The intended outcome of this legislation is twofold: to empower patients with the necessary information to make financially informed healthcare decisions and to foster competition among healthcare providers. By revealing their pricing structures, it is anticipated that hospitals and ASCs will be incentivized to offer more competitive pricing in order to attract patients, ultimately leading to reduced healthcare costs statewide. Additionally, the legislation seeks to combat rising healthcare costs and enhance accountability within the Medicare program.
Summary
House Bill 4839, titled the Hospital and ASC Price Transparency Act of 2023, aims to enhance price transparency within Medicare by mandating specified hospitals and ambulatory surgical centers (ASCs) to publicly disclose their pricing information. Beginning January 1, 2026, hospitals will be required to make their standard charges, including gross charges and discounted cash prices for medical services, accessible to consumers without any subscription fees. Furthermore, starting January 1, 2028, ASCs will also need to adhere to similar transparency requirements, thereby promoting informed consumer choices in healthcare services.
Contention
Noteworthy points of contention around HB 4839 include concerns about the feasibility and implementation of these transparency measures by providers, particularly among smaller hospitals and those in underserved regions. Critics express that the financial burden of complying with the new regulations could disproportionately affect these facilities, potentially leading to a reduction in services offered or even closure. Moreover, there are discussions surrounding the adequacy of the information to be disclosed, as merely revealing prices might not equate to true transparency if such prices do not reflect out-of-pocket costs for patients based on their specific insurance coverage.
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.
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.