Texas 2021 - 87th Regular

Texas House Bill HB2487 Compare Versions

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1	1	87R5120 JCG-D
2	2	By: Oliverson H.B. No. 2487
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the required disclosure by hospitals of prices for
8	8	hospital services and items; providing administrative penalties.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 311, Health and Safety Code, is amended
11	11	by adding Subchapter A-1 to read as follows:
12	12	SUBCHAPTER A-1. DISCLOSURE OF PRICES
13	13	Sec. 311.011. DEFINITIONS. In this subchapter:
14	14	(1) "Ancillary service" means a hospital item or
15	15	service that a hospital customarily provides as part of a shoppable
16	16	service.
17	17	(2) "Chargemaster" means the list of all hospital
18	18	items or services maintained by a hospital for which the hospital
19	19	has established a charge.
20	20	(3) "Commission" means the Health and Human Services
21	21	Commission.
22	22	(4) "De-identified maximum negotiated charge" means
23	23	the highest charge that a hospital has negotiated with all third
24	24	party payers for a hospital item or service.
25	25	(5) "De-identified minimum negotiated charge" means
26	26	the lowest charge that a hospital has negotiated with all third
27	27	party payers for a hospital item or service.
28	28	(6) "Discounted cash price" means the charge that
29	29	applies to an individual who pays cash, or a cash equivalent, for a
30	30	hospital item or service.
31	31	(7) "Gross charge" means the charge for a hospital
32	32	item or service that is reflected on a hospital's chargemaster,
33	33	absent any discounts.
34	34	(8) "Hospital" means a hospital:
35	35	(A) licensed under Chapter 241; or
36	36	(B) owned or operated by this state or an agency
37	37	of this state.
38	38	(9) "Hospital items or services" means all items and
39	39	services, including individual items and services and service
40	40	packages, that may be provided by a hospital to a patient in
41	41	connection with an inpatient admission or an outpatient department
42	42	visit for which the hospital has established a standard charge,
43	43	including:
44	44	(A) supplies and procedures;
45	45	(B) room and board;
46	46	(C) use of the facility and other areas,
47	47	generally referred to as facility fees;
48	48	(D) services of physicians and non-physician
49	49	practitioners, generally referred to as professional charges; and
50	50	(E) any other item or service for which a
51	51	hospital has established a standard charge.
52	52	(10) "Machine-readable format" means a digital
53	53	representation of information in a file that can be imported or read
54	54	into a computer system for further processing. The term includes
55	55	.XML, .JSON and .CSV formats.
56	56	(11) "Payer-specific negotiated charge" means the
57	57	charge that a hospital has negotiated with a third party payer for a
58	58	hospital item or service.
59	59	(12) "Service package" means an aggregation of
60	60	individual hospital items or services into a single service with a
61	61	single charge.
62	62	(13) "Shoppable service" means a service that may be
63	63	scheduled by a health care consumer in advance.
64	64	(14) "Standard charge" means the regular rate
65	65	established by the hospital for a hospital item or service provided
66	66	to a specific group of paying patients. The term includes all of
67	67	the following, as defined under this section:
68	68	(A) the gross charge;
69	69	(B) the payer-specific negotiated charge;
70	70	(C) the de-identified minimum negotiated charge;
71	71	(D) the de-identified maximum negotiated charge;
72	72	and
73	73	(E) the discounted cash price.
74	74	(15) "Third party payer" means an entity that is, by
75	75	statute, contract, or agreement, legally responsible for payment of
76	76	a claim for a hospital item or service.
77	77	Sec. 311.012. PUBLIC AVAILABILITY OF PRICE INFORMATION
78	78	REQUIRED. Notwithstanding any other law, a hospital must make
79	79	public:
80	80	(1) a digital file in a machine-readable format that
81	81	contains a list of all standard charges for all hospital items or
82	82	services as described by Section 311.013; and
83	83	(2) a consumer-friendly list of standard charges for a
84	84	limited set of shoppable services as provided in Section 311.014.
