I 
113TH CONGRESS 
1ST SESSION H. R. 2853 
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 
JULY 30, 2013 
Mr. LIPINSKI (for himself, Mr. MULLIN, Mr. DEFAZIO, Mr. MICHAUD, Mr. 
PETERSON, and Mr. POLIS) introduced the following bill; which was re-
ferred 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. 
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 ‘‘Hospital Price Trans-
parency and Disclosure Act of 2013’’. 
SEC. 2. PUBLIC DISCLOSURE OF HOSPITAL DATA. 
Part B of title II of the Public Health Service Act 
(42 U.S.C. 238 et seq.) is amended by adding at the end 
the following new section: 
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‘‘DATA REPORTING BY HOSPITALS AND AMBULATORY 
SURGICAL CENTERS AND PUBLIC POSTING 
‘‘SEC. 249. (a) SEMIANNUAL REPORTING REQUIRE-
MENT.—Not later than 80 days after the end of each semi-
annual period beginning January 1 or July 1 (beginning 
more than one year after the date of the enactment of 
this section), a hospital and an ambulatory surgical center 
shall report to the Secretary the following data: 
‘‘(1) In the case of a hospital— 
‘‘(A) the frequency of occurrence for such 
hospital during such period of each treatment 
episode identified under subsection (c)(1) for a 
condition or disease selected under subpara-
graph (A) or (B) of such subsection (or up-
dated under subsection (c)(3)), furnished in an 
inpatient or outpatient setting, respectively; and 
‘‘(B) if care was furnished for such a 
treatment episode by such hospital during such 
period— 
‘‘(i) the total number of such treat-
ment episodes for which care was so fur-
nished by the hospital during such period; 
‘‘(ii) the insured individual average 
charge (as computed under subsection 
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(e)(3)) by the hospital for such treatment 
episode during such period; and 
‘‘(iii) the uninsured individual average 
charge (as computed under subsection 
(e)(4)) by the hospital for such treatment 
episode during such period. 
‘‘(2) In the case of an ambulatory surgical cen-
ter— 
‘‘(A) the frequency of occurrence for such 
center during such period of each treatment 
episode identified under subsection (c)(1) for a 
condition or disease selected under subpara-
graph (C) of such subsection (or updated under 
subsection (c)(3)); and 
‘‘(B) if care was furnished for such a 
treatment episode by such center during such 
period— 
‘‘(i) the total number of such treat-
ment episodes for which care was so fur-
nished by the center during such period; 
‘‘(ii) the insured individual average 
charge (as computed under subsection 
(e)(3)) by the center for such episode dur-
ing such period; and 
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‘‘(iii) the uninsured individual average 
charge (as computed under subsection 
(e)(4)) by the center for such episode dur-
ing such period. 
‘‘(b) PUBLIC AVAILABILITY OF DATA.— 
‘‘(1) PUBLIC
POSTING
OF
DATA.—The Sec-
retary shall promptly post, on the official public 
Internet site of the Department of Health and 
Human Services, the data reported under subsection 
(a) and an appropriate link, with respect to a hos-
pital or center for which the data is reported, to 
other consumer quality information maintained on 
such site (or a site maintained by the Centers for 
Medicare & Medicaid Services) relating to the hos-
pital or center. Such data shall be set forth in a 
manner that promotes charge comparison among 
hospitals and among ambulatory surgical centers. 
‘‘(2) NOTICE
OF
AVAILABILITY.—A hospital 
and an ambulatory surgical center shall prominently 
post at each admission site of the hospital or center 
a notice of the availability of the data reported 
under subsection (a) on the official public Internet 
site under paragraph (1). 
‘‘(c) SPECIFICATION OF TREATMENT EPISODES.— 
For purposes of this section: 
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‘‘(1) IN GENERAL.—The Secretary shall iden-
tify treatment episodes for each of the following: 
‘‘(A) The 100 conditions and diseases se-
lected by the Secretary as being the most fre-
quently treated conditions and diseases in a 
hospital inpatient setting. 
‘‘(B) The 100 conditions and diseases se-
lected by the Secretary as being the most fre-
quently treated conditions and diseases in a 
hospital outpatient setting. 
‘‘(C) The 100 conditions and diseases se-
lected by the Secretary as being the most fre-
quently treated conditions and diseases in an 
ambulatory surgical center setting. 
