One critical component of HB4822 is the requirement for hospitals to provide a comprehensive list of their standard charges for items and services. It also introduces limits on cost-sharing for specific Medicare Part D drugs, ensuring that out-of-pocket expenses do not exceed the average net price for those medications. In effect, this bill modifies existing state laws regarding healthcare pricing and patient access to essential cost information. By doing so, it aims to foster a more transparent healthcare environment, where patients are better informed about what they will pay for services and prescriptions.
Summary
House Bill 4822, referred to as the Health Care Price Transparency Act of 2023, seeks to enhance price transparency in healthcare services, particularly focusing on Medicare. The bill mandates healthcare providers, including specific hospitals and pharmacies, to publicly disclose their service charges and drug prices, thus aiming to facilitate better decision-making for patients and reduce the ambiguity around healthcare costs. This is expected to empower patients and lead to more competitive pricing in the healthcare market.
Contention
Notably, this bill has encountered pushback regarding the implications on pharmacy benefit managers (PBMs) and the compliance burden placed on healthcare providers. Critics are concerned that while the intention is to improve transparency, the administrative costs associated with compliance might outweigh the benefits, particularly for smaller providers. Additionally, discussions surrounding the specifics of enforcement provisions and penalties for non-compliance have raised concerns about the potential for increased costs being passed down to patients or providers unable to comply due to resource constraints. The overall discourse emphasizes the balance between transparency and practicality in healthcare pricing.
Related
To amend title XVIII of the Social Security Act to require each off-campus outpatient department of a provider to include a unique identifier on claims for items and services, and to require providers with a department of a provider to submit to the Centers for Medicare & Medicaid Services an attestation with respect to each such department.
Health Care Prices Revealed and Information to Consumers Explained Transparency Act or the Health Care PRICE Transparency Act This bill provides statutory authority for requirements for hospitals and health insurance plans to disclose certain information about the costs for items and services. Specifically, hospitals must publish in their list of standard charges certain rates negotiated with insurers, discounts for cash payments, and billing codes. Further, hospitals generally must publish the standard charges for the services provided by the hospital that may be scheduled in advance. Additionally, insurance plans must publish the in-network and out-of-network charges for covered items and services and the negotiated prices for covered prescription drugs. Plans must provide a tool for consumers to search for this cost information. Consumers also may request additional information about the costs of specific items or services under their plans.