I 
109TH CONGRESS 
1ST SESSION H. R. 4450 
To require hospitals and ambulatory surgical centers to disclose charge- 
related information and to provide price protection for treatments not 
covered by insurance as conditions for receiving protection from charge- 
related legal actions. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 6, 2005 
Mr. SESSIONS introduced the following bill; which was referred to the Com-
mittee on the Judiciary, and in addition to the Committee on Energy and 
Commerce, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To require hospitals and ambulatory surgical centers to dis-
close charge-related information and to provide price pro-
tection for treatments not covered by insurance as condi-
tions for receiving protection from charge-related legal 
actions. 
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 and ASC 
Price Disclosure and Litigation Protection Act of 2005’’.
SEC. 2. PROTECTION FROM CERTAIN LEGAL ACTIONS PRO-
VIDED TO HOSPITALS AND AMBULATORY 
SURGICAL CENTERS THAT COMPLY WITH 
CHARGE-RELATED REQUIREMENTS. 
(a) IN GENERAL.—A charge-related legal action may 
not be brought by an individual— 
(1) against a hospital, if the hospital— 
(A) has met the charge-related disclosure 
requirements under paragraphs (1)(A) and 
(2)(A) of section 3(a), with respect to such indi-
vidual; 
(B) complies with the reporting and post-
ing requirements under paragraphs (1)(A) and 
(3)(A) of section 3(b); and 
(C) has entered into an agreement under 
paragraph (1) of section 3(c) with the indi-
vidual and has met the terms of such agree-
ment; and 
(2) against an ambulatory surgical center, if 
the ambulatory surgical center— 
(A) has met the charge-related disclosure 
requirements under paragraphs (1)(B) and 
(2)(B) of section 3(a), with respect to such in-
dividual;
(B) complies with the reporting and post-
ing requirements under paragraphs (1)(B) and 
(3)(B) of section 3(b); and 
(C) has entered into an agreement under 
paragraph (2) of section 3(c) with the indi-
vidual and has met the terms of such agree-
ment. 
(b) CHARGE-RELATED LEGAL ACTION DEFINED.— 
(1) IN GENERAL.—For purposes of this section, 
the term ‘‘charge-related legal action’’ means any 
Federal or State legal action brought by an indi-
vidual for any damages or other relief, with respect 
to the amount charged by a hospital or an ambula-
tory surgical center for a treatment (or course of 
treatment), sought against the hospital or ambula-
tory surgical center, respectively, regardless of the 
legal basis for the action, including a violation of the 
Internal Revenue Code of 1986, section 1867 of the 
Social Security Act (42 U.S.C. 1395dd), or any 
other Federal law, a breach of contract claim, a 
breach of good faith and fair dealing claim, or other-
wise. 
(2) EXCEPTION.—Such term does not include a 
State legal action for which the legal basis is a claim 
of liability of the hospital or ambulatory surgical
center created by a statute of the State in which the 
action is brought. 
(c) EFFECTIVE DATE.—This section shall take effect 
on the date of the enactment of this Act and shall apply 
to actions brought on or after such day. 
SEC. 3. CHARGE-RELATED REQUIREMENTS. 
(a) CHARGE-RELATED DISCLOSURE TO INDIVIDUALS 
REQUIRED.— 
(1) PRE-TREATMENT DISCLOSURE.— 
(A) 
HOSPITAL
DISCLOSURE
REQUIRE-
MENT.—Subject to paragraph (3) and for pur-
poses of complying with section 2(a)(1)(A), the 
charge-related disclosure requirement of this 
subparagraph is that a hospital provide to an 
individual who is scheduled to receive a treat-
ment (or to begin a course of treatment) that 
is not for an emergency medical condition, the 
following (determined at the time of sched-
uling): 
(i) 
STATEMENT
REGARDING
DIS-
COUNT PRICES.—The following statement: 
‘‘Prices for enrollees in group plans and 
medicare beneficiaries may be lower be-
cause individuals pooled together in groups 
are sometimes offered discounted prices.’’.
(ii) 
ESTIMATED
PRICES
TO
BE 
CHARGED.—The estimated price that the 
hospital will charge for the treatment (or 
course of treatment). 
(iii) NETWORK PLANS AND MANAGED 
CARE PLANS PAYMENT RATE.—The rate of 
payment for the treatment (or course of 
treatment) to the hospital that has been 
negotiated by or on behalf of the hospital 
with the network plan or managed care 
plan that has the largest number of enroll-
ees, without regard to cost-sharing. 
(iv) MEDICARE PAYMENT RATE.—The 
rate of payment for the treatment (or 
course of treatment) applicable to the hos-
pital under the medicare program, without 
regard to cost-sharing. 
