Wisconsin 2023-2024 Regular Session

Wisconsin Senate Bill SB328 Compare Versions

Only one version of the bill is available at this time.

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3	3	2023 - 2024 LEGISLATURE
4	4	2023 SENATE BILL 328
5	5	June 8, 2023 - Introduced by Senators FELZKOWSKI, BRADLEY, HUTTON, KNODL,
6	6	LARSON, NASS and STROEBEL, cosponsored by Representatives BROOKS, ROZAR,
7	7	ALLEN, BODDEN, BRANDTJEN, DITTRICH, DONOVAN, DUCHOW, GOEBEN, GREEN,
8	8	GUNDRUM, GUSTAFSON, MACCO, RETTINGER, SCHRAA, SHANKLAND, SORTWELL and
9	9	WICHGERS. Referred to Committee on Health.
10	10	*AUTHORS SUBJECT TO CHANGE*
11	11	AN ACT to create 50.40 of the statutes; relating to: price transparency in
12	12	hospitals and providing a penalty.
13	13	Analysis by the Legislative Reference Bureau
14	14	This bill creates several requirements for hospitals to provide cost information
15	15	for certain items and services provided by the hospital. Under the bill, each hospital
16	16	must make publicly available a digital file in a machine-readable format that
17	17	contains a list of standard charges for certain items and services provided by the
18	18	hospital and a consumer-friendly list of standard charges for certain shoppable
19	19	services. “Standard charge” is defined to mean the regular rate established by the
20	20	hospital for an item or service provided to a specific group of paying patients and
21	21	includes certain price information, including the gross charge, the payor-specific
22	22	negotiated charge, and the discounted cash price. “Shoppable service” is defined to
23	23	mean a service that may be scheduled by a health care consumer in advance. If the
24	24	Department of Health Services determines that a hospital is not in compliance with
25	25	any of the price transparency requirements specified in the bill, the bill requires DHS
26	26	to take certain actions, including providing a written notice to the hospital,
27	27	requesting a corrective action plan from the hospital, or imposing a penalty. The bill
28	28	establishes escalating penalties for violations of the hospital price transparency
29	29	requirements specified in the bill based on the hospital's bed count, from $600 for
30	30	each day in which a hospital with 30 beds or fewer violates the hospital price
31	31	transparency requirements under the bill up to $10,000 for each day in which a
32	32	hospital with greater than 550 beds violates the hospital price transparency
33	33	requirements under the bill. The bill also requires DHS to maintain a publicly
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37	37	SENATE BILL 328
38	38	available list of hospitals that have been found to have violated any of the price
39	39	transparency requirements specified in the bill.
40	40	Under the bill, the list of standard charges must be available at all times to the
41	41	public in a machine-readable format, must be displayed in a prominent location on
42	42	the home page of the hospital's website, and must include certain information,
43	43	including a description of each hospital item or service provided and any code used
44	44	by the hospital for purposes of accounting or billing. Further, the list of standard
45	45	charges must meet certain criteria, including that it must be available free of charge
46	46	and without having to establish a user account or password, that the list is available
47	47	without having to submit personal identifying information, that the list is digitally
48	48	searchable, and that the list is accessible to a commercial operator of an Internet
49	49	search engine as necessary for the search engine to index the list and display the list
50	50	as a result in response to a search query of a user of the search engine. The list of
51	51	standard charges must be updated at least once each year.
52	52	Further, under the bill, the consumer-friendly list of standard charges for
53	53	shoppable services must be publicly available and must contain standard charge
54	54	information for each of at least 300 shoppable services provided by the hospital. The
55	55	bill allows a hospital to select the shoppable services to be included in the list, except
56	56	that the list must include either the 70 services specified as shoppable services by
57	57	the federal Centers for Medicare and Medicaid Services (CMS) or, if the hospital does
58	58	not provide all of the shoppable services specified by CMS, as many of the 70 services
59	59	specified as shoppable services by CMS as the hospital provides. If a hospital does
60	60	not provide at least 300 shoppable services, the bill requires the hospital to maintain
61	61	a list of all shoppable services that the hospital provides. The consumer-friendly list
62	62	of standard charges for shoppable services must include certain information,
63	63	including certain price information and a plain-language description of each
64	64	shoppable service included on the list, whether each hospital location provides the
65	65	shoppable service and whether the standard charges included in the list apply at that
66	66	location, and whether one or more of the shoppable services specified by CMS is not
67	67	provided by the hospital. The consumer-friendly list of standard charges for
68	68	shoppable services must meet certain criteria, including that the list is available free
69	69	of charge without having to establish a user account or password, that the list is
70	70	searchable by service description, billing code, and payor, and that the list is
71	71	accessible to a common commercial operator of an Internet search engine as
72	72	necessary for the search engine to index the list and display the list as a result in
73	73	response to a search query of a user of the search engine. The consumer-friendly list
74	74	of standard charges for shoppable services must be updated at least once each year.
