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HOUSE BILL 263
57
TH LEGISLATURE
-
STATE
OF
NEW
MEXICO
-
FIRST SESSION
,
2025
INTRODUCED BY
Elizabeth "Liz" Thomson and Marianna Anaya and Sarah Silva
and Reena Szczepanski and Anita Gonzales
AN ACT
RELATING TO HEALTH CARE; ENACTING THE HOSPITAL PRICE
TRANSPARENCY ACT; REQUIRING HOSPITALS TO PROVIDE PRICING
INFORMATION ON SERVICES AND ITEMS PROVIDED AT THE HOSPITALS;
REQUIRING THE HEALTH CARE AUTHORITY TO IMPLEMENT AND ADMINISTER
THE HOSPITAL PRICE TRANSPARENCY ACT; PROVIDING PENALTIES;
PROVIDING CIVIL RELIEF TO CONSUMERS.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. [NEW MATERIAL] SHORT TITLE.--This act may be
cited as the "Hospital Price Transparency Act".
SECTION 2. [NEW MATERIAL] DEFINITIONS.--As used in the
Hospital Price Transparency Act:
A. "ancillary service" means a hospital item or
service that a hospital customarily provides as part of a
shoppable service;
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B. "authority" means the health care authority;
C. "chargemaster" means the list of all hospital
items or services maintained by a hospital for which the
hospital has established a charge;
D. "collection action" means 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 in violation of the
Hospital Price Transparency Act:
(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;
or
(3) directly or indirectly causing a report to
be made to a consumer reporting agency;
E. "collection agency" means a person that:
(1) engages in a business for the principal
purpose of collecting debts; or
(2) does any of the following:
(a) regularly collects or attempts to
collect, directly or indirectly, debts owed or due or asserted
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to be owed or due to another;
(b) takes assignment of debts for
collection purposes; or
(c) directly or indirectly solicits for
collection debts owed or due or asserted to be owed or due to
another;
F. "consumer reporting agency" means a person that,
for a monetary fee or dues or on a cooperative nonprofit basis,
regularly engages 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. "Consumer reporting agency" does not include business
entities that only provide check verification or check
guarantee services;
G. "debt" means 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.
"Debt" does not include a debt for business, investment,
commercial or agricultural purposes or a debt incurred by a
business;
H. "debt collector" means a person employed or
engaged by a collection agency to perform the collection of
debts owed or due or debts asserted to be owed or due to
another;
I. "de-identified maximum negotiated charge" means
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the highest charge that a hospital has negotiated with all
third-party payors for a hospital item or service;
J. "de-identified minimum negotiated charge" means
the lowest charge that a hospital has negotiated with all
third-party payors for a hospital item or service;
K. "discounted cash price" means the charge that
applies to a person who pays cash or a cash equivalent for a
hospital item or service;
L. "gross charge" means the charge for a hospital
item or service that is reflected on the hospital's
chargemaster, absent of any discount;
M. "hospital" means a public hospital, profit or
nonprofit private hospital or a general or special hospital
that is licensed as a hospital by the authority;
N. "item or service" means an item or service 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) a facility fee;
(4) a professional fee; or
(5) any other item or service for which a
hospital has established a standard charge;
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O. "machine-readable format" means a digital
representation of information in a file that can be easily
imported or read into a computer system for further processing
without any additional preparation;
P. "payor-specific negotiated charge" means the
charge that a hospital has negotiated with a third-party payor
for a hospital item or service;
Q. "professional fee" means a fee charged by a
health care practitioner for medical services;
R. "shoppable service" means a service that may be
scheduled by a person in advance;
S. "standard charge" means the regular rate
established by a hospital for a hospital item or service
provided to a specific group of paying patients. "Standard
charge" includes the:
(1) gross charge;
(2) payor-specific negotiated charge;
(3) de-identified maximum negotiated charge;
(4) de-identified minimum negotiated charge;
and
(5) discounted cash price; and
T. "third-party payor" means an entity that is
legally responsible for payment of a claim for a hospital item
or service.
