Rhode Island 2023 Regular Session

Rhode Island Senate Bill S0584 Compare Versions

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

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5	5	2023 -- S 0584
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7	7	LC001939
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9	9	S TATE OF RHODE IS LAND
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO HEALTH AND SAFETY -- DISCLOSURE OF PRICES -- MEDICAL
16	16	FACILITY ITEMS
17	17	Introduced By: Senators de la Cruz, Rogers, DiPalma, Lombardo, Ciccone, and Burke
18	18	Date Introduced: March 07, 2023
19	19	Referred To: Senate Health & Human Services
20	20
21	21
22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby 1
24	24	amended by adding thereto the following chapter: 2
25	25	CHAPTER 99 3
26	26	DISCLOSURE OF PRICES - MEDICAL FACILITY ITEMS 4
27	27	23-99-1. Definitions. 5
28	28	As used in this chapter: 6
29	29	(1) "Ancillary service" means a facility item or service that a facility customarily provides 7
30	30	as part of a shoppable service. 8
31	31	(2) "Chargemaster" means the list of all facility items or services maintained by a facility 9
32	32	for which the facility has established a charge. 10
33	33	(3) "Commission" means the health and human services commission. 11
34	34	(4) "De-identified maximum negotiated charge" means the highest charge that a facility 12
35	35	has negotiated with all third-party payors for a facility item or service. 13
36	36	(5) "De-identified minimum negotiated charge" means the lowest charge that a facility has 14
37	37	negotiated with all third-party payors for a facility item or service. 15
38	38	(6) "Discounted cash price" means the charge that applies to an individual who pays cash, 16
39	39	or a cash equivalent, for a facility item or service. 17
40	40	(7) "Facility" means a hospital licensed under chapter 17 of title 23. 18
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43	43	LC001939 - Page 2 of 10
44	44	(8) "Facility items or services" means all items and services, including individual items and 1
45	45	services and service packages, that may be provided by a facility to a patient in connection with an 2
46	46	inpatient admission or an outpatient department visit, as applicable, for which the facility has 3
47	47	established a standard charge, including: 4
48	48	(i) Supplies and procedures; 5
49	49	(ii) Room and board; 6
50	50	(iii) Use of the facility and other areas, the charges for which are generally referred to as 7
51	51	facility fees; 8
52	52	(iv) Services of physicians and non-physician practitioners, employed by the facility, the 9
53	53	charges for which are generally referred to as professional charges; and 10
54	54	(v) Any other item or service for which a facility has established a standard charge. 11
55	55	(9) "Gross charge" means the charge for a facility item or service that is reflected on a 12
56	56	facility's chargemaster, absent any discounts. 13
57	57	(10) "Machine-readable format" means a digital representation of information in a file that 14
58	58	can be imported or read into a computer system for further processing. The term includes .XML, 15
59	59	.JSON, and .CSV formats. 16
60	60	(11) "Payor-specific negotiated charge" means the charge that a facility has negotiated with 17
61	61	a third-party payor for a facility item or service. 18
62	62	(12) "Service package" means an aggregation of individual facility items or services into a 19
63	63	single service with a single charge. 20
64	64	(13) "Shoppable service" means a service that may be scheduled by a health care consumer 21
65	65	in advance. 22
66	66	(14) "Standard charge" means the regular rate established by the facility for a facility item 23
67	67	or service provided to a specific group of paying patients. The term includes all of the following, 24
68	68	as defined under this section: 25
69	69	(i) The gross charge; 26
70	70	(ii) The payor-specific negotiated charge; 27
71	71	(iii) The de-identified minimum negotiated charge; 28
72	72	(iv) The de-identified maximum negotiated charge; and 29
73	73	(v) The discounted cash price. 30
74	74	(15) "Third-party payor" means an entity that is, by statute, contract, or agreement, legally 31
75	75	responsible for payment of a claim for a facility item or service. 32
76	76	23-99-2. Public availability of price information required. 33
77	77	(a) Notwithstanding any other law, a facility must make public: 34
78	78
79	79
80	80	LC001939 - Page 3 of 10
81	81	(1) A digital file in a machine-readable format that contains a list of all standard charges 1
82	82	for all facility items or services as described by § 23-99-3; and 2
83	83	(2) A consumer-friendly list of standard charges for a limited set of shoppable services as 3
