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2023 - 2024 LEGISLATURE
2023 SENATE BILL 328
June 8, 2023 - Introduced by Senators FELZKOWSKI, BRADLEY, HUTTON, KNODL,
LARSON, NASS and STROEBEL, cosponsored by Representatives BROOKS, ROZAR,
ALLEN, BODDEN, BRANDTJEN, DITTRICH, DONOVAN, DUCHOW, GOEBEN, GREEN,
GUNDRUM, GUSTAFSON, MACCO, RETTINGER, SCHRAA, SHANKLAND, SORTWELL and
WICHGERS. Referred to Committee on Health.
***AUTHORS SUBJECT TO CHANGE***
AN ACT to create 50.40 of the statutes; relating to: price transparency in
hospitals and providing a penalty.
Analysis by the Legislative Reference Bureau
This bill creates several requirements for hospitals to provide cost information
for certain items and services provided by the hospital. Under the bill, each hospital
must make publicly available a digital file in a machine-readable format that
contains a list of standard charges for certain items and services provided by the
hospital and a consumer-friendly list of standard charges for certain shoppable
services. “Standard charge” is defined to mean the regular rate established by the
hospital for an item or service provided to a specific group of paying patients and
includes certain price information, including the gross charge, the payor-specific
negotiated charge, and the discounted cash price. “Shoppable service” is defined to
mean a service that may be scheduled by a health care consumer in advance. If the
Department of Health Services determines that a hospital is not in compliance with
any of the price transparency requirements specified in the bill, the bill requires DHS
to take certain actions, including providing a written notice to the hospital,
requesting a corrective action plan from the hospital, or imposing a penalty. The bill
establishes escalating penalties for violations of the hospital price transparency
requirements specified in the bill based on the hospital's bed count, from $600 for
each day in which a hospital with 30 beds or fewer violates the hospital price
transparency requirements under the bill up to $10,000 for each day in which a
hospital with greater than 550 beds violates the hospital price transparency
requirements under the bill. The bill also requires DHS to maintain a publicly
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available list of hospitals that have been found to have violated any of the price
transparency requirements specified in the bill.
Under the bill, the list of standard charges must be available at all times to the
public in a machine-readable format, must be displayed in a prominent location on
the home page of the hospital's website, and must include certain information,
including a description of each hospital item or service provided and any code used
by the hospital for purposes of accounting or billing. Further, the list of standard
charges must meet certain criteria, including that it must be available free of charge
and without having to establish a user account or password, that the list is available
without having to submit personal identifying information, that the list is digitally
searchable, and that the list is accessible to a commercial operator of an Internet
search engine as 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. The list of
standard charges must be updated at least once each year.
Further, under the bill, the consumer-friendly list of standard charges for
shoppable services must be publicly available and must contain standard charge
information for each of at least 300 shoppable services provided by the hospital. The
bill allows a hospital to select the shoppable services to be included in the list, except
that the list must include either the 70 services specified as shoppable services by
the federal Centers for Medicare and Medicaid Services (CMS) or, if the hospital does
not provide all of the shoppable services specified by CMS, as many of the 70 services
specified as shoppable services by CMS as the hospital provides. If a hospital does
not provide at least 300 shoppable services, the bill requires the hospital to maintain
a list of all shoppable services that the hospital provides. The consumer-friendly list
of standard charges for shoppable services must include certain information,
including certain price information and a plain-language description of each
shoppable service included on the list, whether each hospital location provides the
shoppable service and whether the standard charges included in the list apply at that
location, and whether one or more of the shoppable services specified by CMS is not
provided by the hospital. The consumer-friendly list of standard charges for
shoppable services must meet certain criteria, including that the list is available free
of charge without having to establish a user account or password, that the list is
searchable by service description, billing code, and payor, and that the list is
accessible to a common commercial operator of an Internet search engine as
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. The consumer-friendly list
of standard charges for shoppable services must be updated at least once each year.
The bill provides that every time a hospital updates the list of standard charges
or the consumer-friendly list of standard charges for shoppable services, the hospital
must submit the updated list to DHS. Under the bill, DHS must monitor each
hospital's compliance with the price transparency requirements specified in the bill
by evaluating complaints, reviewing any analysis prepared regarding
noncompliance, auditing the websites of hospitals, or confirming that each hospital
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For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SECTION 1. 50.40 of the statutes is created to read:
50.40 Hospital price transparency. (1) DEFINITIONS. In this section:
(a) “Ancillary service” means a hospital item or service that a hospital
customarily provides as part of a shoppable service.
