HLS 14RS-557 ORIGINAL
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Regular Session, 2014
HOUSE BILL NO. 251
BY REPRESENTATIVE TALBOT
HEALTH SERVICES: Provides for transparency in prices of hospital procedures,
treatments, and other health care services
AN ACT1
To amend and reenact R.S. 40:1300.112(introductory paragraph), to enact Part I-A of2
Chapter 11 of Title 40 of the Louisiana Revised Statutes of 1950, to be comprised3
of R.S. 40:2031 through 2039, and to repeal R.S. 40:2010, relative to consumer4
information concerning prices of certain health care services and health care facility5
policies; to provide for legislative intent; to prohibit hospitals from assessing certain6
charges; to provide for duties of the Department of Health and Hospitals; to provide7
for requirements of hospitals and ambulatory surgical centers; to provide for8
classification and reporting of charges by certain health care providers; to require9
disclosure of charity care policies and costs by certain health care providers; to10
require the Department of Health and Hospitals to publish information on health care11
service pricing and health care facility policies; to provide for promulgation of rules;12
and to provide for related matters.13
Be it enacted by the Legislature of Louisiana:14
Section 1. R.S. 40:1300.112(introductory paragraph) is hereby amended and15
reenacted and Part I-A of Chapter 11 of Title 40 of the Louisiana Revised Statutes of 1950,16
comprised of R.S. 40:2031 through 2039, is hereby enacted to read as follows:17 HLS 14RS-557 ORIGINAL
HB NO. 251
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§1300.112. Data collection; powers and duties of the Department of Health and1
Hospitals2
The In addition to the requirements of R.S. 40:2032 et seq. relative to3
collection of data on prices charged for certain health care procedures, the4
Department of Health and Hospitals, in consultation with the Health Data Panel,5
shall:6
* * *7
PART I-A. TRANSPARENCY IN HOSPITAL8
AND SURGICAL CENTER PRICES AND POLICIES9
SUBPART A. BILLED SERVICES BY HOSPITALS10
§2010. §2031. Itemized statement of billed services by hospitals ; prohibited charges11
A. Not later than ten business days after the date of discharge, each hospital12
in the state which is licensed by the Department of Health and Hospitals shall have13
available an itemized statement of billed services for individuals who have received14
the services from the hospital. The availability of the statement shall be made known15
to each individual who receives service from the hospital before the individual is16
discharged from the hospital, and a duplicate copy of the billed services statement17
shall be presented to each patient within the specified ten day ten-day period. No18
insurance company, employee benefit trust, self-insurance plan, or other entity which19
is obligated to reimburse the individual or to pay for him or on his behalf the charges20
for the services rendered by the hospital shall pay those benefits to the individual21
when the itemized statement submitted to such entity clearly indicates that the22
individual's rights to those benefits have been assigned to the hospital. When any23
insurance company, employee benefit trust, self-insurance plan, or other entity has24
notice of such assignment prior to such payment, any payment to the insured shall25
not release said entity from liability to the hospital to which the benefits have been26
assigned, nor shall such payment be a defense to any action by the hospital against27
that entity to collect the assigned benefits. However, an interim statement shall be28
provided when requested by the patient or his authorized agent.29 HLS 14RS-557 ORIGINAL
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B. It shall be unlawful for any hospital to charge or accept payment for any1
health care procedure or component of any health care procedure that it did not2
perform or supply.3
SUBPART B. PRICE TRANSPARENCY4
§2032. Legislative intent5
It is the intent of the legislature to improve transparency in prices of health6
care services through requiring provision of information to the public on the costs7
of the most frequently reported diagnosis-related groups for hospital inpatient care,8
and for the most common surgical procedures and imaging procedures provided in9
hospital outpatient settings and ambulatory surgical centers.10
§2033. Definitions11
As used in this Subpart, the following terms have the meaning ascribed to12
them in this Section:13
(1) "Ambulatory surgical center" means a facility licensed as an ambulatory14
surgical center pursuant to the provisions of Part IV of this Chapter (R.S. 40:213115
et seq.).16
(2) "CPT" means the Current Procedural Terminology set of medical codes17
maintained by the American Medical Association.18
(3) "Department" means the Department of Health and Hospitals.19
(4) "DRG" means the diagnosis-related group system of classifying types of20
inpatient hospital stays for the purposes of billing and payment.21
(5) "HCPCS" means the Healthcare Common Procedure Coding System22
utilized in the Medicare and Medicaid programs.23
(6) "Health insurer" means an insurance company or other entity authorized24
to transact and currently transacting health insurance business in this state, provided25
that "health insurer" shall not include self-insured plans or group health plans as26
defined in Section 607(1) of the Employee Retirement Income Security Act of 1974.27
(7) "Hospital" means a facility licensed as a hospital pursuant to the28
