,i #aahth ,,congress #ast ,session ,h4 ,r4 #cbha ,,in ,,the ,,house ,,of ,,representatives ,may #ae1 #bjbc ,mrs4 ,rodgers of ,washington 7for herself and ,mr4 ,pallone7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to promote hospital and insurer price transparency4 #a4 ,short title ,this ,act may be cited as the ,transparent ,prices ,required to ,inform ,consumer and ,employers ,act or the ,transparent ,,price ,act4 #b4 ,price transparency requirements 7a7 ,in general ,section #bgah7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ah7;e77 is amended-- 7#a7 by striking ,each hospital and inserting the following3 7#a7 ,in general ,each hospital 2 7#b7 by inserting 1 without subscription and free of charge1 in a single machine-readable file1 after a list2 7#c7 by inserting and a list1 in plain language and without subscription and free of charge1 in a consumer-friendly format1 of the hospital's standard charges for as many of the #gj ,centers for ,medicare ,medicaid ,services-specified shoppable services that are provided by the hospital1 and as many additional hospital-selected shoppable services 7or all such additional services1 if such hospital provides fewer than #cjj shoppable services7 as may be necessary for a combined total of at least #cjj shoppable services after ,social ,security ,act2 and 7#d7 by adding at the end the following3 ,such lists shall be updated not less frequently than annually4 ,beginning ,january #a1 #bjbd1 each hospital shall include in its lists of standard charges1 along with such additional information as the ,secretary may require with respect to such charges for purposes of promoting public awareness of hospital pricing in advance of receiving a hospital item or service1 the following3 7,a7 ,a plain language description of each item or service included on such list1 including1 as applicable1 the ,healthcare ,common ,procedure ,coding ,system 7,,hcpcs7 code1 the ,diagnosis ,related ,group 7,,drg71 the ,national ,drug ,code 7,,ndc71 or other payer identifier used or approved by the ,centers for ,medicare ,medicaid ,services for such item or service4 7,b7 ,the gross charge1 expressed as a dollar amount1 for each such item or service1 when provided in1 as applicable1 the hospital inpatient setting and outpatient department setting4 7,c7 ,any current payer-specific negotiated charges1 clearly associated with the name of the third party payer and plan and expressed as a dollar amount1 that applies to each such item or service when provided in1 as applicable1 the hospital inpatient setting and outpatient department setting4 7,d7 ,the de-identified maximum and minimum negotiated charges for each such item or service4 7,e7 ,the discounted cash price1 expressed as a dollar amount1 for each such item or service when provided in1 as applicable1 the hospital inpatient setting and outpatient department setting4 ,if the discounted cash price is a percentage of another value provided1 the calculated value must be entered as a dollar amount4 ,if the discounted cash price equates to the gross charge1 the gross charge shall be re-entered to indicate that no cash discount is available4 7#b7 ,deemed compliance with shoppable services requirement for certain years ,with respect to a year before #bjbe1 a hospital shall be deemed to meet the requirement of paragraph 7#a7 that such hospital make available a list of standard charges for shoppable services if the hospital maintains an internet-based price estimator tool that meets the following requirements3 7,a7 ,the tool provides estimates for as many of the #gj ,centers for ,medicare ,medicaid ,services specified shoppable services that are provided by the hospital1 and as many additional hospital-selected shoppable services 7or all such additional services1 if such hospital provides fewer than #cjj shoppable services7 as may be necessary for a combined total of at least #cjj shoppable services4 7,b7 ,the tool allows health care consumers to1 at the time they use the tool1 obtain an estimate of the amount they will be obligated to pay the hospital for the shoppable service4 7,c7 ,the tool is prominently displayed on the hospital's website and easily accessible to the public1 without subscription1 fee1 or having to submit personal identifying information1 and searchable by service description1 billing code1 and payer4 ,the ,secretary may not deem the establishment of an internet-based price estimator tool that meets the requirements of this paragraph to constitute compliance with the requirement of paragraph 7#a7 that such hospital make available a list of standard charges for shoppable services for #bjbe or a subsequent