New Mexico 2025 Regular Session

New Mexico House Bill HB263 Compare Versions

Only one version of the bill is available at this time.

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28	28	HOUSE BILL 263
29	29	57
30	30	TH LEGISLATURE
31	31	-
32	32
33	33	STATE
34	34
35	35	OF
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37	37	NEW
38	38
39	39	MEXICO
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41	41	-
42	42	FIRST SESSION
43	43	,
44	44
45	45	2025
46	46	INTRODUCED BY
47	47	Elizabeth "Liz" Thomson and Marianna Anaya and Sarah Silva
48	48	and Reena Szczepanski and Anita Gonzales
49	49	AN ACT
50	50	RELATING TO HEALTH CARE; ENACTING THE HOSPITAL PRICE
51	51	TRANSPARENCY ACT; REQUIRING HOSPITALS TO PROVIDE PRICING
52	52	INFORMATION ON SERVICES AND ITEMS PROVIDED AT THE HOSPITALS;
53	53	REQUIRING THE HEALTH CARE AUTHORITY TO IMPLEMENT AND ADMINISTER
54	54	THE HOSPITAL PRICE TRANSPARENCY ACT; PROVIDING PENALTIES;
55	55	PROVIDING CIVIL RELIEF TO CONSUMERS.
56	56	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
57	57	SECTION 1. [NEW MATERIAL] SHORT TITLE.--This act may be
58	58	cited as the "Hospital Price Transparency Act".
59	59	SECTION 2. [NEW MATERIAL] DEFINITIONS.--As used in the
60	60	Hospital Price Transparency Act:
61	61	A. "ancillary service" means a hospital item or
62	62	service that a hospital customarily provides as part of a
63	63	shoppable service;
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91	91	B. "authority" means the health care authority;
92	92	C. "chargemaster" means the list of all hospital
93	93	items or services maintained by a hospital for which the
94	94	hospital has established a charge;
95	95	D. "collection action" means any of the following
96	96	actions taken with respect to a debt for an item or service
97	97	that was purchased from or provided to a patient by a hospital
98	98	on a date during which the hospital was in violation of the
99	99	Hospital Price Transparency Act:
100	100	(1) attempting to collect a debt from a
101	101	patient or patient guarantor by referring the debt, directly or
102	102	indirectly, to a debt collector, a collection agency or other
103	103	third party retained by or on behalf of the hospital;
104	104	(2) suing the patient or patient guarantor or
105	105	enforcing an arbitration or mediation clause in a hospital
106	106	document, including any contract, agreement, statement or bill;
107	107	or
108	108	(3) directly or indirectly causing a report to
109	109	be made to a consumer reporting agency;
110	110	E. "collection agency" means a person that:
111	111	(1) engages in a business for the principal
112	112	purpose of collecting debts; or
113	113	(2) does any of the following:
114	114	(a) regularly collects or attempts to
115	115	collect, directly or indirectly, debts owed or due or asserted
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144	144	to be owed or due to another;
145	145	(b) takes assignment of debts for
146	146	collection purposes; or
147	147	(c) directly or indirectly solicits for
148	148	collection debts owed or due or asserted to be owed or due to
149	149	another;
150	150	F. "consumer reporting agency" means a person that,
151	151	for a monetary fee or dues or on a cooperative nonprofit basis,
152	152	regularly engages in the practice of assembling or evaluating
153	153	consumer credit information or other information on consumers
154	154	for the purpose of furnishing consumer reports to third
155	155	parties. "Consumer reporting agency" does not include business
156	156	entities that only provide check verification or check
157	157	guarantee services;
158	158	G. "debt" means an obligation or alleged obligation
159	159	of a consumer to pay money arising out of a transaction,
160	160	whether or not the obligation has been reduced to judgment.