75	75	The bill provides that every time a hospital updates the list of standard charges
76	76	or the consumer-friendly list of standard charges for shoppable services, the hospital
77	77	must submit the updated list to DHS. Under the bill, DHS must monitor each
78	78	hospital's compliance with the price transparency requirements specified in the bill
79	79	by evaluating complaints, reviewing any analysis prepared regarding
80	80	noncompliance, auditing the websites of hospitals, or confirming that each hospital
81	81	submitted the required lists. - 3 -2023 - 2024 Legislature
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84	84	SENATE BILL 328
85	85	For further information see the state fiscal estimate, which will be printed as
86	86	an appendix to this bill.
87	87	The people of the state of Wisconsin, represented in senate and assembly, do
88	88	enact as follows:
89	89	SECTION 1. 50.40 of the statutes is created to read:
90	90	50.40 Hospital price transparency. (1) DEFINITIONS. In this section:
91	91	(a) “Ancillary service” means a hospital item or service that a hospital
92	92	customarily provides as part of a shoppable service.
93	93	(b) “Chargemaster” means the list of all hospital items or services maintained
94	94	by a hospital for which the hospital has established a charge.
95	95	(c) “De-identified maximum negotiated charge” means the highest charge that
96	96	a hospital has negotiated with all 3rd-party payors for a hospital item or service.
97	97	(d) “De-identified minimum negotiated charge” means the lowest charge that
98	98	a hospital has negotiated with all 3rd-party payors for a hospital item or service.
99	99	(e) “Discounted cash price” means the charge that applies to an individual who
100	100	pays cash, or a cash equivalent, for a hospital item or service.
101	101	(f) “Gross charge” means the charge for a hospital item or service that is
102	102	reflected on a hospital's chargemaster, absent any discounts.
103	103	(g) “Hospital items or services” means all items and services, including
104	104	individual items and services and service packages, that may be provided by a
105	105	hospital to a patient in connection with an inpatient admission or an outpatient
106	106	department visit for which the hospital has established a standard charge, including
107	107	all of the following:
108	108	1. Supplies and procedures.
109	109	2. Room and board.
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132	132	SECTION 1 SENATE BILL 328
133	133	3. Use of the hospital and other areas.
134	134	4. Services of physicians and nonphysician practitioners employed by the
135	135	hospital.
136	136	5. Any other item or service for which a hospital has established a standard
137	137	charge.
138	138	(h) “Machine-readable format” means a digital representation of information
139	139	in a file that can be imported or read into a computer system for further processing.
140	140	“Machine-readable format” includes .XML, .JSON, and .CSV formats.
141	141	(i) “Payor-specific negotiated charge” means the charge that a hospital has
142	142	negotiated with a 3rd-party payor for a hospital item or service.
143	143	(j) “Service package” means an aggregation of individual hospital items or
144	144	services into a single service with a single charge.
145	145	(k) “Shoppable service” means a service that may be scheduled by a health care
146	146	consumer in advance.
147	147	(L) “Standard charge” means the regular rate established by the hospital for
148	148	a hospital item or service provided to a specific group of paying patients and includes
149	149	all of the following:
150	150	1. The gross charge.
151	151	2. The payor-specific negotiated charge.
152	152	3. The de-identified minimum negotiated charge.
153	153	4. The de-identified maximum negotiated charge.
154	154	5. The discounted cash price.
155	155	(m) “Third-party payor” means an entity that is, by statute, contract, or
156	156	agreement, legally responsible for payment of a claim for a hospital item or service.