(b) “Chargemaster” means the list of all hospital items or services maintained
by a hospital for which the hospital has established a charge.
(c) “De-identified maximum negotiated charge” means the highest charge that
a hospital has negotiated with all 3rd-party payors for a hospital item or service.
(d) “De-identified minimum negotiated charge” means the lowest charge that
a hospital has negotiated with all 3rd-party payors for a hospital item or service.
(e) “Discounted cash price” means the charge that applies to an individual who
pays cash, or a cash equivalent, for a hospital item or service.
(f) “Gross charge” means the charge for a hospital item or service that is
reflected on a hospital's chargemaster, absent any discounts.
(g) “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
all of the following:
1. Supplies and procedures.
2. Room and board.
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3. Use of the hospital and other areas.
4. Services of physicians and nonphysician practitioners employed by the
hospital.
5. Any other item or service for which a hospital has established a standard
charge.
(h) “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.
“Machine-readable format” includes .XML, .JSON, and .CSV formats.
(i) “Payor-specific negotiated charge” means the charge that a hospital has
negotiated with a 3rd-party payor for a hospital item or service.
(j) “Service package” means an aggregation of individual hospital items or
services into a single service with a single charge.
(k) “Shoppable service” means a service that may be scheduled by a health care
consumer in advance.
(L) “Standard charge” means the regular rate established by the hospital for
a hospital item or service provided to a specific group of paying patients and includes
all of the following:
1. The gross charge.
2. The payor-specific negotiated charge.
3. The de-identified minimum negotiated charge.
4. The de-identified maximum negotiated charge.
5. The discounted cash price.
(m) “Third-party payor” means an entity that is, by statute, contract, or
agreement, legally responsible for payment of a claim for a hospital item or service.
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(2) PUBLIC AVAILABILITY OF PRICE INFORMATION REQUIRED. A hospital shall make
publicly available all of the following:
(a) A digital file in a machine-readable format that contains a list of all
standard charges for all hospital items or services described under sub. (3).
(b) A consumer-friendly list of standard charges for a limited set of shoppable
services as provided in sub. (4).
(3) LIST OF STANDARD CHARGES REQUIRED. (a) A hospital shall do all of the
following:
1. Maintain a list of all standard charges for all hospital items or services in
accordance with this section.
2. Ensure the list required under subd. 1. is available at all times to the public,
including by posting the list electronically in the manner provided in this section.
(b) The standard charges contained in the list required to be maintained by a
hospital under par. (a) 1. shall 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 par. (a) 1. shall include all of the following
information:
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:
a. The gross charge.
b. The de-identified minimum negotiated charge.
c. The de-identified maximum negotiated charge.
d. The discounted cash price.
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e. The payor-specific negotiated charge, listed by the name of the 3rd-party
payor and plan associated with the charge and displayed in a manner that clearly
associates the charge with each 3rd-party payor and plan.
3. Any code used by the hospital for purposes of accounting or billing for the
hospital item or service, including the current procedural terminology code, the
healthcare common procedure coding system code, the diagnosis related group code,
the national drug code, or other common identifier.
(d) The information contained in the list required under par. (a) 1. shall be
published in a single digital file that is in a machine-readable format.
(e) The list required under par. (a) 1. shall be displayed in a prominent location
on the home page of the hospital's website or accessible by selecting a dedicated link
that is prominently displayed on the hospital's website. If the hospital operates
multiple locations and maintains a single website, the list required under par. (a) 1.
shall 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 par. (a) 1. shall satisfy all of the following criteria:
1. The list is available free of charge and without having to establish a user
account or password.
2. The list is available without having to submit personal identifying
information.
3. The list is available without having to overcome any other impediment,
including entering a code.
4. The list is 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.
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5. The list is formatted in a manner prescribed by the department.
6. The list is digitally searchable.
7. The list uses a naming convention specified by the federal centers for
medicare and medicaid services.
(g) In prescribing the format of the list under par. (f) 5., the department shall
do all of the following:
1. Develop a template for each hospital to use in formatting the list.
2. 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 hospital.
3. Design the template under subd. 1. to be substantially similar to the
template used by the federal centers for medicare and medicaid services for purposes
similar to the purposes of the list required under par. (a) 1. if the department
determines that designing the template under subd. 1. to be substantially similar to
the template used by the federal centers for medicare and medicaid services benefits
the department.
(h) A hospital shall update the list required under par. (a) 1. at least once each
year. The hospital shall 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.
