Hospital and ASC Price Transparency Act of 2023

Bill: 118-hr-4839
Sponsor: full_name: Rep. Steel, Michelle [R-CA-45]
Introduced: 2023-07-24
Policy area: Health
Subjects: Civil actions and liability

Congressional oversight

Government information and archives

Health care costs and insurance

Home and outpatient care

Hospital care

Internet, web applications, social media

Medicare
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>Hospital and ASC Price Transparency Act of 2023</strong></p><p>This bill requires Medicare hospitals and ambulatory surgical centers to publish their prices.</p><p>Specifically, hospitals and ambulatory surgical centers must publish pricing information for at least 300 shoppable services designated by the Centers for Medicare &amp; Medicaid Services (CMS), including the gross charge and discounted cash price. The CMS must establish the method and manner of publication; hospitals and ambulatory surgical centers that have price estimator tools are deemed to be in compliance with the bill's requirements if the tool meets certain specified criteria.</p><p>Hospitals and ambulatory surgical centers are subject to civil penalties for noncompliance. The CMS must publish information about the status of each hospital and ambulatory surgical center's compliance.</p><p>The bill provides funds for FY2024 to implement these requirements.</p>

tv_txt: I 118th CONGRESS 1st Session H. R. 4839 IN THE HOUSE OF REPRESENTATIVES July 24, 2023 Mrs. Steel 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 require certain facilities under the Medicare program to disclose certain information relating to charges and prices.

