,i #aahth ,,congress #ast ,session ,h4 ,r4 #dhci ,,in ,,the ,,house ,,of ,,representatives ,july #bd1 #bjbc,mrs4 ,steel introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 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 prices4 #a4 ,short title ,this ,act may be cited as the ,hospital and ,,asc ,price ,transparency ,act of #bjbc4 #b4 ,requiring certain facilities under the ,medicare program to disclose certain information relating to charges and prices 7a7 ,in general ,part ,e of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex et seq47 is amended by adding at the end the following new section3 #ahii;,c4 ,price transparency requirements 7a7 ,price transparency requirements for specified hospitals 7#a7 ,in general ,beginning ,january #a1 #bjbf1 each specified hospital 7as defined in paragraph 7#f77 that receives payment under this title for furnishing items and services shall comply with the price transparency requirement described in paragraph 7#b74 7#b7 ,requirement described 7,a7 ,in general ,for purposes of paragraph 7#a71 the price transparency requirement described in this paragraph is1 with respect to a specified hospital1 that such hospital1 in accordance with a method and format established by the ,secretary under subparagraph 7,c71 compile and make public 7without subscription and free of charge7 for each year-- 7i7 one or more lists1 in a format specified by the ,secretary 7which may be a machine-readable format71 of the hospital's standard charges 7including the information described in subparagraph 7,b77 for each item and service furnished by such hospital2 and 7ii7 information in a consumer-friendly format 7as specified by the ,secretary7-- 7,i7 on the hospital's prices 7including the information described in subparagraph 7,b77 for as many of the ,centers for ,medicare ,medicaid ,services-specified shoppable services that are furnished by the hospital1 and as many additional hospital-selected shoppable services 7or all such additional services1 if such hospital furnishes fewer than #cjj shoppable services7 as may be necessary for a combined total of at least #cjj shoppable services2 and 7,,ii7 that includes1 with respect to each ,centers for ,medicare ,medicaid ,services-specified shoppable service that is not furnished by the hospital1 an indication that such service is not so furnished4 7,b7 ,information described ,for purposes of subparagraph 7,a71 the information described in this subparagraph is1 with respect to standard charges and prices 7as applicable7 made public by a specified hospital1 the following3 7i7 ,a description of each item or service1 accompanied by1 as applicable1 the ,healthcare ,common ,procedure ,coding ,system code1 the diagnosis-related group1 the national drug code1 or other identifier used or approved by the ,centers for ,medicare ,medicaid ,services4 7ii7 ,the gross charge1 expressed as a dollar amount1 for each such item or service1 when provided in1 as applicable1 the inpatient setting and outpatient department setting4 7iii7 ,the discounted cash price1 expressed as a dollar amount1 for each such item or service when provided in1 as applicable1 the inpatient setting and outpatient department setting 7or1 in the case no discounted cash price is available for an item or service1 the gross charge for such item or service74 7iv7 ,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 hospital1 except information that is duplicative of any other reporting requirement under this section4 ,such information may include any current payer-specific negotiated rates1 clearly associated with the name of the third party payer and plan and expressed as a dollar amount1 that apply to each such item or service when provided in1 as applicable1 the inpatient setting and outpatient department setting4 7,c7 ,method and format ,not later than ,january #a1 #bjbf1 the ,secretary shall establish one or more methods and formats for specified facilities to use in compiling and making public standard charges and prices 7as applicable7 pursuant to subparagraph 7,a74 ,any such method and format-- 7i7 may be similar to any template made available by the ,centers for ,medicare ,medicaid ,services as of the date of the enactment of this subparagraph2 7ii7 shall meet such standards as determined appropriate by the ,secretary in order to ensure the accessibility and usability of such charges and prices2 and 7iii7 shall be updated as determined appropriate by the ,secretary1 in consultation with stakeholders4 7#c7 ,deemed compliance with shoppable services requirement for hospitals with a price estimator tool 7,a7 ,in general ,with respect to each year until the effective date of regulations implementing the provisions of sections #bgii;,a-#a7;f7 and #bgii;,b-#f of the ,public ,health ,service ,act 7relating to advanced explanations of benefits71 including regulations on establishing data transfer standards to effectuate such provisions1 a specified hospital shall be deemed to have complied with the requirement described in paragraph 7#b77;,a77ii7 7relating to shoppable services7 if such hospital maintains a price