,,ii #aafth ,,congress #ast ,session ,s4 #adig ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ae1 #bjai,mr4 ,wyden introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to improve cost and quality transparency under the ,medicare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,health ,care ,price ,check ,act of #bjai4 #b4 ,improving cost and quality transparency under the ,medicare program 7a7 ,secretary 7#a7 ,in general ,section #ahjd of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b7 is amended-- 7,a7 in subsection 7b71 in the first sentence1 by striking ,the ,secretary and inserting ,subject to subsection 7e77#a71 the ,secretary2 and 7,b7 by adding at the end the following new subsection3 7e7 ,cost and quality transparency 7#a7 ,requirements for toll-free telephone number ,not later than #a year after the date of the enactment of this ,act 7except as provided in subparagraph 7,a77iv771 the ,secretary shall ensure that the following information is available to an individual who calls the toll-free telephone number under subsection 7b73 7,a7 ,costs ,the following information regarding costs for items and services under parts ,a and ,b3 7i7 ,the individual's out-of-pocket costs for a specific item or service furnished by a specific provider of services or supplier4 7ii7 ,the payment amount under this title for such item or service furnished by such provider or supplier4 7iii7 ,the total allowable charges for such item or service furnished by such provider or supplier4 7iv7 ,not later than #b years after the date of the enactment of this ,act1 the information described in clauses 7i7 through 7iii7 for items and services that are frequently furnished together with the item or service described in such clauses1 as determined by the ,secretary4 7v7 ,an explanation of the cost-sharing components under parts ,a and ,b1 including with respect to-- 7,i7 deductibles2 7,,ii7 copayments2 and 7,,iii7 coinsurance4 7,b7 ,quality ,quality information available through the ,medicare ,physician ,compare1 ,hospital ,compare1 ,nursing ,home ,compare1 ,dialysis ,facility ,compare1 ,inpatient ,rehabilitation ,facility ,compare1 ,long-,term ,care ,hospital ,compare1 and ,hospice ,compare websites4 7,c7 ,additional information ,other cost and quality information determined appropriate by the ,secretary4 7#b7 ,internet website 7,a7 ,in general ,not later than #b years after the date of the enactment of this ,act1 the ,secretary shall ensure that an internet website is in place that meets the following requirements3 7i7 ,search function ,subject to clause 7iv71 the internet website contains a search function that enables an individual to search for an item or service in a geographic area-- 7,i7 by the type of item or service2 and 7,,ii7 by providers of services or suppliers1 including both a general search and search by a specific name4 7ii7 ,information ,the internet website is able to provide the information described in paragraph 7#a74 7iii7 ,compare function ,the internet website contains a compare function that enables an individual to compare the out-of-pocket costs and quality for an item or service furnished by different providers of services or suppliers4 7,b7 ,limit ,the ,secretary may limit the number of items and services for which information is available on the website but shall ensure that items and services which account for at least #ej percent of spending under parts ,a and ,b are included4 7,c7 ,existing website ,the ,secretary may comply with the requirements under this paragraph through the use of an internet website that is in place as of the date of the enactment of this subsection4 7#c7 ,alert regarding estimates of costs ,the ,secretary shall ensure that individuals receiving cost information under paragraph 7#a7 or 7#b7 are alerted that the information provided is an estimate and that the actual costs that the individual will be responsible for may vary4 4 7#b7 ,funding ,there are appropriated to the ,secretary of ,health and ,human ,services such sums as the ,secretary determines are necessary to carry out subsection 7e7 of section #ahjd of the ,social ,security ,act1 as added by paragraph 7#a74 7b7 ,medicare ,advantage ,section #aheb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7 is amended-- 7#a7 in subsection 7c71 by adding at the end the following new paragraph3 7#c7 ,cost and quality transparency ,for plan year #bjba and subsequent plan years1 subject to paragraph 7#d7 of subsection 7o71 the ,medicare ,advantage organization shall comply with the requirements under such subsection74 2 and 7#b7 by adding at the end the following new subsection3 7o7 ,cost and quality transparency 7#a7 ,toll-free telephone number 7,a7 ,in general ,each ,medicare ,advantage organization offering a ,medicare ,advantage plan shall have in place a toll-free telephone number under which enrollees in the plan that call