H0807B0765A01498 AJB:EJH 06/27/23 #90 A01498
AMENDMENTS TO HOUSE BILL NO. 807
Sponsor: REPRESENTATIVE ROWE
Printer's No. 765
Amend Bill, page 1, line 23, by striking out the period after
"education" and inserting
; and providing for hospital price transparency and for
prohibition on collection action of debt against patients for
noncompliant hospitals.
Amend Bill, page 2, by inserting between lines 26 and 27
Section 2. The act is amended by adding articles to read:
ARTICLE XXI-G
HOSPITAL PRICE TRANSPARENCY
Section 21 01-G. Purpose.
The purpose of this article is to require hospitals to
disclose prices for certain items and services provided by
hospitals and to provide for enforcement by the department.
Section 21 02-G. Definitions.
The following words and phrases when used in this article
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Ancillary service." A hospital item or service that a
hospital customarily provides as part of a shoppable service.
"Chargemaster." The list of all hospital items or services
maintained by a hospital for which the hospital has established
a charge.
"CMS." The Centers for Medicare and Medicaid Services.
"De-identified maximum negotiated charge." The highest
charge that a hospital has negotiated with all third-party
payors for a hospital item or service.
"De-identified minimum negotiated charge." The lowest charge
that a hospital has negotiated with all third-party payors for a
hospital item or service.
"Department." The Department of Health of the Commonwealth.
"Discounted cash price." The charge that applies to an
individual who pays cash or a cash equivalent for a hospital
item or service.
"Gross charge." The charge for a hospital item or service
that is reflected on the hospital's chargemaster, absent any
discount.
"Hospital." As defined in section 802.1 of the act of July
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19, 1979 (P.L.130, No.48), known as the Health Care Facilities
Act.
"Item or service." An item or service, including an
individual items or services package, that could be provided by
a hospital to a patient in connection with an inpatient
admission or an outpatient department visit for which the
hospital has established a standard charge, including any of the
following:
(1) A supply or procedure.
(2) Room and board.
(3) The use of the hospital or other item, which is
generally described as a facility fee.
(4) The service of a physician or nonphysician
practitioner, which is generally described as a professional
charge.
(5) Any other item or service for which a hospital has
established a standard charge.
"Machine-readable format." A digital representation of
information in a file that can be imported or read into a
computer system for further processing. The term includes the
.XML, .JSON or .CSV format.
"Payor-specific negotiated charge." The charge that a
hospital has negotiated with a third-party payor for a hospital
item or service.
"Shoppable service." A service that may be scheduled by an
individual in advance.
"Standard charge." The regular rate established by the
hospital for a hospital item or service provided to a specific
group of paying patients. The term includes any of the
following:
(1) The gross charge.
(2) The payor-specific negotiated charge.
(3) The de-identified minimum negotiated charge.
(4) The de-identified maximum negotiated charge.
(5) The discounted cash price.
"Third-party payor." An entity that is legally responsible
for payment of a claim for a hospital item or service.
Section 21 03-G. Public availability of price information
required.
Notwithstanding any other provision of law, a hospital shall
publish all of the following on its publicly accessible Internet
website and provide hard copies upon request:
(1) A digital file in a machine-readable format and
printable format that contains a list of all standard charges
for all hospital items or services as specified under section
21 04-G.
(2) A consumer-friendly and printable list of standard
charges for a limited set of shoppable services as provided
for under section 21 05-G.
Section 21 04-G. List of standard charges.
(a) List.--A hospital shall have the following duties:
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(1) Maintain a list of all standard charges for all
hospital items or services in accordance with this article.
(2) Ensure that the list is always available to the
public, including publishing the list electronically in the
manner specified under section 21 03-G.
(b) Standard charges.--The standard charges contained in the
list under subsection (a) shall reflect the standard charges
applicable to the location of the hospital, regardless of
whether the hospital operates in more than one location or
operates under the same license as another hospital.
(c) Contents.--A hospital shall include all of the following
information in the list under subsection (a):
(1) A description of each hospital item or service
provided by the hospital.
(2) The following charges for each individual hospital
item or service when provided in either an inpatient setting
or an outpatient department setting, as applicable,
including:
(i) The gross charge.