estimator tool described in subparagraph 7,b74 7,b7 ,price estimator tool described ,for purposes of subparagraph 7,a71 the price estimator tool described in this subparagraph is1 with respect to a specified hospital1 a tool that meets the following requirements3 7i7 ,such tool allows an individual to immediately obtain a price estimate 7taking into account whether such individual is covered under any plan1 coverage1 or program described in clause 7iv77,,iii77 and the discounted cash price charged by a specified hospital1 for each ,centers for ,medicare ,medicaid ,services-specified shoppable service that is furnished by such hospital1 and for each additional shoppable service as such hospital may select1 such that price estimates are available through such tool for at least #cjj shoppable services 7or for all such services1 if such hospital furnishes fewer than #cjj shoppable services74 7ii7 ,such tool allows an individual to obtain such an estimate by billing code and by service description4 7iii7 ,such tool is prominently displayed on the public internet website of such hospital4 7iv7 ,such tool does not require an individual seeking such an estimate to create an account or otherwise input personal information1 except that such tool may require that such individual provide information specified by the ,secretary1 which may include the following3 7,i7 ,the name of such individual4 7,,ii7 ,the date of birth of such individual4 7,,iii7 ,in the case such individual is covered under a group health plan1 group or individual health insurance coverage1 a ,federal health care program1 or the program established under chapter #hi of title #e1 ,united ,states ,code1 an identifying number assigned by such plan1 coverage1 or program to such individual4 7,,iv7 ,in the case of an individual described in subclause 7,,iii71 an indication as to whether such individual is the primary insured individual under such plan1 coverage1 or program 7and1 if such individual is not the primary insured individual1 a description of the individual's relationship to such primary insured individual74 7,v7 ,any other information specified by the ,secretary4 7v7 ,such tool contains a statement confirming the accuracy and completeness of information presented through such tool as of the date such request is made4 7vi7 ,such tool meets any other requirement specified by the ,secretary4 7#d7 ,monitoring compliance ,the ,secretary shall1 through notice and comment rulemaking and in consultation with the ,inspector ,general of the ,department of ,health and ,human ,services1 establish a process to monitor compliance with this subsection4 ,such process shall ensure that each specified hospital's compliance with this subsection is reviewed not less frequently than once every #c years4 7#e7 ,enforcement 7,a7 ,in general ,in the case of a specified hospital that fails to comply with the requirements of 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 upon request of the ,secretary1 the hospital shall submit to the ,secretary1 not later than #de days after the date of such request1 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 another provision of law1 a specified hospital that has received a notification under subparagraph 7,a77i7 and fails to comply with the requirements of this section by the date that is #ij days after such notification 7or1 in the case of such a hospital that has submitted a corrective action plan described in subparagraph 7,a77ii7 in response to a request so described1 by the date that is #ij days after the ,secretary identifies the failure of such hospital to satisfactorily complete such corrective action plan7 shall be subject to a civil monetary penalty of an amount specified by the ,secretary for each subsequent day during which such failure is ongoing4 ,such amount shall not exceed-- 7,i7 in the case of a specified hospital that is a hospital or critical access hospital with #cj or fewer beds1 #cjj per day2 and 7,,ii7 in the case of any specified hospital and except as provided in clause 7iii71 #b1jjj1jjj for a #a-year period4 7ii7 ,increase authority ,in applying this subparagraph with respect to violations occurring in #bjbg or a subsequent year1 the ,secretary may through notice and comment rulemaking increase-- 7,i7 the limitation on the per day amount of any penalty applicable to a specified hospital that is a hospital or critical access hospital with #cj or fewer beds under clause 7i72 7,,ii7 the limitation on the amount of any penalty applicable for a #a-year period under such clause2 and 7,,iii7 the limitation on the increase of any penalty applied under clause 7iii74 7iii7 ,persistent noncompliance ,in the case of a specified hospital 7other than a specified hospital that is a hospital or critical access hospital with #cj or fewer beds7 that the ,secretary has determined to be knowingly and willfully noncompliant with the provisions of this subsection two or more times during a #a-year period1 the ,secretary may increase any penalty otherwise applicable under this subparagraph by not more than #a1jjj1jjj and may require such