provisions of Part II of this Chapter (R.S. 40:2100 et seq.).29 HLS 14RS-557 ORIGINAL
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(8) "Public or private third party" means an entity that functions as a third-1
party payer for a health care service and may include the state, the federal2
government, an employer, a health insurer, a third-party administrator, or a managed3
care organization.4
§2034. General requirements5
The department shall make available to the public on its Internet website the6
most current price information it receives from hospitals and ambulatory surgical7
centers pursuant to the requirements of this Subpart. The department shall provide8
this information in a manner that is easily understood by the public and meets all of9
the following minimum requirements:10
(1) Price information for each hospital is listed separately and hospitals are11
listed in groups by major category as established by the department in rule.12
(2) Information for each hospital outpatient department and each ambulatory13
surgical facility is listed separately.14
§2035. Ownership of data15
All data disclosed to the department by a hospital or ambulatory surgical16
center pursuant to the requirements of this Subpart shall be and shall remain the sole17
property of the facility that submitted the data. Any data or product derived from18
data disclosed pursuant to this Subpart, including a consolidation or analysis of the19
data, shall be and shall remain property of the state. The department shall not allow20
proprietary information it receives pursuant to this Subpart to be used by a person21
or entity for any commercial purpose.22
§2036. Disclosure of prices for most frequently reported codes; duties of hospitals,23
ambulatory surgical centers, and the Department of Health and Hospitals24
A.(1) Beginning with the quarter ending December 31, 2014, and quarterly25
thereafter, each hospital shall provide, utilizing electronic health records software,26
the following information to the department concerning the one hundred most27
frequently reported admissions by DRG for inpatients:28 HLS 14RS-557 ORIGINAL
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(a) The amount that will be charged to a patient for each DRG if all charges1
are paid in full without a public or private third party paying for any portion of the2
charges.3
(b) The average negotiated settlement on the amount that will be charged to4
a patient as provided for in Subparagraph (a) of this Paragraph.5
(c) The total amount of Medicaid reimbursements for each DRG, including6
claims and pro rata supplemental payments.7
(d) The total amount of Medicare reimbursements for each DRG.8
(e) For the five largest health insurers providing payment to the hospital on9
behalf of insured patients, the range of the total amount of payments made for each10
DRG. Prior to providing this information to the department, each hospital shall11
redact the names of the health insurers and any other information that would identify12
those insurers.13
(2) In accordance with Subsection C of this Section, the department shall14
establish by rule the listing of the one hundred most frequently reported admissions15
provided for in this Subsection.16
B.(1) Beginning with the quarter ending March 31, 2015, and quarterly17
thereafter, each hospital and ambulatory surgical center shall provide to the18
department, utilizing electronic health records software, information on the total19
costs for the twenty most common surgical procedures and the twenty most common20
imaging procedures, by volume, performed in hospital outpatient settings or in21
ambulatory surgical centers, along with the related CPT and HCPCS codes.22
(2) Hospitals and ambulatory surgical centers shall report the information23
required by this Subsection in the same manner as prescribed in Subsection A of this24
Section.25
(3) In accordance with Subsection C of this Section, the department shall26
establish by rule the listing of the twenty most common surgical procedures and the27
twenty most common imaging procedures provided for in this Subsection.28 HLS 14RS-557 ORIGINAL
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C. The department shall adopt all rules in accordance with the1
Administrative Procedure Act on or before December 1, 2014, as are necessary to2
ensure the proper implementation of the provisions of this Section, and to ensure that3
hospitals and ambulatory surgical centers report the information required herein to4
the department in a uniform manner. The rules shall provide, at minimum, the5
following:6
(1) A listing of the one hundred most frequently reported DRGs for7
inpatients for which hospitals shall provide the data required by Subsection A of this8
Section.9
(2) Specific major categories by which the department groups hospitals for10
the purpose of disclosing hospital price information to the public on the department's11
Internet website.12
(3) The list of the twenty most common surgical procedures, by volume,13
performed in a hospital outpatient setting and those performed in an ambulatory14
surgical center, along with the related CPT and HCPCS codes.15
(4) The list of the twenty most common imaging procedures, by volume,16
performed in a hospital outpatient setting and those performed in an ambulatory17
surgical center, along with the related CPT and HCPCS codes.18
§2037. Provision of cost information to patients; requirements19
A. Upon request of a patient for a particular DRG, imaging procedure, or20
surgery procedure to which the reporting requirements of this Subpart applies, a21