161	161	"Debt" does not include a debt for business, investment,
162	162	commercial or agricultural purposes or a debt incurred by a
163	163	business;
164	164	H. "debt collector" means a person employed or
165	165	engaged by a collection agency to perform the collection of
166	166	debts owed or due or debts asserted to be owed or due to
167	167	another;
168	168	I. "de-identified maximum negotiated charge" means
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197	197	the highest charge that a hospital has negotiated with all
198	198	third-party payors for a hospital item or service;
199	199	J. "de-identified minimum negotiated charge" means
200	200	the lowest charge that a hospital has negotiated with all
201	201	third-party payors for a hospital item or service;
202	202	K. "discounted cash price" means the charge that
203	203	applies to a person who pays cash or a cash equivalent for a
204	204	hospital item or service;
205	205	L. "gross charge" means the charge for a hospital
206	206	item or service that is reflected on the hospital's
207	207	chargemaster, absent of any discount;
208	208	M. "hospital" means a public hospital, profit or
209	209	nonprofit private hospital or a general or special hospital
210	210	that is licensed as a hospital by the authority;
211	211	N. "item or service" means an item or service that
212	212	could be provided by a hospital to a patient in connection with
213	213	an inpatient admission or an outpatient department visit for
214	214	which the hospital has established a standard charge, including
215	215	any of the following:
216	216	(1) a supply or procedure;
217	217	(2) room and board;
218	218	(3) a facility fee;
219	219	(4) a professional fee; or
220	220	(5) any other item or service for which a
221	221	hospital has established a standard charge;
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250	250	O. "machine-readable format" means a digital
251	251	representation of information in a file that can be easily
252	252	imported or read into a computer system for further processing
253	253	without any additional preparation;
254	254	P. "payor-specific negotiated charge" means the
255	255	charge that a hospital has negotiated with a third-party payor
256	256	for a hospital item or service;
257	257	Q. "professional fee" means a fee charged by a
258	258	health care practitioner for medical services;
259	259	R. "shoppable service" means a service that may be
260	260	scheduled by a person in advance;
261	261	S. "standard charge" means the regular rate
262	262	established by a hospital for a hospital item or service
263	263	provided to a specific group of paying patients. "Standard
264	264	charge" includes the:
265	265	(1) gross charge;
266	266	(2) payor-specific negotiated charge;
267	267	(3) de-identified maximum negotiated charge;
268	268	(4) de-identified minimum negotiated charge;
269	269	and
270	270	(5) discounted cash price; and
271	271	T. "third-party payor" means an entity that is
272	272	legally responsible for payment of a claim for a hospital item
273	273	or service.
274	274	SECTION 3. [NEW MATERIAL] PUBLIC AVAILABILITY OF PRICE
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303	303	INFORMATION REQUIRED.--
304	304	A. Each hospital shall publish the following
305	305	information on the hospital's publicly accessible website:
306	306	(1) a digital file in a machine-readable
307	307	format that contains the following information for each item or
308	308	service provided in either an inpatient setting or an
309	309	outpatient setting:
310	310	(a) the gross charge;
311	311	(b) the de-identified minimum negotiated
312	312	charge;
313	313	(c) the de-identified maximum negotiated
314	314	charge;
315	315	(d) the discounted cash price;
316	316	(e) the payor-specific negotiated
317	317	charge, delineated by the name of the third-party payor and
318	318	plan. A hospital shall include all payors and plans accepted
319	319	by the hospital; and
320	320	(f) a code used by the hospital for the
321	321	purpose of accounting or billing for the hospital item or
322	322	service, including the current procedural terminology code, the
323	323	healthcare common procedure coding system code, the diagnosis-
324	324	related group code, the national drug code or other common
325	325	identifier; and
326	326	(2) a consumer-friendly list that contains
327	327	information for at least three hundred shoppable services
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356	356	provided by the hospital with charges specific to that
357	357	individual hospital location. The hospital may select the
358	358	shoppable services to be included in the list, except that the
359	359	list shall include the seventy services specified as shoppable
360	360	services by the federal centers for medicare and medicaid
361	361	services. If the hospital does not provide all of the
362	362	shoppable services specified by the federal centers for
363	363	medicare and medicaid services, the hospital shall include all
364	364	of the shoppable services provided by the hospital. If a
365	365	hospital does not provide three hundred shoppable services, the
366	366	hospital shall include the total number of shoppable services
367	367	that the hospital provides. The list shall include the
368	368	following information for each shoppable service and any
369	369	associated ancillary service:
370	370	(a) a plain-language description;
371	371	(b) the payor-specific negotiated
372	372	charge, delineated by the name of the third-party payor and
373	373	plan. A hospital shall include all payors and plans accepted
374	374	by the hospital;
375	375	(c) the discounted cash price or, if the
376	376	hospital does not offer a discounted cash price, the gross
377	377	charge;
378	378	(d) the de-identified minimum negotiated
379	379	charge;
380	380	(e) the de-identified maximum negotiated
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409	409	charge; and
410	410	(f) a code used by the hospital for
411	411	purposes of accounting or billing for each item or service,
412	412	including the current procedural terminology code, the
413	413	healthcare common procedure coding system code, the diagnosis-
414	414	related group code, the national drug code or other common
415	415	identifier.
416	416	B. A hospital shall make all information required
417	417	to be published under this section available to the public by
418	418	posting the information in a prominent location on the home
419	419	page of the hospital's publicly accessible website or making
420	420	the list accessible by a dedicated link that is prominently
421	421	displayed on the home page of the hospital's publicly
422	422	accessible website. If the hospital operates multiple
423	423	locations and maintains a single website, the hospital shall
424	424	post the specific information for each location that the
425	425	hospital operates in a manner that clearly associates the
426	426	information with the applicable location of the hospital.
