[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5547 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 5547

To amend title XIX of the Social Security Act to provide for increased 
     price transparency of hospital information and to provide for 
   additional research on consumer information on charges and out-of-
                             pocket costs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 21, 2016

 Mr. Burgess (for himself and Mr. Gene Green of Texas) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
To amend title XIX of the Social Security Act to provide for increased 
     price transparency of hospital information and to provide for 
   additional research on consumer information on charges and out-of-
                             pocket costs.

    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 ``Health Care Price Transparency 
Promotion Act of 2016''.

SEC. 2. INCREASING THE TRANSPARENCY OF INFORMATION ON HOSPITAL CHARGES 
              AND MAKING AVAILABLE INFORMATION ON ESTIMATED OUT-OF-
              POCKET COSTS FOR HEALTH CARE SERVICES.

    (a) In General.--Title XIX of the Social Security Act is amended--
            (1) in section 1902(a) (42 U.S.C. 1396a(a)), by inserting 
        after paragraph (77) the following new paragraph:
            ``(78) provide that the State will establish and maintain 
        laws, in accordance with the requirements of section 1921A, to 
        require disclosure of information on hospital charges, to make 
        such information available to the public, and to provide 
        individuals with information about estimated out-of-pocket 
        costs for health care services;''; and
            (2) by inserting after section 1921 (42 U.S.C. 1396r-2) the 
        following new section:

 ``increasing the transparency of information on hospital charges and 
 providing consumers with estimates of out-of-pocket costs for health 
                             care services

    ``Sec. 1921A.  (a) In General.--The requirements referred to in 
section 1902(a)(78) are that the laws of a State must--
            ``(1) in accordance with subsection (b)--
                    ``(A) require the disclosure of information on 
                hospital charges; and
                    ``(B) provide for access to such information; and
            ``(2) in accordance with subsection (c), require the 
        provision of a statement of the estimated out-of-pocket costs 
        of an individual for anticipated future health care services.
    ``(b) Information on Hospital Charges.--The laws of a State must--
            ``(1) require disclosure, by each hospital located in the 
        State, of information on the charges for certain inpatient and 
        outpatient hospital services (as determined by the State) 
        provided at the hospital; and
            ``(2) provide for timely access to such information by 
        individuals seeking or requiring such services.
    ``(c) Estimated Out-of-Pocket Costs.--The laws of a State must 
require that, upon the request of any individual with health insurance 
coverage sponsored by a health insurance issuer, the issuer must 
provide a statement of the estimated out-of-pocket costs that are 
likely to be incurred by the individual if the individual receives 
particular health care items and services within a specified period of 
time.
    ``(d) Rules of Construction.--Nothing in this section shall be 
construed as--
            ``(1) authorizing or requiring the Secretary to establish 
        uniform standards for the State laws required by subsections 
        (b) and (c);
            ``(2) requiring any State with a law enacted on or before 
        the date of the enactment of this section that--
                    ``(A) meets the requirements of subsection (b) or 
                subsection (c) to modify or amend such law; or
                    ``(B) meets some but not all of the requirements of 
                subsection (b) or subsection (c) to modify or amend 
                such law except to the extent necessary to address the 
                unmet requirements;
            ``(3) precluding any State in which a program of voluntary 
        disclosure of information on hospital charges is in effect from 
        adopting a law codifying such program (other than its voluntary 
        nature) to satisfy the requirement of subsection (b)(1); or
            ``(4) guaranteeing that the out-of-pocket costs of an 
        individual will not exceed the estimate of such costs provided 
        pursuant to subsection (c).
    ``(e) Definitions.--For purposes of this section:
            ``(1) The term `health insurance coverage' has the meaning 
        given such term in section 2791(b)(1) of the Public Health 
        Service Act.
            ``(2) The term `health insurance issuer' has the meaning 
        given such term in section 2791(b)(2) of the Public Health 
        Service Act, except that such term also includes--
                    ``(A) a Medicaid managed care organization (as 
                defined in section 1903(m)); and
                    ``(B) a Medicare Advantage organization (as defined 
                in section 1859(a)(1), taking into account the 
                operation of section 201(b) of the Medicare 
                Prescription Drug, Improvement, and Modernization Act 
                of 2003).
        Section 1856(b)(3) shall not preclude the application to a 
        Medicare Advantage organization or a Medicare Advantage plan 
        offered by such an organization of any State law adopted to 
        carry out the requirements of subsection (b) or (c).
            ``(3) The term `hospital' means an institution that meets 
        the requirements of paragraphs (1) and (7) of section 1861(e) 
        and includes those to which section 1820(c) applies.''.
    (b) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by subsection (a) shall take effect on October 
        1, 2017.
            (2) Exception.--In the case of a State plan for medical 
        assistance under title XIX of the Social Security Act which the 
        Secretary of Health and Human Services determines requires 
        State legislation (other than legislation appropriating funds) 
        in order for the plan to meet the additional requirements 
        imposed by the amendment made by subsection (a), the State plan 
        shall not be regarded as failing to comply with the 
        requirements of such title solely on the basis of its failure 
        to meet these additional requirements before the first day of 
        the first calendar quarter beginning after the close of the 
        first regular session of the State legislature that begins 
        after the date of the enactment of this Act. For purposes of 
        the previous sentence, in the case of a State that has a 2-year 
        legislative session, each year of such session shall be deemed 
        to be a separate regular session of the State legislature.

SEC. 3. RESEARCH ON INFORMATION VALUED BY CONSUMERS ON CHARGES AND OUT-
              OF-POCKET COSTS FOR HEALTH CARE SERVICES.

    (a) Research on Information Valued and Used by Consumers.--The 
Director of the Agency for Healthcare Research and Quality (in this 
section referred to as ``AHRQ'') shall conduct or support research, 
pursuant to section 901(b)(1)(D) of the Public Health Service Act (42 
U.S.C. 299(b)(1)(D)), on--
            (1) the types of information on the charges, and out-of-
        pocket costs, for health care services that individuals find 
        useful in making decisions about where, when, and from whom to 
        receive care;
            (2) how the types of information valued by individuals for 
        making such decisions vary by whether they have health benefits 
        coverage and, if they do, the type of such coverage they have, 
        such as traditional insurance, health maintenance 
        organizations, preferred provider organizations, and high 
        deductible plans coupled with health savings accounts; and
            (3) ways in which such information may be made available on 
        a timely basis and in easy-to-understand form to individuals 
        facing such decisions.
    (b) Report.--The Director of AHRQ shall report to the Congress on 
the results of such research not later than 18 months after the date of 
the enactment of this Act, together with recommendations for ways in 
which the Federal Government can assist the States in achieving the 
objective specified in subsection (a)(3).
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section.
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