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183	183	SECTION 1
184	184	SENATE BILL 328
185	185	(2) PUBLIC AVAILABILITY OF PRICE INFORMATION REQUIRED. A hospital shall make
186	186	publicly available all of the following:
187	187	(a) A digital file in a machine-readable format that contains a list of all
188	188	standard charges for all hospital items or services described under sub. (3).
189	189	(b) A consumer-friendly list of standard charges for a limited set of shoppable
190	190	services as provided in sub. (4).
191	191	(3) LIST OF STANDARD CHARGES REQUIRED. (a) A hospital shall do all of the
192	192	following:
193	193	1. Maintain a list of all standard charges for all hospital items or services in
194	194	accordance with this section.
195	195	2. Ensure the list required under subd. 1. is available at all times to the public,
196	196	including by posting the list electronically in the manner provided in this section.
197	197	(b) The standard charges contained in the list required to be maintained by a
198	198	hospital under par. (a) 1. shall reflect the standard charges applicable to that location
199	199	of the hospital, regardless of whether the hospital operates in more than one location
200	200	or operates under the same license as another hospital.
201	201	(c) The list required under par. (a) 1. shall include all of the following
202	202	information:
203	203	1. A description of each hospital item or service provided by the hospital.
204	204	2. The following charges for each individual hospital item or service when
205	205	provided in either an inpatient setting or an outpatient department setting:
206	206	a. The gross charge.
207	207	b. The de-identified minimum negotiated charge.
208	208	c. The de-identified maximum negotiated charge.
209	209	d. The discounted cash price.
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236	236	SECTION 1 SENATE BILL 328
237	237	e. The payor-specific negotiated charge, listed by the name of the 3rd-party
238	238	payor and plan associated with the charge and displayed in a manner that clearly
239	239	associates the charge with each 3rd-party payor and plan.
240	240	3. Any code used by the hospital for purposes of accounting or billing for the
241	241	hospital item or service, including the current procedural terminology code, the
242	242	healthcare common procedure coding system code, the diagnosis related group code,
243	243	the national drug code, or other common identifier.
244	244	(d) The information contained in the list required under par. (a) 1. shall be
245	245	published in a single digital file that is in a machine-readable format.
246	246	(e) The list required under par. (a) 1. shall be displayed in a prominent location
247	247	on the home page of the hospital's website or accessible by selecting a dedicated link
248	248	that is prominently displayed on the hospital's website. If the hospital operates
249	249	multiple locations and maintains a single website, the list required under par. (a) 1.
250	250	shall be posted for each location the hospital operates in a manner that clearly
251	251	associates the list with the applicable location of the hospital.
252	252	(f) The list required under par. (a) 1. shall satisfy all of the following criteria:
253	253	1. The list is available free of charge and without having to establish a user
254	254	account or password.
255	255	2. The list is available without having to submit personal identifying
256	256	information.
257	257	3. The list is available without having to overcome any other impediment,
258	258	including entering a code.
259	259	4. The list is accessible to a common commercial operator of an Internet search
260	260	engine to the extent necessary for the search engine to index the list and display the
261	261	list as a result in response to a search query of a user of the search engine.
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289	289	SECTION 1
290	290	SENATE BILL 328
291	291	5. The list is formatted in a manner prescribed by the department.
292	292	6. The list is digitally searchable.
293	293	7. The list uses a naming convention specified by the federal centers for
294	294	medicare and medicaid services.
295	295	(g) In prescribing the format of the list under par. (f) 5., the department shall
296	296	do all of the following:
297	297	1. Develop a template for each hospital to use in formatting the list.
298	298	2. Consider any applicable federal guidelines for formatting similar lists
299	299	required by federal law or rule and ensure that the design of the template enables
300	300	health care researchers to compare the charges contained in the lists maintained by
301	301	each hospital.
302	302	3. Design the template under subd. 1. to be substantially similar to the
303	303	template used by the federal centers for medicare and medicaid services for purposes
304	304	similar to the purposes of the list required under par. (a) 1. if the department
305	305	determines that designing the template under subd. 1. to be substantially similar to
306	306	the template used by the federal centers for medicare and medicaid services benefits
307	307	the department.
