[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.
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