Hospital and ASC Price Disclosure and Litigation Protection Act of 2005 - Prohibits a charge-related legal action from being brought by an individual against a hospital or ambulatory surgical center if the hospital or center: (1) has met the requirements under this Act; (2) has entered into an agreement with the uninsured individual before treatment that sets the maximum price that will be charged for such treatment; and (3) has met the terms of such agreement.
Sets forth disclosures that a hospital or center must provide to an individual who is scheduled to receive treatment and include in any itemized bill, including: (1) the estimated price or the price charged for the treatment; (2) the payment rate for the treatment negotiated with the network plan or managed care plan that has the largest number of enrollees; and (3) the Medicare payment rate for the treatment. Excludes from such requirements a treatment for which there exists a third-party price arrangement unless the individual involved requests such information.
Requires a hospital or ambulatory surgical center to report data to the Secretary of Health and Human Services regarding: (1) the frequency of performing certain services and administering certain drugs; (2) the charge by the hospital or center for such services or drugs; (3) the negotiated rate of payment for the treatment by the plan with the largest number of enrollees; and (4) the Medicare payment rate for the treatment.
Requires the Secretary to: (1) publicly post such information on the Internet in a manner that promotes charge comparisons among hospitals and centers; and (2) select which services or drugs are to be reported based on the frequency with which the services are performed or the drugs are administered.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4450 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 4450
To require hospitals and ambulatory surgical centers to disclose
charge-related information and to provide price protection for
treatments not covered by insurance as conditions for receiving
protection from charge-related legal actions.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 6, 2005
Mr. Sessions introduced the following bill; which was referred to the
Committee on the Judiciary, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To require hospitals and ambulatory surgical centers to disclose
charge-related information and to provide price protection for
treatments not covered by insurance as conditions for receiving
protection from charge-related legal actions.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Hospital and ASC Price Disclosure
and Litigation Protection Act of 2005''.
SEC. 2. PROTECTION FROM CERTAIN LEGAL ACTIONS PROVIDED TO HOSPITALS AND
AMBULATORY SURGICAL CENTERS THAT COMPLY WITH CHARGE-
RELATED REQUIREMENTS.
(a) In General.--A charge-related legal action may not be brought
by an individual--
(1) against a hospital, if the hospital--
(A) has met the charge-related disclosure
requirements under paragraphs (1)(A) and (2)(A) of
section 3(a), with respect to such individual;
(B) complies with the reporting and posting
requirements under paragraphs (1)(A) and (3)(A) of
section 3(b); and
(C) has entered into an agreement under paragraph
(1) of section 3(c) with the individual and has met the
terms of such agreement; and
(2) against an ambulatory surgical center, if the
ambulatory surgical center--
(A) has met the charge-related disclosure
requirements under paragraphs (1)(B) and (2)(B) of
section 3(a), with respect to such individual;
(B) complies with the reporting and posting
requirements under paragraphs (1)(B) and (3)(B) of
section 3(b); and
(C) has entered into an agreement under paragraph
(2) of section 3(c) with the individual and has met the
terms of such agreement.
(b) Charge-Related Legal Action Defined.--
(1) In general.--For purposes of this section, the term
``charge-related legal action'' means any Federal or State
legal action brought by an individual for any damages or other
relief, with respect to the amount charged by a hospital or an
ambulatory surgical center for a treatment (or course of
treatment), sought against the hospital or ambulatory surgical
center, respectively, regardless of the legal basis for the
action, including a violation of the Internal Revenue Code of
1986, section 1867 of the Social Security Act (42 U.S.C.
1395dd), or any other Federal law, a breach of contract claim,
a breach of good faith and fair dealing claim, or otherwise.
(2) Exception.--Such term does not include a State legal
action for which the legal basis is a claim of liability of the
hospital or ambulatory surgical center created by a statute of
the State in which the action is brought.
(c) Effective Date.--This section shall take effect on the date of
the enactment of this Act and shall apply to actions brought on or
after such day.
SEC. 3. CHARGE-RELATED REQUIREMENTS.