308	308	(h) A hospital shall update the list required under par. (a) 1. at least once each
309	309	year. The hospital shall clearly indicate the date on which the list was most recently
310	310	updated, either on the list or in a manner that is clearly associated with the list.
311	311	(4) CONSUMER-FRIENDLY LIST OF SHOPPABLE SERVICES. (a) Except as provided in
312	312	par. (c), a hospital shall maintain and make publicly available a list of the standard
313	313	charges described under sub. (3) (c) 2. b., c., d., and e. for each of at least 300
314	314	shoppable services provided by the hospital. The hospital may select the shoppable
315	315	services to be included in the list, except that the list shall include either the 70
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342	342	SECTION 1 SENATE BILL 328
343	343	services specified as shoppable services by the federal centers for medicare and
344	344	medicaid services or, if the hospital does not provide all of the shoppable services
345	345	specified by the federal centers for medicare and medicaid services, as many of the
346	346	70 services specified as shoppable services by the federal centers for medicare and
347	347	medicaid services as the hospital provides.
348	348	(b) In selecting a shoppable service for inclusion in the list, the hospital shall
349	349	consider how frequently the hospital provides the services and the hospital's billing
350	350	rate for the services and prioritize the selection of services that are among the
351	351	services most frequently provided by the hospital.
352	352	(c) If a hospital does not provide at least 300 shoppable services, then the
353	353	hospital shall maintain a list of all shoppable services that the hospital provides
354	354	consistent with the requirements of this subsection.
355	355	(d) The list required under this subsection shall satisfy all of the following:
356	356	1. The list shall include the following information:
357	357	a. A plain-language description of each shoppable service included on the list.
358	358	b. The payor-specific negotiated charge that applies to each shoppable service
359	359	included on the list and any ancillary service, listed by the name of the 3rd-party
360	360	payor and plan associated with the negotiated charge and displayed in a manner that
361	361	clearly associates the negotiated charge with the 3rd-party payor and plan.
362	362	c. The discounted cash price that applies to each shoppable service included on
363	363	the list and any ancillary service or, if the hospital does not offer a discounted cash
364	364	price for one or more of the shoppable services on the list or ancillary services, the
365	365	gross charge for the shoppable service or ancillary service.
366	366	d. The de-identified minimum negotiated charge that applies to each
367	367	shoppable service included on the list and any ancillary service.
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395	395	SECTION 1
396	396	SENATE BILL 328
397	397	e. The de-identified maximum negotiated charge that applies to each
398	398	shoppable service included on the list and any ancillary service.
399	399	f. Any code used by the hospital for purposes of accounting or billing for each
400	400	shoppable service included on the list and any ancillary service, including the
401	401	current procedural terminology code, the healthcare common procedure coding
402	402	system code, the diagnosis related group code, the national drug code, or other
403	403	common identifier.
404	404	2. If applicable, the list shall do all of the following:
405	405	a. State each location at which the hospital provides the shoppable service and
406	406	whether the standard charges included in the list apply at that location to the
407	407	provision of that shoppable service in an inpatient setting, an outpatient department
408	408	setting, or in both of those settings.
409	409	b. Indicate if one or more of the shoppable services specified by the federal
410	410	centers for medicare and medicaid services is not provided by the hospital.
411	411	(e) The list required under this subsection shall satisfy all of the following
412	412	criteria:
413	413	1. The list is displayed in the manner provided in sub. (3) (e).
414	414	2. The list is available free of charge, without having to register or establish a
415	415	user account or password, without having to submit personal identifying
416	416	information, and without having to overcome any other impediment, including
417	417	entering a code to access the list.
418	418	3. The list is searchable by service description, billing code, and payor.
419	419	4. The list is updated in the manner provided in sub. (3) (h).
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444	444	SECTION 1 SENATE BILL 328
445	445	5. The list is accessible to a common commercial operator of an Internet search
446	446	engine to the extent necessary for the search engine to index the list and display the
447	447	list as a result in response to a search query of a user of the search engine.
448	448	6. The list is formatted in a manner that is consistent with the format
449	449	prescribed by the department under sub. (3) (f) 5.
450	450	(5) REPORTING. Every time a hospital updates a list as required under subs. (3)
451	451	(h) and (4) (e) 4., the hospital shall submit the updated list to the department. The
452	452	department shall prescribe the form in which the updated list shall be submitted to
453	453	the department.