85	85	Sec. 311.013. LIST OF STANDARD CHARGES REQUIRED. (a) A
86	86	hospital shall:
87	87	(1) maintain a list of all standard charges for all
88	88	hospital items or services in accordance with this section; and
89	89	(2) ensure the list required under Subdivision (1) is
90	90	available at all times to the public, including by posting the list
91	91	electronically in the manner provided by this section.
92	92	(b) The standard charges contained in the list required to
93	93	be maintained by a hospital under Subsection (a) must reflect the
94	94	standard charges applicable to that location of the hospital,
95	95	regardless of whether the hospital operates in more than one
96	96	location or operates under the same license as another hospital.
97	97	(c) The list required under Subsection (a) must include the
98	98	following items, as applicable:
99	99	(1) a description of each hospital item or service
100	100	provided by the hospital;
101	101	(2) the following charges for each individual hospital
102	102	item or service when provided in either an inpatient setting or an
103	103	outpatient department setting, as applicable:
104	104	(A) the gross charge;
105	105	(B) the de-identified minimum negotiated charge;
106	106	(C) the de-identified maximum negotiated charge;
107	107	(D) the discounted cash price; and
108	108	(E) the payer-specific negotiated charge, listed
109	109	by the name of the third party payer and plan associated with the
110	110	charge and displayed in a manner that clearly associates the charge
111	111	with each third party payer and plan; and
112	112	(3) any code used by the hospital for purposes of
113	113	accounting or billing for the hospital item or service, including
114	114	the Current Procedural Terminology (CPT) code, the Healthcare
115	115	Common Procedure Coding System (HCPCS) code, the Diagnosis Related
116	116	Group (DRG) code, the National Drug Code (NDC), or other common
117	117	identifier.
118	118	(d) The information contained in the list required under
119	119	Subsection (a) must be published in a single digital file that is in
120	120	a machine-readable format.
121	121	(e) The list required under Subsection (a) must be displayed
122	122	in a prominent location on the hospital's publicly accessible
123	123	Internet website. If the hospital operates multiple locations and
124	124	maintains a single Internet website, the list required under
125	125	Subsection (a) must be posted for each location the hospital
126	126	operates in a manner that clearly associates the list with the
127	127	applicable location of the hospital.
128	128	(f) The list required under Subsection (a) must:
129	129	(1) be available:
130	130	(A) free of charge;
131	131	(B) without having to establish a user account or
132	132	password; and
133	133	(C) without having to submit personal
134	134	identifying information;
135	135	(2) be digitally searchable; and
136	136	(3) use the following naming convention specified by
137	137	the Centers for Medicare and Medicaid Services, specifically:
138	138	<ein>_<hospital-name>_standardcharges.[jsonxmlcsv]
139	139	(g) The hospital must update the list required under
140	140	Subsection (a) at least once each year. The hospital must clearly
141	141	indicate the date on which the list was most recently updated,
142	142	either on the list or in a manner that is clearly associated with
143	143	the list.
144	144	Sec. 311.014. CONSUMER-FRIENDLY LIST OF SHOPPABLE
145	145	SERVICES. (a) Except as provided by Subsection (c) of this
146	146	section, a hospital shall maintain and make publicly available a
147	147	list of the standard charges described by Sections
148	148	311.013(c)(2)(B), (C), (D), and (E) for each of at least 300
149	149	shoppable services provided by the hospital. The hospital may
150	150	select the shoppable services to be included in the list, except
151	151	that the list must include:
152	152	(1) the 70 services specified as shoppable services by
153	153	the Centers for Medicare and Medicaid Services; or
154	154	(2) if the hospital does not provide all of the
155	155	shoppable services described by Subdivision (1), as many of the
156	156	shoppable services described by that subdivision that the hospital
157	157	does provide.
