I 

111TH CONGRESS 

1ST SESSION H. R. 2249 

To amend title XIX of the Social Security Act to provide for increased 

price transparency of hospital information and to provide for additional 

research on consumer information on charges and out-of-pocket costs. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 5, 2009 

Mr. BURGESS (for himself, Mr. GENE GREEN of Texas, Mr. CARTER, Mr. 

THORNBERRY, and Mr. CUELLAR) introduced the following bill; which 

was referred to the Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to provide 

for increased price transparency of hospital information 

and to provide for additional research on consumer information on charges and out-of-pocket costs. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Care Price 

5 Transparency Promotion Act of 2009’’. 


rfrederick on PROD1PC67 with BILLS
2 

•HR 2249 IH

1 SEC. 2. INCREASING THE TRANSPARENCY OF INFORMA2 TION ON HOSPITAL CHARGES AND MAKING 

3 AVAILABLE INFORMATION ON ESTIMATED 

4 OUT-OF-POCKET COSTS FOR HEALTH CARE 

5 SERVICES. 

6 (a) IN GENERAL.—Section 1902(a) of the Social Se7 curity Act (42 U.S.C. 1396a(a)), as amended by section 

8 5006(e)(2)(A) of division B of Public Law 111–5, is 

9 amended— 

10 (1) by striking ‘‘and’’ at the end of paragraph 

11 (72); 

12 (2) by striking the period at the end of para13 graph (73) and inserting ‘‘; and’’; 

14 (3) by inserting after paragraph (73) the fol15 lowing new paragraph: 

16 ‘‘(74) provide that the State will establish and 

17 maintain laws, in accordance with the requirements 

18 of section 1921A, to require disclosure of informa19 tion on hospital charges, to make such information 

20 available to the public, and to provide individuals 

21 with information about estimated out-of-pocket costs 

22 for health care services.’’; and 

23 (4) by inserting after section 1921 the following 

24 new section: 


rfrederick on PROD1PC67 with BILLS
3 

•HR 2249 IH

1 ‘‘INCREASING THE TRANSPARENCY OF INFORMATION ON

2 HOSPITAL CHARGES AND PROVIDING CONSUMERS

3 WITH ESTIMATES OF OUT-OF-POCKET COSTS FOR

4 HEALTH CARE SERVICES

5 ‘‘SEC. 1921A. (a) IN GENERAL.—The requirements 

6 referred to in section 1902(a)(74) are that the laws of a 

7 State must— 

8 ‘‘(1) in accordance with subsection (b)— 

9 ‘‘(A) require the disclosure of information 

10 on hospital charges; and 

11 ‘‘(B) provide for access to such informa12 tion; and 

13 ‘‘(2) in accordance with subsection (c), require 

14 the provision of a statement of the estimated out-of15 pocket costs of an individual for anticipated future 

16 health care services. 

17 ‘‘(b) INFORMATION ON HOSPITAL CHARGES.—The 

18 laws of a State must— 

19 ‘‘(1) require disclosure, by each hospital located 

20 in the State, of information on the charges for cer21 tain inpatient and outpatient hospital services (as 

22 determined by the State) provided at the hospital; 

23 and 


rfrederick on PROD1PC67 with BILLS
4 

•HR 2249 IH

1 ‘‘(2) provide for timely access to such informa2 tion by individuals seeking or requiring such serv3 ices. 

4 ‘‘(c) ESTIMATED OUT-OF-POCKET COSTS.—The laws 

5 of a State must require that, upon the request of any indi6 vidual with health insurance coverage sponsored by a 

7 health insurance issuer, the issuer must provide a state8 ment of the estimated out-of-pocket costs that are likely 

9 to be incurred by the individual if the individual receives 

10 particular health care items and services within a specified 

11 period of time. 

12 ‘‘(d) RULES OF CONSTRUCTION.—Nothing in this 

13 section shall be construed as— 

14 ‘‘(1) authorizing or requiring the Secretary to 

15 establish uniform standards for the State laws re16 quired by subsections (b) and (c); 

17 ‘‘(2) requiring any State with a law enacted on 

18 or before the date of the enactment of this section 

19 that— 

20 ‘‘(A) meets the requirements of subsection 

21 (b) or subsection (c) to modify or amend such 

22 law; or 

23 ‘‘(B) meets some but not all of the require24 ments of subsection (b) or subsection (c) to 


rfrederick on PROD1PC67 with BILLS
5 

•HR 2249 IH

1 modify or amend such law except to the extent 

2 necessary to address the unmet requirements; 

3 ‘‘(3) precluding any State in which a program 

4 of voluntary disclosure of information on hospital 

5 charges is in effect from adopting a law codifying 

6 such program (other than its voluntary nature) to 

7 satisfy the requirement of subsection (b)(1); or 

8 ‘‘(4) guaranteeing that the out-of-pocket costs 

9 of an individual will not exceed the estimate of such 

10 costs provided pursuant to subsection (c). 