454	454	(6) MONITORING AND ENFORCEMENT. (a) The department shall monitor each
455	455	hospital's compliance with the requirements of this section using any of the following
456	456	methods:
457	457	1. Evaluating complaints made by persons to the department regarding
458	458	noncompliance with this section.
459	459	2. Reviewing any analysis prepared regarding noncompliance with this
460	460	section.
461	461	3. Auditing the websites of hospitals for noncompliance with this section.
462	462	4. Confirming that each hospital submitted the lists required under sub. (5).
463	463	(b) If the department determines that a hospital is not in compliance with any
464	464	provisions of this section, the department shall take the following actions:
465	465	1. Provide a written notice to the hospital that clearly explains the manner in
466	466	which the hospital is not in compliance with this section.
467	467	2. Request a corrective action plan from the hospital if the hospital has
468	468	materially violated a provision of this section, as determined under sub. (7).
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495	495	SECTION 1
496	496	SENATE BILL 328
497	497	3. Impose a penalty determined under sub. (8) and publicize the penalty on the
498	498	department's website. The department shall impose a penalty only if the hospital
499	499	does any of the following:
500	500	a. Fails to respond to the department's request to submit a corrective action
501	501	plan.
502	502	b. Fails to comply with the requirements of a corrective action plan submitted
503	503	to the department.
504	504	(c) The department shall create and maintain a publicly available list on its
505	505	website of hospitals that have been found to have violated any provision of this
506	506	section, that have been issued a penalty, or that have been sent a warning notice,
507	507	request for a corrective action plan, or any other written communication from the
508	508	department.
509	509	(d) In considering an application for renewal of a hospital's license, the
510	510	department shall consider whether the hospital is or has been in compliance with
511	511	this section.
512	512	(7) MATERIAL VIOLATION; CORRECTIVE ACTION PLAN. (a) A hospital materially
513	513	violates this section if the hospital does any of the following:
514	514	1. Fails to comply with the requirements of sub. (2).
515	515	2. Fails to publicize the hospital's standard charges in the form and manner
516	516	required by subs. (3) and (4).
517	517	(b) If the department determines that a hospital has materially violated this
518	518	section, the department shall issue a notice of material violation to the hospital and
519	519	request that the hospital submit a corrective plan of action. The notice shall indicate
520	520	the form and manner in which the corrective action plan shall be submitted to the
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546	546	SECTION 1 SENATE BILL 328
547	547	department, and clearly state the date by which the hospital is required to submit
548	548	the plan.
549	549	(c) A hospital that receives a notice under par. (b) shall do all of the following:
550	550	1. Submit a corrective action plan in the form and manner, and by the specified
551	551	date, prescribed by the notice of violation.
552	552	2. As soon as practicable after submission of a corrective action plan to the
553	553	department, act to comply with the corrective action plan.
554	554	(d) A corrective action plan submitted to the department shall satisfy all of the
555	555	following criteria:
556	556	1. Describe in detail the corrective actions the hospital will take to address any
557	557	violation identified by the department in the notice provided under par. (b).
558	558	2. Provide a date by which the hospital will complete the corrective actions
559	559	described in subd. 1.
560	560	(e) A corrective action plan is subject to review and approval by the department.
561	561	After the department reviews and approves a hospital's corrective action plan, the
562	562	department shall monitor and evaluate the hospital's compliance with the corrective
563	563	action plan.
564	564	(f) A hospital is considered to have failed to respond to the department's request
565	565	to submit a corrective action plan if the hospital does any of the following:
566	566	1. Fails to submit a corrective action plan in the form and manner specified in
567	567	the notice provided under par. (b).
568	568	2. Fails to submit a corrective action plan by the date specified in the notice
569	569	provided under par. (b).
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593	593	LRB-2922/2
594	594	JPC:amn
595	595	SECTION 1
596	596	SENATE BILL 328
597	597	(g) A hospital is considered to have failed to comply with a corrective action plan
598	598	if the hospital fails to address a violation within the specified period of time contained
599	599	in the corrective action plan.
