I 
112TH CONGRESS 
2D SESSION 
H. R. 5800 
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 
MAY 17, 2012 
Mr. BURGESS (for himself, Mr. GENE GREEN of Texas, Mr. CARTER, and Mr. 
THORNBERRY) 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 infor-
mation on charges and out-of-pocket costs. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Care Price 
Transparency Promotion Act of 2012’’. 
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SEC. 2. INCREASING THE TRANSPARENCY OF INFORMA-
TION ON HOSPITAL CHARGES AND MAKING 
AVAILABLE INFORMATION ON ESTIMATED 
OUT-OF-POCKET COSTS FOR HEALTH CARE 
SERVICES. 
(a) IN GENERAL.—Title XIX of the Social Security 
Act is amended— 
(1) in section 1902(a) (42 U.S.C. 1396a(a)), by 
inserting after paragraph (77) the following new 
paragraph: 
‘‘(78) provide that the State will establish and 
maintain laws, in accordance with the requirements 
of section 1921A, to require disclosure of informa-
tion on hospital charges, to make such information 
available to the public, and to provide individuals 
with information about estimated out-of-pocket costs 
for health care services;’’; and 
(2) by inserting after section 1921 (42 U.S.C. 
1396r–2) the following new section: 
‘‘INCREASING THE TRANSPARENCY OF INFORMATION ON 
HOSPITAL
CHARGES
AND
PROVIDING
CONSUMERS 
WITH
ESTIMATES
OF
OUT-OF-POCKET
COSTS
FOR 
HEALTH CARE SERVICES 
‘‘SEC. 1921A. (a) IN GENERAL.—The requirements 
referred to in section 1902(a)(78) are that the laws of a 
State must— 
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‘‘(1) in accordance with subsection (b)— 
‘‘(A) require the disclosure of information 
on hospital charges; and 
‘‘(B) provide for access to such informa-
tion; and 
‘‘(2) in accordance with subsection (c), require 
the provision of a statement of the estimated out-of- 
pocket costs of an individual for anticipated future 
health care services. 
‘‘(b) INFORMATION ON HOSPITAL CHARGES.—The 
laws of a State must— 
‘‘(1) require disclosure, by each hospital located 
in the State, of information on the charges for cer-
tain inpatient and outpatient hospital services (as 
determined by the State) provided at the hospital; 
and 
‘‘(2) provide for timely access to such informa-
tion by individuals seeking or requiring such serv-
ices. 
‘‘(c) ESTIMATED OUT-OF-POCKET COSTS.—The laws 
of a State must require that, upon the request of any indi-
vidual with health insurance coverage sponsored by a 
health insurance issuer, the issuer must provide a state-
ment of the estimated out-of-pocket costs that are likely 
to be incurred by the individual if the individual receives 
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particular health care items and services within a specified 
period of time. 
‘‘(d) RULES OF CONSTRUCTION.—Nothing in this 
section shall be construed as— 
‘‘(1) authorizing or requiring the Secretary to 
establish uniform standards for the State laws re-
quired by subsections (b) and (c); 
‘‘(2) requiring any State with a law enacted on 
or before the date of the enactment of this section 
that— 
‘‘(A) meets the requirements of subsection 
(b) or subsection (c) to modify or amend such 
law; or 
‘‘(B) meets some but not all of the require-
ments of subsection (b) or subsection (c) to 
modify or amend such law except to the extent 
necessary to address the unmet requirements; 
‘‘(3) precluding any State in which a program 
of voluntary disclosure of information on hospital 
charges is in effect from adopting a law codifying 
such program (other than its voluntary nature) to 
satisfy the requirement of subsection (b)(1); or 
‘‘(4) guaranteeing that the out-of-pocket costs 
of an individual will not exceed the estimate of such 
costs provided pursuant to subsection (c). 
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‘‘(e) DEFINITIONS.—For purposes of this section: 
‘‘(1) The term ‘health insurance coverage’ has 
the meaning given such term in section 2791(b)(1) 
of the Public Health Service Act. 
‘‘(2) The term ‘health insurance issuer’ has the 
meaning given such term in section 2791(b)(2) of 
the Public Health Service Act, except that such term 
also includes— 
‘‘(A) a Medicaid managed care organiza-
tion (as defined in section 1903(m)); and 
‘‘(B) a Medicare Advantage organization 
(as defined in 1859(a)(1), taking into account 
the operation of section 201(b) of the Medicare 
Prescription Drug, Improvement, and Mod-
ernization Act of 2003). 
Section 1856(b)(3) shall not preclude the application 
to a Medicare Advantage organization or a Medicare 
Advantage plan offered by such an organization of 
any State law adopted to carry out the requirements 
of subsection (b) or (c). 
‘‘(3) The term ‘hospital’ means an institution 
that meets the requirements of paragraphs (1) and 
(7) of section 1861(e) and includes those to which 
section 1820(c) applies.’’. 
(b) EFFECTIVE DATE.— 
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(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by subsection (a) 
shall take effect on October 1, 2013. 
(2) EXCEPTION.—In the case of a State plan 
for medical assistance under title XIX of the Social 
Security Act which the Secretary of Health and 
Human Services determines requires State legisla-
tion (other than legislation appropriating funds) in 
order for the plan to meet the additional require-
ments imposed by the amendment made by sub-
section (a), the State plan shall not be regarded as 
failing to comply with the requirements of such title 
solely on the basis of its failure to meet these addi-
tional requirements before the first day of the first 
calendar quarter beginning after the close of the 
first regular session of the State legislature that be-
gins after the date of the enactment of this Act. For 
purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year 
of such session shall be deemed to be a separate reg-
ular session of the State legislature. 
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SEC. 3. RESEARCH ON INFORMATION VALUED BY CON-
SUMERS ON CHARGES AND OUT-OF-POCKET 
COSTS FOR HEALTH CARE SERVICES. 
(a) RESEARCH ON INFORMATION VALUED AND USED 
BY
CONSUMERS.—The Director of the Agency for 
Healthcare Research and Quality (in this section referred 
to as ‘‘AHRQ’’) shall conduct or support research, pursu-
ant to section 901(b)(1)(D) of the Public Health Service 
Act (42 U.S.C. 299(b)(1)(D)), on— 
(1) the types of information on the charges, and 
out-of-pocket costs, for health care services that in-
dividuals find useful in making decisions about 
where, when, and from whom to receive care; 
(2) how the types of information valued by indi-
viduals for making such decisions vary by whether 
they have health benefits coverage and, if they do, 
the type of such coverage they have, such as tradi-
tional insurance, health maintenance organizations, 
preferred provider organizations, and high deductible 
plans coupled with health savings accounts; and 
(3) ways in which such information may be 
made available on a timely basis and in easy-to-un-
derstand form to individuals facing such decisions. 
(b) REPORT.—The Director of AHRQ shall report to 
the Congress on the results of such research not later than 
18 months after the date of the enactment of this Act, 
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together with recommendations for ways in which the Fed-
eral Government can assist the States in achieving the ob-
jective specified in subsection (a)(3). 
(c) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section. 
Æ 
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