hospital or ambulatory surgical center shall furnish the cost information required by22
this Subpart to the patient in writing.23
B. The hospital or ambulatory surgical center shall provide such cost24
information within three business days after receiving the request of a patient, and25
may furnish the information to the patient either electronically or by mail.26 HLS 14RS-557 ORIGINAL
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SUBPART C. DISCLOSURE OF CHARITY CARE1
POLICY AND COSTS2
§2038. Definitions3
As used in this Subpart, the following terms have the meaning ascribed to4
them in this Section:5
(1) "Financial assistance costs" means the costs reported by a health care6
provider on Schedule H of IRS Form 990 related to the provider's financial7
assistance at cost, the amounts related to the provider's bad debt expense, and the8
estimated amount of the provider's bad debt expense attributable to patients eligible9
under the organization's financial assistance policy.10
(2) "Financial assistance policy" means a policy that meets the requirements11
of Section 501(r) of the Internal Revenue Code.12
§2039. Disclosure of charity care policy and costs; publication by the department13
A. The provisions of this Subpart apply exclusively to hospitals and14
ambulatory surgical centers that file Internal Revenue Service (IRS) Form 990,15
"Return of Organization Exempt From Income Tax", and that are required to16
complete and attach Schedule H thereto.17
B.(1) Each hospital and ambulatory surgical center subject to the provisions18
of this Subpart shall make publicly available, in the manner prescribed in this19
Subsection, its financial assistance policy and its annual financial assistance costs as20
reported on Schedule H of its most recently filed IRS Form 990.21
(2)(a) At least annually, each hospital and ambulatory surgical center subject22
to the provisions of this Subpart shall submit the information provided for in23
Paragraph (1) of this Subsection to the department in the time, manner, and format24
required by the department.25
(b) Each hospital and ambulatory surgical center subject to the provisions of26
this Subpart shall post the information provided for in Paragraph (1) of this27
Subsection in a conspicuous location in its place of business.28 HLS 14RS-557 ORIGINAL
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C. The department shall publish on its Internet website the information it1
receives from hospitals and ambulatory surgical centers pursuant to the provisions2
of this Section.3
Section 2. R.S. 40:2010 is hereby repealed in its entirety.4
Section 3. On or before October 1, 2014, the Department of Health and Hospitals5
shall communicate the requirements of this Act to all hospitals licensed pursuant to the6
Hospital Licensing Law (R.S. 40:2100 et seq.), and to all ambulatory surgical centers7
licensed pursuant to the Ambulatory Surgical Centers Licensing Law (R.S. 40:2131 et seq.).8
Section 4. The Louisiana State Law Institute is hereby authorized and requested to9
redesignate, in accordance with the provisions of the Act which originated as House Bill No.10
____ of this 2014 Regular Session of the Legislature, the number of any Section of statute11
amended by this Act and recodified by the provisions of the Act which originated as House12
Bill No. ____ of this 2014 Regular Session of the Legislature.13
Section 5. This Act shall become effective upon signature by the governor or, if not14
signed by the governor, upon expiration of the time for bills to become law without signature15
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If16
vetoed by the governor and subsequently approved by the legislature, this Act shall become17
effective on the day following such approval.18
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Talbot HB No. 251
Abstract: Provides for transparency in prices of hospital procedures, treatments, and other
health care services through required reporting of information to the public on costs
of the most frequently delivered types of such health care services.
General Provisions
Proposed law provides that the intent of proposed law is to improve transparency in prices
of health care services through requiring provision of information to the public on costs of
the most frequently reported diagnosis-related groups for hospital inpatient care, and for the
most common surgical procedures and imaging procedures provided in hospital outpatient
settings and ambulatory surgical centers. HLS 14RS-557 ORIGINAL
HB NO. 251
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are additions.
Proposed law retains and relocates present law relative to itemized statements of billed
services by hospitals.
Proposed law establishes that it shall be unlawful for any hospital to charge or accept
payment for any health care procedure or component of any health care procedure that it did
not perform or supply.
Provisions Relative to Price Transparency
Proposed law requires the Dept. of Health and Hospitals (DHH) to make available to the
public on its website the most current price information it receives from hospitals and
ambulatory surgical centers pursuant to the requirements of proposed law. Further requires
that DHH provide this information in a manner that is easily understood and meets all of the
following minimum requirements:
(1)Price information for each hospital is listed separately and hospitals are listed in
groups by major category as established by the department in rule.
(2)Information for each hospital outpatient department and each ambulatory surgical
facility is listed separately.
