Lower Costs, More Transparency Act

Bill: 118-hr-5378
Sponsor: Rep. McMorris Rodgers, Cathy [R-WA-5]
Introduced: 2023-09-08 in the House
Policy area: Health
Subjects: Administrative law and regulatory procedures
Advisory bodies
Civil actions and liability
Computers and information technology
Congressional oversight
Consumer affairs
Department of Health and Human Services
Digestive and metabolic diseases
Government information and archives
Health care costs and insurance
Health care coverage and access
Health facilities and institutions
Health personnel
Home and outpatient care
Hospital care
Medicaid
Medicare
Photography and imaging
Prescription drugs
State and local government operations
Surgery and anesthesia

Summary:
action_date: 2023-09-08
text: 

Lower Costs, More Transparency Act

 
This bill requires health care providers and insurers to disclose certain information about health care costs. It also establishes requirements for certain payment methodologies under Medicare and Medicaid and extends several public health programs.
 
For example, the bill provides statutory authority for regulations that require hospitals to annually publish their prices and related information, including the discounted cash price and negotiated charges. The bill also specifically extends these requirements to clinical laboratories, imaging service providers, and ambulatory surgical centers that participate in Medicare. Additionally, pharmacy benefit managers (PBMs) must semiannually report to health plan sponsors on the number and types of claims for covered drugs, including whether the drugs were brand-name or generic drugs and associated costs. Contracts with PBMs for employer-sponsored health plans must also allow health plan fiduciaries to audit certain claims and cost information without undue restrictions. 
 
In addition, the bill requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with PBMs under Medicaid. It also requires Medicare payments for certain drug administration services at off-campus hospital outpatient departments to be the same as that for other provider settings (i.e., physician offices).
 
The bill provides funds for the Department of Health and Human Services, the Department of Treasury, and the Department of Labor to implement and enforce the bill's requirements.
 
Finally, the bill extends several public health programs, including the Teaching Health Center Graduate Medical Education Program (through FY2030) and the National Health Service Corps (through December 31, 2025).

action_date: 2023-12-11
text: 

Lower Costs, More Transparency Act

 
This bill requires health care providers and insurers to disclose certain information about health care costs. It also establishes requirements for certain payment methodologies under Medicare and Medicaid and extends several public health programs.
 
For example, the bill provides statutory authority for regulations that require hospitals to annually publish their prices and related information, including the discounted cash price and negotiated charges. The bill also specifically extends these requirements to clinical laboratories, imaging service providers, and ambulatory surgical centers that participate in Medicare. Additionally, pharmacy benefit managers (PBMs) must semiannually report to health plan sponsors certain information on spending, rebates, and fees that are associated with covered drugs. Contracts with PBMs for employer-sponsored health plans must also allow health plan fiduciaries to audit certain claims and cost information without undue restrictions. 
 
In addition, the bill requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with PBMs under Medicaid. It also requires Medicare payments for certain drug administration services at off-campus hospital outpatient departments to be the same as that for other provider settings (i.e., physician offices).
 
The bill provides funds for the Department of Health and Human Services, the Department of Treasury, and the Department of Labor to implement and enforce the bill's requirements.
 
Finally, the bill extends several public health programs, including the Teaching Health Center Graduate Medical Education Program (through FY2030) and the National Health Service Corps (through December 31, 2025).


Legislative actions:
action_date: 2023-12-11
text: Motion to reconsider laid on the table Agreed to without objection.
action_date: 2023-12-11
text: On motion to suspend the rules and pass the bill, as amended Agreed to by the Yeas and Nays: (2/3 required): 320 - 71, 1 Present (Roll no. 708). (text: CR H6762-6785)
action_date: 2023-12-11
text: Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by the Yeas and Nays: (2/3 required): 320 - 71, 1 Present (Roll no. 708). (text: CR H6762-6785)
action_date: 2023-12-11
text: Considered as unfinished business. (consideration: CR H6801-6802)
action_date: 2023-12-11
text: At the conclusion of debate, the Yeas and Nays were demanded and ordered. Pursuant to the provisions of clause 8, rule XX, the Chair announced that further proceedings on the motion would be postponed.
action_date: 2023-12-11
text: DEBATE - The House proceeded with forty minutes of debate on H.R. 5378.
action_date: 2023-12-11
text: Considered under suspension of the rules. (consideration: CR H6762-6789)
action_date: 2023-12-11
text: Mrs. Rodgers (WA) moved to suspend the rules and pass the bill, as amended.
action_date: 2023-09-15
text: Referred to the Subcommittee on Health.
action_date: 2023-09-08
text: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
action_date: 2023-09-08
text: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
action_date: 2023-09-08
text: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
action_date: 2023-09-08
text: Introduced in House
action_date: 2023-09-08
text: Introduced in House