the telephone number are able to receive the following information3 7i7 ,costs for items and services ,the following information regarding costs for items and services under the plan3 7,i7 ,the enrollee's out-of-pocket costs for a specific item or service furnished by a specific in-network provider of services or supplier4 7,,ii7 ,the information described in subclause 7,i7 for items and services that are frequently furnished together with the item or service described in such subclause1 as determined by the ,secretary4 7,,iii7 ,an explanation of the cost-sharing components1 both generally and under the plan specifically1 including with respect to-- 7aa7 deductibles2 7bb7 copayments2 and 7cc7 coinsurance4 7ii7 ,costs for covered part ,d drugs ,in the case of an ,,ma-,,pd plan1 the information described in section #ahfj;,d-#d7o77#a77;,a74 7iii7 ,quality ,information on the quality of items and services furnished by providers of services and suppliers under the plan1 as determined appropriate by the ,secretary4 7iv7 ,out-of-network providers ,if an enrollee of the plan requests information on an out-of-network provider of services or supplier1-- 7,i7 information on the out-of-network benefits offered under the plan2 and 7,,ii7 other information1 as determined appropriate by the ,secretary4 7v7 ,additional information ,other cost and quality information determined appropriate by the ,secretary4 7,b7 ,access ,the toll-free telephone number under subparagraph 7,a7 shall be accessible by calling a number directly or by charge-free transfer pursuant to section #ahjd7;b74 7,c7 ,integration with existing telephone number ,the requirements for a toll-free telephone number under subparagraph 7,a7 may be provided through an existing enrollee toll-free telephone number4 7#b7 ,internet website 7,a7 ,in general ,subject to clause 7iv71 each ,medicare ,advantage organization offering a ,medicare ,advantage plan shall have in place an internet website that meets the following requirements3 7i7 ,search function ,the internet website contains a search function that enables an enrollee to search-- 7,i7 for an item or service in a geographic area-- 7aa7 by the type of item or service2 and 7bb7 by providers of services or suppliers2 and 7,,ii7 in the case of an ,,ma-,,pd plan1 for a covered part ,d drug under the plan4 7ii7 ,information ,the internet website is able to provide the information described in-- 7,i7 paragraph 7#a77;,a72 and 7,,ii7 in the case of an ,,ma-,,pd plan1 section #ahfj;,d-#d7o77#a77;,a74 7iii7 ,compare function ,the internet website contains a compare function that enables an enrollee to compare-- 7,i7 the out-of-pocket costs and quality for an item or service furnished by different providers of services or suppliers2 and 7,,ii7 in the case of an ,,ma-,,pd plan1 each of subclauses 7,i7 and 7,,ii7 of section #ahfj;,d-#d7o77#b77;,a77iii7 for a covered part ,d drug4 7iv7 ,limit ,a ,medicare ,advantage organization may limit the number of items and services for which information is available on the website pursuant to the limits established by the ,secretary under section #ahjd7;e77#b77;,a77iv74 7,b7 ,integration with existing internet website ,if a ,medicare ,advantage organization offering a ,medicare ,advantage plan has in place an internet website for the plan as of the date of the enactment of this subsection1 the organization shall integrate the requirements under subparagraph 7,a7 into such website1 including through the same log-in process as the existing website4 7,c7 ,link to an external internet website for information on covered part ,d drugs ,a ,medicare ,advantage organization offering a ,medicare ,advantage plan may provide the information described subparagraph 7,a77ii77,,ii7 for the plan through a link on the plan's internet website to an external internet website4 7#c7 ,alert regarding estimates of costs ,each ,medicare ,advantage organization offering a ,medicare ,advantage plan shall ensure that enrollees of the plan receiving cost information under paragraph 7#a7 or 7#b7 are alerted that the information provided is an estimate and that the actual costs that the enrollee will be responsible for may vary4 7#d7 ,exemption ,the requirements of this subsection shall not apply to a ,medicare ,advantage organization if the total number of enrollees in all the ,medicare ,advantage plans offered by the organization is less than a number of enrollees determined appropriate by the ,secretary4 4 7c7 ,prescription drug plans ,section #ahfj;,d-#d of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7 is amended-- 7#a7 by redesignating the subsection 7m7 as added by section #fjfc7;c7 of the ,,support for ,patients and ,communities ,act 7,public ,law #aae-bga7 as subsection 7n72 and 7#b7 by adding at the end the following new subsection3 7o7 ,cost transparency ,for plan year #bjba and subsequent plan years1 subject to paragraph 