‘‘(2) AGREEMENT WITH IOM.—In carrying out 
paragraph (1), the Secretary may enter into an 
agreement with the Institute of Medicine to define a 
treatment episode for any condition or disease se-
lected by the Secretary under this subsection. Such 
a definition may take into account the varying com-
plexity associated with respect to different treat-
ments. 
‘‘(3) UPDATING
SELECTION.—The Secretary 
shall periodically update the conditions and diseases 
selected under paragraph (1). 
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‘‘(d) CIVIL MONEY PENALTY.—The Secretary may 
impose a civil money penalty of not more than $10,000 
for each knowing violation of subsection (a) or (b)(2) by 
a hospital or an ambulatory surgical center. The provi-
sions of subsection (i)(2) of section 351A shall apply with 
respect to civil money penalties under this subsection in 
the same manner as such provisions apply to civil money 
penalties under subsection (i)(1) of such section. 
‘‘(e) ADMINISTRATIVE PROVISIONS.— 
‘‘(1) IN
GENERAL.—The Secretary shall pre-
scribe such regulations and issue such guidelines as 
may be required to carry out this section. 
‘‘(2) CLASSIFICATION OF SERVICES.—The regu-
lations and guidelines under paragraph (1) shall in-
clude rules on the classification of different treat-
ment episodes and the assignment of items and pro-
cedures to those episodes. 
‘‘(3) COMPUTATION
OF
INSURED
INDIVIDUAL 
AVERAGE CHARGES.— 
‘‘(A) IN GENERAL.—For purposes of sub-
sections (a)(1)(B)(ii) and (a)(2)(B)(ii), an in-
sured individual average charge for a treatment 
episode, with respect to a hospital or ambula-
tory surgical center during a period, shall be 
computed as the average of the rates (including 
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any applicable copayment, coinsurance, other 
cost sharing, or other fees, such as facility fees, 
associated with treatment in the hospital or 
center) for such episode that have been nego-
tiated by the hospital or ambulatory surgical 
center, respectively, with the 5 most used health 
insurance providers for such hospital or center 
during such period. 
‘‘(B) 5 MOST USED HEALTH INSURANCE 
PROVIDERS.—For purposes of subparagraph 
(A), the 5 most used health insurance pro-
viders, with respect to a hospital or ambulatory 
surgical center during a period, are the 5 group 
health plans or insurance issuers offering health 
insurance coverage— 
‘‘(i) that have negotiated with the hos-
pital or center a rate for the treatment epi-
sode involved; and 
‘‘(ii) the enrollees of which represent 
the highest number of patients of the hos-
pital or center, respectively. 
‘‘(4) COMPUTATION OF UNINSURED INDIVIDUAL 
AVERAGE CHARGES.— 
‘‘(A) IN GENERAL.—For purposes of sub-
sections (a)(1)(B)(iii) and (a)(2)(B)(iii), an un-
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insured individual average charge for a treat-
ment episode, with respect to a hospital or am-
bulatory surgical center during a period, shall 
be computed as the average of the total 
amounts charged for such an episode for which 
care was furnished to an uninsured individual 
by such hospital or ambulatory surgical center 
during such period. 
‘‘(B) UNINSURED INDIVIDUAL DEFINED.— 
For purposes of subparagraph (A), the term 
‘uninsured individual’ means, with respect to 
care furnished to the individual by a hospital or 
ambulatory surgical center, an individual who 
does not have insurance or other third-party 
contractual benefits that provides payment for 
costs incurred for such care. 
‘‘(5) FORM OF REPORT AND NOTICE.—The reg-
ulations and guidelines under paragraph (1) shall 
specify the electronic form and manner by which a 
hospital or an ambulatory surgical center shall re-
port data under subsection (a) and the form for 
posting of notices under subsection (b)(2). 
‘‘(f) RULES OF CONSTRUCTION.— 
‘‘(1) NON-PREEMPTION
OF
STATE
LAWS.— 
Nothing in this section shall be construed as pre-
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empting or otherwise affecting any provision of 
State law relating to the disclosure of charges or 
other information for a hospital or an ambulatory 
surgical center. 
‘‘(2) CHARGES.—Nothing in this section shall 
be construed to regulate or set hospital or ambula-
tory surgical center charges. 
‘‘(g) HOSPITAL AND AMBULATORY SURGICAL CEN-
TER DEFINED.—For purposes of this section, the terms 
‘hospital’ and ‘ambulatory surgical center’ have the mean-
ing given such terms by the Secretary.’’. 
Æ 
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