub- 6 section by the date that is 90 days after 7 such notification shall be subject to a civil 8 monetary penalty of an amount— 9 ‘‘(I) in the case the hospital pro- 10 vides not more than 30 beds (as de- 11 termined under section 12 180.90(c)(2)(ii)(D) of title 45, Code 13 of Federal Regulations, as in effect on 14 the date of the enactment of this 15 paragraph), not to exceed $300 per 16 day that the violation is ongoing as 17 determined by the Secretary; and 18 ‘‘(II) in the case the hospital pro- 19 vides more than 30 beds (as so deter- 20 mined), equal to— 21 ‘‘(aa) subject to item (bb), 22 $10 per bed per day that the vio- 23 lation is ongoing as determined 24 by the Secretary, but for viola- 25 VerDate Sep 11 2014 01:34 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3561.IH H3561 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 3561 IH tions occurring before January 1, 1 2024, not to exceed $5,500 per 2 each such day; or 3 ‘‘(bb) in the case such hos- 4 pital has failed to satisfy the re- 5 quirement under subparagraph 6 (A)(ii) or otherwise comply with 7 the requirements of this sub- 8 section for any continuous 1-year 9 period beginning on or after Jan- 10 uary 1, 2024, and the amount 11 otherwise imposed under item 12 (aa) for such failure for such pe- 13 riod would be less than 14 $5,000,000, an amount not less 15 than $5,000,000. 16 ‘‘(ii) INCREASE AUTHORITY.—In ap- 17 plying this subparagraph with respect to 18 violations occurring in 2025 or a subse- 19 quent year, the Secretary may through no- 20 tice and comment rulemaking increase any 21 dollar amount applied under this subpara- 22 graph by an amount specified by the Sec- 23 retary. 24 VerDate Sep 11 2014 01:34 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3561.IH H3561 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 3561 IH ‘‘(iii) APPLICATION OF CERTAIN PRO- 1 VISIONS.—The provisions of section 1128A 2 of the Social Security Act (other than sub- 3 sections (a) and (b) of such section) shall 4 apply to a civil monetary penalty imposed 5 under clause (i) in the same manner as 6 such provisions apply to a civil monetary 7 penalty imposed under subsection (a) of 8 such section.’’. 9 (b) PUBLICATION OF LIST OF HOSPITALS.— 10 (1) LIST OF HOSPITALS.—Beginning not later 11 than 90 days after the date of enactment of this 12 Act, the Secretary of Health and Human Services 13 (referred to in this section as the ‘‘Secretary’’) shall 14 establish and maintain a publicly available list on 15 the website of the Centers for Medicare & Medicaid 16 Services of each hospital with respect to which the 17 Secretary has conducted a review of such hospital’s 18 compliance with the provisions of section 2718(e) of 19 the Public Health Service Act (42 U.S.C. 300gg– 20 18(e)). Such list shall include, with respect to each 21 such hospital that was noncompliant with such pro- 22 visions, a specification as to whether such hospital— 23 (A) has been issued a civil monetary pen- 24 alty; 25 VerDate Sep 11 2014 01:34 Jun 14, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3561.IH H3561 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 3561 IH (B) has received a warning notice; or 1 (C) has submitted a corrective action plan. 2 (2) ADDITIONS AND UPDATES.—In the case of 3 a hospital not included on the list described in para- 4 graph (1) as of the date of the establishment of such 5 list and that is subject to a review of such hospital’s 6 compliance with the provisions described in such 7 paragraph after such date, the Secretary shall add 8 such hospital to such list, along with the specifica- 9 tions described in such paragraph, not later than 1 10 business day after such review occurs. The Secretary 11 shall update such specifications with respect to any 12 hospital included on such list— 13 (A) not later than 1 business day after any 14 subsequent review of such hospital’s compliance 15 with such provisions; and 16 (B) not later than 1 business day after any 17 penalty, notice, or request described in para- 18 graph (1) is made with respect to such hospital. 19 (3) FOIA REQUESTS.—Any penalty, notice, or 20 request described in paragraph (1) shall be subject 21 to public disclosure, in full and without redaction, 22 under section 552 of title 21, United States Code, 23 notwithstanding any exemptions or exclusions other- 24 wise available under such section 552. 25 VerDate Sep 11 2014 01:34 Jun 14, 202 [Text truncated for display. Full text available on Congress.gov.]