S.B. No. 1137
AN ACT
relating to the required disclosure of prices for certain items and
services provided by certain medical facilities; providing
administrative penalties.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle G, Title 4, Health and Safety Code, is
amended by adding Chapter 327 to read as follows:
CHAPTER 327. DISCLOSURE OF PRICES
Sec. 327.001. DEFINITIONS. In this chapter:
(1) "Ancillary service" means a facility item or
service that a facility customarily provides as part of a shoppable
service.
(2) "Chargemaster" means the list of all facility
items or services maintained by a facility for which the facility
has established a charge.
(3) "Commission" means the Health and Human Services
Commission.
(4) "De-identified maximum negotiated charge" means
the highest charge that a facility has negotiated with all third
party payors for a facility item or service.
(5) "De-identified minimum negotiated charge" means
the lowest charge that a facility has negotiated with all third
party payors for a facility item or service.
(6) "Discounted cash price" means the charge that
applies to an individual who pays cash, or a cash equivalent, for a
facility item or service.
(7) "Facility" means a hospital licensed under Chapter
241.
(8) "Facility items or services" means all items and
services, including individual items and services and service
packages, that may be provided by a facility to a patient in
connection with an inpatient admission or an outpatient department
visit, as applicable, for which the facility has established a
standard charge, including:
(A) supplies and procedures;
(B) room and board;
(C) use of the facility and other areas, the
charges for which are generally referred to as facility fees;
(D) services of physicians and non-physician
practitioners, employed by the facility, the charges for which are
generally referred to as professional charges; and
(E) any other item or service for which a
facility has established a standard charge.
(9) "Gross charge" means the charge for a facility
item or service that is reflected on a facility's chargemaster,
absent any discounts.
(10) "Machine-readable format" means a digital
representation of information in a file that can be imported or read
into a computer system for further processing. The term includes
.XML, .JSON, and .CSV formats.
(11) "Payor-specific negotiated charge" means the
charge that a facility has negotiated with a third party payor for a
facility item or service.
(12) "Service package" means an aggregation of
individual facility items or services into a single service with a
single charge.
(13) "Shoppable service" means a service that may be
scheduled by a health care consumer in advance.
(14) "Standard charge" means the regular rate
established by the facility for a facility item or service provided
to a specific group of paying patients. The term includes all of
the following, as defined under this section:
(A) the gross charge;
(B) the payor-specific negotiated charge;
(C) the de-identified minimum negotiated charge;
(D) the de-identified maximum negotiated charge;
and
(E) the discounted cash price.
(15) "Third party payor" means an entity that is, by
statute, contract, or agreement, legally responsible for payment of
a claim for a facility item or service.
Sec. 327.002. PUBLIC AVAILABILITY OF PRICE INFORMATION
REQUIRED. Notwithstanding any other law, a facility must make
public:
(1) a digital file in a machine-readable format that
contains a list of all standard charges for all facility items or
services as described by Section 327.003; and
(2) a consumer-friendly list of standard charges for a
limited set of shoppable services as provided in Section 327.004.
Sec. 327.003. LIST OF STANDARD CHARGES REQUIRED. (a) A
facility shall:
(1) maintain a list of all standard charges for all
facility items or services in accordance with this section; and
(2) ensure the list required under Subdivision (1) is
available at all times to the public, including by posting the list
electronically in the manner provided by this section.
(b) The standard charges contained in the list required to
be maintained by a facility under Subsection (a) must reflect the
standard charges applicable to that location of the facility,
regardless of whether the facility operates in more than one
location or operates under the same license as another facility.
(c) The list required under Subsection (a) must include the
following items, as applicable:
(1) a description of each facility item or service
provided by the facility;
(2) the following charges for each individual facility
item or service when provided in either an inpatient setting or an
outpatient department setting, as applicable:
(A) the gross charge;
(B) the de-identified minimum negotiated charge;
(C) the de-identified maximum negotiated charge;
(D) the discounted cash price; and
(E) the payor-specific negotiated charge, listed
by the name of the third party payor and plan associated with the
charge and displayed in a manner that clearly associates the charge
with each third party payor and plan; and
(3) any code used by the facility for purposes of
accounting or billing for the facility item or service, including
the Current Procedural Terminology (CPT) code, the Healthcare
Common Procedure Coding System (HCPCS) code, the Diagnosis Related
Group (DRG) code, the National Drug Code (NDC), or other common
identifier.
(d) The information contained in the list required under
Subsection (a) must be published in a single digital file that is in
a machine-readable format.
(e) The list required under Subsection (a) must be displayed
in a prominent location on the home page of the facility's publicly
accessible Internet website or accessible by selecting a dedicated
link that is prominently displayed on the home page of the
facility's publicly accessible Internet website. If the facility
operates multiple locations and maintains a single Internet
website, the list required under Subsection (a) must be posted for
each location the facility operates in a manner that clearly
associates the list with the applicable location of the facility.