(B) AMBULATORY SURGICAL CENTER DIS-
CLOSURE
REQUIREMENT.—Subject to para-
graph (3) and for purposes of complying with 
section 2(a)(2)(A), the charge-related disclosure 
requirement of this subparagraph is that an 
ambulatory surgical center provide to an indi-
vidual who is scheduled to receive a treatment 
(or to begin a course of treatment) that is not
for an emergency medical condition, the fol-
lowing (determined at the time of scheduling): 
(i) 
STATEMENT
REGARDING
DIS-
COUNT PRICES.—The statement described 
in subparagraph (A)(i). 
(ii) 
ESTIMATED
PRICES
TO
BE 
CHARGED.—The estimated price that the 
ambulatory surgical center will charge for 
the treatment (or course of treatment). 
(iii) NETWORK PLANS AND MANAGED 
CARE PLANS PAYMENT RATE.—The rate of 
payment for the treatment (or course of 
treatment) to the ambulatory surgical cen-
ter that has been negotiated by or on be-
half of the ambulatory surgical center with 
the network plan or managed care plan 
that has the largest number of enrollees, 
without regard to cost-sharing. 
(iv) MEDICARE PAYMENT RATE.—The 
rate of payment for the treatment (or 
course of treatment) applicable to the am-
bulatory surgical center under the medi-
care program, without regard to cost-shar-
ing. 
(2) POST-TREATMENT DISCLOSURE.—
(A) 
HOSPITAL
DISCLOSURE
REQUIRE-
MENT.—Subject to paragraph (3) and for pur-
poses of complying with section 2(a)(1)(A), the 
charge-related disclosure requirement of this 
subparagraph is that the hospital include with 
any bill that includes the charges for a treat-
ment an itemized list of component charges for 
such treatment, including charges for drugs and 
medical equipment involved, as determined at 
the time of billing. With respect to each item 
included on such list, the hospital shall include 
the following: 
(i) PRICES CHARGED.—The price that 
the hospital charged for each item. 
(ii) NETWORK PLANS AND MANAGED 
CARE PLANS PAYMENT RATE.—The rate of 
payment for each item to the hospital that 
has been negotiated by or on behalf of the 
hospital with the network plan or managed 
care plan that has the largest number of 
enrollees, without regard to cost-sharing. 
(iii) MEDICARE PAYMENT RATE.—The 
rate of payment for each item applicable to 
the hospital under the medicare program, 
without regard to cost-sharing.
(B) AMBULATORY SURGICAL CENTER RE-
QUIREMENT.—Subject to paragraph (3) and for 
purposes of complying with section 2(a)(2)(A), 
the charge-related disclosure requirement of 
this subparagraph is that the ambulatory sur-
gical center include with any bill that includes 
the charges for a treatment an itemized list of 
component charges for such treatment, includ-
ing charges for drugs and medical equipment 
involved, as determined at the time of billing. 
With respect to each item included on such list, 
the ambulatory surgical center shall include the 
following: 
(i) PRICES CHARGED.—The price that 
the ambulatory surgical center charged for 
each item. 
(ii) NETWORK PLANS AND MANAGED 
CARE PLANS PAYMENT RATE.—The rate of 
payment for each item to the ambulatory 
surgical center that has been negotiated by 
or on behalf of the ambulatory surgical 
center with the network plan or managed 
care plan that has the largest number of 
enrollees, without regard to cost-sharing.
(iii) MEDICARE PAYMENT RATE.—The 
rate of payment for each item applicable to 
the ambulatory surgical center under the 
medicare program, without regard to cost- 
sharing. 
(3) APPLICATION OF REQUIREMENT ONLY ON 
REQUEST IF THIRD-PARTY PRICE ARRANGEMENT EX-
ISTS.—A hospital or an ambulatory surgical center 
is not required to provide the applicable information 
under paragraph (1) or (2) for a treatment (or a 
course of treatment) for which there exists a third- 
party price arrangement unless the individual in-
volved requests such information on or after the 
time of scheduling and before the time of billing for 
the treatment. 
(b) HOSPITAL
PUBLIC
REPORTING
AND
AVAIL-
ABILITY
OF
CHARGE-RELATED
INFORMATION
RE-
QUIRED.— 
(1) 
SEMIANNUAL
REPORTING
REQUIRE-
MENTS.— 
(A) FOR
HOSPITALS.—For purposes of 
complying with section 2(a)(1)(B), the report-
ing requirement of this subparagraph is that, 
not later than 80 days after the end of each 
semiannual period described in subparagraph
(C), a hospital report to the Secretary the fol-
lowing data: 
(i) The frequency with which the hos-
pital performed each procedure selected 
under clause (i) or (ii) of paragraph (4)(A) 
in an inpatient or outpatient setting, re-
spectively, during such period and the fre-
quency with which the hospital adminis-
tered a drug selected under clause (iv) of 
such paragraph in an inpatient setting 
during such period. 