7#d71 each ,,pdp sponsor offering a prescription drug plan shall comply with the following3 7#a7 ,toll-free telephone number 7,a7 ,in general ,the ,,pdp sponsor offering the prescription drug plan shall have in place a toll-free telephone number under which enrollees in the plan that call the telephone number are able to receive the following information3 7i7 ,the enrollee's out-of-pocket costs for a specific covered part ,d drug filled by a specific in-network pharmacy4 7ii7 ,an explanation of the cost-sharing components for covered part ,d drugs1 both generally and under the plan specifically1 including with respect to-- 7,i7 deductibles2 7,,ii7 copayments2 and 7,,iii7 coinsurance4 7,b7 ,integration with existing telephone number ,the requirements for a toll-free telephone number under subparagraph 7,a7 may be provided through an existing enrollee toll-free telephone number4 7#b7 ,internet website 7,a7 ,in general ,each ,,pdp sponsor offering a prescription drug plan shall have in place an internet website that meets the following requirements3 7i7 ,search function ,the internet website contains a search function that enables an enrollee to search for a covered part ,d drug under the plan4 7ii7 ,information ,the internet website is able to provide the information described in subparagraph 7,a7 of paragraph 7#a74 7iii7 ,compare function ,the internet website contains a compare function that enables an enrollee to compare each of the following for a covered part ,d drug3 7,i7 ,the out-of-pocket costs for multiple pharmacies1 including mail order if available4 7,,ii7 ,the out-of-pocket costs for clinically equivalent therapeutic options1 including but not limited to generic alternatives4 7,b7 ,integration with existing internet website ,if a ,,pdp sponsor offering a prescription drug plan has in place an internet website for the plan as of the date of the enactment of this subsection1 the organization shall integrate the requirements under subparagraph 7,a7 into such website1 including through the same log-in process as the existing website4 7,c7 ,link to an external internet website ,a ,,pdp sponsor offering a prescription drug plan may provide the information described subparagraph 7,a77ii7 for the plan through a link on the plan's internet website to an external internet website4 7#c7 ,alert regarding estimates of costs ,each ,,pdp sponsor offering a prescription drug plan shall ensure that enrollees of the plan receiving cost information under paragraph 7#a7 or 7#b7 are alerted that the information provided is an estimate and that the actual costs that the enrollee will be responsible for may vary4 7#d7 ,exemption ,the requirements of this subsection shall not apply to a ,,pdp sponsor if the total number of enrollees in all the prescription drug plans offered by the sponsor is less than a number of enrollees determined appropriate by the ,secretary4 4 #c4 ,improving cost and quality transparency under private health insurance 7a7 ,in general ,title ,,xxvii of the ,public ,health ,service ,act is amended by inserting after section #bgae;,a 7#db ,u4,s4,c4 #cjj;gg-#ae;a7 the following3 #bgae;,b4 ,improving cost and quality transparency under private health insurance 7a7 ,toll-,free telephone number 7#a7 ,in general ,a group health plan and a health insurance issuer offering group or individual health insurance coverage shall have in place a toll-free telephone number under which enrollees in the plan or coverage calling the telephone number are able to receive1 directly or through charge-free transfer1 information regarding the quality of in-network providers and facilities1 as defined by the ,secretary1 and the following information regarding out-of-pocket costs for benefits under the plan or coverage3 7,a7 ,the enrollee's out-of-pocket costs for a specific covered benefit provided by a specific in-network provider or facility1 and other covered benefits frequently associated with the specific covered benefit1 as determined by the ,secretary4 7,b7 ,an explanation of the cost-sharing components under the applicable plan or coverage1 including with respect to-- 7i7 deductibles2 7ii7 copayments2 and 7iii7 coinsurance4 7,c7 ,with respect to prescription drugs covered by the plan or coverage-- 7i7 out-of-pocket costs2 7ii7 variation in the costs1 coverage1 and prices described in clause 7i7 by pharmacy options1 including the preferred pharmacy1 mail order pharmacy 7if applicable71 and other pharmacies in the designated geographic area2 and 7iii7 variation in such costs with respect to generic or other therapeutically equivalent alternatives4 7,d7 ,with respect to services provided by an out-of-network provider1 a summary of the out-of-network benefits offered under the plan or coverage1 and other information determined appropriate by the ,secretary2 and 7,e7 ,other information determined appropriate by the ,secretary4 7#b7 ,integration with existing services ,the requirements for a toll-free telephone number under paragraph 7#a7 may be provided through an existing enrollee toll-free telephone number4 7#c7 ,prescription drug information ,a group health plan or health insurance issuer that has a contract with another entity offering prescription drug management services with respect to the plan or applicable health insurance coverage may satisfy the requirement to provide the information required under paragraph 7#a77;,c7 by connecting enrollees to a toll-free telephone service of such entity where such entity makes such information available4 7b7 ,internet website 7#a7 ,in general ,a group health plan and a health insurance issuer offering group or individual health insurance coverage shall have in place an internet website that meets the following requirements with respect to providing enrollees with information regarding the quality of in-network providers and facilities1 as defined by the ,secretary1 and information on out-of-pocket costs for benefits under the plan or coverage3 7,a7 ,search function ,the internet website contains a search function that enables an enrollee to search for a benefit in a geographic area1 at minimum-- 7i7 by the type of benefit2 and 7ii7 by providers in the area4 7,b7 ,costs ,the internet website is able to provide the following information3 7i7 ,the enrollee's out-of-pocket costs for a specific benefit provided by a specific in-network provider1 and other covered benefits frequently associated with the specific covered benefit1 as determined by the ,secretary4 7ii7 ,an explanation of the cost-sharing components1 under the applicable plan or coverage specifically1 including with respect to-- 7,i7 deductibles2 7,,ii7 copayments2 and 7,,iii7 coinsurance4 7iii7 ,with respect to prescription drugs covered by the plan or coverage-- 7,i7 out-of-pocket costs2 7,,ii7 variation in the costs described in subclause 7,i7 by pharmacy options1 including the preferred pharmacy1 mail order pharmacy 7if applicable71 and other pharmacies in the designated geographic area2 and 7,,iii7 variation in such costs1 coverage1 and prices with respect to generic or other therapeutically equivalent alternatives4 7iv7 ,with respect to services provided by an out-of-network provider1 a summary of the out-of-network benefits offered under the plan or coverage1 and other information determined appropriate by the ,secretary2 and 7v7 ,other information determined appropriate by the ,secretary4 7,c7 ,compare function ,the internet website contains a compare function that enables an enrollee to compare the out-of-pocket costs and quality measures for a benefit furnished by different providers4 7#b7 ,integration ,if a group health plan or health insurance issuer has in place an internet website for enrollees in a plan or coverage as of the date of the enactment of this section1 the plan or issuer shall integrate the requirements under paragraph 7#a7 into such website1 including through the same log-in process as the existing website4 7#c7 ,extent of information ,a group health plan or health insurance issuer may limit the number of health care services for which the information required under paragraph 7#a77;,b7 is available on the website to a number determined by the ,secretary4 7#d7 ,prescription drug information ,a group health plan or health insurance issuer that has a contract with another entity offering prescription drug management services with respect to the plan or applicable health insurance coverage may satisfy the requirement to provide the information required under paragraph 7#a77;,b77iii7 by providing a link to the internet website of such entity where such entity makes such information available4 7c7 ,disclosure requirement ,a group health plan or health insurance issuer shall inform enrollees seeking information through the toll-free telephone number under subsection 7a7 or the internet website under subsection 7b7 that the cost information provided are estimates and that the actual amount the enrollee will be responsible for paying may vary4 7d7 ,regulations ,the ,secretary1 in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall promulgate regulations to carry out this section in a manner similar to the requirements for out-of-pocket cost transparency applicable to ,medicare ,advantage organizations under section #aheb7o7 of the ,social ,security ,act4 7e7 ,exemption ,the requirements of this section shall not apply to a small or regional group health plan1 or to a small or regional health insurance issuer with respect to health insurance coverage4 ,the ,secretary shall define small or regional group health plan and small or regional health insurance issuer for purposes of this subsection4 4 7b7 ,effective date ,section #bgae;,a of the ,public ,health ,service ,act1 as added by subsection 7a71 shall take effect on ,january #a1 #bjba4