Source: http://healthcareconsumernavigatorcenter.com/consumer-information-navigator/enacted-healthcare-state-legislation-pricing-disclose-healthcare-costs/
Timestamp: 2019-04-22 07:03:02+00:00

Document:
In the past decade, health care price transparency or disclosure of costs has emerged as a hot topic in state legislatures, as a strategy for containing health costs. States, the federal government and the private sector have enacted legal requirements and initiated programs that aim to shed light on the costs of health care services. The following describes a number of state actions over the past two decades that promote efforts to improve price transparency in health charges and provider payments.
Ariz. Rev. Stat. §36-125.05. · Requires the Arizona Department of Human Services to implement a uniform patient reporting system for all hospitals, outpatient surgical centers and emergency departments, including average charge per patient, average charge per physician.
· Also requires the state to publish a semiannual comparative report of patient charges, and simplified average charges per confinement for the most common diagnoses and procedures.
· Reports are available at:compiled-health-facility-financial-reporting.
Ark. Code Ann. §§20-7-301—307 · Provides data to the Arkansas Hospital Association for its price transparency and consumer driven health care project that will make price and quality information about Arkansas hospitals available to the public.
Cal. Health and Safety Code §1339.55., 056, .58, .585 · Requires hospitals to file a master charge description with the Office of Statewide Health Planning and Development and to estimate future charge increases for patient services.
· Requires hospitals to disclose prices for the top 25 most common outpatient services or procedures, and requires, upon request, a person to be provided with a written estimate of charges for the health care services that are reasonably expected to be provided and billed to the person if the person does not have health coverage.
· Allows for the provision of information regarding where data about hospital quality and health outcomes may be obtained.
· Upon the request of a person without health coverage, a hospital shall provide the person with a written estimate of the amount the hospital will require the person to pay for the health care services, procedures, and supplies that are reasonably expected to be provided to the person by the hospital, based upon an average length of stay and services provided for the person’s diagnosis.
· Requires health insurance carriers to provide enrollees with information regarding whether specific prescription drugs are covered under the carrier’s formulary upon request.
Cal.Insurance Code §10123.192, .199 · Requires health insurance carriers that provide coverage for prescription drugs and use a formulary to post the formulary on the carrier’s website. The formularies used by the carrier are to kept up-to-date. The carrier is to use a standard formulary template to post formularies no later than 6 months after such a template is developed. The template will be developed by January 1, 2017.
o Access the report card at: http://www.cha.com/CHA/Resources/Colorado_Hospital_Report_Card/CHA/_Resources/Colorado_Hospital_Report_Card.aspx?hkey=a513e409-4b71-4eee-bbf6-1440067be285.
Fla. Stat. §408.05, .061, .063 · Establishes the Florida Center for Health Information and Policy Analysis. Defines the duties of the Center, including, but not limited to, administrating a comprehensive health information system.
· Requires “health care facilities, health care providers, and health insurers” to provide data to the state.
20 Ill. Comp. Stat. 2215/4-1, 4-2, 4-4 · Requires the state to collect, analyze, and disseminate healthcare cost information via a uniform system.
· Requires the provision of data to the state.
· Requires the state to publish a consumer guide.
· Requires hospitals to provide prospective patients with the normal costs of service(s) prior to treatment.
Effective Jan. 1, 2014 · Massachusetts Law for Health Care Cost Reduction. 2012, chapter 224, An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation.
§ 228(a): Prior to an admission, procedure or service and upon request by a patient or prospective patient, a health care provider shall, within 2 working days, disclose the allowed amount or charge of the admission, procedure or service, including the amount for any facility fees required; provided, however, that if a health care provider is unable to quote a specific amount in advance due to the health care provider’s inability to predict the specific treatment or diagnostic code, the health care provider shall disclose the estimated maximum allowed amount or charge for a proposed admission, procedure or service, including the amount for any facility fees required.
Minn. Stat. §62J.81, .82, .823 · Requires healthcare providers to provide patients with an estimate of the costs of treatment and the costs that must be paid by the patient.
