I 

114TH CONGRESS 

2D SESSION H. R. 5497 

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 

JUNE 16, 2016 

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 2016’’. 

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) and an appropriate link, with respect to a hos11 pital or center for which the data is reported, to 

12 other consumer quality information maintained on 

13 such site (or a site maintained by the Centers for 

14 Medicare & Medicaid Services) relating to the hos15 pital or center. Such data shall be set forth in a 

16 manner that promotes charge comparison among 

17 hospitals and among ambulatory surgical centers. 

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

19 and an ambulatory surgical center shall prominently 

20 post at each admission site of the hospital or center 

21 a notice of the availability of the data reported 

22 under subsection (a) on the official public Internet 

23 site under paragraph (1). 

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

25 For purposes of this section: 


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1 ‘‘(1) IN GENERAL.—The Secretary shall iden2 tify treatment episodes for each of the following: 

3 ‘‘(A) The 100 conditions and diseases se4 lected by the Secretary as being the most fre5 quently treated conditions and diseases in a 

6 hospital inpatient setting. 

7 ‘‘(B) The 100 conditions and diseases se8 lected by the Secretary as being the most fre9 quently treated conditions and diseases in a 

10 hospital outpatient setting. 

11 ‘‘(C) The 100 conditions and diseases se12 lected by the Secretary as being the most fre13 quently treated conditions and diseases in an 

14 ambulatory surgical center setting. 

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

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

17 agreement with the Institute of Medicine to define a 

18 treatment episode for any condition or disease se19 lected by the Secretary under this subsection. Such 

20 a definition may take into account the varying com21 plexity associated with respect to different treat22 ments. 

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

24 shall periodically update the conditions and diseases 

25 selected under paragraph (1). 


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

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

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

4 a hospital or an ambulatory surgical center. The provi5 sions of subsection (i)(2) of section 351A shall apply with 

6 respect to civil money penalties under this subsection in 

7 the same manner as such provisions apply to civil money 

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

9 ‘‘(e) ADMINISTRATIVE PROVISIONS.— 

10 ‘‘(1) IN GENERAL.—The Secretary shall pre11 scribe such regulations and issue such guidelines as 

12 may be required to carry out this section. 

13 ‘‘(2) CLASSIFICATION OF SERVICES.—The regu14 lations and guidelines under paragraph (1) shall in15 clude rules on the classification of different treat16 ment episodes and the assignment of items and pro17 cedures to those episodes. 

18 ‘‘(3) COMPUTATION OF INSURED INDIVIDUAL

19 AVERAGE CHARGES.— 

20 ‘‘(A) IN GENERAL.—For purposes of sub21 sections (a)(1)(B)(ii) and (a)(2)(B)(ii), an in22 sured individual average charge for a treatment 

23 episode, with respect to a hospital or ambula24 tory surgical center during a period, shall be 

25 computed as the average of the rates (including 


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1 any applicable copayment, coinsurance, other 

2 cost sharing, or other fees, such as facility fees, 

3 associated with treatment in the hospital or 

4 center) for such episode that have been nego5 tiated by the hospital or ambulatory surgical 

6 center, respectively, with the 5 most used health 

7 insurance providers for such hospital or center 

8 during such period. 

9 ‘‘(B) 5 MOST USED HEALTH INSURANCE

10 PROVIDERS.—For purposes of subparagraph 

11 (A), the 5 most used health insurance pro12 viders, with respect to a hospital or ambulatory 

13 surgical center during a period, are the 5 group 

14 health plans or insurance issuers offering health 

15 insurance coverage— 

16 ‘‘(i) that have negotiated with the hos17 pital or center a rate for the treatment epi18 sode involved; and 

19 ‘‘(ii) the enrollees of which represent 

20 the highest number of patients of the hos21 pital or center, respectively. 

22 ‘‘(4) COMPUTATION OF UNINSURED INDIVIDUAL

23 AVERAGE CHARGES.— 

24 ‘‘(A) IN GENERAL.—For purposes of sub25 sections (a)(1)(B)(iii) and (a)(2)(B)(iii), an unVerDate Sep 11 2014 23:34 Jun 17, 2016 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5497.IH H5497

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1 insured individual average charge for a treat2 ment episode, with respect to a hospital or am3 bulatory surgical center during a period, shall 

4 be computed as the average of the total 

5 amounts charged for such an episode for which 

6 care was furnished to an uninsured individual 

7 by such hospital or ambulatory surgical center 

8 during such period. 

9 ‘‘(B) UNINSURED INDIVIDUAL DEFINED.— 

10 For purposes of subparagraph (A), the term 

11 ‘uninsured individual’ means, with respect to 

12 care furnished to the individual by a hospital or 

13 ambulatory surgical center, an individual who 

14 does not have insurance or other third-party 

15 contractual benefits that provides payment for 

16 costs incurred for such care. 

17 ‘‘(5) FORM OF REPORT AND NOTICE.—The reg18 ulations and guidelines under paragraph (1) shall 

19 specify the electronic form and manner by which a 

20 hospital or an ambulatory surgical center shall re21 port data under subsection (a) and the form for 

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

23 ‘‘(f) RULES OF CONSTRUCTION.— 

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

25 Nothing in this section shall be construed as preVerDate Sep 11 2014 23:34 Jun 17, 2016 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5497.IH H5497

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1 empting or otherwise affecting any provision of 

2 State law relating to the disclosure of charges or 

3 other information for a hospital or an ambulatory 

4 surgical center. 

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

6 be construed to regulate or set hospital or ambula7 tory surgical center charges. 

8 ‘‘(g) HOSPITAL AND AMBULATORY SURGICAL CEN9 TER DEFINED.—For purposes of this section, the terms 

10 ‘hospital’ and ‘ambulatory surgical center’ have the mean11 ing given such terms by the Secretary.’’. 

Æ 


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