84	84	provided in § 23-99-4. 4
85	85	23-99-3. List of standard charges required. 5
86	86	(a) A facility shall: 6
87	87	(1) Maintain a list of all standard charges for all facility items or services in accordance 7
88	88	with this section; and 8
89	89	(2) Ensure the list required under subsection (a)(1) of this section is available at all times 9
90	90	to the public, including by posting the list electronically in the manner provided by this section. 10
91	91	(b) The standard charges contained in the list required to be maintained by a facility under 11
92	92	subsection (a) of this section must reflect the standard charges applicable to that location of the 12
93	93	facility, regardless of whether the facility operates in more than one location or operates under the 13
94	94	same license as another facility. 14
95	95	(c) The list required under subsection (a) of this section must include the following items, 15
96	96	as applicable: 16
97	97	(1) A description of each facility item or service provided by the facility; 17
98	98	(2) The following charges for each individual facility item or service when provided in 18
99	99	either an inpatient setting or an outpatient department setting, as applicable: 19
100	100	(i) The gross charge; 20
101	101	(ii) The de-identified minimum negotiated charge; 21
102	102	(iii) The de-identified maximum negotiated charge; 22
103	103	(iv) The discounted cash price; and 23
104	104	(v) The payor-specific negotiated charge, listed by the name of the third-party payor and 24
105	105	plan associated with the charge and displayed in a manner that clearly associates the charge with 25
106	106	each third-party payor and plan; and 26
107	107	(3) Any code used by the facility for purposes of accounting or billing for the facility item 27
108	108	or service, including the Current Procedural Terminology (CPT) code, the Healthcare Common 28
109	109	Procedure Coding System (HCPCS) code, the Diagnosis Related Group (DRG) code, the National 29
110	110	Drug Code (NDC), or other common identifier. 30
111	111	(d) The information contained in the list required under subsection (a) of this section must 31
112	112	be published in a single digital file that is in a machine-readable format. 32
113	113	(e) The list required under subsection (a) of this section must be displayed in a prominent 33
114	114	location on the home page of the facility's publicly accessible Internet website or accessible by 34
115	115
116	116
117	117	LC001939 - Page 4 of 10
118	118	selecting a dedicated link that is prominently displayed on the home page of the facility's publicly 1
119	119	accessible Internet website. If the facility operates multiple locations and maintains a single Internet 2
120	120	website, the list required under subsection (a) of this section must be posted for each location the 3
121	121	facility operates in a manner that clearly associates the list with the applicable location of the 4
122	122	facility. 5
123	123	(f) The list required under subsection (a) of this section must: 6
124	124	(1) Be available: 7
125	125	(i) Free of charge; 8
126	126	(ii) Without having to establish a user account or password; 9
127	127	(iii) Without having to submit personal identifying information; and 10
128	128	(iv) Without having to overcome any other impediment, including entering a code to access 11
129	129	the list; 12
130	130	(2) Be accessible to a common commercial operator of an Internet search engine to the 13
131	131	extent necessary for the search engine to index the list and display the list as a result in response to 14
132	132	a search query of a user of the search engine; 15
133	133	(3) Be formatted in a manner prescribed by the commission; 16
134	134	(4) Be digitally searchable; and 17
135	135	(5) Use the following naming convention specified by the Centers for Medicare and 18
136	136	Medicaid Services, specifically: 19
137	137	(i) In prescribing the format of the list under subsection (f)(3) of this section, the 20
138	138	commission shall: 21
139	139	(A) Develop a template that each facility must use in formatting the list; and 22
140	140	(B) In developing the template under subsection (1) of this section: 23
141	141	(I) Consider any applicable federal guidelines for formatting similar lists required by 24
142	142	federal law or rule and ensure that the design of the template enables health care researchers to 25
143	143	compare the charges contained in the lists maintained by each facility; and 26
144	144	(II) Design the template to be substantially similar to the template used by the Centers for 27
145	145	Medicare and Medicaid Services for purposes similar to those of this chapter, if the commission 28
146	146	determines that designing the template in that manner serves the purposes of subsection (a) of this 29