158	158	(b) In selecting a shoppable service for purposes of
159	159	inclusion in the list required under Subsection (a), a hospital
160	160	must consider how frequently the hospital provides the service and
161	161	the hospital's billing rate for that service.
162	162	(c) If a hospital does not provide 300 shoppable services,
163	163	the hospital must maintain a list of the total number of shoppable
164	164	services that the hospital provides in a manner that otherwise
165	165	complies with the requirements of Subsection (a).
166	166	(d) The list required under Subsection (a) or (c), as
167	167	applicable, must:
168	168	(1) include:
169	169	(A) a plain-language description of each
170	170	shoppable service included on the list;
171	171	(B) the payer-specific negotiated charge that
172	172	applies to each shoppable service included on the list and any
173	173	ancillary service, listed by the name of the third party payer and
174	174	plan associated with the charge and displayed in a manner that
175	175	clearly associates the charge with the third party payer and plan;
176	176	(C) the discounted cash price that applies to
177	177	each shoppable service included on the list and any ancillary
178	178	service or, if the hospital does not offer a discounted cash price
179	179	for one or more of the shoppable or ancillary services on the list,
180	180	the gross charge for the shoppable service or ancillary service, as
181	181	applicable;
182	182	(D) the de-identified minimum negotiated charge
183	183	that applies to each shoppable service included on the list and any
184	184	ancillary service;
185	185	(E) the de-identified maximum negotiated charge
186	186	that applies to each shoppable service included on the list and any
187	187	ancillary service; and
188	188	(F) any code used by the hospital for purposes of
189	189	accounting or billing for each shoppable service included on the
190	190	list and any ancillary service, including the Current Procedural
191	191	Terminology (CPT) code, the Healthcare Common Procedure Coding
192	192	System (HCPCS) code, the Diagnosis Related Group (DRG) code, the
193	193	National Drug Code (NDC), or other common identifier; and
194	194	(2) if applicable:
195	195	(A) state each location at which the hospital
196	196	provides the shoppable service and whether the standard charges
197	197	included in the list apply at that location to the provision of that
198	198	shoppable service in an inpatient setting, an outpatient department
199	199	setting, or in both of those settings; and
200	200	(B) indicate if one or more of the shoppable
201	201	services specified by the Centers of Medicare and Medicaid Services
202	202	is not provided by the hospital.
203	203	(e) The list required under Subsection (a) or (c) of this
204	204	section, as applicable, must be:
205	205	(1) displayed in the manner prescribed by Section
206	206	311.013(e) for the list required under that section;
207	207	(2) available:
208	208	(A) free of charge;
209	209	(B) without having to register or establish a
210	210	user account or password; and
211	211	(C) without having to submit personal
212	212	identifying information;
213	213	(3) searchable by service description, billing code,
214	214	and payer; and
215	215	(4) updated in the manner prescribed by Section
216	216	311.013(g) for the list required under that section.
217	217	(f) Notwithstanding any other provision of this section, a
218	218	hospital is considered to meet the requirements of this section if
219	219	the hospital maintains, as determined by the commission, an
220	220	Internet-based price estimator tool that:
221	221	(1) provides a cost estimate for each shoppable
222	222	service and any ancillary service included on the list maintained
223	223	by the hospital under Subsection (a);
224	224	(2) allows a person to obtain an estimate of the amount
225	225	the person will be obligated to pay the hospital if the person
226	226	elects to use the hospital to provide the service; and
227	227	(3) is:
228	228	(A) prominently displayed on the hospital's
229	229	publicly accessible Internet website; and
230	230	(B) accessible to the public:
231	231	(i) without charge; and
232	232	(ii) without having to register or
233	233	establish a user account or password.
234	234	Sec. 311.015. MONITORING AND ENFORCEMENT. (a) The
235	235	commission may monitor hospital compliance with the requirements of
236	236	this subchapter using any of the following methods:
237	237	(1) evaluating complaints made by persons to the
238	238	commission regarding noncompliance with this subchapter;
239	239	(2) reviewing any analysis prepared regarding
240	240	noncompliance with this subchapter; and
241	241	(3) auditing the Internet websites of hospitals for
242	242	compliance with this subchapter.