(a) Charge-Related Disclosure to Individuals Required.--
(1) Pre-treatment disclosure.--
(A) Hospital disclosure requirement.--Subject to
paragraph (3) and for purposes of complying with
section 2(a)(1)(A), the charge-related disclosure
requirement of this subparagraph is that a hospital
provide to an individual who is scheduled to receive a
treatment (or to begin a course of treatment) that is
not for an emergency medical condition, the following
(determined at the time of scheduling):
(i) Statement regarding discount prices.--
The following statement: ``Prices for enrollees
in group plans and medicare beneficiaries may
be lower because individuals pooled together in
groups are sometimes offered discounted
prices.''.
(ii) Estimated prices to be charged.--The
estimated price that the hospital will charge
for the treatment (or course of treatment).
(iii) Network plans and managed care plans
payment rate.--The rate of payment for the
treatment (or course of treatment) to the
hospital that has been negotiated by or on
behalf of the hospital with the network plan or
managed care plan that has the largest number
of enrollees, without regard to cost-sharing.
(iv) Medicare payment rate.--The rate of
payment for the treatment (or course of
treatment) applicable to the hospital under the
medicare program, without regard to cost-
sharing.
(B) Ambulatory surgical center disclosure
requirement.--Subject to paragraph (3) and for purposes
of complying with section 2(a)(2)(A), the charge-
related disclosure requirement of this subparagraph is
that an ambulatory surgical center provide to an
individual who is scheduled to receive a treatment (or
to begin a course of treatment) that is not for an
emergency medical condition, the following (determined
at the time of scheduling):
(i) Statement regarding discount prices.--
The statement described in subparagraph (A)(i).
(ii) Estimated prices to be charged.--The
estimated price that the ambulatory surgical
center will charge for the treatment (or course
of treatment).
(iii) Network plans and managed care plans
payment rate.--The rate of payment for the
treatment (or course of treatment) to the
ambulatory surgical center that has been
negotiated by or on behalf of the ambulatory
surgical center with the network plan or
managed care plan that has the largest number
of enrollees, without regard to cost-sharing.
(iv) Medicare payment rate.--The rate of
payment for the treatment (or course of
treatment) applicable to the ambulatory
surgical center under the medicare program,
without regard to cost-sharing.
(2) Post-treatment disclosure.--
(A) Hospital disclosure requirement.--Subject to
paragraph (3) and for purposes of complying with
section 2(a)(1)(A), the charge-related disclosure
requirement of this subparagraph is that the hospital
include with any bill that includes the charges for a
treatment an itemized list of component charges for
such treatment, including charges for drugs and medical
equipment involved, as determined at the time of
billing. With respect to each item included on such
list, the hospital shall include the following:
(i) Prices charged.--The price that the
hospital charged for each item.
(ii) Network plans and managed care plans
payment rate.--The rate of payment for each
item to the hospital that has been negotiated
by or on behalf of the hospital with the
network plan or managed care plan that has the
largest number of enrollees, without regard to
cost-sharing.
(iii) Medicare payment rate.--The rate of
payment for each item applicable to the
hospital under the medicare program, without
regard to cost-sharing.
(B) Ambulatory surgical center requirement.--
Subject to paragraph (3) and for purposes of complying
with section 2(a)(2)(A), the charge-related disclosure
requirement of this subparagraph is that the ambulatory
surgical center include with any bill that includes the
charges for a treatment an itemized list of component
charges for such treatment, including charges for drugs
and medical equipment involved, as determined at the
time of billing. With respect to each item included on
such list, the ambulatory surgical center shall include
the following:
(i) Prices charged.--The price that the
ambulatory surgical center charged for each
item.
(ii) Network plans and managed care plans
payment rate.--The rate of payment for each
item to the ambulatory surgical center that has
been negotiated by or on behalf of the
ambulatory surgical center with the network
plan or managed care plan that has the largest
number of enrollees, without regard to cost-
sharing.
(iii) Medicare payment rate.--The rate of
payment for each item applicable to the
ambulatory surgical center under the medicare
program, without regard to cost-sharing.
(3) Application of requirement only on request if third-
party price arrangement exists.--A hospital or an ambulatory
surgical center is not required to provide the applicable
information under paragraph (1) or (2) for a treatment (or a
course of treatment) for which there exists a third-party price
arrangement unless the individual involved requests such
information on or after the time of scheduling and before the
time of billing for the treatment.