· Requires the development of a web-based system for reporting charge information, including average charge, average charge per day and median charge, for each of the 50 most common inpatient diagnosis-related groups and the 25 most common outpatient surgical. Creates the Hospital Pricing Transparency Act.
N.H. Rev. Stat. Ann. §420-G:11, G:11-a · Requires disclosure of pricing information by health carriers.
Ohio Rev. Code Ann. §3727.33—45 · Requires hospitals to submit reports to the director health. Reports must include hospital charge information.
· Authorizes the director of health to audit hospital reports.
· Requires hospitals to inform the director of health of charge data for the 60 most frequently provided outpatient service categories.
· Requires the director of health to publish information submitted by hospitals online.
· Requires the director to make information submitted by hospitals available for sale to any person or government entity 90 days after submission.
· Requires hospitals to compile a list of charges for a variety of services and to inform patients of the existence of the list at the time of admission.
Oregon Rev. Stat. §442.405, .420, .425, .450, .460, .463 · Declaration of legislative policy to require health facilities to disclose charge data.
· Requires the Administrator of the Office for Oregon Health Policy and Research to conduct studies on health care facilities costs.
· Authorizes the Administrator to create uniform systems of cost reporting.
· Exempts certain health care providers from cost reporting requirements.
· Authorizes the acceptance of cost information data from a variety of sources.
35 Pa. Stat. Ann. §449.1; §§.3—.16; .17a—.19 · The Health Care Cost Containment Act. Requires health care facilities to submit a report containing charge and payment data. The Council will compile a report using this data.
· All fees and charges for health care procedures shall be disclosed by a health care provider or facility upon request of a patient.
· Requires hospitals to provide charge information annually to the South Dakota Association of Healthcare Organizations.
· Requires the South Dakota Association of Healthcare Organizations to publish hospital charge information online to be freely available to the public.
Tex. Health & Safety Code §324.101. · Requires health care facilities to inform patients at the time of admission of whether the facility is covered by the patient’s insurance.
Utah Code Ann. §§26-33a-101—111; 115 · The Utah Health Data Authority Act. Requires the establishment of a Committee to collect health care data. Data collected must include charge and quality data. The data must be published in a report.
Va. Code Ann. §32.1-276.2—.11 · Requires providers to submit data on the utilization of “reviewable services.” The Commissioner shall negotiate and contract with a nonprofit organization for an annual survey of carriers offering private group health insurance policies, which are subject to Healthcare Effectiveness Data and Information Set (HEDIS) reporting, to determine the reimbursement that is paid for a minimum of 25 most frequently reported health care services which may include inpatient and outpatient diagnostic services, surgical services or the treatment of certain conditions or diseases. Each carrier shall report the average reimbursement paid for a specific service from all providers and provider types, to include hospitals, outpatient or ambulatory surgery centers and physician offices. Continues the Virginia Patient Level Data System.
· Requires hospitals to report inpatient and outpatient services data, including charge information.
· Requires a comparison between data submitted by providers in Virginia and national and regional providers.
· Creates the Virginia All-Payer Claims Database.
Wis. Stat. §153.05, .08, .20–.22, .45, .46 · Requires providers, except hospitals and ambulatory surgical centers, to submit data to the state. The state must analyze this data and disseminate information in a manner that is readily understandable to laypersons.
· Requires hospitals that wish to increase their prices beyond those established in the 1992 consumer price index to publish a notice of the proposed price increase prior to its implementation.
· Requires the department to compile and submit a report containing data from providers, not including hospitals or ambulatory surgical centers.
· Requires a list of hospital charge data for the 75 most common diagnoses groups requiring inpatient care and the 75 most common outpatient procedures to be distributed to hospitals.
· Requires the department to release data.
· Requires the entity charged with data collection to release data.
· Requires measures to protect patient privacy when releasing information.

References: §36
 §1339
 §10123
 §408

§ 228
 §62
 §420
 §3727
 §442
 §449
 §324
 §32
 §153