(ii) The de-identified minimum negotiated charge.
(iii) The de-identified maximum negotiated charge.
(iv) The discounted cash price.
(v) The payor-specific negotiated charge, delineated
by the name of the third-party payor and plan associated
with the charge and displayed in a manner that clearly
associates the charge with the third-party payor and
plan.
(vi) A code used by the hospital for the purpose of
accounting or billing for the hospital item or service,
including the Current Procedural Terminology (CPT) code,
the Healthcare Common Procedure Coding System (HCPCS)
code, the Diagnosis Related Group (DRG) code, the
National Drug Code (NDC) or other common identifier.
(d) Format.--A hospital shall publish the information
contained in the list under subsection (a) in a single digital
file that is in a machine-readable format.
(e) Display.--A hospital shall display the list under
subsection (a) by posting the list in a prominent location on
the home page of the hospital's publicly accessible Internet
website or making the list accessible by a dedicated link that
is prominently displayed on the home page of the hospital's
publicly accessible Internet website. If the hospital operates
multiple locations and maintains a single Internet website, the
hospital shall post the list for each location that the hospital
operates in a manner that clearly associates the list with the
applicable location of the hospital.
(f) Availability.--
(1) A hospital shall ensure that the list under
subsection (a) complies with the following requirements:
(i) Be available free of charge.
(ii) Be accessible to a common commercial operator
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of an Internet search engine to the extent necessary for
the search engine to index the list and display the list
in response to a search query of a user of the search
engine.
(iii) Be formatted in a manner specified under this
article and by the department via a notice submitted to
the Legislative Reference Bureau for publication in the
next available issue of the Pennsylvania Bulletin.
(iv) Be digitally searchable and printable by
service description, billing code and third-party payor.
(v) Use a format and a naming convention specified
by the department via a notice submitted to the
Legislative Reference Bureau for publication in the next
available issue of the Pennsylvania Bulletin. The
department shall consider a naming convention as may be
specified by CMS.
(2) The department shall ensure the list under
subsection (a) does not require any of the following:
(i) The establishment of a user account or password
or other information of the user.
(ii) The submission of personal identifying
information.
(iii) Any other impediment, including entering a
code to access the list.
(g) Template.--In determining the format of the list under
subsection (a) as required under subsection (f)(1)(iv), the
department shall develop a template that each hospital shall use
in formatting the list and publish the template via a notice
submitted to the Legislative Reference Bureau for publication in
the next available issue of the Pennsylvania Bulletin. In
developing the template as required under this subsection, the
department shall have the following duties:
(1) Take into consideration applicable Federal
guidelines for formatting similar lists required by Federal
law and ensure that the design of the template enables an
individual to compare the charges contained in the lists
maintained by each hospital.
(2) Design the template to be substantially like the
template used by CMS for the purposes specified in this
article.
(h) Updates.--A hospital shall update the list under
subsection (a) no less than once each year. The hospital shall
clearly indicate the date when the list was most recently
updated, either on the list or in a manner that is clearly
associated with the list. The hospital shall make available no
less than the three most recent versions of the list as required
under this article.
Section 21 05-G. List of shoppable services.
(a) List.-- Except as provided under subsection (c), a
hospital shall maintain and make publicly available a list of
the standard charges for each of at least 300 shoppable services
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provided by the hospital. The hospital may select the shoppable
services to be included in the list, except that the list shall
include the 70 services specified as shoppable services by CMS.
If the hospital does not provide all the shoppable services
specified by CMS, the hospital shall include all the shoppable
services provided by the hospital.
(b) Selection.--In selecting a shoppable service for the
purpose of inclusion in the list under subsection (a), a
hospital shall have following duties:
(1) Consider how frequently the hospital provides the
service and the hospital's billing rate for the service.
(2) Prioritize the selection of services that are among
the services most frequently provided by the hospital.
(c) Exception.--If a hospital does not provide 300 shoppable
services in the list under subsection (a), the hospital shall
include the total number of shoppable services that the hospital
provides in a manner that otherwise complies with the
requirements of subsection (a).
(d) Contents.--A hospital shall include all of the following
information in the list under subsection (a):
(1) A plain-language description of each shoppable
service included on the list.