Proposed law stipulates all of the following relative to data disclosed to DHH pursuant to
proposed law:
(1)All data disclosed to DHH by a hospital or ambulatory surgical center pursuant to the
requirements of proposed law shall be and shall remain the sole property of the
facility that submitted the data.
(2)Any data or product derived from data disclosed pursuant to proposed law, including
a consolidation or analysis of the data, shall be and shall remain property of the state.
(3)DHH shall not allow proprietary information it receives pursuant to proposed law to
be used by a person or entity for any commercial purpose.
Beginning with the quarter ending Dec. 31, 2014, and quarterly thereafter, proposed law
requires each hospital to provide, utilizing electronic health records software, the following
information to DHH concerning the 100 most frequently reported inpatient admissions:
(1)The amount that will be charged to a patient for each diagnosis-related group
("DRG") if all charges are paid in full without a public or private third party paying
for any portion of the charges.
(2)The average negotiated settlement on the amount that will be charged to a patient for
each DRG if all charges are paid in full without a public or private third party paying
for any portion of the charges.
(3)The total amount of Medicaid reimbursements for each DRG, including claims and
pro rata supplemental payments.
(4)The total amount of Medicare reimbursements for each DRG.
(5)For the five largest health insurers providing payment to the hospital on behalf of
insured patients, the range of the total amount of payments made for each DRG, with
the names of the health insurers and any other information that would identify those
insurers redacted. HLS 14RS-557 ORIGINAL
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Beginning with the quarter ending March 31, 2015, and quarterly thereafter, proposed law
requires each hospital and ambulatory surgical center to provide to DHH, utilizing electronic
health records software, information on the following:
(1)Total costs for the 20 most common surgical procedures performed in hospital
outpatient settings or in ambulatory surgical centers, along with the related Current
Procedural Terminology (CPT) and Healthcare Common Procedure Coding System
(HCPCS) codes.
(2)Total costs for the 20 most common imaging procedures performed in hospital
outpatient settings or in ambulatory surgical centers, along with the related CPT and
HCPCS codes.
Proposed law requires DHH to adopt rules in accordance with the APA on or before Dec.
1, 2014, as are necessary to ensure that proposed law is properly implemented. Provides that
such rules shall include, at minimum:
(1)A listing of the 100 most frequently reported DRGs for inpatients on which hospitals
are required to provide data.
(2)Specific major categories by which DHH groups hospitals for the purpose of
disclosing hospital price information to the public on its website.
(3)The list of the 20 most common surgical procedures performed in a hospital
outpatient setting and those performed in an ambulatory surgical center, along with
the related CPT and HCPCS codes.
(4)The list of the 20 most common imaging procedures performed in a hospital
outpatient setting and those performed in an ambulatory surgical center, along with
the related CPT and HCPCS codes.
Proposed law requires that upon request of a patient for a particular DRG, imaging
procedure, or surgery procedure to which the reporting requirements of proposed law
applies, a hospital or ambulatory surgical center shall furnish the cost information required
by proposed law to the patient in writing within three business days.
Provisions Relative to Charity Care Policies and Costs
Proposed law stipulates that provisions of proposed law relative to disclosure of charity care
policy and costs apply exclusively to hospitals and ambulatory surgical centers that file
Internal Revenue Service (IRS) Form 990, "Return of Organization Exempt From Income
Tax", and that are required to complete and attach Schedule H to that form.
Proposed law provides that in provisions of proposed law relative to disclosure of charity
care policy and costs, the following definitions apply:
(1)"Financial assistance costs" means the costs reported by a health care provider on
Schedule H of IRS Form 990 related to the provider's financial assistance at cost, the
amounts related to the provider's bad debt expense, and the estimated amount of the
provider's bad debt expense attributable to patients eligible under the organization's
financial assistance policy.
(2)"Financial assistance policy" means a policy that meets the requirements of Section
501(r) of the Internal Revenue Code.
Proposed law requires each hospital and ambulatory surgical center subject to the provisions
of proposed law relative to disclosure of charity care policy and costs to: HLS 14RS-557 ORIGINAL
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(1)Make publicly available its financial assistance policy and its annual financial
assistance costs as reported on Schedule H of its most recently filed IRS Form 990.
(2)At least annually, submit to DHH the information provided for in proposed law in
the time, manner, and format required by the department.
(3)Post the information provided for in proposed law in a conspicuous location in its
place of business.
Proposed law requires DHH to publish on its website the information it receives from
hospitals and ambulatory surgical centers pursuant to proposed law.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Amends R.S. 40:1300.112(intro. para.); Adds R.S. 40:2031-2039; Repeals R.S. 40:2010)