1. Short title This Act may be cited as the Hospital and ASC Price Transparency Act of 2023 . 2. Requiring certain facilities under the Medicare program to disclose certain information relating to charges and prices (a) In general 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. Price transparency requirements (a) Price transparency requirements for specified hospitals (1) In general Beginning January 1, 2026, each specified hospital (as defined in paragraph (6)) that receives payment under this title for furnishing items and services shall comply with the price transparency requirement described in paragraph (2). (2) Requirement described (A) In general For purposes of paragraph (1), the price transparency requirement described in this paragraph is, with respect to a specified hospital, that such hospital, in accordance with a method and format established by the Secretary under subparagraph (C), compile and make public (without subscription and free of charge) for each year— (i) one or more lists, in a format specified by the Secretary (which may be a machine-readable format), of the hospital’s standard charges (including the information described in subparagraph (B)) for each item and service furnished by such hospital; and (ii) information in a consumer-friendly format (as specified by the Secretary)— (I) on the hospital’s prices (including the information described in subparagraph (B)) for as many of the Centers for Medicare & Medicaid Services-specified shoppable services that are furnished by the hospital, and as many additional hospital-selected shoppable services (or all such additional services, if such hospital furnishes fewer than 300 shoppable services) as may be necessary for a combined total of at least 300 shoppable services; and (II) that includes, with respect to each Centers for Medicare & Medicaid Services-specified shoppable service that is not furnished by the hospital, an indication that such service is not so furnished. (B) Information described For purposes of subparagraph (A), the information described in this subparagraph is, with respect to standard charges and prices (as applicable) made public by a specified hospital, the following: (i) A description of each item or service, accompanied by, as applicable, the Healthcare Common Procedure Coding System code, the diagnosis-related group, the national drug code, or other identifier used or approved by the Centers for Medicare & Medicaid Services. (ii) The gross charge, expressed as a dollar amount, for each such item or service, when provided in, as applicable, the inpatient setting and outpatient department setting. (iii) The discounted cash price, expressed as a dollar amount, for each such item or service when provided in, as applicable, the inpatient setting and outpatient department setting (or, in the case no discounted cash price is available for an item or service, the gross charge for such item or service). (iv) Any other information the Secretary may require for purposes of promoting public awareness of specified hospital standard charges or prices in advance of receiving an item or service from such a hospital, except information that is duplicative of any other reporting requirement under this section. Such information may include any current payer-specific negotiated rates, clearly associated with the name of the third party payer and plan and expressed as a dollar amount, that apply to each such item or service when provided in, as applicable, the inpatient setting and outpatient department setting. (C) Method and format Not later than January 1, 2026, the Secretary shall establish one or more methods and formats for specified facilities to use in compiling and making public standard charges and prices (as applicable) pursuant to subparagraph (A). Any such method and format— (i) may be similar to any template made available by the Centers for Medicare & Medicaid Services as of the date of the enactment of this subparagraph; (ii) shall meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such charges and prices; and (iii) shall be updated as determined appropriate by the Secretary, in consultation with stakeholders. (3) Deemed compliance with shoppable services requirement for hospitals with a price estimator tool (A) In general With respect to each year until the effective date of regulations implementing the provisions of sections 2799A–1(f) and 2799B–6 of the Public Health Service Act (relating to advanced explanations of benefits), including regulations on establishing data transfer standards to effectuate such provisions, a specified hospital shall be deemed to have complied with the requirement described in paragraph (2)(A)(ii) (relating to shoppable services) if such hospital maintains a price estimator tool described in subparagraph (B). (B) Price estimator tool described For purposes of subparagraph (A), the price estimator tool described in this subparagraph is, with respect to a specified hospital, a tool that meets the following requirements: (i) Such tool allows an individual to immediately obtain a price estimate (taking into account whether such individual is covered under any plan, coverage, or program described in clause (iv)(III)) and the discounted cash price charged by a specified hospital, for each Centers for Medicare & Medicaid Services-specified shoppable service that is furnished by such hospital, and for each additional shoppable service as such hospital may select, such that price estimates are available through such tool for at least 300 shoppable services (or for all such services, if such hospital furnishes fewer than 300 shoppable services). (ii) Such tool allows an individual to obtain such an estimate by billing code and by service description. (iii) Such tool is prominently displayed on the public internet website of such hospital. (iv) Such tool does not require an individual seeking such an estimate to create an account or otherwise input personal information, except that such tool may require that such individual provide information specified by the Secretary, which may include the following: (I) The name of such individual. (II) The date of birth of such individual. (III) In the case such individual is covered under a group health plan, group or individual health insurance coverage, a Federal health care program, or the program established under chapter 89 of title 5, United States Code, an identifying number assigned by such plan, coverage, or program to such individual. (IV) In the case of an individual described in