600	600	(8) FORFEITURE. (a) The department shall impose a forfeiture on a hospital in
601	601	if the hospital does any of the following:
602	602	1. Fails to respond to the department's request to submit a corrective action
603	603	plan.
604	604	2. Fails to comply with the requirements of a corrective action plan submitted
605	605	to the department.
606	606	(b) The department shall impose a forfeiture on a hospital for a violation of each
607	607	requirement of this section. The department shall set the forfeiture in an amount
608	608	sufficient to ensure compliance by hospitals with the provisions of this section
609	609	subject to the limitations under par. (c).
610	610	(c) The forfeiture imposed under this subsection shall comply with all of the
611	611	following:
612	612	1. In the case of a hospital with 30 beds or fewer, the forfeiture may not be lower
613	613	than $600 for each day in which the hospital violates this section.
614	614	2. In the case of a hospital with a bed count that is greater than 30 but less than
615	615	101, the forfeiture may not be lower than $1,200 for each day in which the hospital
616	616	violates this section.
617	617	3. In the case of a hospital with a bed count that is greater than 100 but less
618	618	than 551, the forfeiture may not be lower than $2,500 for each day in which the
619	619	hospital violates this section.
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643	643	JPC:amn
644	644	SECTION 1 SENATE BILL 328
645	645	4. In the case of a hospital with a bed count that is greater than 550, the
646	646	forfeiture may not be less than $10,000 for each day in which the hospital violates
647	647	this section.
648	648	(d) Each day a violation continues is considered a separate violation for
649	649	purposes of this subsection.
650	650	(e) In determining the amount of the forfeiture under this subsection, the
651	651	department shall consider all of the following factors:
652	652	1. Previous violations by the hospital's operator.
653	653	2. The seriousness of the violation.
654	654	3. Any demonstrated good faith by the hospital's operator.
655	655	4. Any other matters that the department determines is relevant.
656	656	(f) If a hospital desires to contest the imposing of a forfeiture under this
657	657	subsection, the hospital shall, within 10 days after receipt of notice, notify the
658	658	department in writing of its request for a hearing under s. 227.44. The department
659	659	shall hold the hearing within 30 days after receipt of such notice and shall send notice
660	660	to the hospital of the hearing as provided under s. 227.44 (2).
661	661	(g) All forfeitures shall be paid to the department within 10 days after receipt
662	662	of notice of forfeiture or, if the forfeiture is contested under par. (f), within 10 days
663	663	after receipt of the final decision after exhaustion of administrative review, unless
664	664	the final decision is appealed and the order is stayed by court order.
665	665	(h) 1. All administrative remedies shall be exhausted before an agency
666	666	determination under this subsection shall be subject to judicial review. Final
667	667	decisions after hearing shall be subject to judicial review exclusively as provided in
668	668	s. 227.52, except that any petition for review of department action under this
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693	693	LRB-2922/2
694	694	JPC:amn
695	695	SECTION 1
696	696	SENATE BILL 328
697	697	subsection shall be filed within 15 days after receipt of notice of the final agency
698	698	determination.
699	699	2. The court may stay enforcement under s. 227.54 of the department's final
700	700	decision if a showing is made that there is a substantial probability that the party
701	701	seeking review will prevail on the merits and will suffer irreparable harm if a stay
702	702	is not granted, and that the hospital will meet the requirements of this section during
703	703	such stay. When a stay is granted, the court may impose such conditions on the
704	704	granting of the stay as may be necessary to safeguard the public and to assure
705	705	compliance by the hospital with the requirements of this section.
706	706	3. The attorney general may delegate to the department the authority to
707	707	represent the state in any action brought to challenge department decisions prior to
708	708	exhaustion of administrative remedies and final disposition by the department.
709	709	(i) The department shall remit all forfeitures paid under this subsection to the
710	710	secretary of administration for deposit in the general fund.
711	711	(9) LEGISLATIVE RECOMMENDATIONS . Biennially, the department shall prepare
712	712	a report to be distributed to the legislature in the manner provided in s. 13.172 (2)
713	713	recommending amendments to this section, including recommendations in response
714	714	to amendments to 45 CFR part 180.
715	715	SECTION 2.0Effective date.
716	716	(1) This act takes effect on the first day of the 4th month beginning after
717	717	publication.
718	718	(END)
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