Health Care PRICE Transparency Act

Bill: 116-s-4106
Sponsor: full_name: Sen. Braun, Mike [R-IN]
Introduced: 2020-06-30
Policy area: Health
Subjects: Consumer affairs

Health care costs and insurance

Health care coverage and access

Health information and medical records
Latest action: action_date: 2020-06-30
text: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

Summaries:
action_date: 2020-06-30
action_desc: Introduced in Senate
text: <p><b>Health Care Prices Revealed and Information to Consumers Explained Transparency Act or the Health Care PRICE Transparency Act</b></p> <p>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.</p>

tv_txt: II 116th CONGRESS 2d Session S. 4106 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.

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 . 2. Price transparency requirements (a) Hospitals Section 2718(e) of the Public Health Service Act (42 U.S.C. § 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) .