[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4828 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 4828
To amend title XVIII of the Social Security Act to promote price
transparency for imaging tests under the Medicare program.
_______________________________________________________________________
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Imaging Services Price Transparency
Act of 2023''.
SEC. 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:
``SEC. 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).''.
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