427	427	C. A hospital shall ensure that all information
428	428	required to be published under this section is:
429	429	(1) available free of charge;
430	430	(2) accessible to a common commercial operator
431	431	of an internet search engine to the extent necessary for the
432	432	search engine to index the list and display the list in
433	433	response to a search query of a user of the search engine;
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462	462	(3) formatted in a manner that complies with
463	463	the Hospital Price Transparency Act and any requirements set
464	464	forth by the authority; and
465	465	(4) digitally searchable by service
466	466	description, billing code and third-party payor.
467	467	D. A hospital shall not restrict access to the
468	468	information required to be published under this section by
469	469	requiring:
470	470	(1) the establishment of a user account or
471	471	password;
472	472	(2) the submission of personal identifying
473	473	information; or
474	474	(3) any other impediment, including entering a
475	475	code to access the information.
476	476	E. The authority shall develop a template that each
477	477	hospital shall use in formatting the information required to be
478	478	published under Paragraph (1) of Subsection A of this section.
479	479	When developing the template, the authority shall:
480	480	(1) take into consideration applicable federal
481	481	guidelines for formatting similar information required by
482	482	federal law;
483	483	(2) ensure that the template's design enables
484	484	a person to compare charges for items or services provided at
485	485	each hospital; and
486	486	(3) design the template to be substantially
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515	515	similar to the template used by the federal centers for
516	516	medicare and medicaid services for purposes similar to this
517	517	section.
518	518	F. A hospital shall update the information required
519	519	to be published under this section no less than once each year.
520	520	The hospital shall clearly indicate the date when the
521	521	information was most recently updated. The hospital shall make
522	522	all versions of each list available for at least seven years.
523	523	G. When selecting a shoppable service for the
524	524	purpose of inclusion in the list published pursuant to
525	525	Paragraph (2) of Subsection A of this section, a hospital
526	526	shall:
527	527	(1) consider how frequently the hospital
528	528	provides the service and the hospital's billing rate for the
529	529	service; and
530	530	(2) prioritize the selection of services that
531	531	are among the services most frequently provided by the
532	532	hospital.
533	533	H. Any information on the price of an item or
534	534	service, or the amount charged for an item or service, required
535	535	to be published under this section shall be expressed in United
536	536	States dollars.
537	537	SECTION 4. [NEW MATERIAL] REPORTING REQUIREMENTS.--
538	538	A. Each time a hospital creates or updates a list
539	539	required to be published by the Hospital Price Transparency
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568	568	Act, the hospital shall submit the list to the authority.
569	569	B. The authority shall make all lists available on
570	570	the authority's website within sixty days of receipt of each
571	571	list.
572	572	C. The authority shall annually submit a report to
573	573	the legislative finance committee and the interim legislative
574	574	health and human services committee on the progress in
575	575	implementing and administering the Hospital Price Transparency
576	576	Act.
577	577	SECTION 5. [NEW MATERIAL] ENFORCEMENT.--
578	578	A. The authority shall establish an electronic form
579	579	for individuals to submit complaints for alleged violations of
580	580	the Hospital Price Transparency Act. The authority shall post
581	581	the electronic form on the authority's website. The authority
582	582	shall also accept complaints via a customer service telephone
583	583	number.
584	584	B. A hospital shall be in violation of the Hospital
585	585	Price Transparency Act if the hospital:
586	586	(1) for any item or service, charges a patient
587	587	more than the dollar amount published in the lists required
588	588	under Paragraphs (1) and (2) of Subsection A of Section 3 of
589	589	the Hospital Price Transparency Act;
590	590	(2) violates the provisions of the Hospital
591	591	Price Transparency Act or the rules promulgated pursuant to
592	592	that act;
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621	621	(3) fails to take immediate action to remedy a
622	622	violation of the provisions of the Hospital Price Transparency
623	623	Act or the rules promulgated pursuant to that act;
624	624	(4) fails to submit a plan of correction in
625	625	accordance with the requirements of this section;
626	626	(5) fails to comply with a plan of correction;
627	627	or
628	628	(6) violates an order previously issued by the
629	629	authority in a disciplinary matter.
630	630	C. Upon determining that a hospital has violated
631	631	the provisions of the Hospital Price Transparency Act or the
632	632	rules promulgated pursuant to that act, the authority shall
633	633	issue a written notice to the hospital stating that a violation
634	634	has been committed by the hospital. The written notice shall:
635	635	(1) state that the hospital is required to
636	636	take immediate action to remedy the violation or, if the
637	637	hospital is unable to immediately remedy the violation, submit
638	638	a plan of correction to the authority; and
639	639	(2) state that the hospital is required to
640	640	provide prompt confirmation to the authority that the
641	641	corrective action has been taken.