(4) CONSUMER-FRIENDLY LIST OF SHOPPABLE SERVICES. (a) Except as provided in
par. (c), a hospital shall maintain and make publicly available a list of the standard
charges described under sub. (3) (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 shall include either the 70
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services specified as shoppable services by the federal centers for medicare and
medicaid services or, if the hospital does not provide all of the shoppable services
specified by the federal centers for medicare and medicaid services, as many of the
70 services specified as shoppable services by the federal centers for medicare and
medicaid services as the hospital provides.
(b) In selecting a shoppable service for inclusion in the list, the hospital shall
consider how frequently the hospital provides the services and the hospital's billing
rate for the services and prioritize the selection of services that are among the
services most frequently provided by the hospital.
(c) If a hospital does not provide at least 300 shoppable services, then the
hospital shall maintain a list of all shoppable services that the hospital provides
consistent with the requirements of this subsection.
(d) The list required under this subsection shall satisfy all of the following:
1. The list shall include the following information:
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 3rd-party
payor and plan associated with the negotiated charge and displayed in a manner that
clearly associates the negotiated charge with the 3rd-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 hospital does not offer a discounted cash
price for one or more of the shoppable services on the list or ancillary services, the
gross charge for the shoppable service or ancillary service.
d. The de-identified minimum negotiated charge that applies to each
shoppable service included on the list and any ancillary service.
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e. The de-identified maximum negotiated charge that applies to each
shoppable service included on the list and any ancillary service.
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 code, the healthcare common procedure coding
system code, the diagnosis related group code, the national drug code, or other
common identifier.
2. If applicable, the list shall do all of the following:
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.
b. Indicate if one or more of the shoppable services specified by the federal
centers for medicare and medicaid services is not provided by the hospital.
(e) The list required under this subsection shall satisfy all of the following
criteria:
1. The list is displayed in the manner provided in sub. (3) (e).
2. The list is available free of charge, without having to register or establish a
user account or password, without having to submit personal identifying
information, and without having to overcome any other impediment, including
entering a code to access the list.
3. The list is searchable by service description, billing code, and payor.
4. The list is updated in the manner provided in sub. (3) (h).
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5. The list is 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.
6. The list is formatted in a manner that is consistent with the format
prescribed by the department under sub. (3) (f) 5.
(5) REPORTING. Every time a hospital updates a list as required under subs. (3)
(h) and (4) (e) 4., the hospital shall submit the updated list to the department. The
department shall prescribe the form in which the updated list shall be submitted to
the department.
(6) MONITORING AND ENFORCEMENT. (a) The department shall monitor each
hospital's compliance with the requirements of this section using any of the following
methods:
1. Evaluating complaints made by persons to the department regarding
noncompliance with this section.
2. Reviewing any analysis prepared regarding noncompliance with this
section.
3. Auditing the websites of hospitals for noncompliance with this section.
4. Confirming that each hospital submitted the lists required under sub. (5).
(b) If the department determines that a hospital is not in compliance with any
provisions of this section, the department shall take the following actions:
1. Provide a written notice to the hospital that clearly explains the manner in
which the hospital is not in compliance with this section.
2. Request a corrective action plan from the hospital if the hospital has
materially violated a provision of this section, as determined under sub. (7).
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3. Impose a penalty determined under sub. (8) and publicize the penalty on the
department's website. The department shall impose a penalty only if the hospital
does any of the following:
a. Fails to respond to the department's request to submit a corrective action
plan.
b. Fails to comply with the requirements of a corrective action plan submitted
to the department.
(c) The department shall create and maintain a publicly available list on its
website of hospitals that have been found to have violated any provision of this
section, that have been issued a penalty, or that have been sent a warning notice,
request for a corrective action plan, or any other written communication from the
department.
(d) In considering an application for renewal of a hospital's license, the
department shall consider whether the hospital is or has been in compliance with
this section.
(7) MATERIAL VIOLATION; CORRECTIVE ACTION PLAN. (a) A hospital materially
violates this section if the hospital does any of the following:
1. Fails to comply with the requirements of sub. (2).
2. Fails to publicize the hospital's standard charges in the form and manner
required by subs. (3) and (4).
(b) If the department determines that a hospital has materially violated this
section, the department shall issue a notice of material violation to the hospital and
request that the hospital submit a corrective plan of action. The notice shall indicate
the form and manner in which the corrective action plan shall be submitted to the
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department, and clearly state the date by which the hospital is required to submit
the plan.
(c) A hospital that receives a notice under par. (b) shall do all of the following:
1. Submit a corrective action plan in the form and manner, and by the specified
date, prescribed by the notice of violation.