(2) The payor-specific negotiated charge that applies to
each shoppable service included on the list and any ancillary
service, delineated by the name of the third-party payor and
plan associated with the charge and displayed in a manner
that clearly associates the charge with the third-party payor
and plan.
(3) The discounted cash price that applies to each
shoppable service included on the list and any ancillary
service or, if the hospital does not offer a discounted cash
price for a shoppable service or an ancillary service on the
list, the gross charge for the shoppable service or ancillary
service, as applicable.
(4) The de-identified minimum negotiated charge that
applies to each shoppable service included on the list and
any ancillary service.
(5) The de-identified maximum negotiated charge that
applies to each shoppable service included on the list and
any ancillary service.
(6) A code used by the hospital for purposes of
accounting or billing for each shoppable service included on
the list and any ancillary service, including the Current
Procedural Terminology (CPT) code, the Healthcare Common
Procedure Coding System (HCPCS) code, the Diagnosis Related
Group (DRG) code, the National Drug Code (NDC) or other
common identifier.
(7) If applicable, each location where the hospital
provides a shoppable service and whether the standard charges
included in the list apply at the location to the provision
of the shoppable service in an inpatient setting or an
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outpatient department setting.
(8) If applicable, an indication if a shoppable service
specified by CMS is not provided by the hospital.
(e) Availability.--
(1) A hospital shall ensure that the list under
subsection (a) complies with the following requirements:
(i) Be available free of charge.
(ii) Be accessible to a common commercial operator
of an Internet search engine to the extent necessary for
the search engine to index the list and display the list
in response to a search query of a user of the search
engine.
(iii) Be formatted in a manner specified under this
article and by the department via a notice submitted to
the Legislative Reference Bureau for publication in the
next available issue of the Pennsylvania Bulletin.
(iv) Be digitally searchable and printable by
service description, billing code and third-party payor.
(v) Use a format and a naming convention specified
by the department via a notice submitted to the
Legislative Reference Bureau for publication in the next
available issue of the Pennsylvania Bulletin. The
department shall consider a naming convention as may be
specified by CMS.
(2) The department shall ensure that the list under
subsection (a) does not require any of the following:
(i) The establishment of a user account or password
or other information of the user.
(ii) The submission of personal identifying
information.
(iii) Any other impediment, including entering a
code to access the list.
(f) Template.--In determining the format of the list under
subsection (a) as required under subsection (e)(1)(iv), the
department shall develop a template that each hospital shall use
in formatting the list and publish the template via a notice
submitted to the Legislative Reference Bureau for publication in
the next available issue of the Pennsylvania Bulletin. In
developing the template as required under this subsection, the
department shall have the following duties:
(1) Take into consideration applicable Federal
guidelines for formatting similar lists required by Federal
law and ensure that the design of the template enables an
individual to compare the charges contained in the lists
maintained by each hospital.
(2) Design the template to be substantially like the
template used by CMS for the purposes specified in this
article.
(g) Updates.--A hospital shall update the list under
subsection (a) no less than once each year. The hospital shall
clearly indicate the date when the list was most recently
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updated, either on the list or in a manner that is clearly
associated with the list. The hospital shall make available no
less than the three most recent versions of the list as required
under this article.
Section 21 06-G. Reporting requirements.
Each time a hospital updates the list as required under
section 2104-G(h) or 2105-G(g) , the hospital shall submit a
report on the updated list to the department. The department
shall determine the form of the report via a notice submitted to
the Legislative Reference Bureau for publication in the next
available issue of the Pennsylvania Bulleti n.
Section 21 07-G. Submission of complaints.
The department shall establish an electronic form for
individuals to submit complaints for alleged violations of this
article. The department shall post the electronic form on its
publicly accessible Internet website. The department shall also
accept complaints via a department customer service telephone
number.
Section 21 08-G . Plans of correction.
Upon determining that a hospital has violated the provisions
of this article or the regulations promulgated under section
21 11-G , the department may issue a written notice to the
hospital stating that a violation has been committed by the
hospital. The following shall apply:
(1) The department shall state in the written notice
that the hospital is required to take immediate action to
remedy the violation or, if the hospital is unable to
immediately remedy the violation, submit a plan of correction
to the department.