147	147	section and that the commission benefits from developing and requiring that substantially similar 30
148	148	design. 31
149	149	(g) The facility must update the list required under subsection (a) of this section at least 32
150	150	once each year. The facility must clearly indicate the date on which the list was most recently 33
151	151	updated, either on the list or in a manner that is clearly associated with the list. 34
152	152
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155	155	23-99-4. Consumer-friendly list of shoppable services. 1
156	156	(a) Except as provided by subsection (c) of this section, a facility shall maintain and make 2
157	157	publicly available a list of the standard charges described by §§ 23-99-3 (c)(2)(ii), (iii), (iv), and 3
158	158	(v) for each of at least three hundred (300) shoppable services provided by the facility. The facility 4
159	159	may select the shoppable services to be included in the list, except that the list must include: 5
160	160	(1) The seventy (70) services specified as shoppable services by the Centers for Medicare 6
161	161	and Medicaid Services; or 7
162	162	(2) If the facility does not provide all of the shoppable services described by subsection 8
163	163	(a)(1) of this section, as many of those shoppable services the facility does provide. 9
164	164	(b) In selecting a shoppable service for purposes of inclusion in the list required under 10
165	165	subsection (a) of this section, a facility must: 11
166	166	(1) Consider how frequently the facility provides the service and the facility's billing rate 12
167	167	for that service; and 13
168	168	(2) Prioritize the selection of services that are among the services most frequently provided 14
169	169	by the facility. 15
170	170	(c) If a facility does not provide three hundred (300) shoppable services, the facility must 16
171	171	maintain a list of the total number of shoppable services that the facility provides in a manner that 17
172	172	otherwise complies with the requirements of subsection (a) of this section. 18
173	173	(d) The list required under subsection (a) or (c) of this section, as applicable, must: 19
174	174	(1) Include: 20
175	175	(i) A plain-language description of each shoppable service included on the list; 21
176	176	(ii) The payor-specific negotiated charge that applies to each shoppable service included 22
177	177	on the list and any ancillary service, listed by the name of the third-party payor and plan associated 23
178	178	with the charge and displayed in a manner that clearly associates the charge with the third-party 24
179	179	payor and plan; 25
180	180	(iii) The discounted cash price that applies to each shoppable service included on the list 26
181	181	and any ancillary service or, if the facility does not offer a discounted cash price for one or more 27
182	182	of the shoppable or ancillary services on the list, the gross charge for the shoppable service or 28
183	183	ancillary service, as applicable; 29
184	184	(iv) The de-identified minimum negotiated charge that applies to each shoppable service 30
185	185	included on the list and any ancillary service; 31
186	186	(v) The de-identified maximum negotiated charge that applies to each shoppable service 32
187	187	included on the list and any ancillary service; and 33
188	188	(vi) Any code used by the facility for purposes of accounting or billing for each shoppable 34
189	189
190	190
191	191	LC001939 - Page 6 of 10
192	192	service included on the list and any ancillary service, including the Current Procedural Terminology 1
193	193	(CPT) code, the Healthcare Common Procedure Coding System (HCPCS) code, the Diagnosis 2
194	194	Related Group (DRG) code, the National Drug Code (NDC), or other common identifier; and 3
195	195	(2) If applicable: 4
196	196	(i) State each location at which the facility provides the shoppable service and whether the 5
197	197	standard charges included in the list apply at that location to the provision of that shoppable service 6
198	198	in an inpatient setting, an outpatient department setting, or in both of those settings, as applicable; 7
199	199	and 8
200	200	(ii) Indicate if one or more of the shoppable services specified by the Centers for Medicare 9
201	201	and Medicaid Services is not provided by the facility. 10
202	202	(e) The list required under subsection (a) or (c) of this section, as applicable, must be: 11
203	203	(1) Displayed in the manner prescribed by § 23-99-3(e) for the list required under that 12
204	204	section; 13
205	205	(2) Available: 14
206	206	(i) Free of charge; 15
207	207	(ii) Without having to register or establish a user account or password; 16
208	208	(iii) Without having to submit personal identifying information; and 17