(f) The list required under Subsection (a) must:
(1) be available:
(A) free of charge;
(B) without having to establish a user account or
password;
(C) without having to submit personal
identifying information; and
(D) without having to overcome any other
impediment, including entering a code to access the list;
(2) be 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 as a result in
response to a search query of a user of the search engine;
(3) be formatted in a manner prescribed by the
commission;
(4) be digitally searchable; and
(5) use the following naming convention specified by
the Centers for Medicare and Medicaid Services, specifically:
<ein>_<facility-name>_standardcharges.[jsonxmlcsv]
(g) In prescribing the format of the list under Subsection
(f)(3), the commission shall:
(1) develop a template that each facility must use in
formatting the list; and
(2) in developing the template under Subdivision (1):
(A) consider any applicable federal guidelines
for formatting similar lists required by federal law or rule and
ensure that the design of the template enables health care
researchers to compare the charges contained in the lists
maintained by each facility; and
(B) design the template to be substantially
similar to the template used by the Centers for Medicare and
Medicaid Services for purposes similar to those of this chapter, if
the commission determines that designing the template in that
manner serves the purposes of Paragraph (A) and that the commission
benefits from developing and requiring that substantially similar
design.
(h) The facility must update the list required under
Subsection (a) at least once each year. The facility must clearly
indicate the date on which the list was most recently updated,
either on the list or in a manner that is clearly associated with
the list.
Sec. 327.004. CONSUMER-FRIENDLY LIST OF SHOPPABLE
SERVICES. (a) Except as provided by Subsection (c), a facility
shall maintain and make publicly available a list of the standard
charges described by Sections 327.003(c)(2)(B), (C), (D), and (E)
for each of at least 300 shoppable services provided by the
facility. The facility may select the shoppable services to be
included in the list, except that the list must include:
(1) the 70 services specified as shoppable services by
the Centers for Medicare and Medicaid Services; or
(2) if the facility does not provide all of the
shoppable services described by Subdivision (1), as many of those
shoppable services the facility does provide.
(b) In selecting a shoppable service for purposes of
inclusion in the list required under Subsection (a), a facility
must:
(1) consider how frequently the facility provides the
service and the facility's billing rate for that service; and
(2) prioritize the selection of services that are
among the services most frequently provided by the facility.
(c) If a facility does not provide 300 shoppable services,
the facility must maintain a list of the total number of shoppable
services that the facility provides in a manner that otherwise
complies with the requirements of Subsection (a).
(d) The list required under Subsection (a) or (c), as
applicable, must:
(1) include:
(A) a plain-language description of each
shoppable service included on the list;
(B) the payor-specific negotiated charge that
applies to each shoppable service included on the list and any
ancillary service, listed by the name of the third party payor and
plan associated with the charge and displayed in a manner that
clearly associates the charge with the third party payor and plan;
(C) the discounted cash price that applies to
each shoppable service included on the list and any ancillary
service or, if the facility does not offer a discounted cash price
for one or more of the shoppable or ancillary services on the list,
the gross charge for the shoppable service or ancillary service, as
applicable;
(D) the de-identified minimum negotiated charge
that applies to each shoppable service included on the list and any
ancillary service;
(E) the de-identified maximum negotiated charge
that applies to each shoppable service included on the list and any
ancillary service; and
(F) any code used by the facility for purposes of
accounting or billing for each shoppable service included on the
list and any ancillary service, including the Current Procedural
Terminology (CPT) code, the Healthcare Common Procedure Coding
System (HCPCS) code, the Diagnosis Related Group (DRG) code, the
National Drug Code (NDC), or other common identifier; and
(2) if applicable:
(A) state each location at which the facility
provides the shoppable service and whether the standard charges
included in the list apply at that location to the provision of that
shoppable service in an inpatient setting, an outpatient department
setting, or in both of those settings, as applicable; and
(B) indicate if one or more of the shoppable
services specified by the Centers for Medicare and Medicaid
Services is not provided by the facility.
(e) The list required under Subsection (a) or (c), as
applicable, must be:
(1) displayed in the manner prescribed by Section
327.003(e) for the list required under that section;
(2) available:
(A) free of charge;
(B) without having to register or establish a
user account or password;
(C) without having to submit personal
identifying information; and
(D) without having to overcome any other
impediment, including entering a code to access the list;
(3) searchable by service description, billing code,
and payor;
(4) updated in the manner prescribed by Section
327.003(h) for the list required under that section;
(5) 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 as a result in
response to a search query of a user of the search engine; and
(6) formatted in a manner that is consistent with the
format prescribed by the commission under Section 327.003(f)(3).
(f) Notwithstanding any other provision of this section, a
facility is considered to meet the requirements of this section if
the facility maintains, as determined by the commission, an
Internet-based price estimator tool that:
(1) provides a cost estimate for each shoppable
service and any ancillary service included on the list maintained
by the facility under Subsection (a);
(2) allows a person to obtain an estimate of the amount
the person will be obligated to pay the facility if the person
elects to use the facility to provide the service; and
(3) is:
(A) prominently displayed on the facility's
publicly accessible Internet website; and
(B) accessible to the public:
(i) without charge; and
(ii) without having to register or
establish a user account or password.
