Bill Summary
This bill, known as the "Health Care Prices Revealed and Information to Consumers Explained Transparency Act" or the "Health Care PRICE Transparency Act," aims to increase transparency in the healthcare industry by requiring hospitals and insurance providers to make their pricing information easily accessible and understandable to the public. This includes listing standard charges, negotiated rates, and discounted cash prices for all items and services, as well as providing aggregate payment information for out-of-network providers. The bill also requires the Secretary to establish standards for electronic delivery of this information through an internet website and open application program interfaces (APIs). Failure to comply with these requirements may result in penalties for hospitals and insurance providers.
Possible Impacts
1. Increased transparency in healthcare pricing could allow individuals to make more informed decisions about their healthcare providers, potentially saving them money and providing more affordable options.
2. The requirement for hospitals to provide information in a machine-readable format could make it easier for people to access and compare healthcare prices online, instead of needing to call or visit multiple hospitals.
3. The legislation could also potentially hold hospitals accountable for not complying with the price transparency requirements, as they could face a civil monetary penalty for ongoing violations. This could help protect consumers from being overcharged or misled by hospitals.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4106 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
2d Session
S. 4106
To amend the Public Health Service Act to provide for hospital and
insurer price transparency.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 30, 2020
Mr. Braun (for himself, Mr. Kennedy, Mrs. Loeffler, Mr. Grassley, Mr.
Enzi, Ms. Ernst, and Mr. Barrasso) introduced the following bill; which
was read twice and referred to the Committee on Health, Education,
Labor, and Pensions
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to provide for hospital and
insurer price transparency.
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 ``Health Care Prices Revealed and
Information to Consumers Explained Transparency Act'' or the ``Health
Care PRICE Transparency Act''.
SEC. 2. PRICE TRANSPARENCY REQUIREMENTS.
(a) Hospitals.--Section 2718(e) of the Public Health Service Act
(42 U.S.C. Sec. 300gg-18(e)) is amended--
(1) by striking ``Each hospital'' and inserting the
following:
``(1) In general.--Each hospital'';
(2) by inserting ``, in a machine-readable format, via open
application program interfaces (APIs)'' after ``a list'';
(3) by inserting ``, 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 service'' before the
period; and
(4) by adding at the end the following:
``(2) Definition of standard charges.--Notwithstanding any
other provision of law, for purposes of paragraph (1), the term
`standard charges' means the rates hospitals, including
providers or entities that contract with or practice at a
hospital, charge for all items and services at a minimum,
chargemaster rates, rates that hospitals negotiate with third
party payers across all plans, including those related to a
patient's specific plan, discounted cash prices, and other
rates determined by the Secretary.
``(3) Enforcement.--In addition to any other enforcement
actions or penalties that may apply under subsection (b)(3) or
another provision of law, a hospital that fails to provide the
information required by this subsection and has not completed a
corrective action plan to comply with the requirements of such
subsection shall be subject to a civil monetary penalty of an
amount not to exceed $300 per day that the violation is ongoing
as determined by the Secretary. Such penalty shall be imposed
and collected in the same manner as civil money penalties under
subsection (a) of section 1128A of the Social Security Act are
imposed and collected.''.
(b) Transparency in Coverage.--Section 1311(e)(3) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031(e)(3)) is amended--
(1) in subparagraph (A)--
(A) in clause (vii), by inserting before the period
the following: ``, including, for all items and
services covered under the plan, aggregate information
on specific payments the plan has made to out-of-
network health care providers on behalf of plan
enrollees''; and
(B) by designating clause (ix) as clause (x); and
(C) by inserting after clause (viii), the
following:
``(ix) Information on the specific
negotiated payment rates between the plan and
health care providers for all items and
services covered under the plan.'';
(2) in subparagraph (B)--
(A) in the heading, by striking ``use'' and
inserting ``delivery methods and use'';
(B) by inserting ``, as applicable,'' after
``English proficiency''; and
(C) by inserting after the second sentence, the
following: ``The Secretary shall establish standards
for electronic delivery and access to such information
by individuals, free of charge, in machine readable
format, through an internet website and via open
APIs.'';
(3) in subparagraph (C)--
(A) in the first sentence, by inserting ``or out-
of-network provider'' after ``item or service by a
participating provider'';
(B) in the second sentence, by striking ``through
an internet website'' and inserting ``free of charge,
in machine readable format, through an internet
website, and via open APIs, in accordance with
standards established by the Secretary,''; and
(C) by adding at the end the following: ``Such
information shall include specific negotiated rates
that allow for comparison between providers and across
plans, and related to a patient's specific plan,
including after an enrollee has exceeded their
deductible responsibility.''; and
(4) in subparagraph (D) by striking ``subparagraph (A)''
and inserting ``subparagraphs (A), (B), and (C)''.
<all>