209	209	(iv) Without having to overcome any other impediment, including entering a code to access 18
210	210	the list; 19
211	211	(3) Searchable by service description, billing code, and payor; 20
212	212	(4) Updated in the manner prescribed by § 23-99-3(h) for the list required under that 21
213	213	section; 22
214	214	(5) Accessible to a common commercial operator of an Internet search engine to the extent 23
215	215	necessary for the search engine to index the list and display the list as a result in response to a 24
216	216	search query of a user of the search engine; and 25
217	217	(6) Formatted in a manner that is consistent with the format prescribed by the commission 26
218	218	under § 23-99-3(f)(3). 27
219	219	(f) Notwithstanding any other provision of this section, a facility is considered to meet the 28
220	220	requirements of this section if the facility maintains, as determined by the commission, an Internet-29
221	221	based price estimator tool that: 30
222	222	(1) Provides a cost estimate for each shoppable service and any ancillary service included 31
223	223	on the list maintained by the facility under subsection (a) of this section; 32
224	224	(2) Allows a person to obtain an estimate of the amount the person will be obligated to pay 33
225	225	the facility if the person elects to use the facility to provide the service; and 34
226	226
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229	229	(3) Is: 1
230	230	(i) Prominently displayed on the facility's publicly accessible Internet website; and 2
231	231	(ii) Accessible to the public: 3
232	232	(A) Without charge; and 4
233	233	(B) Without having to register or establish a user account or password. 5
234	234	23-99-5. Reporting requirement. 6
235	235	Each time a facility updates a list as required under §§ 23-99-3(h) and 23-99-4(e)(4), the 7
236	236	facility shall submit the updated list to the commission. The commission may prescribe the form in 8
237	237	which the updated list must be submitted to the commission. 9
238	238	23-99-6. Monitoring and enforcement. 10
239	239	(a) The commission shall monitor each facility's compliance with the requirements of this 11
240	240	chapter using any of the following methods: 12
241	241	(1) Evaluating complaints made by persons to the commission regarding noncompliance 13
242	242	with this chapter; 14
243	243	(2) Reviewing any analysis prepared regarding noncompliance with this chapter; 15
244	244	(3) Auditing the Internet websites of facilities for compliance with this chapter; and 16
245	245	(4) Confirming that each facility submitted the lists required under § 23-99-5. 17
246	246	(b) If the commission determines that a facility is not in compliance with a provision of 18
247	247	this chapter, the commission may take any of the following actions, without regard to the order of 19
248	248	the actions: 20
249	249	(1) Provide a written notice to the facility that clearly explains the manner in which the 21
250	250	facility is not in compliance with this chapter; 22
251	251	(2) Request a corrective action plan from the facility if the facility has materially violated 23
252	252	a provision of this chapter, as determined under § 23-99-7; and 24
253	253	(3) Impose an administrative penalty on the facility and publicize the penalty on the 25
254	254	commission's Internet website if the facility fails to: 26
255	255	(i) Respond to the commission's request to submit a corrective action plan; or 27
256	256	(ii) Comply with the requirements of a corrective action plan submitted to the commission. 28
257	257	23-99-7. Material violation; corrective action plan. 29
258	258	(a) A facility materially violates this chapter if the facility fails to: 30
259	259	(1) Comply with the requirements of § 23-99-2; or 31
260	260	(2) Publicize the facility's standard charges in the form and manner required by §§ 23-99-32
261	261	3 and 23-99-4. 33
262	262	(b) If the commission determines that a facility has materially violated this chapter, the 34
263	263
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265	265	LC001939 - Page 8 of 10
266	266	commission may issue a notice of material violation to the facility and request that the facility 1
267	267	submit a corrective action plan. The notice must indicate the form and manner in which the 2
268	268	corrective action plan must be submitted to the commission, and clearly state the date by which the 3
269	269	facility must submit the plan. 4
270	270	(c) A facility that receives a notice under subsection (b) of this section must: 5
271	271	(1) Submit a corrective action plan in the form and manner, and by the specified date, 6
272	272	prescribed by the notice of violation; and 7
273	273	(2) As soon as practicable after submission of a corrective action plan to the commission, 8