2. As soon as practicable after submission of a corrective action plan to the
department, act to comply with the corrective action plan.
(d) A corrective action plan submitted to the department shall satisfy all of the
following criteria:
1. Describe in detail the corrective actions the hospital will take to address any
violation identified by the department in the notice provided under par. (b).
2. Provide a date by which the hospital will complete the corrective actions
described in subd. 1.
(e) A corrective action plan is subject to review and approval by the department.
After the department reviews and approves a hospital's corrective action plan, the
department shall monitor and evaluate the hospital's compliance with the corrective
action plan.
(f) A hospital is considered to have failed to respond to the department's request
to submit a corrective action plan if the hospital does any of the following:
1. Fails to submit a corrective action plan in the form and manner specified in
the notice provided under par. (b).
2. Fails to submit a corrective action plan by the date specified in the notice
provided under par. (b).
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(g) A hospital is considered to have failed to comply with a corrective action plan
if the hospital fails to address a violation within the specified period of time contained
in the corrective action plan.
(8) FORFEITURE. (a) The department shall impose a forfeiture on a hospital in
if the hospital does any of the following:
1. Fails to respond to the department's request to submit a corrective action
plan.
2. Fails to comply with the requirements of a corrective action plan submitted
to the department.
(b) The department shall impose a forfeiture on a hospital for a violation of each
requirement of this section. The department shall set the forfeiture in an amount
sufficient to ensure compliance by hospitals with the provisions of this section
subject to the limitations under par. (c).
(c) The forfeiture imposed under this subsection shall comply with all of the
following:
1. In the case of a hospital with 30 beds or fewer, the forfeiture may not be lower
than $600 for each day in which the hospital violates this section.
2. In the case of a hospital with a bed count that is greater than 30 but less than
101, the forfeiture may not be lower than $1,200 for each day in which the hospital
violates this section.
3. In the case of a hospital with a bed count that is greater than 100 but less
than 551, the forfeiture may not be lower than $2,500 for each day in which the
hospital violates this section.
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4. In the case of a hospital with a bed count that is greater than 550, the
forfeiture may not be less than $10,000 for each day in which the hospital violates
this section.
(d) Each day a violation continues is considered a separate violation for
purposes of this subsection.
(e) In determining the amount of the forfeiture under this subsection, the
department shall consider all of the following factors:
1. Previous violations by the hospital's operator.
2. The seriousness of the violation.
3. Any demonstrated good faith by the hospital's operator.
4. Any other matters that the department determines is relevant.
(f) If a hospital desires to contest the imposing of a forfeiture under this
subsection, the hospital shall, within 10 days after receipt of notice, notify the
department in writing of its request for a hearing under s. 227.44. The department
shall hold the hearing within 30 days after receipt of such notice and shall send notice
to the hospital of the hearing as provided under s. 227.44 (2).
(g) All forfeitures shall be paid to the department within 10 days after receipt
of notice of forfeiture or, if the forfeiture is contested under par. (f), within 10 days
after receipt of the final decision after exhaustion of administrative review, unless
the final decision is appealed and the order is stayed by court order.
(h) 1. All administrative remedies shall be exhausted before an agency
determination under this subsection shall be subject to judicial review. Final
decisions after hearing shall be subject to judicial review exclusively as provided in
s. 227.52, except that any petition for review of department action under this
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subsection shall be filed within 15 days after receipt of notice of the final agency
determination.
2. The court may stay enforcement under s. 227.54 of the department's final
decision if a showing is made that there is a substantial probability that the party
seeking review will prevail on the merits and will suffer irreparable harm if a stay
is not granted, and that the hospital will meet the requirements of this section during
such stay. When a stay is granted, the court may impose such conditions on the
granting of the stay as may be necessary to safeguard the public and to assure
compliance by the hospital with the requirements of this section.
3. The attorney general may delegate to the department the authority to
represent the state in any action brought to challenge department decisions prior to
exhaustion of administrative remedies and final disposition by the department.
(i) The department shall remit all forfeitures paid under this subsection to the
secretary of administration for deposit in the general fund.
(9) LEGISLATIVE RECOMMENDATIONS . Biennially, the department shall prepare
a report to be distributed to the legislature in the manner provided in s. 13.172 (2)
recommending amendments to this section, including recommendations in response
to amendments to 45 CFR part 180.
SECTION 2.0Effective date.
(1) This act takes effect on the first day of the 4th month beginning after
publication.
(END)
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