Sec. 327.005. REPORTING REQUIREMENT. Each time a facility
updates a list as required under Sections 327.003(h) and
327.004(e)(4), the facility shall submit the updated list to the
commission. The commission may prescribe the form in which the
updated list must be submitted to the commission.
Sec. 327.006. MONITORING AND ENFORCEMENT. (a) The
commission shall monitor each facility's compliance with the
requirements of this chapter using any of the following methods:
(1) evaluating complaints made by persons to the
commission regarding noncompliance with this chapter;
(2) reviewing any analysis prepared regarding
noncompliance with this chapter;
(3) auditing the Internet websites of facilities for
compliance with this chapter; and
(4) confirming that each facility submitted the lists
required under Section 327.005.
(b) If the commission determines that a facility is not in
compliance with a provision of this chapter, the commission may
take any of the following actions, without regard to the order of
the actions:
(1) provide a written notice to the facility that
clearly explains the manner in which the facility is not in
compliance with this chapter;
(2) request a corrective action plan from the facility
if the facility has materially violated a provision of this
chapter, as determined under Section 327.007; and
(3) impose an administrative penalty on the facility
and publicize the penalty on the commission's Internet website if
the facility fails to:
(A) respond to the commission's request to submit
a corrective action plan; or
(B) comply with the requirements of a corrective
action plan submitted to the commission.
Sec. 327.007. MATERIAL VIOLATION; CORRECTIVE ACTION PLAN.
(a) A facility materially violates this chapter if the facility
fails to:
(1) comply with the requirements of Section 327.002;
or
(2) publicize the facility's standard charges in the
form and manner required by Sections 327.003 and 327.004.
(b) If the commission determines that a facility has
materially violated this chapter, the commission may issue a notice
of material violation to the facility and request that the facility
submit a corrective action plan. The notice must indicate the form
and manner in which the corrective action plan must be submitted to
the commission, and clearly state the date by which the facility
must submit the plan.
(c) A facility that receives a notice under Subsection (b)
must:
(1) submit a corrective action plan in the form and
manner, and by the specified date, prescribed by the notice of
violation; and
(2) as soon as practicable after submission of a
corrective action plan to the commission, act to comply with the
plan.
(d) A corrective action plan submitted to the commission
must:
(1) describe in detail the corrective action the
facility will take to address any violation identified by the
commission in the notice provided under Subsection (b); and
(2) provide a date by which the facility will complete
the corrective action described by Subdivision (1).
(e) A corrective action plan is subject to review and
approval by the commission. After the commission reviews and
approves a facility's corrective action plan, the commission may
monitor and evaluate the facility's compliance with the plan.
(f) A facility is considered to have failed to respond to
the commission's request to submit a corrective action plan if the
facility fails to submit a corrective action plan:
(1) in the form and manner specified in the notice
provided under Subsection (b); or
(2) by the date specified in the notice provided under
Subsection (b).
(g) A facility is considered to have failed to comply with a
corrective action plan if the facility fails to address a violation
within the specified period of time contained in the plan.
Sec. 327.008. ADMINISTRATIVE PENALTY. (a) The commission
may impose an administrative penalty on a facility in accordance
with Chapter 241 if the facility fails to:
(1) respond to the commission's request to submit a
corrective action plan; or
(2) comply with the requirements of a corrective
action plan submitted to the commission.
(b) The commission may impose an administrative penalty on a
facility for a violation of each requirement of this chapter. The
commission shall set the penalty in an amount sufficient to ensure
compliance by facilities with the provisions of this chapter
subject to the limitations prescribed by Subsection (c).
(c) For a facility with one of the following total gross
revenues as reported to the Centers for Medicare and Medicaid
Services or to another entity designated by commission rule in the
year preceding the year in which a penalty is imposed, the penalty
imposed by the commission may not exceed:
(1) $10 for each day the facility violated this
chapter, if the facility's total gross revenue is less than
$10,000,000;
(2) $100 for each day the facility violated this
chapter, if the facility's total gross revenue is $10,000,000 or
more and less than $100,000,000; and
(3) $1,000 for each day the facility violated this
chapter, if the facility's total gross revenue is $100,000,000 or
more.
(d) Each day a violation continues is considered a separate
violation.
(e) In determining the amount of the penalty, the commission
shall consider:
(1) previous violations by the facility's operator;
(2) the seriousness of the violation;
(3) the demonstrated good faith of the facility's
operator; and
(4) any other matters as justice may require.
(f) An administrative penalty collected under this chapter
shall be deposited to the credit of an account in the general
revenue fund administered by the commission. Money in the account
may be appropriated only to the commission.
Sec. 327.009. LEGISLATIVE RECOMMENDATIONS. The commission
may propose to the legislature recommendations for amending this
chapter, including recommendations in response to amendments by the
Centers for Medicare and Medicaid Services to 45 C.F.R. Part 180.
SECTION 2. This Act takes effect September 1, 2021.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1137 passed the Senate on
March 31, 2021, by the following vote: Yeas 31, Nays 0; and that
the Senate concurred in House amendment on May 27, 2021, by the
following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1137 passed the House, with
amendment, on May 20, 2021, by the following vote: Yeas 145,
Nays 0, one present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor