I 

114TH CONGRESS 

2D SESSION H. R. 5547 

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 

JUNE 21, 2016 

Mr. BURGESS (for himself and Mr. GENE GREEN of Texas) 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 2016’’. 


smartinez on DSK3GLQ082PROD with BILLS
2 

•HR 5547 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.—Title XIX of the Social Security 

7 Act is amended— 

8 (1) in section 1902(a) (42 U.S.C. 1396a(a)), by 

9 inserting after paragraph (77) the following new 

10 paragraph: 

11 ‘‘(78) provide that the State will establish and 

12 maintain laws, in accordance with the requirements 

13 of section 1921A, to require disclosure of informa14 tion on hospital charges, to make such information 

15 available to the public, and to provide individuals 

16 with information about estimated out-of-pocket costs 

17 for health care services;’’; and 

18 (2) by inserting after section 1921 (42 U.S.C. 

19 1396r–2) the following new section: 

20 ‘‘INCREASING THE TRANSPARENCY OF INFORMATION ON

21 HOSPITAL CHARGES AND PROVIDING CONSUMERS

22 WITH ESTIMATES OF OUT-OF-POCKET COSTS FOR

23 HEALTH CARE SERVICES

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

25 referred to in section 1902(a)(78) are that the laws of a 

26 State must— 


smartinez on DSK3GLQ082PROD with BILLS
3 

•HR 5547 IH

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

2 ‘‘(A) require the disclosure of information 

3 on hospital charges; and 

4 ‘‘(B) provide for access to such informa5 tion; and 

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

7 the provision of a statement of the estimated out-of8 pocket costs of an individual for anticipated future 

9 health care services. 

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

11 laws of a State must— 

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

13 in the State, of information on the charges for cer14 tain inpatient and outpatient hospital services (as 

15 determined by the State) provided at the hospital; 

16 and 

17 ‘‘(2) provide for timely access to such informa18 tion by individuals seeking or requiring such serv19 ices. 

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

21 of a State must require that, upon the request of any indi22 vidual with health insurance coverage sponsored by a 

23 health insurance issuer, the issuer must provide a state24 ment of the estimated out-of-pocket costs that are likely 

25 to be incurred by the individual if the individual receives 


smartinez on DSK3GLQ082PROD with BILLS
4 

•HR 5547 IH

1 particular health care items and services within a specified 

2 period of time. 

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

4 section shall be construed as— 

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

6 establish uniform standards for the State laws re7 quired by subsections (b) and (c); 

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

9 or before the date of the enactment of this section 

10 that— 

11 ‘‘(A) meets the requirements of subsection 

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

13 law; or 

14 ‘‘(B) meets some but not all of the require15 ments of subsection (b) or subsection (c) to 

16 modify or amend such law except to the extent 

17 necessary to address the unmet requirements; 

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

19 of voluntary disclosure of information on hospital 

20 charges is in effect from adopting a law codifying 

21 such program (other than its voluntary nature) to 

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

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

24 of an individual will not exceed the estimate of such 

25 costs provided pursuant to subsection (c). 


smartinez on DSK3GLQ082PROD with BILLS
5 

•HR 5547 IH

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

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

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

4 of the Public Health Service Act. 

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

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

7 the Public Health Service Act, except that such term 

8 also includes— 

9 ‘‘(A) a Medicaid managed care organiza10 tion (as defined in section 1903(m)); and 

11 ‘‘(B) a Medicare Advantage organization 

12 (as defined in section 1859(a)(1), taking into 

13 account the operation of section 201(b) of the 

14 Medicare Prescription Drug, Improvement, and 

15 Modernization Act of 2003). 

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

17 to a Medicare Advantage organization or a Medicare 

18 Advantage plan offered by such an organization of 

19 any State law adopted to carry out the requirements 

20 of subsection (b) or (c). 

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

22 that meets the requirements of paragraphs (1) and 

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

24 section 1820(c) applies.’’. 

25 (b) EFFECTIVE DATE.— 


smartinez on DSK3GLQ082PROD with BILLS
6 

•HR 5547 IH

1 (1) IN GENERAL.—Except as provided in para2 graph (2), the amendments made by subsection (a) 

3 shall take effect on October 1, 2017. 

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

5 for medical assistance under title XIX of the Social 

6 Security Act which the Secretary of Health and 

7 Human Services determines requires State legisla8 tion (other than legislation appropriating funds) in 

9 order for the plan to meet the additional require10 ments imposed by the amendment made by sub11 section (a), the State plan shall not be regarded as 

12 failing to comply with the requirements of such title 

13 solely on the basis of its failure to meet these addi14 tional requirements before the first day of the first 

15 calendar quarter beginning after the close of the 

16 first regular session of the State legislature that be17 gins after the date of the enactment of this Act. For 

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

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

20 of such session shall be deemed to be a separate reg21 ular session of the State legislature. 


smartinez on DSK3GLQ082PROD with BILLS
7 

•HR 5547 IH

1 SEC. 3. RESEARCH ON INFORMATION VALUED BY CON2 SUMERS ON CHARGES AND OUT-OF-POCKET 

3 COSTS FOR HEALTH CARE SERVICES. 

4 (a) RESEARCH ON INFORMATION VALUED AND USED

5 BY CONSUMERS.—The Director of the Agency for 

6 Healthcare Research and Quality (in this section referred 

7 to as ‘‘AHRQ’’) shall conduct or support research, pursu8 ant to section 901(b)(1)(D) of the Public Health Service 

9 Act (42 U.S.C. 299(b)(1)(D)), on— 

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

11 out-of-pocket costs, for health care services that in12 dividuals find useful in making decisions about 

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

14 (2) how the types of information valued by indi15 viduals for making such decisions vary by whether 

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

17 the type of such coverage they have, such as tradi18 tional insurance, health maintenance organizations, 

19 preferred provider organizations, and high deductible 

20 plans coupled with health savings accounts; and 

21 (3) ways in which such information may be 

22 made available on a timely basis and in easy-to-un23 derstand form to individuals facing such decisions. 

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

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

26 18 months after the date of the enactment of this Act, 


smartinez on DSK3GLQ082PROD with BILLS
8 

•HR 5547 IH

1 together with recommendations for ways in which the Fed2 eral Government can assist the States in achieving the ob3 jective specified in subsection (a)(3). 

4 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated such sums as may be 

6 necessary to carry out this section. 

Æ 


smartinez on DSK3GLQ082PROD with BILLS