(ii) If such a procedure was so per-
formed or such a drug was so administered 
during such period— 
(I) the average charge billed by 
the hospital during such period for 
such procedure or drug in cases in 
which there did not exist a third-party 
price arrangement for such procedure 
or drug; 
(II) the rate of payment during 
such period for such procedure or 
drug to the hospital that has been ne-
gotiated by or on behalf of the hos-
pital with the network plan or man-
aged care plan that has the largest 
number of enrollees, without regard to 
cost-sharing; and 
(III) the rate of payment during 
such period for such procedure or 
drug applicable to the hospital under 
the medicare program, without regard 
to cost-sharing. 
(B) FOR
AMBULATORY
SURGICAL
CEN-
TERS.—For purposes of complying with section 
2(a)(2)(B), the reporting requirement of this 
subparagraph is that, not later than 80 days 
after the end of each semiannual period de-
scribed in subparagraph (C), an ambulatory 
surgical center report to the Secretary the fol-
lowing data: 
(i) The frequency with which the am-
bulatory surgical center performed each 
procedure selected under clause (iii) of 
paragraph (4)(A) during such period. 
(ii) If the procedure was so performed 
during such period— 
(I) the average charge billed by 
the ambulatory surgical center during 
such period for such procedure in
cases in which there did not exist a 
third-party price arrangement for 
such procedure; 
(II) the rate of payment during 
such period for such procedure to the 
ambulatory surgical center that has 
been negotiated by or on behalf of the 
ambulatory surgical center with the 
network plan or managed care plan 
that has the largest number of enroll-
ees, without regard to cost-sharing; 
and 
(III) the rate of payment during 
such period for such procedure appli-
cable to the ambulatory surgical cen-
ter under the medicare program, with-
out regard to cost-sharing. 
(C) SEMIANNUAL
PERIOD
DESCRIBED.— 
For purposes of this paragraph, a semiannual 
period described in this subparagraph is a pe-
riod of six months beginning on January 1 or 
July 1, with the first such period beginning 
more than one year after the date of the enact-
ment of this Act.
(2) PUBLIC POSTING OF INFORMATION.—The 
Secretary of Health and Human Services shall 
promptly post, on the official public Internet site of 
the Department of Health and Human Services, the 
information reported under paragraph (1). Such in-
formation shall be set forth in a manner that pro-
motes charge comparison among hospitals and 
among ambulatory surgical centers. 
(3) AVAILABILITY OF INFORMATION POSTED.— 
(A) REQUIREMENT FOR HOSPITALS.—For 
purposes of complying with section 2(a)(1)(B), 
the posting requirement of this subparagraph is 
that, not later than the date of the enactment 
of this Act, a hospital prominently post at each 
admission site of the hospital— 
(i) a notice of the availability of the 
information described in paragraphs (1)(A) 
and (2)(A) of subsection (a); and 
(ii) a notice of the availability of the 
information reported under paragraph 
(1)(A) on the official public Internet site 
under paragraph (2). 
(B) 
REQUIREMENT
FOR
AMBULATORY 
SURGICAL
CENTERS.—For purposes of com-
plying with section 2(a)(2)(B), the posting re-
quirement of this subparagraph is that, not 
later than the date of the enactment of this 
Act, an ambulatory surgical center prominently 
post at each admission site of the ambulatory 
surgical center— 
(i) a notice of the availability of the 
information described in paragraphs (1)(B) 
and (2)(B) of subsection (a); and 
(ii) a notice of the availability of the 
information reported under paragraph 
(1)(B) on the official public Internet site 
under paragraph (2). 
(4) SELECTION OF PROCEDURES AND DRUGS.— 
For purposes of this subsection: 
(A) INITIAL
SELECTION.—Based on na-
tional data, the Secretary shall select the fol-
lowing: 
(i) The 25 most frequently performed 
procedures in a hospital inpatient setting, 
as identified by diagnosis-related group. 
(ii) The 25 most frequently performed 
procedures in a hospital outpatient setting, 
as identified under the classification sys-
tem for covered OPD services under sec-
tion 1833(t)(2)(A) of the Social Security 
Act (42 U.S.C. 1395l(t)(2)(A)). 
(iii) The 25 most frequently per-
formed procedures in an ambulatory sur-
gical center setting. 