SECTION 3. [NEW MATERIAL] PUBLIC AVAILABILITY OF PRICE
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INFORMATION REQUIRED.--
A. Each hospital shall publish the following
information on the hospital's publicly accessible website:
(1) a digital file in a machine-readable
format that contains the following information for each item or
service provided in either an inpatient setting or an
outpatient setting:
(a) the gross charge;
(b) the de-identified minimum negotiated
charge;
(c) the de-identified maximum negotiated
charge;
(d) the discounted cash price;
(e) the payor-specific negotiated
charge, delineated by the name of the third-party payor and
plan. A hospital shall include all payors and plans accepted
by the hospital; and
(f) a code used by the hospital for the
purpose of accounting or billing for the hospital item or
service, including the current procedural terminology code, the
healthcare common procedure coding system code, the diagnosis-
related group code, the national drug code or other common
identifier; and
(2) a consumer-friendly list that contains
information for at least three hundred shoppable services
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provided by the hospital with charges specific to that
individual hospital location. The hospital may select the
shoppable services to be included in the list, except that the
list shall include the seventy services specified as shoppable
services by the federal centers for medicare and medicaid
services. If the hospital does not provide all of the
shoppable services specified by the federal centers for
medicare and medicaid services, the hospital shall include all
of the shoppable services provided by the hospital. If a
hospital does not provide three hundred shoppable services, the
hospital shall include the total number of shoppable services
that the hospital provides. The list shall include the
following information for each shoppable service and any
associated ancillary service:
(a) a plain-language description;
(b) the payor-specific negotiated
charge, delineated by the name of the third-party payor and
plan. A hospital shall include all payors and plans accepted
by the hospital;
(c) the discounted cash price or, if the
hospital does not offer a discounted cash price, the gross
charge;
(d) the de-identified minimum negotiated
charge;
(e) the de-identified maximum negotiated
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charge; and
(f) a code used by the hospital for
purposes of accounting or billing for each item or service,
including the current procedural terminology code, the
healthcare common procedure coding system code, the diagnosis-
related group code, the national drug code or other common
identifier.
B. A hospital shall make all information required
to be published under this section available to the public by
posting the information in a prominent location on the home
page of the hospital's publicly accessible website or making
the list accessible by a dedicated link that is prominently
displayed on the home page of the hospital's publicly
accessible website. If the hospital operates multiple
locations and maintains a single website, the hospital shall
post the specific information for each location that the
hospital operates in a manner that clearly associates the
information with the applicable location of the hospital.
C. A hospital shall ensure that all information
required to be published under this section is:
(1) available free of charge;
(2) 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;
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(3) formatted in a manner that complies with
the Hospital Price Transparency Act and any requirements set
forth by the authority; and
(4) digitally searchable by service
description, billing code and third-party payor.
D. A hospital shall not restrict access to the
information required to be published under this section by
requiring:
(1) the establishment of a user account or
password;
(2) the submission of personal identifying
information; or
(3) any other impediment, including entering a
code to access the information.
E. The authority shall develop a template that each
hospital shall use in formatting the information required to be
published under Paragraph (1) of Subsection A of this section.
When developing the template, the authority shall:
(1) take into consideration applicable federal
guidelines for formatting similar information required by
federal law;
(2) ensure that the template's design enables
a person to compare charges for items or services provided at
each hospital; and
(3) design the template to be substantially
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similar to the template used by the federal centers for
medicare and medicaid services for purposes similar to this
section.
F. A hospital shall update the information required
to be published under this section no less than once each year.
The hospital shall clearly indicate the date when the
information was most recently updated. The hospital shall make
all versions of each list available for at least seven years.
G. When selecting a shoppable service for the
purpose of inclusion in the list published pursuant to
Paragraph (2) of Subsection A of this section, a hospital
shall:
(1) consider how frequently the hospital
provides the service and the hospital's billing rate for the
service; and
(2) prioritize the selection of services that
are among the services most frequently provided by the
hospital.
H. Any information on the price of an item or
service, or the amount charged for an item or service, required
to be published under this section shall be expressed in United
States dollars.
SECTION 4. [NEW MATERIAL] REPORTING REQUIREMENTS.--
A. Each time a hospital creates or updates a list
required to be published by the Hospital Price Transparency
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Act, the hospital shall submit the list to the authority.
B. The authority shall make all lists available on
the authority's website within sixty days of receipt of each
list.
