Diagnostic Lab Testing Transparency Act

To amend title XVIII of the Social Security Act to increase price transparency of clinical diagnostic laboratory tests under the Medicare program. 1. Short title This Act may be cited as the Diagnostic Lab Testing Transparency Act 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 (1) in the header, by inserting and additional requirements sanctions (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 individual health insurance coverage (B) Specified clinical diagnostic laboratory test The term specified clinical diagnostic laboratory test .

Summary: Diagnostic Lab Testing Transparency Act This bill requires providers of clinical diagnostic laboratory tests under Medicare to publicly post certain information relating to the prices of services. Specifically, providers must post and annually update information about the discounted cash price and the minimum and maximum negotiated rates of each test, including ancillary services. The Centers for Medicare & Medicaid Services may assess civil penalties for violations.