(b) Hospital Public Reporting and Availability of Charge-Related
Information Required.--
(1) Semiannual reporting requirements.--
(A) For hospitals.--For purposes of complying with
section 2(a)(1)(B), the reporting requirement of this
subparagraph is that, not later than 80 days after the
end of each semiannual period described in subparagraph
(C), a hospital report to the Secretary the following
data:
(i) The frequency with which the hospital
performed each procedure selected under clause
(i) or (ii) of paragraph (4)(A) in an inpatient
or outpatient setting, respectively, during
such period and the frequency with which the
hospital administered a drug selected under
clause (iv) of such paragraph in an inpatient
setting during such period.
(ii) If such a procedure was so performed
or such a drug was so administered during such
period--
(I) the average charge billed by
the hospital during such period for
such procedure or drug in cases in
which there did not exist a third-party
price arrangement for such procedure or
drug;
(II) the rate of payment during
such period for such procedure or drug
to the hospital that has been
negotiated by or on behalf of the
hospital with the network plan or
managed care plan that has the largest
number of enrollees, without regard to
cost-sharing; and
(III) the rate of payment during
such period for such procedure or drug
applicable to the hospital under the
medicare program, without regard to
cost-sharing.
(B) For ambulatory surgical centers.--For purposes
of complying with section 2(a)(2)(B), the reporting
requirement of this subparagraph is that, not later
than 80 days after the end of each semiannual period
described in subparagraph (C), an ambulatory surgical
center report to the Secretary the following data:
(i) The frequency with which the ambulatory
surgical center performed each procedure
selected under clause (iii) of paragraph (4)(A)
during such period.
(ii) If the procedure was so performed
during such period--
(I) the average charge billed by
the ambulatory surgical center during
such period for such procedure in cases
in which there did not exist a third-
party price arrangement for such
procedure;
(II) the rate of payment during
such period for such procedure to the
ambulatory surgical center that has
been negotiated by or on behalf of the
ambulatory surgical center with the
network plan or managed care plan that
has the largest number of enrollees,
without regard to cost-sharing; and
(III) the rate of payment during
such period for such procedure
applicable to the ambulatory surgical
center under the medicare program,
without regard to cost-sharing.
(C) Semiannual period described.--For purposes of
this paragraph, a semiannual period described in this
subparagraph is a period of six months beginning on
January 1 or July 1, with the first such period
beginning more than one year after the date of the
enactment of this Act.
(2) Public posting of information.--The Secretary of Health
and Human Services shall promptly post, on the official public
Internet site of the Department of Health and Human Services,
the information reported under paragraph (1). Such information
shall be set forth in a manner that promotes charge comparison
among hospitals and among ambulatory surgical centers.
(3) Availability of information posted.--
(A) Requirement for hospitals.--For purposes of
complying with section 2(a)(1)(B), the posting
requirement of this subparagraph is that, not later
than the date of the enactment of this Act, a hospital
prominently post at each admission site of the
hospital--
(i) a notice of the availability of the
information described in paragraphs (1)(A) and
(2)(A) of subsection (a); and
(ii) a notice of the availability of the
information reported under paragraph (1)(A) on
the official public Internet site under
paragraph (2).
(B) Requirement for ambulatory surgical centers.--
For purposes of complying with section 2(a)(2)(B), the
posting requirement of this subparagraph is that, not
later than the date of the enactment of this Act, an
ambulatory surgical center prominently post at each
admission site of the ambulatory surgical center--
(i) a notice of the availability of the
information described in paragraphs (1)(B) and
(2)(B) of subsection (a); and
(ii) a notice of the availability of the
information reported under paragraph (1)(B) on
the official public Internet site under
paragraph (2).
(4) Selection of procedures and drugs.--For purposes of
this subsection:
(A) Initial selection.--Based on national data, the
Secretary shall select the following:
(i) The 25 most frequently performed
procedures in a hospital inpatient setting, as
identified by diagnosis-related group.
(ii) The 25 most frequently performed
procedures in a hospital outpatient setting, as
identified under the classification system for
covered OPD services under section
1833(t)(2)(A) of the Social Security Act (42
U.S.C. 1395l(t)(2)(A)).