(iv) The 50 most frequently adminis-
tered drugs in a hospital inpatient setting. 
(B) UPDATING
SELECTION.—The Sec-
retary shall periodically update the procedures 
and drugs selected under subparagraph (A). 
(c) CHARGE AGREEMENTS FOR UNINSURED TREAT-
MENTS.— 
(1) FOR HOSPITALS.—Subject to paragraph (3) 
and for purposes of complying with section 
2(a)(1)(C), an agreement under this paragraph is an 
agreement entered into between a hospital and an 
individual, on or after the date of scheduling treat-
ment involved for the individual and before the date 
of such treatment, that provides that the hospital 
will not charge for the treatment an amount that is 
greater than the price that has been agreed to by 
the hospital and the individual and specified in writ-
ing in such agreement. 
(2) FOR AMBULATORY SURGICAL CENTERS.— 
Subject to paragraph (3) and for purposes of com-
plying with section 2(a)(2)(C), an agreement under 
this paragraph is an agreement entered into between 
an ambulatory surgical center and an individual, on 
or after the date of scheduling treatment involved 
for the individual and before the date of such treat-
ment, that provides that the ambulatory surgical 
center will not charge for the treatment an amount 
that is greater than the price that has been agreed 
to by the ambulatory surgical center and the indi-
vidual and specified in writing in such agreement. 
(3) APPLICATION OF REQUIREMENT ONLY TO 
UNINSURED TREATMENTS.—Paragraphs (1) and (2) 
shall apply only with respect to a treatment (or 
course of treatment) for which there does not exist 
a third-party price arrangement. 
(d) 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) FORM OF REPORT AND NOTICE.—The regu-
lations and guidelines under paragraph (1) shall 
specify the following: 
(A) FOR DISCLOSURE TO INDIVIDUALS.— 
The form and manner in which a hospital or an 
ambulatory surgical center shall provide the in-
formation 
under 
subsection 
(a)(1)(A) 
or 
(a)(1)(B), respectively. 
(B) FOR PUBLIC REPORTING.—The elec-
tronic form and manner by which a hospital or 
an ambulatory surgical center shall report data 
under subsection (b)(1)(A) or (b)(1)(B), respec-
tively. 
(C) FOR PUBLIC POSTING.—The form in 
which a hospital or an ambulatory surgical cen-
ter shall post notices under subsection (b)(3)(A) 
or (b)(3)(B), respectively. 
(e) NON-PREEMPTION OF STATE LAWS.—Nothing in 
this section shall be construed as preempting or otherwise 
affecting any provision of State law relating to the disclo-
sure or posting of price, charge, or other information for 
a hospital or an ambulatory surgical center. 
SEC. 4. DEFINITIONS. 
In this Act: 
(1) AMBULATORY
SURGICAL
CENTER.—The 
term ‘‘ambulatory surgical center’’ means an ambu-
latory 
surgical 
center 
described 
in 
section 
1832(a)(2)(F)(i). 
(2) EMERGENCY
MEDICAL
CONDITION.—The 
term ‘‘emergency medical condition’’ has the mean-
ing given that term in section 1867(e)(1) of the So-
cial Security Act (42 U.S.C. 1395dd(e)(1)). 
(3) HOSPITAL.—The term ‘‘hospital’’ has the 
meaning given that term in section 1861(e) of the 
Social Security Act (42 U.S.C. 1395x(e)). 
(4) MEDICAID PROGRAM.—The term ‘‘medicaid 
program’’ means the program under title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.). 
(5) 
MEDICARE
BENEFICIARY.—The 
term 
‘‘medicare beneficiary’’ means an individual who is 
entitled to benefits under part A, and enrolled under 
part B, of the medicare program, and who is not en-
rolled in a Medicare Advantage plan under part C 
of such program. 
(6) MEDICARE PROGRAM.—The term ‘‘medicare 
program’’ means the program under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.). 
(7) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(8) STATE.—The term ‘‘State’’ includes the 
District of Columbia, the Commonwealth of Puerto 
Rico, the Virgin Islands, Guam, and American 
Samoa. 
(9) THIRD-PARTY PRICE ARRANGEMENT.—The 
term ‘‘third-party price arrangement’’ means, with
respect to a treatment (or course of treatment) in a 
hospital or an ambulatory surgical center, a contract 
or other agreement between the hospital or the am-
bulatory surgical center, respectively, and a third 
party, including an arrangement— 
(A) with a health maintenance organiza-
tion plan, network plan, or managed care plan, 
or 
(B) under the medicare or medicaid pro-
gram, 
that establishes the price or the maximum price of 
the treatment (or course of treatment) for bene-
ficiaries under the plan or title. 
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