hospital to complete such additional corrective actions plans as the ,secretary may specify4 7iv7 ,application of certain provisions ,the provisions of section #aabh;,a 7other than subsections 7a7 and 7b7 of such section7 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 7a7 of such section4 7v7 ,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 7such as in the case of a hospital located in a rural or underserved area where imposition of such penalty may result in1 or contribute to1 a lack of access to care for individuals in such area74 7,c7 ,publication of hospital price transparency information ,beginning on ,january #a1 #bjbf1 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 subsection4 ,such information shall be updated not less than annually and include1 with respect to each year-- 7i7 the number of reviews of compliance with this subsection undertaken by the ,secretary2 7ii7 the number of notifications described in subparagraph 7,a77i7 sent by the ,secretary2 7iii7 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 subsection2 7iv7 the amount of any civil monetary penalty imposed on such hospital under subparagraph 7,b72 7v7 whether such hospital subsequently came into compliance with this subsection2 and 7vi7 any other information as determined by the ,secretary4 7#f7 ,definitions ,for purposes of this subsection3 7,a7 ,discounted cash price ,the term discounted cash price means the charge that applies to an individual who pays cash1 or cash equivalent1 for a specified hospital-furnished item or service4 7,b7 ,federal health care program ,the term ,federal health care program has the meaning given such term in section #aabh;,b4 7,c7 ,gross charge ,the term gross charge means the charge for an individual item or service that is reflected on a specified hospital's chargemaster1 absent any discounts4 7,d7 ,group health plan2 group health insurance coverage2 individual health insurance coverage ,the terms group health plan1 group health insurance coverage1 and individual health insurance coverage have the meaning given such terms in section #bgia of the ,public ,health ,service ,act4 7,e7 ,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 service4 7,f7 ,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 service4 7,g7 ,specified hospital ,the term specified hospital means a hospital 7as defined in section #ahfa7;e771 a critical access hospital 7as defined in section #ahfa7mmm77#a771 or a rural emergency hospital 7as defined in section #ahfa7kkk774 7,h7 ,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 7b7 ,price transparency requirements for ambulatory surgical centers 7#a7 ,in general ,beginning ,january #a1 #bjbh1 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 7#b74 7#b7 ,requirement described 7,a7 ,in general ,for purposes of paragraph 7#a71 the price transparency requirement described in this subsection is1 with respect to an ambulatory surgical center1 that such surgical center in accordance with a method and format established by the ,secretary under subparagraph 7,c771 compile and make public 7without subscription and free of charge71 for each year-- 7i7 one or more lists1 in a format specified by the ,secretary1 of the surgical center's standard charges 7including the information described in subparagraph 7,b77 for each item and service furnished by the surgical center2 7ii7 information on the surgical center's prices 7including the information described in subparagraph 7,b77 for as many of the ,centers for ,medicare ,medicaid ,services-specified shoppable services that are furnished by the surgical center1 and as many additional surgical center-selected shoppable services 7or all such additional services1 if such surgical center furnishes fewer than #cjj shoppable services7 as may be necessary for a combined total of at least #cjj shoppable services2 7iii7 with respect to each ,centers for ,medicare ,medicaid ,services-specified shoppable service that is not furnished by the ambulatory surgical center1 an indication that such service is not so furnished2 and 7iv7 any additional information specified by the ,secretary4 7,b7 ,information described ,for purposes of subparagraph 7,a71 the information described in this subparagraph is1 with respect to standard charges and prices 7as applicable7 made public by a specified surgical center1 the following3 7i7 ,a description of each item or service1 accompanied by1 as applicable1 the ,healthcare ,common ,procedure ,coding ,system code1 the diagnosis-related group1 the national drug code1 or other identifier used or approved by the ,centers for ,medicare ,medicaid ,services4 7ii7 ,the gross charge1 expressed as a dollar amount1 for each such item or service4 7iii7 ,the discounted cash price1 expressed as a dollar amount1 for each such item or service 7or1 in the case no discounted cash price is available for an item or service1 the median price charged by such ambulatory surgical center for such item or service for the previous three years1 expressed as a dollar amount74 7iv7 ,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 center1 which may include any current payer-specific negotiated rates1 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 service4 7,c7 ,method and format ,not later than ,january #a1 #bjbh1 the ,secretary shall establish one or more methods and formats for ambulatory surgical centers to use in making public standard charges and prices 7as applicable7 pursuant to subparagraph 7,a74 ,any such method and format-- 7i7 may be similar to any template made available by the ,centers for ,medicare ,medicaid ,services as of the date of the enactment of this paragraph2 7ii7 shall meet such standards as determined appropriate by the ,secretary in order to ensure the accessibility and usability of such charges and prices2 and 7iii7 shall be updated as determined appropriate by the ,secretary1 in consultation with stakeholders4 7#c7 ,deemed compliance with shoppable services requirement for ambulatory surgical centers with a price estimator tool 7,a7 ,in general ,an ambulatory surgical center shall be deemed to have complied with the requirement described in subsection 7b77#a77;,b7 7relating to shoppable services7 if such surgical center maintains a price estimator tool described in subparagraph 7,b74 7,b7 ,price estimator tool described ,for purposes of subparagraph 7,a71 the price estimator tool described in this subparagraph is1 with respect to an ambulatory surgical center1 a tool that meets the following requirements3 7i7 ,such tool allows an individual to immediately obtain a price estimate 7taking into account whether such individual is covered under any plan1 coverage1 or program described in subparagraph 7,c77iii77 for each ,centers for ,medicare ,medicaid ,services-specified shoppable service that is furnished by the surgical center1 and for each additional shoppable service as such surgical center may select such that price estimates are available through such tool for at least #cjj shoppable services 7or for all such services1 if such surgical center furnishes fewer than #cjj shoppable services74 7ii7 ,such tool allows an individual to obtain such an estimate by billing code and by service description4 7iii7 ,such tool is prominently displayed on the public internet website of such ambulatory surgical center4 7iv7 ,such tool does not require an individual seeking such an estimate to create an account or otherwise input personal information1 except that such tool may require that such individual provide information specified by the ,secretary1 which may include the following3 7,i7 ,the name of such individual4 7,,ii7 ,the date of birth of such individual4 7,,iii7 ,in the case such individual is covered under a group health plan1 group or individual health insurance coverage1 a ,federal health care program1 or the program established under chapter #hi of title #e1 ,united ,states ,code1 an identifying number assigned by such plan1 coverage1 or program to such individual4 7,,iv7 ,in the case of an individual described in clause 7iii71 an indication as to whether such individual is the primary insured individual under such plan1 coverage1 or program 7and1 if such individual is not the primary insured individual1 a description of the individual's relationship to such primary insured individual74 7,v7 ,any other information specified by the ,secretary4 7v7 ,such tool contains a statement confirming the accuracy and completeness of information presented through such tool as of the date such request is made4 7vi7 ,such tool meets any other requirement specified by the ,secretary4 7#d7 ,monitoring compliance ,the ,secretary shall1 through notice and comment rulemaking and in consultation with the ,inspector ,general of the ,department of ,health and ,human ,services1 establish a process to monitor compliance with this subsection4 ,such process shall ensure that each ambulatory surgical center's compliance with this subsection is reviewed not less frequently than once every #c years4 7#e7 ,enforcement 7,a7 ,in general ,in the case of an ambulatory surgical center that fails to comply with the requirements of this subsection-- 7i7 the ,secretary shall notify such ambulatory surgical center of such failure not later than #cj days after the date on which the ,secretary determines such failure exists2 and 7ii7 upon request of the ,secretary1 the ambulatory surgical center shall submit to the ,secretary1 not later than #de days after the date of such request1 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 another provision of law1 an ambulatory surgical center that has received a notification under subparagraph 7,a77i7 and fails to comply with the requirements of this subsection by the date that is #ij days after such notification 7or1 in the case of an ambulatory surgical center that has submitted a corrective action plan described in subparagraph 7,a77ii7 in response to a request so described1 by the date that is #ij days after such submission7 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 7not to exceed #cjj per day74 7ii7 ,increase authority ,in applying this subparagraph with respect to violations occurring in #bjbg or a subsequent year1 