[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5497 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 5497

   To amend the Public Health Service Act to provide for the public 
  disclosure of charges for certain hospital and ambulatory surgical 
                       center treatment episodes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 16, 2016

 Mr. Lipinski introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend the Public Health Service Act to provide for the public 
  disclosure of charges for certain hospital and ambulatory surgical 
                       center treatment episodes.

    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 Price Transparency and 
Disclosure Act of 2016''.

SEC. 2. PUBLIC DISCLOSURE OF HOSPITAL DATA.

    Part B of title II of the Public Health Service Act (42 U.S.C. 238 
et seq.) is amended by adding at the end the following new section:

   ``data reporting by hospitals and ambulatory surgical centers and 
                             public posting

    ``Sec. 249.  (a) Semiannual Reporting Requirement.--Not later than 
80 days after the end of each semiannual period beginning January 1 or 
July 1 (beginning more than one year after the date of the enactment of 
this section), a hospital and an ambulatory surgical center shall 
report to the Secretary the following data:
            ``(1) In the case of a hospital--
                    ``(A) the frequency of occurrence for such hospital 
                during such period of each treatment episode identified 
                under subsection (c)(1) for a condition or disease 
                selected under subparagraph (A) or (B) of such 
                subsection (or updated under subsection (c)(3)), 
                furnished in an inpatient or outpatient setting, 
                respectively; and
                    ``(B) if care was furnished for such a treatment 
                episode by such hospital during such period--
                            ``(i) the total number of such treatment 
                        episodes for which care was so furnished by the 
                        hospital during such period;
                            ``(ii) the insured individual average 
                        charge (as computed under subsection (e)(3)) by 
                        the hospital for such treatment episode during 
                        such period; and
                            ``(iii) the uninsured individual average 
                        charge (as computed under subsection (e)(4)) by 
                        the hospital for such treatment episode during 
                        such period.
            ``(2) In the case of an ambulatory surgical center--
                    ``(A) the frequency of occurrence for such center 
                during such period of each treatment episode identified 
                under subsection (c)(1) for a condition or disease 
                selected under subparagraph (C) of such subsection (or 
                updated under subsection (c)(3)); and
                    ``(B) if care was furnished for such a treatment 
                episode by such center during such period--
                            ``(i) the total number of such treatment 
                        episodes for which care was so furnished by the 
                        center during such period;
                            ``(ii) the insured individual average 
                        charge (as computed under subsection (e)(3)) by 
                        the center for such episode during such period; 
                        and
                            ``(iii) the uninsured individual average 
                        charge (as computed under subsection (e)(4)) by 
                        the center for such episode during such period.
    ``(b) Public Availability of Data.--
            ``(1) Public posting of data.--The Secretary shall promptly 
        post, on the official public Internet site of the Department of 
        Health and Human Services, the data reported under subsection 
        (a) and an appropriate link, with respect to a hospital or 
        center for which the data is reported, to other consumer 
        quality information maintained on such site (or a site 
        maintained by the Centers for Medicare & Medicaid Services) 
        relating to the hospital or center. Such data shall be set 
        forth in a manner that promotes charge comparison among 
        hospitals and among ambulatory surgical centers.
            ``(2) Notice of availability.--A hospital and an ambulatory 
        surgical center shall prominently post at each admission site 
        of the hospital or center a notice of the availability of the 
        data reported under subsection (a) on the official public 
        Internet site under paragraph (1).
    ``(c) Specification of Treatment Episodes.--For purposes of this 
section:
            ``(1) In general.--The Secretary shall identify treatment 
        episodes for each of the following:
                    ``(A) The 100 conditions and diseases selected by 
                the Secretary as being the most frequently treated 
                conditions and diseases in a hospital inpatient 
                setting.
                    ``(B) The 100 conditions and diseases selected by 