11 ‘‘(e) DEFINITIONS.—For purposes of this section: 

12 ‘‘(1) The term ‘health insurance coverage’ has 

13 the meaning given such term in section 2791(b)(1) 

14 of the Public Health Service Act. 

15 ‘‘(2) The term ‘health insurance issuer’ has the 

16 meaning given such term in section 2791(b)(2) of 

17 the Public Health Service Act, except that such term 

18 also includes— 

19 ‘‘(A) a Medicaid managed care organiza20 tion (as defined in section 1903(m)); and 

21 ‘‘(B) a Medicare Advantage organization 

22 (as defined in 1859(a)(1), taking into account 

23 the operation of section 201(b) of the Medicare 

24 Prescription Drug, Improvement, and Mod25 ernization Act of 2003). 


rfrederick on PROD1PC67 with BILLS
6 

•HR 2249 IH

1 Section 1856(b)(3) shall not preclude the application 

2 to a Medicare Advantage organization or a Medicare 

3 Advantage plan offered by such an organization of 

4 any State law adopted to carry out the requirements 

5 of subsection (b) or (c). 

6 ‘‘(3) The term ‘hospital’ means an institution 

7 that meets the requirements of paragraphs (1) and 

8 (7) of section 1861(e) and includes those to which 

9 section 1820(c) applies.’’. 

10 (b) EFFECTIVE DATE.— 

11 (1) IN GENERAL.—Except as provided in para12 graph (2), the amendments made by subsection (a) 

13 shall take effect on October 1, 2010. 

14 (2) EXCEPTION.—In the case of a State plan 

15 for medical assistance under title XIX of the Social 

16 Security Act which the Secretary of Health and 

17 Human Services determines requires State legisla18 tion (other than legislation appropriating funds) in 

19 order for the plan to meet the additional require20 ments imposed by the amendment made by sub21 section (a), the State plan shall not be regarded as 

22 failing to comply with the requirements of such title 

23 solely on the basis of its failure to meet these addi24 tional requirements before the first day of the first 

25 calendar quarter beginning after the close of the 


rfrederick on PROD1PC67 with BILLS
7 

•HR 2249 IH

1 first regular session of the State legislature that be2 gins after the date of the enactment of this Act. For 

3 purposes of the previous sentence, in the case of a 

4 State that has a 2-year legislative session, each year 

5 of such session shall be deemed to be a separate reg6 ular session of the State legislature. 

7 SEC. 3. RESEARCH ON INFORMATION VALUED BY CON8 SUMERS ON CHARGES AND OUT-OF-POCKET 

9 COSTS FOR HEALTH CARE SERVICES. 

10 (a) RESEARCH ON INFORMATION VALUED AND USED

11 BY CONSUMERS.—The Director of the Agency for 

12 Healthcare Research and Quality (in this section referred 

13 to as ‘‘AHRQ’’) shall conduct or support research, pursu14 ant to section 901(b)(1)(D) of the Public Health Service 

15 Act (42 U.S.C. 299(b)(1)(D)), on— 

16 (1) the types of information on the charges, and 

17 out-of-pocket costs, for health care services that in18 dividuals find useful in making decisions about 

19 where, when, and from whom to receive care; 

20 (2) how the types of information valued by indi21 viduals for making such decisions vary by whether 

22 they have health benefits coverage and, if they do, 

23 the type of such coverage they have, such as tradi24 tional insurance, health maintenance organizations, 


rfrederick on PROD1PC67 with BILLS
8 

•HR 2249 IH

1 preferred provider organizations, and high deductible 

2 plans coupled with health savings accounts; and 

3 (3) ways in which such information may be 

4 made available on a timely basis and in easy-to-un5 derstand form to individuals facing such decisions. 

6 (b) REPORT.—The Director of AHRQ shall report to 

7 the Congress on the results of such research not later than 

8 18 months after the date of the enactment of this Act, 

9 together with recommendations for ways in which the Fed10 eral Government can assist the States in achieving the ob11 jective specified in subsection (a)(3). 

12 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated such sums as may be 

14 necessary to carry out this section. 

Æ 


rfrederick on PROD1PC67 with BILLS