(2) If the hospital is required to submit a plan of
correction to the department under paragraph (1), the
department may direct that the violation be remedied within a
specified period of time. The hospital must submit the plan
of correction within 30 days of the department's issuance of
the written notice.
(3) If the department determines that the hospital is
required to take immediate corrective action, the department
shall state in the written notice that the hospital is
required to provide prompt confirmation to the department
that the corrective action has been taken.
Section 21 09-G. Sanctions and penalties.
(a) Grounds for sanctions.--The department may sanction a
hospital for any of the following reasons:
(1) Violating the provisions of this article or the
regulations promulgated under section 21 11-G.
(2) Failing to take immediate action to remedy a
violation of the provisions of this article or regulations
promulgated under section 21 11-G.
(3) Failing to submit a plan of correction to the
department or failing to comply with a plan of correction in
accordance with section 21 08-G .
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(4) Violating an order previously issued by the
department in a disciplinary matter.
(5) Any other reason specified in this article or the
regulations promulgated by the department under section 21 11-
G as necessary to implement this article.
(b) Civil penalties.--The department may impose a civil
penalty for conduct prohibited under subsection (a), with each
day when a hospital engages in the conduct constituting a
separate and distinct incident, as follows:
(1) No more than $2,500 for a first incident.
(2) No more than $5,000 for a second incident.
(3) No more than $10,000 for a third incident.
(4) No more than $15,000 for a fourth or subsequent
incident.
(c) Audits.--The department may audit the publicly
accessible Internet websites of hospitals to ensure compliance
with this article.
(d) General government appropriations.--Money received from
civil penalties imposed by the department on a hospital shall be
paid into the State Treasury and shall be credited to the
general government appropriations of the department for
administering and enforcing the provisions of this article.
(e) Administrative proceedings.--The department shall hold
hearings and issue adjudications for proceedings conducted under
this article in accordance with 2 Pa.C.S. (relating to
administrative law and procedure) and shall conduct the
proceedings in accordance with 1 Pa. Code Pt. II (relating to
general rules of administrative practice and procedure).
(f) Judicial appeals.--Department adjudications issued under
this article may be appealed to Commonwealth Court under 42
Pa.C.S. ยง 763 (relating to direct appeals from government
agencies).
Section 21 10-G . Reports.
The department shall report annually on the progress in
implementing and administering this article and submit the
report to the chair and minority chair of the Health and Human
Services Committee of the Senate and the chair and minority
chair of the Health Committee of the House of Representatives.
Section 21 11-G . Regulations.
(a) Temporary regulations.--In order to facilitate the
prompt implementation of this article, regulations promulgated
by the department shall be deemed temporary regulations that
shall expire no later than two years following publication.
Temporary regulations promulgated under this subsection shall
not be subject to:
(1) Section 612 of the act of April 9, 1929 (P.L.177,
No.175), known as The Administrative Code of 1929.
(2) Sections 201, 202, 203, 204 and 205 of the act of
July 31, 1968 (P.L.769, No.240), referred to as the
Commonwealth Documents Law.
(3) Sections 204(b) and 301(10) of the act of October
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15, 1980 (P.L.950, No.164), known as the Commonwealth
Attorneys Act.
(4) The act of June 25, 1982 (P.L.633, No.181), known as
the Regulatory Review Act.
(b) Expiration.--Notwithstanding any other provision of law,
the department's authority to adopt temporary regulations under
subsection (a) shall expire two years after the effective date
of this section. Regulations adopted after this period shall be
promulgated as provided by law.
(c) Publication.--The department shall begin submitting the
temporary regulations to the Legislative Reference Bureau for
publication in the next available issue of the Pennsylvania
Bulletin no later than six months after the effective date of
this section.
(d) Regulations.--The department shall promulgate
regulations as provided by law prior to the expiration of the
temporary regulations as necessary to implement this article.
ARTICLE XXI-H
PROHIBITION ON COLLECTION ACTION OF DEBT
AGAINST PATIENTS FOR NONCOMPLIANT HOSPITALS
Section 21 01-H. Purpose.