243	243	(b) If the commission determines that a hospital is not in
244	244	compliance with a provision of this subchapter, the commission may
245	245	take any of the following actions, without regard to the order of
246	246	the actions:
247	247	(1) provide a written notice to the hospital that
248	248	clearly explains the manner in which the hospital is not in
249	249	compliance with this subchapter;
250	250	(2) request a corrective action plan from the hospital
251	251	if the hospital has materially violated a provision of this
252	252	subchapter, as determined under Section 311.016; and
253	253	(3) impose an administrative penalty on the hospital
254	254	and publicize the penalty on the commission's Internet website if
255	255	the hospital fails to:
256	256	(A) respond to the commission's request to submit
257	257	a corrective action plan; or
258	258	(B) comply with the requirements of a corrective
259	259	action plan submitted to the commission.
260	260	Sec. 311.016. MATERIAL VIOLATION; CORRECTIVE ACTION PLAN.
261	261	(a) A hospital materially violates this subchapter if the
262	262	hospital:
263	263	(1) fails to comply with the requirements of Section
264	264	311.012; or
265	265	(2) fails to publicize the hospital's standard charges
266	266	in the form and manner required by Sections 311.013 and 311.014.
267	267	(b) If the commission determines that a hospital has
268	268	materially violated this subchapter, the commission may issue a
269	269	notice of material violation to the hospital and request that the
270	270	hospital submit a corrective action plan. The notice must indicate
271	271	the form and manner in which the corrective action plan must be
272	272	submitted to the commission, and clearly state the date by which the
273	273	hospital must submit the plan.
274	274	(c) A hospital that receives a notice under Subsection (b)
275	275	must:
276	276	(1) submit a corrective action plan in the form and
277	277	manner, and by the specified date, prescribed by the notice of
278	278	violation; and
279	279	(2) as soon as practicable after submission of a
280	280	corrective action plan to the commission, act to comply with the
281	281	plan.
282	282	(d) A corrective action plan submitted to the commission
283	283	must:
284	284	(1) describe in detail the corrective action the
285	285	hospital will take to address any violation identified by the
286	286	commission in the notice provided under Subsection (b); and
287	287	(2) provide a date by which the hospital will complete
288	288	the corrective action described by Subdivision (1).
289	289	(e) A corrective action plan is subject to review and
290	290	approval by the commission. After the commission reviews and
291	291	approves a hospital's corrective action plan, the commission may
292	292	monitor and evaluate the hospital's compliance with the plan.
293	293	(f) A hospital is considered to have failed to respond to
294	294	the commission's request to submit a corrective action plan if the
295	295	hospital fails to submit a corrective action plan:
296	296	(1) in the form and manner specified in the notice
297	297	provided under Subsection (b); or
298	298	(2) by the date specified in the notice provided under
299	299	Subsection (b).
300	300	(g) A hospital is considered to have failed to comply with a
301	301	corrective action plan if the hospital fails to address a violation
302	302	within a specified period of time contained in the plan.
303	303	Sec. 311.017. ADMINISTRATIVE PENALTY. (a) The commission
304	304	may impose an administrative penalty on a hospital in accordance
305	305	with Section 241.059 if the hospital fails to:
306	306	(1) respond to the commission's request to submit a
307	307	corrective action plan; or
308	308	(2) comply with the requirements of a corrective
309	309	action plan submitted to the commission.
310	310	(b) The commission may impose an administrative penalty on a
311	311	hospital for a violation of each requirement of this subchapter in
312	312	an amount not to exceed $300 for each day in which one or more
313	313	violations occurred, regardless of whether the hospital violated
314	314	multiple requirements of this subchapter in the same day.
315	315	SECTION 2. This Act takes effect September 1, 2021.