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 7i74 7iii7 ,application of certain provisions ,the provisions of section #aabh;,a 7other than subsections 7a7 and 7b7 of such section7 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 7a7 of such section4 7iv7 ,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 7such as in the case of an ambulatory surgical center located in a rural or underserved area where imposition of such penalty may result in1 or contribute to1 a lack of access to care for individuals in such area74 7#f7 ,definitions ,for purposes of this section3 7,a7 ,discounted cash price ,the term discounted cash price means the charge that applies to an individual who pays cash1 or cash equivalent1 for a item or service furnished by an ambulatory surgical center4 7,b7 ,federal health care program ,the term ,federal health care program has the meaning given such term in section #aabh;,b4 7,c7 ,gross charge ,the term gross charge means the charge for an individual item or service that is reflected on a specified surgical center's chargemaster1 absent any discounts4 7,d7 ,group health plan2 group health insurance coverage2 individual health insurance coverage ,the terms group health plan1 group health insurance coverage1 and individual health insurance coverage have the meaning given such terms in section #bgia of the ,public ,health ,service ,act4 7,e7 ,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 service4 7,f7 ,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 service4 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 4 7b7 ,publication of hospital compliance with price transparency requirements ,section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 is amended by adding at the end the following new subsection3 7u7 ,publication of compliance with price transparency requirements 7#a7 ,in general ,beginning ,january #a1 #bjbf1 the ,secretary shall1 for each hospital with respect to which the ,secretary has conducted a review of such hospital's compliance with the provisions of section #ahii;,c7a7 and found such hospital noncompliant with such provisions-- 7,a7 indicate such noncompliance on such hospital's entry on the ,hospital ,compare internet website 7or a successor website72 and 7,b7 specify whether such hospital-- 7i7 submitted a corrective action plan described in subsection 7a77#e77;,a77ii7 of such section 7and1 if so1 the date such plan was received by the ,secretary72 or 7ii7 was subject to a civil monetary penalty imposed under subsection 7a77#e7 of such section 7and1 if so1 the date of the imposition of such penalty and the amount of such penalty74 7#b7 ,additions and updates ,the ,secretary shall update any specification described in subparagraph 7,a7 or 7,b7 of paragraph 7#a7 with respect to such hospital-- 7,a7 in the case of the specification described in such paragraph 7#a77;,b77i71 as soon as practicable after sending a notification described in such subparagraph2 and 7,b7 in the case of the specification described in such paragraph 7#a77;,b77ii71 as soon as practicable after the imposition of a civil monetary penalty described in such subparagraph4 4 7c7 ,conforming amendment ,section #bgah7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ah7;e77 is amended by adding at the end the following new sentence3 ,the preceding sentence shall not apply beginning ,january #a1 #bjbf44 7d7 ,funding 7#a7 ,in general ,in addition to funds otherwise available1 out of any moneys in the ,treasury not otherwise appropriated1 there are appropriated #aj1jjj1jjj for fiscal year #bjbd1 to remain available until expended1 for purposes of-- 7,a7 implementing the amendment made by this subsection 7a72 and 7,b7 monitoring the compliance of entities with such amendment4 7#b7 ,report on expenditures ,not later than #e years after the date of the enactment of this ,act1 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-- 7,a7 describes activities undertaken funded through funds made available under paragraph 7#a71 including a specification of the amount of such funds expended for each such activity2 and 7,b7 identifies all entities with which the ,secretary has entered into contracts for purposes of implementing the amendment made by this subsection 7a71 monitoring compliance of entities with such amendment1 or providing technical assistance to entities to promote compliance with such amendment4 7e7 ,implementation 7#a7 ,accessibility ,in implementing section #ahii;,c7a77#b77;,a77ii7 of the ,social ,security ,act 7as added by subsection 7a771 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 plain1 easily understandable language and that such entity provides access to such interpretation services1 translations1 and other assistive services to make such information accessible to individuals with limited ,english proficiency and individuals with disabilities4 7#b7 ,technical assistance ,the ,secretary of ,health and ,human ,services shall1 to the extent practicable1 provide technical assistance to entities making public standard charges and prices 7as applicable7 pursuant to the amendment made by subsection 7a74