[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5497 Introduced in House (IH)]
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114th CONGRESS
2d Session
H. R. 5497
To amend the Public Health Service Act to provide for the public
disclosure of charges for certain hospital and ambulatory surgical
center treatment episodes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 16, 2016
Mr. Lipinski introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to provide for the public
disclosure of charges for certain hospital and ambulatory surgical
center treatment episodes.
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 ``Hospital Price Transparency and
Disclosure Act of 2016''.
SEC. 2. PUBLIC DISCLOSURE OF HOSPITAL DATA.
Part B of title II of the Public Health Service Act (42 U.S.C. 238
et seq.) is amended by adding at the end the following new section:
``data reporting by hospitals and ambulatory surgical centers and
public posting
``Sec. 249. (a) Semiannual Reporting Requirement.--Not later than
80 days after the end of each semiannual period beginning January 1 or
July 1 (beginning more than one year after the date of the enactment of
this section), a hospital and an ambulatory surgical center shall
report to the Secretary the following data:
``(1) In the case of a hospital--
``(A) the frequency of occurrence for such hospital
during such period of each treatment episode identified
under subsection (c)(1) for a condition or disease
selected under subparagraph (A) or (B) of such
subsection (or updated under subsection (c)(3)),
furnished in an inpatient or outpatient setting,
respectively; and
``(B) if care was furnished for such a treatment
episode by such hospital during such period--
``(i) the total number of such treatment
episodes for which care was so furnished by the
hospital during such period;
``(ii) the insured individual average
charge (as computed under subsection (e)(3)) by
the hospital for such treatment episode during
such period; and
``(iii) the uninsured individual average
charge (as computed under subsection (e)(4)) by
the hospital for such treatment episode during
such period.
``(2) In the case of an ambulatory surgical center--
``(A) the frequency of occurrence for such center
during such period of each treatment episode identified
under subsection (c)(1) for a condition or disease
selected under subparagraph (C) of such subsection (or
updated under subsection (c)(3)); and
``(B) if care was furnished for such a treatment
episode by such center during such period--
``(i) the total number of such treatment
episodes for which care was so furnished by the
center during such period;
``(ii) the insured individual average
charge (as computed under subsection (e)(3)) by
the center for such episode during such period;
and
``(iii) the uninsured individual average
charge (as computed under subsection (e)(4)) by
the center for such episode during such period.
``(b) Public Availability of Data.--
``(1) Public posting of data.--The Secretary shall promptly
post, on the official public Internet site of the Department of
Health and Human Services, the data reported under subsection
(a) and an appropriate link, with respect to a hospital or
center for which the data is reported, to other consumer
quality information maintained on such site (or a site
maintained by the Centers for Medicare & Medicaid Services)
relating to the hospital or center. Such data shall be set
forth in a manner that promotes charge comparison among
hospitals and among ambulatory surgical centers.
``(2) Notice of availability.--A hospital and an ambulatory
surgical center shall prominently post at each admission site
of the hospital or center a notice of the availability of the
data reported under subsection (a) on the official public
Internet site under paragraph (1).
``(c) Specification of Treatment Episodes.--For purposes of this
section:
``(1) In general.--The Secretary shall identify treatment
episodes for each of the following:
``(A) The 100 conditions and diseases selected by
the Secretary as being the most frequently treated
conditions and diseases in a hospital inpatient
setting.
``(B) The 100 conditions and diseases selected by
the Secretary as being the most frequently treated
conditions and diseases in a hospital outpatient
setting.
``(C) The 100 conditions and diseases selected by
the Secretary as being the most frequently treated
conditions and diseases in an ambulatory surgical
center setting.
``(2) Agreement with iom.--In carrying out paragraph (1),
the Secretary may enter into an agreement with the Institute of
Medicine to define a treatment episode for any condition or
disease selected by the Secretary under this subsection. Such a
definition may take into account the varying complexity
associated with respect to different treatments.
``(3) Updating selection.--The Secretary shall periodically
update the conditions and diseases selected under paragraph
(1).
``(d) Civil Money Penalty.--The Secretary may impose a civil money
penalty of not more than $10,000 for each knowing violation of
subsection (a) or (b)(2) by a hospital or an ambulatory surgical
center. The provisions of subsection (i)(2) of section 351A shall apply
with respect to civil money penalties under this subsection in the same
manner as such provisions apply to civil money penalties under
subsection (i)(1) of such section.
``(e) Administrative Provisions.--
``(1) In general.--The Secretary shall prescribe such
regulations and issue such guidelines as may be required to
carry out this section.
``(2) Classification of services.--The regulations and
guidelines under paragraph (1) shall include rules on the
classification of different treatment episodes and the
assignment of items and procedures to those episodes.
``(3) Computation of insured individual average charges.--
``(A) In general.--For purposes of subsections
(a)(1)(B)(ii) and (a)(2)(B)(ii), an insured individual
average charge for a treatment episode, with respect to
a hospital or ambulatory surgical center during a
period, shall be computed as the average of the rates
(including any applicable copayment, coinsurance, other
cost sharing, or other fees, such as facility fees,
associated with treatment in the hospital or center)
for such episode that have been negotiated by the
hospital or ambulatory surgical center, respectively,
with the 5 most used health insurance providers for
such hospital or center during such period.
``(B) 5 most used health insurance providers.--For
purposes of subparagraph (A), the 5 most used health
insurance providers, with respect to a hospital or
ambulatory surgical center during a period, are the 5
group health plans or insurance issuers offering health
insurance coverage--
``(i) that have negotiated with the
hospital or center a rate for the treatment
episode involved; and
``(ii) the enrollees of which represent the
highest number of patients of the hospital or
center, respectively.
``(4) Computation of uninsured individual average
charges.--
``(A) In general.--For purposes of subsections
(a)(1)(B)(iii) and (a)(2)(B)(iii), an uninsured
individual average charge for a treatment episode, with
respect to a hospital or ambulatory surgical center
during a period, shall be computed as the average of
the total amounts charged for such an episode for which
care was furnished to an uninsured individual by such
hospital or ambulatory surgical center during such
period.
``(B) Uninsured individual defined.--For purposes
of subparagraph (A), the term `uninsured individual'
means, with respect to care furnished to the individual
by a hospital or ambulatory surgical center, an
individual who does not have insurance or other third-
party contractual benefits that provides payment for
costs incurred for such care.
``(5) Form of report and notice.--The regulations and
guidelines under paragraph (1) shall specify the electronic
form and manner by which a hospital or an ambulatory surgical
center shall report data under subsection (a) and the form for
posting of notices under subsection (b)(2).
``(f) Rules of Construction.--
``(1) Non-preemption of state laws.--Nothing in this
section shall be construed as preempting or otherwise affecting
any provision of State law relating to the disclosure of
charges or other information for a hospital or an ambulatory
surgical center.
``(2) Charges.--Nothing in this section shall be construed
to regulate or set hospital or ambulatory surgical center
charges.
``(g) Hospital and Ambulatory Surgical Center Defined.--For
purposes of this section, the terms `hospital' and `ambulatory surgical
center' have the meaning given such terms by the Secretary.''.
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