I 

112TH CONGRESS 

2D SESSION H. R. 5709 

To amend the Public Health Service Act to provide for the public disclosure 

of charges for certain hospital and ambulatory surgical center treatment 

episodes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 10, 2012 

Mr. LIPINSKI introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to provide for 

the public disclosure of charges for certain hospital and 

ambulatory surgical center treatment episodes. 

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 ‘‘Hospital Price Trans5 parency and Disclosure Act of 2011’’. 

6 SEC. 2. PUBLIC DISCLOSURE OF HOSPITAL DATA. 

7 Part B of title II of the Public Health Service Act 

8 (42 U.S.C. 238 et seq.) is amended by adding at the end 

9 the following new section: 


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1 ‘‘DATA REPORTING BY HOSPITALS AND AMBULATORY

2 SURGICAL CENTERS AND PUBLIC POSTING

3 ‘‘SEC. 249. (a) SEMIANNUAL REPORTING REQUIRE4 MENT.—Not later than 80 days after the end of each semi5 annual period beginning January 1 or July 1 (beginning 

6 more than one year after the date of the enactment of 

7 this section), a hospital and an ambulatory surgical center 

8 shall report to the Secretary the following data: 

9 ‘‘(1) In the case of a hospital— 

10 ‘‘(A) the frequency of occurrence for such 

11 hospital during such period of each treatment 

12 episode identified under subsection (c)(1) for a 

13 condition or disease selected under subpara14 graph (A) or (B) of such subsection (or up15 dated under subsection (c)(3)), furnished in an 

16 inpatient or outpatient setting, respectively; and 

17 ‘‘(B) if care was furnished for such a 

18 treatment episode by such hospital during such 

19 period— 

20 ‘‘(i) the total number of such treat21 ment episodes for which care was so fur22 nished by the hospital during such period; 

23 ‘‘(ii) the insured individual average 

24 charge (as computed under subsection 


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1 (e)(3)) by the hospital for such treatment 

2 episode during such period; and 

3 ‘‘(iii) the uninsured individual average 

4 charge (as computed under subsection 

5 (e)(4)) by the hospital for such treatment 

6 episode during such period. 

7 ‘‘(2) In the case of an ambulatory surgical cen8 ter— 

9 ‘‘(A) the frequency of occurrence for such 

10 center during such period of each treatment 

11 episode identified under subsection (c)(1) for a 

12 condition or disease selected under subpara13 graph (C) of such subsection (or updated under 

14 subsection (c)(3)); and 

15 ‘‘(B) if care was furnished for such a 

16 treatment episode by such center during such 

17 period— 

18 ‘‘(i) the total number of such treat19 ment episodes for which care was so fur20 nished by the center during such period; 

21 ‘‘(ii) the insured individual average 

22 charge (as computed under subsection 

23 (e)(3)) by the center for such episode dur24 ing such period; and 


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1 ‘‘(iii) the uninsured individual average 

2 charge (as computed under subsection 

3 (e)(4)) by the center for such episode dur4 ing such period. 

5 ‘‘(b) PUBLIC AVAILABILITY OF DATA.— 

6 ‘‘(1) PUBLIC POSTING OF DATA.—The Sec7 retary shall promptly post, on the official public 

8 Internet site of the Department of Health and 

9 Human Services, the data reported under subsection 

10 (a). Such data shall be set forth in a manner that 

11 promotes charge comparison among hospitals and 

12 among ambulatory surgical centers. 

13 ‘‘(2) NOTICE OF AVAILABILITY.—A hospital 

14 and an ambulatory surgical center shall prominently 

15 post at each admission site of the hospital or center 

16 a notice of the availability of the data reported 

17 under subsection (a) on the official public Internet 

18 site under paragraph (1). 

19 ‘‘(c) SPECIFICATION OF TREATMENT EPISODES.— 

20 For purposes of this section: 

21 ‘‘(1) IN GENERAL.—The Secretary shall iden22 tify treatment episodes for each of the following: 

23 ‘‘(A) The 25 conditions and diseases se24 lected by the Secretary as being the most freVerDate Mar 15 2010 01:08 May 13, 2012 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5709.IH H5709

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1 quently treated conditions and diseases in a 

2 hospital inpatient setting. 

3 ‘‘(B) The 25 conditions and diseases se4 lected by the Secretary as being the most fre5 quently treated conditions and diseases in a 

6 hospital outpatient setting. 

7 ‘‘(C) The 25 conditions and diseases se8 lected by the Secretary as being the most fre9 quently treated conditions and diseases in an 

10 ambulatory surgical center setting. 