(iii) The 25 most frequently performed
procedures in an ambulatory surgical center
setting.
(iv) The 50 most frequently administered
drugs in a hospital inpatient setting.
(B) Updating selection.--The Secretary shall
periodically update the procedures and drugs selected
under subparagraph (A).
(c) Charge Agreements for Uninsured Treatments.--
(1) For hospitals.--Subject to paragraph (3) and for
purposes of complying with section 2(a)(1)(C), an agreement
under this paragraph is an agreement entered into between a
hospital and an individual, on or after the date of scheduling
treatment involved for the individual and before the date of
such treatment, that provides that the hospital will not charge
for the treatment an amount that is greater than the price that
has been agreed to by the hospital and the individual and
specified in writing in such agreement.
(2) For ambulatory surgical centers.--Subject to paragraph
(3) and for purposes of complying with section 2(a)(2)(C), an
agreement under this paragraph is an agreement entered into
between an ambulatory surgical center and an individual, on or
after the date of scheduling treatment involved for the
individual and before the date of such treatment, that provides
that the ambulatory surgical center will not charge for the
treatment an amount that is greater than the price that has
been agreed to by the ambulatory surgical center and the
individual and specified in writing in such agreement.
(3) Application of requirement only to uninsured
treatments.--Paragraphs (1) and (2) shall apply only with
respect to a treatment (or course of treatment) for which there
does not exist a third-party price arrangement.
(d) Administrative Provisions.--
(1) In general.--The Secretary shall prescribe such
regulations and issue such guidelines as may be required to
carry out this section.
(2) Form of report and notice.--The regulations and
guidelines under paragraph (1) shall specify the following:
(A) For disclosure to individuals.--The form and
manner in which a hospital or an ambulatory surgical
center shall provide the information under subsection
(a)(1)(A) or (a)(1)(B), respectively.
(B) For public reporting.--The electronic form and
manner by which a hospital or an ambulatory surgical
center shall report data under subsection (b)(1)(A) or
(b)(1)(B), respectively.
(C) For public posting.--The form in which a
hospital or an ambulatory surgical center shall post
notices under subsection (b)(3)(A) or (b)(3)(B),
respectively.
(e) Non-Preemption of State Laws.--Nothing in this section shall be
construed as preempting or otherwise affecting any provision of State
law relating to the disclosure or posting of price, charge, or other
information for a hospital or an ambulatory surgical center.
SEC. 4. DEFINITIONS.
In this Act:
(1) Ambulatory surgical center.--The term ``ambulatory
surgical center'' means an ambulatory surgical center described
in section 1832(a)(2)(F)(i).
(2) Emergency medical condition.--The term ``emergency
medical condition'' has the meaning given that term in section
1867(e)(1) of the Social Security Act (42 U.S.C. 1395dd(e)(1)).
(3) Hospital.--The term ``hospital'' has the meaning given
that term in section 1861(e) of the Social Security Act (42
U.S.C. 1395x(e)).
(4) Medicaid program.--The term ``medicaid program'' means
the program under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(5) Medicare beneficiary.--The term ``medicare
beneficiary'' means an individual who is entitled to benefits
under part A, and enrolled under part B, of the medicare
program, and who is not enrolled in a Medicare Advantage plan
under part C of such program.
(6) Medicare program.--The term ``medicare program'' means
the program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.).
(7) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(8) State.--The term ``State'' includes the District of
Columbia, the Commonwealth of Puerto Rico, the Virgin Islands,
Guam, and American Samoa.
(9) Third-party price arrangement.--The term ``third-party
price arrangement'' means, with respect to a treatment (or
course of treatment) in a hospital or an ambulatory surgical
center, a contract or other agreement between the hospital or
the ambulatory surgical center, respectively, and a third
party, including an arrangement--
(A) with a health maintenance organization plan,
network plan, or managed care plan, or
(B) under the medicare or medicaid program,
that establishes the price or the maximum price of the
treatment (or course of treatment) for beneficiaries under the
plan or title.
<all>
Introduced in House
Introduced in House
Referred to the Committee on the Judiciary, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on the Judiciary, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on the Judiciary, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health, for a period to be subsequently determined by the Chairman.
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