274	274	act to comply with the plan. 9
275	275	(d) A corrective action plan submitted to the commission must: 10
276	276	(1) Describe in detail the corrective action the facility will take to address any violation 11
277	277	identified by the commission in the notice provided under subsection (b) of this section; and 12
278	278	(2) Provide a date by which the facility will complete the corrective action described by 13
279	279	subsection (d)(1) of this section. 14
280	280	(e) A corrective action plan is subject to review and approval by the commission. After the 15
281	281	commission reviews and approves a facility's corrective action plan, the commission may monitor 16
282	282	and evaluate the facility's compliance with the plan. 17
283	283	(f) A facility is considered to have failed to respond to the commission's request to submit 18
284	284	a corrective action plan if the facility fails to submit a corrective action plan: 19
285	285	(1) In the form and manner specified in the notice provided under subsection (b) of this 20
286	286	section; or 21
287	287	(2) By the date specified in the notice provided under subsection (b) of this section. 22
288	288	(g) A facility is considered to have failed to comply with a corrective action plan if the 23
289	289	facility fails to address a violation within the specified period of time contained in the plan. 24
290	290	23-99-8. Administrative penalty. 25
291	291	(a) The commission may impose an administrative penalty on a facility in accordance with 26
292	292	this chapter if the facility fails to: 27
293	293	(1) Respond to the commission's request to submit a corrective action plan; or 28
294	294	(2) Comply with the requirements of a corrective action plan submitted to the commission. 29
295	295	(b) The commission may impose an administrative penalty on a facility for a violation of 30
296	296	each requirement of this chapter. The commission shall set the penalty in an amount sufficient to 31
297	297	ensure compliance by facilities with the provisions of this chapter subject to the limitations 32
298	298	prescribed by subsection (c) of this section. 33
299	299	(c) For a facility with one of the following total gross revenues as reported to the Centers 34
300	300
301	301
302	302	LC001939 - Page 9 of 10
303	303	for Medicare and Medicaid Services or to another entity designated by commission rule in the year 1
304	304	preceding the year in which a penalty is imposed, the penalty imposed by the commission may not 2
305	305	exceed: 3
306	306	(1) Ten dollars ($10.00) for each day the facility violated this chapter, if the facility's total 4
307	307	gross revenue is less than ten million dollars ($10,000,000); 5
308	308	(2) One hundred dollars ($100) for each day the facility violated this chapter, if the facility's 6
309	309	total gross revenue is ten million dollars ($10,000,000) or more and less than one hundred million 7
310	310	dollars ($100,000,000); and 8
311	311	(3) One thousand dollars ($1,000) for each day the facility violated this chapter, if the 9
312	312	facility's total gross revenue is one hundred million dollars ($100,000,000) or more. 10
313	313	(d) Each day a violation continues is considered a separate violation. 11
314	314	(e) In determining the amount of the penalty, the commission shall consider: 12
315	315	(1) Previous violations by the facility's operator; 13
316	316	(2) The seriousness of the violation; 14
317	317	(3) The demonstrated good faith of the facility's operator; and 15
318	318	(4) Any other matters as justice may require. 16
319	319	(f) An administrative penalty collected under this chapter shall be deposited to the credit 17
320	320	of an account in the general revenue fund administered by the commission. Money in the account 18
321	321	may be appropriated only to the commission. 19
322	322	23-99-9. Legislative recommendations. 20
323	323	The commission may propose to the legislature recommendations for amending this 21
324	324	chapter, including recommendations in response to amendments by the Centers for Medicare and 22
325	325	Medicaid Services to 45 C.F.R. Part 180. 23
326	326	SECTION 2. This act shall take effect upon passage. 24
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333	333	EXPLANATION
334	334	BY THE LEGISLATIVE COUNCIL
335	335	OF
336	336	A N A C T
337	337	RELATING TO HEALTH AND SAFETY -- DISCLOSURE OF PRICES -- MEDICAL
338	338	FACILITY ITEMS
339	339	***
340	340	This act would provide a procedure requiring that health care facilities maintain a list with 1
341	341	all standard charges for all facility items. 2
342	342	This act would take effect upon passage. 3
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344	344	LC001939
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