642	642	D. If a hospital is required to submit a plan of
643	643	correction to the authority, the authority may direct that the
644	644	violation be remedied within a specified period of time. The
645	645	hospital shall submit the plan of correction within thirty days
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674	674	of the authority's issuance of the written notice.
675	675	E. The authority may impose a civil penalty for
676	676	violations of the Hospital Price Transparency Act in an amount
677	677	not to exceed:
678	678	(1) two thousand five hundred dollars ($2,500)
679	679	for a first incident;
680	680	(2) five thousand dollars ($5,000) for a
681	681	second incident;
682	682	(3) ten thousand dollars ($10,000) for a third
683	683	incident; and
684	684	(4) fifteen thousand dollars ($15,000) for a
685	685	fourth or subsequent incident.
686	686	F. Each day that a hospital violates the Hospital
687	687	Price Transparency Act constitutes a separate and distinct
688	688	incident.
689	689	G. The authority may audit a hospital's website to
690	690	ensure compliance with the Hospital Price Transparency Act.
691	691	H. A hospital that is in violation of the Hospital
692	692	Price Transparency Act on the date when an item or service is
693	693	provided to a patient shall not initiate or pursue a collection
694	694	action against the patient or patient guarantor for a debt owed
695	695	for the item or service.
696	696	I. If a patient or a patient guarantor believes
697	697	that a hospital is in violation of the Hospital Price
698	698	Transparency Act on the date when an item or service is
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727	727	provided to the patient and the hospital takes a collection
728	728	action against the patient or patient guarantor, the patient or
729	729	patient guarantor may initiate a civil action in a court of
730	730	competent jurisdiction to determine if the hospital is in
731	731	violation of the Hospital Price Transparency Act. The hospital
732	732	shall not take a collection action against the patient or
733	733	patient guarantor or submit a report to a patient's or patient
734	734	guarantor's credit report while the civil action is pending.
735	735	If the court of competent jurisdiction determines that the
736	736	hospital is in violation of the Hospital Price Transparency Act
737	737	and the violation is related to the items or services for which
738	738	the patient was charged, the hospital shall:
739	739	(1) refund the payor an amount of the debt the
740	740	payor has paid and pay a penalty to the patient or patient
741	741	guarantor in an amount equal to the total amount of the debt;
742	742	(2) pay any attorney fees and costs incurred
743	743	by the patient or patient guarantor relating to the action; and
744	744	(3) remove or cause to be removed from the
745	745	patient's or patient guarantor's credit report a report made to
746	746	a consumer reporting agency relating to the debt.
747	747	J. Nothing in the Hospital Price Transparency Act
748	748	shall be construed to:
749	749	(1) prohibit a hospital from billing a
750	750	patient, patient guarantor or third-party payor, including a
751	751	health insurer, for an item or service provided to a patient in
752	752	.228725.3
753	753	- 14 - underscored material = new
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780	780	a manner that is not in violation of the Hospital Price
781	781	Transparency Act; and
782	782	(2) require a hospital to refund a payment
783	783	made to the hospital for an item or service provided to a
784	784	patient if no collection action is taken in violation of the
785	785	Hospital Price Transparency Act.
786	786	SECTION 6. [NEW MATERIAL] INFORMATION REQUIRED TO BE
787	787	PROVIDED TO PATIENTS.--Prior to commencing a collection action,
788	788	a hospital or a debt collector acting on behalf of a hospital
789	789	shall provide a patient with:
790	790	A. an easy-to-understand itemized statement of the
791	791	medical debt owed by the patient to the hospital, which shall
792	792	include the applicable billing codes for each item or service,
793	793	using commonly recognized billing code sets;
794	794	B. a copy of the detailed receipts of any payments
795	795	made to the hospital or debt collector by the patient or the
796	796	patient's guarantor within thirty days of each payment;
797	797	C. information about the availability of language-
798	798	assistance services for persons with limited proficiency in
799	799	English; and
800	800	D. the contact information for an office or
801	801	individual at the hospital that can:
802	802	(1) discuss the specific details of an
803	803	itemized statement; and
804	804	(2) make appropriate changes to the statement.
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833	833	SECTION 7. [NEW MATERIAL] RULEMAKING.--The authority may
834	834	promulgate rules necessary to implement and administer the
835	835	Hospital Price Transparency Act.
836	836	- 16 -
837	837	.228725.3