Imaging Services Price Transparency Act of 2023

Bill: 118-hr-4828
Sponsor: full_name: Rep. Carey, Mike [R-OH-15]
Introduced: 2023-07-24
Policy area: Health
Subjects: Civil actions and liability

Government information and archives

Health care costs and insurance

Health information and medical records

Health technology, devices, supplies

Internet, web applications, social media

Medicare

Photography and imaging
Latest action: action_date: 2024-12-17
text: Referred to the Subcommittee on Health.

Summaries:
action_date: 2023-07-24
action_desc: Introduced in House
text: <p><strong>Imaging Services Price Transparency Act of 2023</strong></p><p>This bill requires providers of certain imaging services under Medicare to publish their prices online.</p><p>Specifically, providers must publish and update at least annually the discounted cash price or gross charge (as applicable) for their services and, if required by the Centers for Medicare &amp; Medicaid Services (CMS), the minimum and maximum negotiated rates between the provider and insurers. The CMS must publish a list of at least 50 shoppable imaging services that are subject to these requirements; if there are fewer than 50 shoppable services, the CMS must include all imaging services on the list. Providers that fail to comply with these requirements may be subject to civil penalties.</p>

tv_txt: I 118th CONGRESS 1st Session H. R. 4828 IN THE HOUSE OF REPRESENTATIVES July 24, 2023 Mr. Carey introduced the following bill; which was referred to the Committee on Ways and Means , 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 jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to promote price transparency for imaging tests under the Medicare program.

1. Short title This Act may be cited as the Imaging Services Price Transparency Act of 2023 . 2. Promoting price transparency for imaging tests under the Medicare program Part E of title XVIII of the Social Security Act ( 42 U.S.C. 1395x et seq. ) is amended by adding at the end the following new section: 1899C. Imaging test price transparency requirement (a) In general Beginning January 1, 2025, each provider of services and supplier that receives payment under this title for furnishing a specified imaging service shall— (1) make publicly available (in a form and manner specified by the Secretary) on an Internet website the information described in subsection (b) with respect to each such service that such provider of services or supplier furnishes; and (2) ensure that such information is updated not less frequently than annually. (b) Information described For purposes of subsection (a), the information described in this subsection is, with respect to a provider of services or supplier and a specified imaging service, the following: (1) The discounted cash price for such service (or, if no such price exists, the gross charge for such service). (2) If required by the Secretary, the deidentified minimum negotiated rate in effect between such provider or supplier and any group health plan or group or individual health insurance coverage for such service and the deidentified maximum negotiated rate in effect between such provider or supplier and any such plan or coverage for such service. (c) Method and format Not later than January 1, 2028, the Secretary shall establish one or more methods and formats for each provider of services and supplier to use in compiling and making public standard charges and prices (as applicable) pursuant to subsection (a). Any such method and format— (1) may be similar to any template made available by the Centers for Medicare & Medicaid Services as of the date of the enactment of this subsection; (2) shall meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such charges and prices; and (3) shall be updated as determined appropriate by the Secretary, in consultation with stakeholders. (d) Monitoring compliance The Secretary shall, through notice and comment rulemaking and in consultation with the Inspector General of the Department of Health and Human Services, establish a process to monitor compliance with this section. (e) Specification of services Not later than January 1, 2025, the Secretary shall publish a list of at least 50 imaging services that the Secretary determines are shoppable (or all such services, if the Secretary determines that fewer than 50 such services are shoppable) between providers of services and suppliers of such services. The Secretary shall update such list as determined appropriate by the Secretary. (f) Enforcement (1) In general In the case that the Secretary determines that a provider of services or supplier is not in compliance with subsection (a)— (A) not later than 30 days after such determination, the Secretary shall notify such provider or supplier of such determination; (B) upon request of the Secretary, such provider or supplier shall submit to the Secretary, not later than 45 days after the date of such request, a corrective action plan to comply with such subsection; and (C) if such provider or supplier continues to fail to comply with such paragraph after the date that is 90 days after such notification is sent (or, in the case of such a provider or supplier that has submitted a corrective action plan described in subparagraph (B) in response to a request so described, after the date that is 90 days after such submission), the Secretary may impose a civil monetary penalty in an amount not to exceed $300 for each subsequent day during which such failure to comply or failure to submit is ongoing. (2) Increase authority In applying this paragraph with respect to violations occurring in 2027 or a subsequent year, the Secretary may through notice and comment rulemaking increase the amount of the civil monetary penalty under paragraph (1)(C). (3) Application of certain provisions The provisions of section 1128A (other than subsections (a) and (b) of such section) shall apply to a civil monetary penalty imposed under this subsection in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section. (4) Authority to waive or reduce penalty The Secretary may waive or reduce any penalty otherwise applicable with respect to a provider of services or supplier under this paragraph if the Secretary determines that imposition of such penalty would result in a significant hardship for such provider or supplier (such as in the case of a provider or supplier located in a rural or underserved area where imposition of such penalty may result in, or contribute to, a lack of access to care for individuals in such area). (5) Clarification of nonapplicability of other enforcement provisions Notwithstanding any other provision of this title, this subsection shall be the sole means of enforcing the provisions of this section. (g) Definitions In this section: (1) Group health plan; group health insurance coverage; individual health insurance coverage The terms group health plan , group health insurance coverage , and individual health insurance coverage have the meaning given such terms in section 2791 of the Public Health Service Act. (2) Specified imaging service The term specified imaging service means an imaging service that is included on the list published by the Secretary under subsection (e). .