year4 7#c7 ,uniform method and format ,not later than ,january #a1 #bjbe1 the ,secretary shall implement a standard1 uniform method and format for hospitals to use in order to satisfy the requirements of this subsection for disclosing directly to the public charge and price information4 ,such method and format may be similar to any template established by the ,centers for ,medicare ,medicaid ,services as of the date of the enactment of this paragraph for reporting such information under this subsection and shall meet such standards as determined appropriate by the ,secretary4 7#d7 ,monitoring of pricing information ,the ,secretary1 in consultation with the ,inspector ,general of the ,department of ,health and ,human ,services1 shall1 through notice and comment rulemaking1 establish a process to regularly monitor the accuracy and validity of pricing information displayed by each hospital pursuant to paragraph 7#a74 7#e7 ,definitions ,notwithstanding any other provision of law1 for the purpose of paragraphs 7#a7 and 7#b73 7,a7 ,de-identified maximum negotiated charge ,the term de-identified maximum negotiated charge means the highest charge that a hospital has negotiated with all third party payers for an item or service4 7,b7 ,de-identified minimum negotiated charge ,the term de-identified minimum negotiated charge means the lowest charge that a hospital has negotiated with all third party payers for an item or service4 7,c7 ,discounted cash price ,the term discounted cash price means the charge that applies to an individual who pays cash1 or cash equivalent1 for a hospital item or service4 ,hospitals that do not offer self-pay discounts may display the hospital's undiscounted gross charges as found in the hospital chargemaster4 7,d7 ,gross charge ,the term gross charge means the charge for an individual item or service that is reflected on a hospital's chargemaster1 absent any discounts4 7,e7 ,payer-specific negotiated charge ,the term payer-specific negotiated charge means the charge that a hospital has negotiated with a third party payer for an item or service4 7,f7 ,shoppable service ,the term shoppable service means a service that can be scheduled by a health care consumer in advance4 7,g7 ,third party payer ,the term third party payer means an entity that is1 by statute1 contract1 or agreement1 legally responsible for payment of a claim for a health care item or service4 7#f7 ,enforcement 7,a7 ,in general ,subject to subparagraph 7,c71 in the case of a hospital that fails to comply with this subsection-- 7i7 the ,secretary shall notify such hospital of such failure not later than #cj days after the date on which the ,secretary determines such failure exists2 and 7ii7 not later than #de days after the date of such notification1 the hospital shall complete a corrective action plan to comply with such requirements4 7,b7 ,civil monetary penalty 7i7 ,in general ,in addition to any other enforcement actions or penalties that may apply under subsection 7b77#c7 or another provision of law1 a hospital that has received a notification under subparagraph 7,a77i7 and fails to satisfy the requirement under subparagraph 7,a77ii7 or otherwise comply with the requirements of this subsection by the date that is #ij days after such notification shall be subject to a civil monetary penalty of an amount-- 7,i7 in the case the hospital provides not more than #cj beds 7as determined under section #ahj4ij7;c77#b77;ii77,d7 of title #de1 ,code of ,federal ,regulations1 as in effect on the date of the enactment of this paragraph71 not to exceed #cjj per day that the violation is ongoing as determined by the ,secretary2 and 7,,ii7 in the case the hospital provides more than #cj beds 7as so determined71 equal to-- 7aa7 subject to item 7bb71 #aj per bed per day that the violation is ongoing as determined by the ,secretary1 but for violations occurring before ,january #a1 #bjbd1 not to exceed #e1ejj per each such day2 or 7bb7 in the case such hospital has failed to satisfy the requirement under subparagraph 7,a77ii7 or otherwise comply with the requirements of this subsection for any continuous #a-year period beginning on or after ,january #a1 #bjbd1 and the amount otherwise imposed under item 7aa7 for such failure for such period would be less than #e1jjj1jjj1 an amount not less than #e1jjj1jjj4 7ii7 ,increase authority ,in applying this subparagraph with respect to violations occurring in #bjbe or a subsequent year1 the ,secretary may through notice and comment rulemaking increase any dollar amount applied under this subparagraph by an amount specified by the ,secretary4 7iii7 ,application of certain