87R5120 JCG-D
By: Hancock S.B. No. 914
A BILL TO BE ENTITLED
AN ACT
relating to the required disclosure by hospitals of prices for
hospital services and items; providing administrative penalties.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 311, Health and Safety Code, is amended
by adding Subchapter A-1 to read as follows:
SUBCHAPTER A-1. DISCLOSURE OF PRICES
Sec. 311.011. DEFINITIONS. In this subchapter:
(1) "Ancillary service" means a hospital item or
service that a hospital customarily provides as part of a shoppable
service.
(2) "Chargemaster" means the list of all hospital
items or services maintained by a hospital for which the hospital
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 hospital has negotiated with all third
party payers for a hospital item or service.
(5) "De-identified minimum negotiated charge" means
the lowest charge that a hospital has negotiated with all third
party payers for a hospital item or service.
(6) "Discounted cash price" means the charge that
applies to an individual who pays cash, or a cash equivalent, for a
hospital item or service.
(7) "Gross charge" means the charge for a hospital
item or service that is reflected on a hospital's chargemaster,
absent any discounts.
(8) "Hospital" means a hospital:
(A) licensed under Chapter 241; or
(B) owned or operated by this state or an agency
of this state.
(9) "Hospital items or services" means all items and
services, including individual items and services and service
packages, that may 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:
(A) supplies and procedures;
(B) room and board;
(C) use of the facility and other areas,
generally referred to as facility fees;
(D) services of physicians and non-physician
practitioners, generally referred to as professional charges; and
(E) any other item or service for which a
hospital has established a standard charge.
(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) "Payer-specific negotiated charge" means the
charge that a hospital has negotiated with a third party payer for a
hospital item or service.
(12) "Service package" means an aggregation of
individual hospital 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 hospital for a hospital 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 payer-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 payer" means an entity that is, by
statute, contract, or agreement, legally responsible for payment of
a claim for a hospital item or service.
Sec. 311.012. PUBLIC AVAILABILITY OF PRICE INFORMATION
REQUIRED. Notwithstanding any other law, a hospital must make
public:
(1) a digital file in a machine-readable format that
contains a list of all standard charges for all hospital items or
services as described by Section 311.013; and
(2) a consumer-friendly list of standard charges for a
limited set of shoppable services as provided in Section 311.014.
Sec. 311.013. LIST OF STANDARD CHARGES REQUIRED. (a) A
hospital shall:
(1) maintain a list of all standard charges for all
hospital 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 hospital under Subsection (a) must reflect the
standard charges applicable to that location of the hospital,
regardless of whether the hospital operates in more than one
location or operates under the same license as another hospital.
(c) The list required under Subsection (a) must include the
following items, as applicable:
(1) a description of each hospital item or service
provided by the hospital;
(2) the following charges for each individual hospital
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 payer-specific negotiated charge, listed
by the name of the third party payer and plan associated with the
charge and displayed in a manner that clearly associates the charge
with each third party payer and plan; and
(3) any code used by the hospital for purposes of
accounting or billing for the hospital 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 hospital's publicly accessible
Internet website. If the hospital operates multiple locations and
maintains a single Internet website, the list required under
Subsection (a) must be posted for each location the hospital
operates in a manner that clearly associates the list with the
applicable location of the hospital.
(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; and
(C) without having to submit personal
identifying information;
(2) be digitally searchable; and
(3) use the following naming convention specified by
the Centers for Medicare and Medicaid Services, specifically:
<ein>_<hospital-name>_standardcharges.[jsonxmlcsv]
(g) The hospital must update the list required under
Subsection (a) at least once each year. The hospital 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. 311.014. CONSUMER-FRIENDLY LIST OF SHOPPABLE
SERVICES. (a) Except as provided by Subsection (c) of this
section, a hospital shall maintain and make publicly available a
list of the standard charges described by Sections
311.013(c)(2)(B), (C), (D), and (E) for each of at least 300
shoppable services provided by the hospital. The hospital 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 hospital does not provide all of the
shoppable services described by Subdivision (1), as many of the
shoppable services described by that subdivision that the hospital
does provide.
(b) In selecting a shoppable service for purposes of
inclusion in the list required under Subsection (a), a hospital
must consider how frequently the hospital provides the service and
the hospital's billing rate for that service.
(c) If a hospital does not provide 300 shoppable services,
the hospital must maintain a list of the total number of shoppable
services that the hospital 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 payer-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 payer and
plan associated with the charge and displayed in a manner that
clearly associates the charge with the third party payer and plan;
(C) the discounted cash price that applies to
each shoppable service included on the list and any ancillary
service or, if the hospital 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 hospital 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 hospital
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; and
(B) indicate if one or more of the shoppable
services specified by the Centers of Medicare and Medicaid Services
is not provided by the hospital.
(e) The list required under Subsection (a) or (c) of this
section, as applicable, must be:
(1) displayed in the manner prescribed by Section
311.013(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; and
(C) without having to submit personal
identifying information;
(3) searchable by service description, billing code,
and payer; and
(4) updated in the manner prescribed by Section
311.013(g) for the list required under that section.
(f) Notwithstanding any other provision of this section, a
hospital is considered to meet the requirements of this section if
the hospital 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 hospital under Subsection (a);
(2) allows a person to obtain an estimate of the amount
the person will be obligated to pay the hospital if the person
elects to use the hospital to provide the service; and
(3) is:
(A) prominently displayed on the hospital'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. 311.015. MONITORING AND ENFORCEMENT. (a) The
commission may monitor hospital compliance with the requirements of
this subchapter using any of the following methods:
(1) evaluating complaints made by persons to the
commission regarding noncompliance with this subchapter;
(2) reviewing any analysis prepared regarding
noncompliance with this subchapter; and
(3) auditing the Internet websites of hospitals for
compliance with this subchapter.
(b) If the commission determines that a hospital is not in
compliance with a provision of this subchapter, the commission may
take any of the following actions, without regard to the order of
the actions:
(1) provide a written notice to the hospital that
clearly explains the manner in which the hospital is not in
compliance with this subchapter;
(2) request a corrective action plan from the hospital
if the hospital has materially violated a provision of this
subchapter, as determined under Section 311.016; and
(3) impose an administrative penalty on the hospital
and publicize the penalty on the commission's Internet website if
the hospital 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. 311.016. MATERIAL VIOLATION; CORRECTIVE ACTION PLAN.
(a) A hospital materially violates this subchapter if the
hospital:
(1) fails to comply with the requirements of Section
311.012; or
(2) fails to publicize the hospital's standard charges
in the form and manner required by Sections 311.013 and 311.014.
(b) If the commission determines that a hospital has
materially violated this subchapter, the commission may issue a
notice of material violation to the hospital and request that the
hospital 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
hospital must submit the plan.
(c) A hospital 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
hospital 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 hospital 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 hospital's corrective action plan, the commission may
monitor and evaluate the hospital's compliance with the plan.
(f) A hospital is considered to have failed to respond to
the commission's request to submit a corrective action plan if the
hospital 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 hospital is considered to have failed to comply with a
corrective action plan if the hospital fails to address a violation
within a specified period of time contained in the plan.
Sec. 311.017. ADMINISTRATIVE PENALTY. (a) The commission
may impose an administrative penalty on a hospital in accordance
with Section 241.059 if the hospital 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
hospital for a violation of each requirement of this subchapter in
an amount not to exceed $300 for each day in which one or more
violations occurred, regardless of whether the hospital violated
multiple requirements of this subchapter in the same day.
SECTION 2. This Act takes effect September 1, 2021.