subclause (III), an indication as to whether such individual is the primary insured individual under such plan, coverage, or program (and, if such individual is not the primary insured individual, a description of the individual’s relationship to such primary insured individual). (V) Any other information specified by the Secretary. (v) Such tool contains a statement confirming the accuracy and completeness of information presented through such tool as of the date such request is made. (vi) Such tool meets any other requirement specified by the Secretary. (4) 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 subsection. Such process shall ensure that each specified hospital’s compliance with this subsection is reviewed not less frequently than once every 3 years. (5) Enforcement (A) In general In the case of a specified hospital that fails to comply with the requirements of this subsection— (i) the Secretary shall notify such hospital of such failure not later than 30 days after the date on which the Secretary determines such failure exists; and (ii) upon request of the Secretary, the hospital shall submit to the Secretary, not later than 45 days after the date of such request, a corrective action plan to comply with such requirements. (B) Civil monetary penalty (i) In general In addition to any other enforcement actions or penalties that may apply under another provision of law, a specified hospital that has received a notification under subparagraph (A)(i) and fails to comply with the requirements of this section by the date that is 90 days after such notification (or, in the case of such a hospital that has submitted a corrective action plan described in subparagraph (A)(ii) in response to a request so described, by the date that is 90 days after the Secretary identifies the failure of such hospital to satisfactorily complete such corrective action plan) shall be subject to a civil monetary penalty of an amount specified by the Secretary for each subsequent day during which such failure is ongoing. Such amount shall not exceed— (I) in the case of a specified hospital that is a hospital or critical access hospital with 30 or fewer beds, $300 per day; and (II) in the case of any specified hospital and except as provided in clause (iii), $2,000,000 for a 1-year period. (ii) Increase authority In applying this subparagraph with respect to violations occurring in 2027 or a subsequent year, the Secretary may through notice and comment rulemaking increase— (I) the limitation on the per day amount of any penalty applicable to a specified hospital that is a hospital or critical access hospital with 30 or fewer beds under clause (i); (II) the limitation on the amount of any penalty applicable for a 1-year period under such clause; and (III) the limitation on the increase of any penalty applied under clause (iii). (iii) Persistent noncompliance In the case of a specified hospital (other than a specified hospital that is a hospital or critical access hospital with 30 or fewer beds) that the Secretary has determined to be knowingly and willfully noncompliant with the provisions of this subsection two or more times during a 1-year period, the Secretary may increase any penalty otherwise applicable under this subparagraph by not more than $1,000,000 and may require such hospital to complete such additional corrective actions plans as the Secretary may specify. (iv) 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 subparagraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section. (v) Authority to waive or reduce penalty The Secretary may waive or reduce any penalty otherwise applicable with respect to a specified hospital under this subparagraph if the Secretary determines that imposition of such penalty would result in a significant hardship for such hospital (such as in the case of a hospital 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). (C) Publication of hospital price transparency information Beginning on January 1, 2026, the Secretary shall make publicly available on the public website of the Centers for Medicare & Medicaid Services information with respect to compliance with the requirements of this subsection and enforcement activities undertaken by the Secretary under this subsection. Such information shall be updated not less than annually and include, with respect to each year— (i) the number of reviews of compliance with this subsection undertaken by the Secretary; (ii) the number of notifications described in subparagraph (A)(i) sent by the Secretary; (iii) the identify of each specified hospital that was sent such a notification and a description of the nature of such hospital’s noncompliance with this subsection; (iv) the amount of any civil monetary penalty imposed on such hospital under subparagraph (B); (v) whether such hospital subsequently came into compliance with this subsection; and (vi) any other information as determined by the Secretary. (6) Definitions For purposes of this subsection: (A) Discounted cash price The term discounted cash price means the charge that applies to an individual who pays cash, or cash equivalent, for a specified hospital-furnished item or service. (B) Federal health care program The term Federal health care program has the meaning given such term in section 1128B. (C) Gross charge The term gross charge means the charge for an individual item or service that is reflected on a specified hospital’s chargemaster, absent any discounts. (D) 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. (E) Payer-specific negotiated charge The term payer-specific negotiated charge means the charge that a specified hospital has negotiated with a third party payer for an item or service. (F) Shoppable service The term shoppable service means a service that can be scheduled by a health care consumer in advance and includes all ancillary items and services customarily furnished as part of such service. (G) Specified hospital The term specified hospital means a hospital (as defined in section 1861(e)), a critical access hospital (as defined in section 1861(mmm)(1)), or a rural emergency hospital (as defined in section 1861(kkk)). (H) Third party payer The term third party payer means an entity that is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service. (b) Price transparency requirements for ambulatory surgical centers (1) In general Beginning January 1, 2028, each ambulatory surgical center that receives payment under this title for furnishing items and services shall comply with the price transparency requirement described in paragraph (2). (2) Requirement described (A) In general For purposes of paragraph (1), the price transparency requirement described in this subsection is, with respect to an ambulatory surgical center, that such surgical center in accordance with a method and format established by the Secretary under subparagraph (C)), compile and make public (without subscription and free of charge), for each year— (i) one or more lists, in a format specified by the Secretary, of the surgical center’s standard charges (including the information described in subparagraph (B)) for each item and service furnished by the surgical center; (ii) information on the surgical center’s prices (including the information described in subparagraph (B)) for as many of the Centers for Medicare & Medicaid Services-specified shoppable services that are furnished by the surgical center, and as many additional surgical center-selected shoppable services (or all such additional services, if such surgical center furnishes fewer than 300 shoppable services) as may be necessary for a combined total of at least 300 shoppable services; (iii) with respect to each Centers for Medicare & Medicaid Services-specified shoppable service that is not furnished by the ambulatory surgical center, an indication that such service is not so furnished; and (iv) any additional information specified by the Secretary. (B) Information described For purposes of subparagraph (A), the information described in this subparagraph is, with respect to standard charges and prices (as applicable) made public by a specified surgical center, the following: (i) A description of each item or service, accompanied by, as applicable, the Healthcare Common Procedure Coding System code, the diagnosis-related group, the national drug code, or other identifier used or approved by the Centers for Medicare & Medicaid Services. (ii) The gross charge, expressed as a dollar amount, for each such item or service. (iii) The discounted cash price, expressed as a dollar amount, for each such item or service (or, in the case no discounted cash price is available for an item or service, the median price charged by such ambulatory surgical center for such item or service for the previous three years, expressed as a dollar amount). (iv) Any other information the Secretary may require that is not duplicative of any other reporting requirement under this subsection for purposes of promoting public awareness of ambulatory surgical center prices in advance of receiving an item or service from such an ambulatory surgical center, which may include any current payer-specific negotiated rates, clearly associated with the name of the third party payer and plan and expressed as a dollar amount, that applies to each such item or service. (C) Method and format Not later than January 1, 2028, the Secretary shall establish one or more methods and formats for ambulatory surgical centers to use in making public standard charges and prices (as applicable) pursuant to subparagraph (A). Any such method and format— (i) may be similar to any template made available by the Centers for Medicare & Medicaid Services as of the date of the enactment of this paragraph; (ii) shall meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such charges and prices; and (iii) shall be updated as determined appropriate by the Secretary, in consultation with stakeholders. (3) Deemed compliance with shoppable services requirement for ambulatory surgical centers with a price estimator tool (A) In general An ambulatory surgical center shall be deemed to have complied with the requirement described in subsection (b)(1)(B) (relating to shoppable services) if such surgical center maintains a price estimator tool described in subparagraph (B). (B) Price estimator tool described For purposes of subparagraph (A), the price estimator tool described in this subparagraph is, with respect to an ambulatory surgical center, a tool that meets the following requirements: (i) Such tool allows an individual to immediately obtain a price estimate (taking into account whether such individual is covered under any plan, coverage, or program described in subparagraph (C)(iii)) for each Centers for Medicare & Medicaid Services-specified shoppable service that is furnished by the surgical center, and for each additional shoppable service as such surgical center may select such that price estimates are available through such tool for at least 300 shoppable services (or for all such services, if such surgical center furnishes fewer than 300 shoppable services). (ii) Such tool allows an individual to obtain such an estimate by billing code and by service description. (iii) Such tool is prominently displayed on the public internet website of such ambulatory surgical center. (iv) Such tool does not require an individual seeking such an estimate to create an account or otherwise input personal information, except that such tool may require that such individual provide information specified by the Secretary, which may include the following: (I) The name of such individual. (II) The date of birth of such individual. (III) In the case such individual is covered under a group health plan, group or individual health insurance coverage, a Federal health care program, or the program established under chapter 89 of title 5, United States Code, an identifying number assigned by such plan, coverage, or program to such individual. (IV) In the case of an individual described in clause (iii), an indication as to whether such individual is the primary insured individual under such plan, coverage, or program (and, if such individual is not the primary insured individual, a description of the individual’s relationship to such primary insured individual). (V) Any other information specified by the Secretary. (v) Such tool contains a statement confirming the accuracy and completeness of information presented through such tool as of the date such request is made. (vi) Such tool meets any other requirement specified by the Secretary. (4) 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 subsection. Such process shall ensure that each ambulatory surgical center’s compliance with this subsection is reviewed not less frequently than once every 3 years. (5) Enforcement (A) In general In the case of an ambulatory surgical center that fails to comply with the requirements of this subsection— (i) the Secretary shall notify such ambulatory surgical center of such failure not later than 30 days after the date on which the Secretary determines such failure exists; and (ii) upon request of the Secretary, the ambulatory surgical center shall submit to the Secretary, not later than 45 days after the date of such request, a corrective action plan to comply with such requirements. (B) Civil monetary penalty (i) In general In addition to any other enforcement actions or penalties that may apply under another provision of law, an ambulatory surgical center that has received a notification under subparagraph (A)(i) and fails to comply with the requirements of this subsection by the date that is 90 days after such notification (or, in the case of an ambulatory surgical center that has submitted a corrective action plan described in subparagraph (A)(ii) in response to a request so described, by the date that is 90 days after such submission) shall be subject to a civil monetary penalty of an amount specified by the Secretary for each subsequent day during which such failure is ongoing (not to exceed $300 per day). (ii) Increase authority In applying this subparagraph with respect to violations occurring in 2027 or a subsequent year, the Secretary may through notice and comment rulemaking increase the limitation on the per day amount of any penalty applicable to an ambulatory surgical center under clause (i). (iii) 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 subparagraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section. (iv) Authority to waive or reduce penalty The Secretary may waive or reduce any penalty otherwise applicable with respect to an ambulatory surgical center under this subparagraph if the Secretary determines that imposition of such penalty would result in a significant hardship for such ambulatory surgical center (such as in the case of an ambulatory surgical center 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). (6) Definitions For purposes of this section: (A) Discounted cash price The term discounted cash price means the charge that applies to an individual who pays cash, or cash equivalent, for a item or service furnished by an ambulatory surgical center. (B) Federal health care program The term Federal health care program has the meaning given such term in section 1128B. (C) Gross charge The term gross charge means the charge for an individual item or service that is reflected on a specified surgical center’s chargemaster, absent any discounts. (D) 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. (E) Payer-specific negotiated charge The term payer-specific negotiated charge means the charge that a specified surgical center has negotiated with a third party payer for an item or service. (F) Shoppable service The term shoppable service means a service that can be scheduled by a health care consumer in advance and includes all ancillary items and services customarily furnished as part of such service. (G) Third party payer The term third party payer means an entity that is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service. . (b) Publication of hospital compliance with price transparency requirements Section 1886 of the Social Security Act ( 42 U.S.C. 1395ww ) is amended by adding at the end the following new subsection: (u) Publication of compliance with price transparency requirements (1) In general Beginning January 1, 2026, the Secretary shall, for each hospital with respect to which the Secretary has conducted a review of such hospital’s compliance with the provisions of section 1899C(a) and found such hospital noncompliant with such provisions— (A) indicate such noncompliance on such hospital’s entry on the Hospital Compare internet website (or a successor website); and (B) specify whether such hospital— (i) submitted a corrective action plan described in subsection (a)(5)(A)(ii) of such section (and, if so, the date such plan was received by the Secretary); or (ii) was subject to a civil monetary penalty imposed under subsection (a)(5) of such section (and, if so, the date of the imposition of such penalty and the amount of such penalty). (2) Additions and updates The Secretary shall update any specification described in subparagraph (A) or (B) of paragraph (1) with respect to such hospital— (A) in the case of the specification described in such paragraph (1)(B)(i), as soon as practicable after sending a notification described in such subparagraph; and (B) in the case of the specification described in such paragraph (1)(B)(ii), as soon as practicable after the imposition of a civil monetary penalty described in such subparagraph. . (c) Conforming amendment Section 2718(e) of the Public Health Service Act ( 42 U.S.C. 300gg–18(e) ) is amended by adding at the end the following new sentence: The preceding sentence shall not apply beginning January 1, 2026. . (d) Funding (1) In general In addition to funds otherwise available, out of any moneys in the Treasury not otherwise appropriated, there are appropriated $10,000,000 for fiscal year 2024, to remain available until expended, for purposes of— (A) implementing the amendment made by this subsection (a); and (B) monitoring the compliance of entities with such amendment. (2) Report on expenditures Not later than 5 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report that— (A) describes activities undertaken funded through funds made available under paragraph (1), including a specification of the amount of such funds expended for each such activity; and (B) identifies all entities with which the Secretary has entered into contracts for purposes of implementing the amendment made by this subsection (a), monitoring compliance of entities with such amendment, or providing technical assistance to entities to promote compliance with such amendment. (e) Implementation (1) Accessibility In implementing section 1899C(a)(2)(A)(ii) of the Social Security Act (as added by subsection (a)), the Secretary of Health and Human Services shall through rulemaking ensure that information made available pursuant to such amendment by an entity is so made available in plain, easily understandable language and that such entity provides access to such interpretation services, translations, and other assistive services to make such information accessible to individuals with limited English proficiency and individuals with disabilities. (2) Technical assistance The Secretary of Health and Human Services shall, to the extent practicable, provide technical assistance to entities making public standard charges and prices (as applicable) pursuant to the amendment made by subsection (a).