C. The authority shall annually submit a report to
the legislative finance committee and the interim legislative
health and human services committee on the progress in
implementing and administering the Hospital Price Transparency
Act.
SECTION 5. [NEW MATERIAL] ENFORCEMENT.--
A. The authority shall establish an electronic form
for individuals to submit complaints for alleged violations of
the Hospital Price Transparency Act. The authority shall post
the electronic form on the authority's website. The authority
shall also accept complaints via a customer service telephone
number.
B. A hospital shall be in violation of the Hospital
Price Transparency Act if the hospital:
(1) for any item or service, charges a patient
more than the dollar amount published in the lists required
under Paragraphs (1) and (2) of Subsection A of Section 3 of
the Hospital Price Transparency Act;
(2) violates the provisions of the Hospital
Price Transparency Act or the rules promulgated pursuant to
that act;
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(3) fails to take immediate action to remedy a
violation of the provisions of the Hospital Price Transparency
Act or the rules promulgated pursuant to that act;
(4) fails to submit a plan of correction in
accordance with the requirements of this section;
(5) fails to comply with a plan of correction;
or
(6) violates an order previously issued by the
authority in a disciplinary matter.
C. Upon determining that a hospital has violated
the provisions of the Hospital Price Transparency Act or the
rules promulgated pursuant to that act, the authority shall
issue a written notice to the hospital stating that a violation
has been committed by the hospital. The written notice shall:
(1) state 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 authority; and
(2) state that the hospital is required to
provide prompt confirmation to the authority that the
corrective action has been taken.
D. If a hospital is required to submit a plan of
correction to the authority, the authority may direct that the
violation be remedied within a specified period of time. The
hospital shall submit the plan of correction within thirty days
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of the authority's issuance of the written notice.
E. The authority may impose a civil penalty for
violations of the Hospital Price Transparency Act in an amount
not to exceed:
(1) two thousand five hundred dollars ($2,500)
for a first incident;
(2) five thousand dollars ($5,000) for a
second incident;
(3) ten thousand dollars ($10,000) for a third
incident; and
(4) fifteen thousand dollars ($15,000) for a
fourth or subsequent incident.
F. Each day that a hospital violates the Hospital
Price Transparency Act constitutes a separate and distinct
incident.
G. The authority may audit a hospital's website to
ensure compliance with the Hospital Price Transparency Act.
H. A hospital that is in violation of the Hospital
Price Transparency Act on the date when an item or service is
provided to a patient shall not initiate or pursue a collection
action against the patient or patient guarantor for a debt owed
for the item or service.
I. If a patient or a patient guarantor believes
that a hospital is in violation of the Hospital Price
Transparency Act on the date when an item or service is
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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 the Hospital Price Transparency Act. The hospital
shall 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.
If the court of competent jurisdiction determines that the
hospital is in violation of the Hospital Price Transparency Act
and the violation is related to the items or services for which
the patient was charged, the hospital 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) pay any attorney fees 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.
J. Nothing in the Hospital Price Transparency Act
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 a patient in
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a manner that is not in violation of the Hospital Price
Transparency Act; and
(2) require a hospital to refund a payment
made to the hospital for an item or service provided to a
patient if no collection action is taken in violation of the
Hospital Price Transparency Act.
SECTION 6. [NEW MATERIAL] INFORMATION REQUIRED TO BE
PROVIDED TO PATIENTS.--Prior to commencing a collection action,
a hospital or a debt collector acting on behalf of a hospital
shall provide a patient with:
A. an easy-to-understand itemized statement of the
medical debt owed by the patient to the hospital, which shall
include the applicable billing codes for each item or service,
using commonly recognized billing code sets;
B. a copy of the detailed receipts of any payments
made to the hospital or debt collector by the patient or the
patient's guarantor within thirty days of each payment;
C. information about the availability of language-
assistance services for persons with limited proficiency in
English; and
D. the contact information for an office or
individual at the hospital that can:
(1) discuss the specific details of an
itemized statement; and
(2) make appropriate changes to the statement.
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SECTION 7. [NEW MATERIAL] RULEMAKING.--The authority may
promulgate rules necessary to implement and administer the
Hospital Price Transparency Act.
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