Title: Health Care PRICE Transparency Act
Policy area: Health

Summary:
Health Care Prices Revealed and Information to Consumers Explained Transparency Act or the Health Care PRICE Transparency Act
This bill revises the format in which hospitals must list their standard charges for items and services to require that such lists are in a machine-readable format; it also revises the transparency requirements related to the costs of items and services for health insurance plans seeking certification as qualified health plans through insurance exchanges.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4106 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 4106

  To amend the Public Health Service Act to provide for hospital and 
                      insurer price transparency.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 30, 2020

 Mr. Braun (for himself, Mr. Kennedy, Mrs. Loeffler, Mr. Grassley, Mr. 
Enzi, Ms. Ernst, and Mr. Barrasso) introduced the following bill; which 
  was read twice and referred to the Committee on Health, Education, 
                          Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
  To amend the Public Health Service Act to provide for hospital and 
                      insurer price transparency.

    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 ``Health Care Prices Revealed and 
Information to Consumers Explained Transparency Act'' or the ``Health 
Care PRICE Transparency Act''.

SEC. 2. PRICE TRANSPARENCY REQUIREMENTS.

    (a) Hospitals.--Section 2718(e) of the Public Health Service Act 
(42 U.S.C. Sec.  300gg-18(e)) is amended--
            (1) by striking ``Each hospital'' and inserting the 
        following:
            ``(1) In general.--Each hospital'';
            (2) by inserting ``, in a machine-readable format, via open 
        application program interfaces (APIs)'' after ``a list'';
            (3) by inserting ``, along with such additional information 
        as the Secretary may require with respect to such charges for 
        purposes of promoting public awareness of hospital pricing in 
        advance of receiving a hospital item or service'' before the 
        period; and
            (4) by adding at the end the following:
            ``(2) Definition of standard charges.--Notwithstanding any 
        other provision of law, for purposes of paragraph (1), the term 
        `standard charges' means the rates hospitals, including 
        providers or entities that contract with or practice at a 
        hospital, charge for all items and services at a minimum, 
        chargemaster rates, rates that hospitals negotiate with third 
        party payers across all plans, including those related to a 
        patient's specific plan, discounted cash prices, and other 
        rates determined by the Secretary.
            ``(3) Enforcement.--In addition to any other enforcement 
        actions or penalties that may apply under subsection (b)(3) or 
        another provision of law, a hospital that fails to provide the 
        information required by this subsection and has not completed a 
        corrective action plan to comply with the requirements of such 
        subsection shall be subject to a civil monetary penalty of an 
        amount not to exceed $300 per day that the violation is ongoing 
        as determined by the Secretary. Such penalty shall be imposed 
        and collected in the same manner as civil money penalties under 
        subsection (a) of section 1128A of the Social Security Act are 
        imposed and collected.''.
    (b) Transparency in Coverage.--Section 1311(e)(3) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18031(e)(3)) is amended--
            (1) in subparagraph (A)--
                    (A) in clause (vii), by inserting before the period 
                the following: ``, including, for all items and 
                services covered under the plan, aggregate information 
                on specific payments the plan has made to out-of-
                network health care providers on behalf of plan 
                enrollees''; and
                    (B) by designating clause (ix) as clause (x); and
                    (C) by inserting after clause (viii), the 
                following:
                            ``(ix) Information on the specific 
                        negotiated payment rates between the plan and 
                        health care providers for all items and 
                        services covered under the plan.'';
            (2) in subparagraph (B)--
                    (A) in the heading, by striking ``use'' and 
                inserting ``delivery methods and use'';
                    (B) by inserting ``, as applicable,'' after 
                ``English proficiency''; and
                    (C) by inserting after the second sentence, the 
                following: ``The Secretary shall establish standards 
                for electronic delivery and access to such information 
                by individuals, free of charge, in machine readable 
                format, through an internet website and via open 
                APIs.'';
            (3) in subparagraph (C)--
                    (A) in the first sentence, by inserting ``or out-
                of-network provider'' after ``item or service by a 
                participating provider'';
                    (B) in the second sentence, by striking ``through 
                an internet website'' and inserting ``free of charge, 
                in machine readable format, through an internet 
                website, and via open APIs, in accordance with 
                standards established by the Secretary,''; and
                    (C) by adding at the end the following: ``Such 
                information shall include specific negotiated rates 
                that allow for comparison between providers and across 
                plans, and related to a patient's specific plan, 
                including after an enrollee has exceeded their 
                deductible responsibility.''; and
            (4) in subparagraph (D) by striking ``subparagraph (A)'' 
        and inserting ``subparagraphs (A), (B), and (C)''.
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