provisions ,the provisions of section #aabh;,a of the ,social ,security ,act 7other than subsections 7a7 and 7b7 of such section7 shall apply to a civil monetary penalty imposed under clause 7i7 in the same manner as such provisions apply to a civil monetary penalty imposed under subsection 7a7 of such section4 7,c7 ,option to forgo notice of noncompliance ,in the case that the ,secretary determines that a hospital has failed to comply with this subsection and further determines that such hospital has made no effort to comply with such subsection1 the ,secretary may elect to request a corrective action plan from such hospital 4 7b7 ,publication of list of hospitals 7#a7 ,list of hospitals ,beginning not later than #ij days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall establish and maintain a publicly available list on the website of the ,centers for ,medicare ,medicaid ,services of each hospital with respect to which the ,secretary has conducted a review of such hospital's compliance with the provisions of section #bgah7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ah7;e774 ,such list shall include1 with respect to each such hospital that was noncompliant with such provisions1 a specification as to whether such hospital-- 7,a7 has been issued a civil monetary penalty2 7,b7 has received a warning notice2 or 7,c7 has submitted a corrective action plan4 7#b7 ,additions and updates ,in the case of a hospital not included on the list described in paragraph 7#a7 as of the date of the establishment of such list and that is subject to a review of such hospital's compliance with the provisions described in such paragraph after such date1 the ,secretary shall add such hospital to such list1 along with the specifications described in such paragraph1 not later than #a business day after such review occurs4 ,the ,secretary shall update such specifications with respect to any hospital included on such list-- 7,a7 not later than #a business day after any subsequent review of such hospital's compliance with such provisions2 and 7,b7 not later than #a business day after any penalty1 notice1 or request described in paragraph 7#a7 is made with respect to such hospital4 7#c7 ,,foia requests ,any penalty1 notice1 or request described in paragraph 7#a7 shall be subject to public disclosure1 in full and without redaction1 under section #eeb of title #ba1 ,united ,states ,code1 notwithstanding any exemptions or exclusions otherwise available under such section #eeb4 7#d7 ,reports to ,congress ,not later than #a year after the date of enactment of this ,act and each year thereafter1 the ,secretary of ,health and ,human ,services shall submit to ,congress1 and make publicly available1 a report that contains information regarding complaints of alleged violations of law and enforcement activities by the ,secretary under the hospital price transparency rule implementing section #bgah7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ah7;e774 ,such report shall be made available to the public on the website of the ,centers for ,medicare ,medicaid ,services4 ,each such report shall include1 with respect to the year involved-- 7,a7 the number of compliance and enforcement inquiries opened by the ,secretary pursuant to such section2 7,b7 the number of notices of noncompliance issued by the ,secretary based on such inquiries2 7,c7 the identity of each hospital entity that received a notice of noncompliance and the nature of the failure giving rise to the ,secretary's determination of noncompliance2 7,d7 the amount of civil monetary penalty assessed against the hospital entity2 7,e7 whether the hospital entity subsequently corrected the noncompliance2 and 7,f7 an analysis of factors contributing to increasing health care costs4 7#e7 ,,gao report ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate a report on the compliance and enforcement with the hospital price transparency rule implementing section #bgah7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ah7;e774 ,the report shall include recommendations related to-- 7,a7 improving price transparency to patients1 employers1 and the public2 and 7,b7 increased civil monetary penalty amounts to ensure compliance4 7#f7 ,request for information ,not later than ,january #a1 #bjbe1 the ,secretary of ,health and ,human ,services shall issue a public request for information as to the best method through which hospitals may be required to publish quality data 7such as data required to be reported under the ,medicare ,hospital ,compare program7 alongside data required to be reported under section #bgah7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ah7;e774 #c4 ,strengthening health insurance transparency requirements 7a7 ,transparency in coverage ,section #acaa7;e77#c77;,c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;e77#c77;,c77 is amended-- 7#a7 by striking ,the ,exchange and inserting the following3 7i7 ,in general ,the ,exchange 2 7#b7 in clause 7i71 as inserted by paragraph 7#a7-- 7,a7 by striking participating provider and inserting provider2 7,b7 by inserting shall include the information specified in clause 7ii7 and after such information2 7,c7 by striking an ,internet website and inserting a self-service tool that meets the requirements of clause 7iii72 and 7,d7 by striking and such other and all that follows through the period and inserting or1 at the option such individual1 through a paper or phone disclosure 7as selected by such individual and provided at no cost to such individual7 that meets such requirements as the ,secretary may specify42 and 7#c7 by adding at the end the following new clauses3 7ii7 ,specified information ,for purposes of clause 7i71 the information specified in this clause is1 with respect to an item or service for which benefits are available under a health plan furnished by a health care provider1 the following3 7,i7 ,if such provider is a participating provider with respect to such item or service1 the in-network rate 7as defined in subparagraph 7,f77 for such item or service4 7,,ii7 ,if such provider is not described in subclause 7,i71 the maximum allowed amount for such item or service4 7,,iii7 ,the amount of cost sharing 7including deductibles1 copayments1 and coinsurance7 that the individual will incur for such item or service 7which1 in the case such item or service is to be furnished by a provider described in subclause 7,,ii71 shall be calculated using the maximum amount described in such subclause74 7,,iv7 ,the amount the individual has already accumulated with respect to any deductible or out of pocket maximum under the plan 7broken down1 in the case separate deductibles or maximums apply to separate individuals enrolled in the plan1 by such separate deductibles or maximums1 in addition to any cumulative deductible or maximum74 7,v7 ,in the case such plan imposes any frequency or volume limitations with respect to such item or service 7excluding medical necessity determinations71 the amount that such individual has accrued towards such limitation with respect to such item or service4 7,,vi7 ,any prior authorization1 concurrent review1 step therapy1 fail first1 or similar requirements applicable to coverage of such item or service under such plan4 7iii7 ,self-service tool ,for purposes of clause 7i71 a self-service tool established by a health plan meets the requirements of this clause if such tool-- 7,i7 is based on an ,internet website2 7,,ii7 provides for real-time responses to requests described in such clause2 7,,iii7 is updated in a manner such that information provided through such tool is timely and accurate2 7,,iv7 allows such a request to be made with respect to an item or service furnished by-- 7aa7 a specific provider that is a participating provider with respect to such item or service2 7bb7 all providers that are participating providers with respect to such plan and such item or service2 or 7cc7 a provider that is not described in item 7bb72 and 7,v7 provides that such a request may be made with respect to an item or service through use of the billing code for such item or service or through use of a descriptive term for such item or service4 ,the ,secretary may require such tool1 as a condition of complying with subclause 7,v71 to link multiple billing codes to a single descriptive term if the ,secretary determines that the billing codes to be so linked correspond to items and services4 4 7b7 ,disclosure of additional information ,section #acaa7;e77#c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;e77#c77 is amended by adding at the end the following new subparagraphs3 7,e7 ,rate and payment information 7i7 ,in general ,not later than ,january #a1 #bjbe1 and every #c months thereafter1 each health plan shall submit to the ,exchange1 the ,secretary1 the ,state insurance commissioner1 and make available to the public1 the rate and payment information described in clause 7ii7 in accordance with clause 7iii74 7ii7 ,rate and payment information described ,for purposes of clause 7i71 the rate and payment information described in this clause is1 with respect to a health plan1 the following3 7,i7 ,with respect to each item or service for which benefits are available under such plan1 the in-network rate in effect as of the date of the submission of such information