[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4839 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 4839
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.
_______________________________________________________________________
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.
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 ``Hospital and ASC Price Transparency
Act of 2023''.
SEC. 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:
``SEC. 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).
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