11 ‘‘(2) AGREEMENT WITH IOM.—In carrying out 

12 paragraph (1), the Secretary may enter into an 

13 agreement with the Institute of Medicine to define a 

14 treatment episode for any condition or disease se15 lected by the Secretary under this subsection. 

16 ‘‘(3) UPDATING SELECTION.—The Secretary 

17 shall periodically update the conditions and diseases 

18 selected under paragraph (1). 

19 ‘‘(d) CIVIL MONEY PENALTY.—The Secretary may 

20 impose a civil money penalty of not more than $10,000 

21 for each knowing violation of subsection (a) or (b)(2) by 

22 a hospital or an ambulatory surgical center. The provi23 sions of subsection (i)(2) of section 351A shall apply with 

24 respect to civil money penalties under this subsection in 


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1 the same manner as such provisions apply to civil money 

2 penalties under subsection (i)(1) of such section. 

3 ‘‘(e) ADMINISTRATIVE PROVISIONS.— 

4 ‘‘(1) IN GENERAL.—The Secretary shall pre5 scribe such regulations and issue such guidelines as 

6 may be required to carry out this section. 

7 ‘‘(2) CLASSIFICATION OF SERVICES.—The regu8 lations and guidelines under paragraph (1) shall in9 clude rules on the classification of different treat10 ment episodes and the assignment of items and pro11 cedures to those episodes. 

12 ‘‘(3) COMPUTATION OF INSURED INDIVIDUAL

13 AVERAGE CHARGES.— 

14 ‘‘(A) IN GENERAL.—For purposes of sub15 sections (a)(1)(B)(ii) and (a)(2)(B)(ii), an in16 sured individual average charge for a treatment 

17 episode, with respect to a hospital or ambula18 tory surgical center during a period, shall be 

19 computed as the average of the rates (including 

20 any applicable copayment, coinsurance, or other 

21 costsharing) for such episode that have been ne22 gotiated by the hospital or ambulatory surgical 

23 center, respectively, with the 3 most used health 

24 insurance providers for such hospital or center 

25 during such period. 


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1 ‘‘(B) 3 MOST USED HEALTH INSURANCE

2 PROVIDERS.—For purposes of subparagraph 

3 (A), the 3 most used health insurance pro4 viders, with respect to a hospital or ambulatory 

5 surgical center during a period, are the 3 group 

6 health plans or insurance issuers offering health 

7 insurance coverage— 

8 ‘‘(i) that have negotiated with the hos9 pital or center a rate for the treatment epi10 sode involved; and 

11 ‘‘(ii) the enrollees of which represent 

12 the highest number of patients of the hos13 pital or center, respectively. 

14 ‘‘(4) COMPUTATION OF UNINSURED INDIVIDUAL

15 AVERAGE CHARGES.— 

16 ‘‘(A) IN GENERAL.—For purposes of sub17 sections (a)(1)(B)(iii) and (a)(2)(B)(iii), an un18 insured individual average charge for a treat19 ment episode, with respect to a hospital or am20 bulatory surgical center during a period, shall 

21 be computed as the average of the total 

22 amounts charged for such an episode for which 

23 care was furnished to an uninsured individual 

24 by such hospital or ambulatory surgical center 

25 during such period. 


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1 ‘‘(B) UNINSURED INDIVIDUAL DEFINED.— 

2 For purposes of subparagraph (A), the term 

3 ‘uninsured individual’ means, with respect to 

4 care furnished to the individual by a hospital or 

5 ambulatory surgical center, an individual who 

6 does not have insurance or other third-party 

7 contractual benefits that provides payment for 

8 costs incurred for such care. 

9 ‘‘(5) FORM OF REPORT AND NOTICE.—The reg10 ulations and guidelines under paragraph (1) shall 

11 specify the electronic form and manner by which a 

12 hospital or an ambulatory surgical center shall re13 port data under subsection (a) and the form for 

14 posting of notices under subsection (b)(2). 

15 ‘‘(f) RULES OF CONSTRUCTION.— 

16 ‘‘(1) NON-PREEMPTION OF STATE LAWS.— 

17 Nothing in this section shall be construed as pre18 empting or otherwise affecting any provision of 

19 State law relating to the disclosure of charges or 

20 other information for a hospital or an ambulatory 

21 surgical center. 

22 ‘‘(2) CHARGES.—Nothing in this section shall 

23 be construed to regulate or set hospital or ambula24 tory surgical center charges. 


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1 ‘‘(g) HOSPITAL AND AMBULATORY SURGICAL CEN2 TER DEFINED.—For purposes of this section, the terms 

3 ‘hospital’ and ‘ambulatory surgical center’ have the mean4 ing given such terms by the Secretary.’’. 

Æ 


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