The purpose of this article is to provide for the prohibition
on collection action of debt for noncompliant hospitals.
Section 21 02-H. Definitions.
The following words and phrases when used in this article
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"CMS." The Centers for Medicare and Medicaid Services.
"Collection action." Any of the following actions taken with
respect to a debt for an item or service that was purchased from
or provided to a patient by a hospital on a date during which
the hospital was not in material compliance with Article XXI-G:
(1) Attempting to collect a debt from a patient or
patient guarantor by referring the debt, directly or
indirectly, to a debt collector, a collection agency or other
third-party retained by or on behalf of the hospital.
(2) Suing the patient or patient guarantor or enforcing
an arbitration or mediation clause in a hospital document,
including any contract, agreement, statement or bill.
(3) Directly or indirectly causing a report to be made
to a consumer reporting agency.
"Collection agency." Any of the following:
(1) A person who engages in a business for the
principal purpose of collecting debts.
(2) A person who does any of the following:
(i) Regularly collects or attempts to collect,
directly or indirectly, debts owed or due or asserted to
be owed or due to another.
(ii) Takes assignment of debts for collection
purposes.
(iii) Directly or indirectly solicits for collection
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debts owed or due or asserted to be owed or due to
another.
"Consumer reporting agency." A person that, for monetary
fees, dues or on a cooperative nonprofit basis, regularly
engages, in whole or in part, in the practice of assembling or
evaluating consumer credit information or other information on
consumers for the purpose of furnishing consumer reports to
third parties. The term includes "consumer reporting agency" as
defined in 15 U.S.C. ยง 1681a(f) (relating to definitions and
rules of construction). The term does not include a business
entity that only provides check verification or check guarantee
services.
"Debt." An obligation or alleged obligation of a consumer to
pay money arising out of a transaction, whether or not the
obligation has been reduced to judgment. The term does not
include a debt for business, investment, commercial or
agricultural purposes or a debt incurred by a business.
"Debt collector." A person employed or engaged by a
collection agency to perform the collection of debts owed or
due, or asserted to be owed or due, to another.
"Hospital." As defined in section 802.1 of the act of July
19, 1979 (P.L.130, No.48), known as the Health Care Facilities
Act.
"Item or service." As defined in s ection 8 02-C of the Health
Care Facilities Act.
Section 21 03-H. Failure to comply with hospital price
transparency.
(a) Prohibition.--Except as provided under subsection (d), a
hospital that is in violation of the requirements under Article
XXI-G on the date when an item or service is purchased from or
provided to a patient by the hospital may not initiate or pursue
a collection action against the patient or patient guarantor for
a debt owed for the item or service.
(b) Civil action.--If a patient believes that a hospital is
in violation of the requirements under Article XXI-G on the date
when an item or service is purchased from or provided to the
patient and the hospital takes a collection action against the
patient or patient guarantor, the patient or patient guarantor
may initiate a civil action in a court of competent jurisdiction
to determine if the hospital is in violation of Article XXI-G
and the noncompliance is related to the item or service. The
hospital may not take a collection action against the patient or
patient guarantor or submit a report to a patient's or patient
guarantor's credit report while the civil action is pending.
(c) Noncompliance.--A hospital that has been determined to
be in violation of the requirements under Article XXI-G shall:
(1) refund the payor an amount of the debt the payor has
paid and pay a penalty to the patient or patient guarantor in
an amount equal to the total amount of the debt;
(2) dismiss or cause to be dismissed a civil action
under subsection (b) with prejudice and pay any attorney fees
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and costs incurred by the patient or patient guarantor
relating to the action; and
(3) remove or cause to be removed from the patient's or
patient guarantor's credit report a report made to a consumer
reporting agency relating to the debt.
(d) Construction.--Nothing in this section shall be
construed to:
(1) prohibit a hospital from billing a patient, patient
guarantor or third-party payor, including a health insurer,
for an item or service provided to the patient in a manner
that is not in violation of this article; or
(2) require a hospital to refund a payment made to the
hospital for an item or service provided to the patient if no
collection action is taken in violation of this article.
Amend Bill, page 2, line 27, by striking out "2" and
inserting
3
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