with each provider 7identified by national provider identifier7 that is a participating provider with respect to such item or service1 other than such a rate in effect with a provider that1 during the #a-year period ending on such date1 submitted fewer than #aj claims for such item or service to such plan4 7,,ii7 ,with respect to each drug 7identified by national drug code7 for which benefits are available under such plan1 the average amount paid by such plan 7net of rebates1 discounts1 and price concessions7 for such drug dispensed or administered during the #ij-;day period beginning #ahj days before such date of submission to each provider that was a participating provider with respect to such drug1 broken down by each such provider 7identified by national provider identifier71 other than such an amount paid to a provider that1 during such period1 submitted fewer than #bj claims for such drug to such plan4 7,,iii7 ,with respect to each item or service for which benefits are available under such plan1 the amount billed1 and the amount allowed by the plan1 for each such item or service furnished during the #ij-;day period specified in subclause 7,,ii7 by a provider that was not a participating provider with respect to such item or service1 broken down by each such provider 7identified by national provider identifier71 other than items and services with respect to which fewer than #bj claims for such item or service were submitted to such plan during such period4 7iii7 ,manner of submission ,rate and payment information required to be submitted and made available under this subparagraph shall be so submitted and so made available in #c separate machine-readable files corresponding to the information described in each of subclauses 7,i7 through 7,,iii7 of clause 7ii7 that meet such requirements as specified by the ,secretary through rulemaking4 ,such requirements shall ensure that such files are limited to an appropriate size1 are made available in a widely-available format that allows for information contained in such files to be compared across health plans1 and are accessible to individuals at no cost and without the need to establish a user account or provider other credentials4 7iv7 ,user guide ,each health plan shall make available to the public instructions written in plain language explaining how individuals may search for information described in clause 7ii7 in files submitted in accordance with clause 7iii74 7,f7 ,definitions ,in this paragraph3 7i7 ,participating provider ,the term participating provider has the meaning given such term in section #bgii;,a-#a of the ,public ,health ,service ,act4 7ii7 ,in-network rate ,the term in-network rate means1 with respect to a health plan and an item or service furnished by a provider that is a participating provider with respect to such plan and item or service1 the contracted rate in effect between such plan and such provider for such item or service4 4 7c7 ,reports 7#a7 ,compliance ,not later than ,january #a1 #bjbe1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report containing-- 7,a7 an analysis of health plan compliance with the amendments made by this section2 7,b7 an analysis of enforcement of such amendments by the ,secretaries of ,health and ,human ,services1 ,labor1 and the ,treasury2 7,c7 recommendations relating to improving such enforcement2 and 7,d7 recommendations relating to improving public disclosure1 and public awareness1 of information required to be made available by such plans pursuant to such amendments4 7#b7 ,prices ,not later than ,january #a1 #bjbh1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report containing an assessment of differences in negotiated prices 7and any trends in such prices7 in the private market between-- 7,a7 rural and urban areas2 7,b7 the individual1 small group1 and large group markets2 7,c7 consolidated and nonconsolidated health care provider areas 7as specified by the ,secretary72 7,d7 nonprofit and for-profit hospitals2 7,e7 nonprofit and for-profit insurers2 and 7,f7 insurers serving local or regional areas and insurers serving multistate or national areas4 7d7 ,effective date 7#a7 ,in general ,the amendments made by subsection 7a7 shall apply beginning ,january #a1 #bjbe4 7#b7 ,continued applicability of rules for previous years ,nothing in the amendments made by this section may be construed as affecting the applicability of the rule entitled ,transparency in ,coverage published by the ,department of the ,treasury1 the ,department of ,labor1 and the ,department of ,health and ,human ,services on ,november #ab1 #bjbj 7#he ,fed4 ,reg4 #gbaeh71 before ,january #a1 #bjbe4