Diagnostic Lab Testing Transparency Act

Subjects: Health


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3248 Introduced in House (IH)]

&lt;DOC&gt;






118th CONGRESS
  1st Session
                                H. R. 3248

   To amend title XVIII of the Social Security Act to increase price 
transparency of clinical diagnostic laboratory tests under the Medicare 
                                program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 11, 2023

    Mrs. Miller-Meeks (for herself and Ms. DeGette) introduced the 
   following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committee on Ways and Means, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
   To amend title XVIII of the Social Security Act to increase price 
transparency of clinical diagnostic laboratory tests under the Medicare 
                                program.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Diagnostic Lab Testing Transparency 
Act''.

SEC. 2. INCREASING PRICE TRANSPARENCY OF CLINICAL DIAGNOSTIC LABORATORY 
              TESTS UNDER THE MEDICARE PROGRAM.

    Section 1846 of the Social Security Act (42 U.S.C. 1395w-2) is 
amended--
            (1) in the header, by inserting ``and additional 
        requirements'' after ``sanctions''; and
            (2) by adding at the end the following new subsection:
    ``(c) Price Transparency Requirement.--
            ``(1) In general.--Beginning January 1, 2025, each provider 
        of services or supplier that is available to furnish any 
        specified clinical diagnostic laboratory test under this title 
        shall--
                    ``(A) make publicly available on an Internet 
                website the information described in paragraph (2) with 
                respect to each such specified clinical diagnostic 
                laboratory test that such provider or supplier is so 
                available to furnish; and
                    ``(B) ensure that such information is updated not 
                less frequently than annually.
            ``(2) Information described.--For purposes of paragraph 
        (1), the information described in this paragraph is, with 
        respect to a provider of services or supplier and a specified 
        clinical diagnostic laboratory test, the following:
                    ``(A) The discounted cash price for such test (or, 
                if no such price exists, the gross charge for such 
                test).
                    ``(B) The deidentified minimum negotiated rate in 
                effect between such provider or supplier and any group 
                health plan or group or individual health insurance 
                coverage for such test.
                    ``(C) The deidentified maximum negotiated rate in 
                effect between such provider or supplier and any such 
                plan or coverage for such test.
            ``(3) Inclusion of ancillary services.--Any price or rate 
        for a specified clinical diagnostic laboratory test available 
        to be furnished by a provider of services or supplier made 
        publicly available in accordance with paragraph (1) shall 
        include the price or rate (as applicable) for any ancillary 
        item or service (such as specimen collection services) that 
        would normally be furnished by such provider or supplier as 
        part of such test, as specified by the Secretary.
            ``(4) Enforcement.--
                    ``(A) In general.--In the case that the Secretary 
                determines that a provider of services or supplier is 
                not in compliance with paragraph (1)--
                            ``(i) not later than 30 days after such 
                        determination, the Secretary shall notify such 
                        provider or supplier of such determination;
                            ``(ii) not later than 90 days after such 
                        notification is sent, such provider or supplier 
                        shall complete a corrective action plan to 
                        comply with such paragraph and submit such plan 
                        to the Secretary; and
                            ``(iii) if such provider or supplier 
                        continues to fail to comply with such paragraph 
                        after the date that is 90 days after such 
                        notification is sent, the Secretary may impose 
                        a civil monetary penalty in an amount not to 
                        exceed $300 for each day (beginning with the 
                        date that is 91 days after such notification 
                        was sent) during which such failure is ongoing.
                    ``(B) Application of certain provisions.--The 
                provisions of section 1128A (other than subsections (a) 
                and (b) of such section) shall apply to a civil 
                monetary penalty imposed under this paragraph in the 
                same manner as such provisions apply to a civil 
                monetary penalty imposed under subsection (a) of such 
                section.
            ``(5) Definitions.--In this subsection:
                    ``(A) Group health plan; group health insurance 
                coverage; individual health insurance coverage.--The 
                terms `group health plan', `group health insurance 
                coverage', and `individual health insurance coverage' 
                have the meaning given such terms in section 2791 of 
                the Public Health Service Act.
                    ``(B) Specified clinical diagnostic laboratory 
                test.--The term `specified clinical diagnostic 
                laboratory test' means a clinical diagnostic laboratory 
                test that is included on the list of shoppable services 
                specified by the Centers for Medicare & Medicaid 
                Services (as described in section 180.60 of title 42, 
                Code of Federal Regulations (or a successor 
                regulation)).''.
                                 &lt;all&gt;
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