                the Secretary as being the most frequently treated 
                conditions and diseases in a hospital outpatient 
                setting.
                    ``(C) The 100 conditions and diseases selected by 
                the Secretary as being the most frequently treated 
                conditions and diseases in an ambulatory surgical 
                center setting.
            ``(2) Agreement with iom.--In carrying out paragraph (1), 
        the Secretary may enter into an agreement with the Institute of 
        Medicine to define a treatment episode for any condition or 
        disease selected by the Secretary under this subsection. Such a 
        definition may take into account the varying complexity 
        associated with respect to different treatments.
            ``(3) Updating selection.--The Secretary shall periodically 
        update the conditions and diseases selected under paragraph 
        (1).
    ``(d) Civil Money Penalty.--The Secretary may impose a civil money 
penalty of not more than $10,000 for each knowing violation of 
subsection (a) or (b)(2) by a hospital or an ambulatory surgical 
center. The provisions of subsection (i)(2) of section 351A shall apply 
with respect to civil money penalties under this subsection in the same 
manner as such provisions apply to civil money penalties under 
subsection (i)(1) of such section.
    ``(e) 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) Classification of services.--The regulations and 
        guidelines under paragraph (1) shall include rules on the 
        classification of different treatment episodes and the 
        assignment of items and procedures to those episodes.
            ``(3) Computation of insured individual average charges.--
                    ``(A) In general.--For purposes of subsections 
                (a)(1)(B)(ii) and (a)(2)(B)(ii), an insured individual 
                average charge for a treatment episode, with respect to 
                a hospital or ambulatory surgical center during a 
                period, shall be computed as the average of the rates 
                (including any applicable copayment, coinsurance, other 
                cost sharing, or other fees, such as facility fees, 
                associated with treatment in the hospital or center) 
                for such episode that have been negotiated by the 
                hospital or ambulatory surgical center, respectively, 
                with the 5 most used health insurance providers for 
                such hospital or center during such period.
                    ``(B) 5 most used health insurance providers.--For 
                purposes of subparagraph (A), the 5 most used health 
                insurance providers, with respect to a hospital or 
                ambulatory surgical center during a period, are the 5 
                group health plans or insurance issuers offering health 
                insurance coverage--
                            ``(i) that have negotiated with the 
                        hospital or center a rate for the treatment 
                        episode involved; and
                            ``(ii) the enrollees of which represent the 
                        highest number of patients of the hospital or 
                        center, respectively.
            ``(4) Computation of uninsured individual average 
        charges.--
                    ``(A) In general.--For purposes of subsections 
                (a)(1)(B)(iii) and (a)(2)(B)(iii), an uninsured 
                individual average charge for a treatment episode, with 
                respect to a hospital or ambulatory surgical center 
                during a period, shall be computed as the average of 
                the total amounts charged for such an episode for which 
                care was furnished to an uninsured individual by such 
                hospital or ambulatory surgical center during such 
                period.
                    ``(B) Uninsured individual defined.--For purposes 
                of subparagraph (A), the term `uninsured individual' 
                means, with respect to care furnished to the individual 
                by a hospital or ambulatory surgical center, an 
                individual who does not have insurance or other third-
                party contractual benefits that provides payment for 
                costs incurred for such care.
            ``(5) Form of report and notice.--The regulations and 
        guidelines under paragraph (1) shall specify the electronic 
        form and manner by which a hospital or an ambulatory surgical 
        center shall report data under subsection (a) and the form for 
        posting of notices under subsection (b)(2).
    ``(f) Rules of Construction.--
            ``(1) 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 of 
        charges or other information for a hospital or an ambulatory 
        surgical center.
            ``(2) Charges.--Nothing in this section shall be construed 
        to regulate or set hospital or ambulatory surgical center 
        charges.
    ``(g) Hospital and Ambulatory Surgical Center Defined.--For 
purposes of this section, the terms `hospital' and `ambulatory surgical 
center' have the meaning given such terms by the Secretary.''.
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