Increasing price transparency of clinical diagnostic laboratory tests under the Medicare program

Section 1846 of the Social Security Act (42 U.S.C. 1395w–2) is amended—(1)in the header, by inserting

and additional requirements

after

sanctions

; and(2)by adding at the end the following new subsection:

(c)

Price transparency requirement

(1)

In general

Beginning January 1, 2025, each provider of services or supplier that is available to furnish any specified clinical diagnostic laboratory test under this title shall—(A)make publicly available on an Internet website the information described in paragraph (2) with respect to each such specified clinical diagnostic laboratory test that such provider or supplier is so available to furnish; and(B)ensure that such information is updated not less frequently than annually.(2)

Information described

For purposes of paragraph (1), the information described in this paragraph is, with respect to a provider of services or supplier and a specified clinical diagnostic laboratory test, the following:(A)The discounted cash price for such test (or, if no such price exists, the gross charge for such test).(B)The deidentified minimum negotiated rate in effect between such provider or supplier and any group health plan or group or individual health insurance coverage for such test.(C)The deidentified maximum negotiated rate in effect between such provider or supplier and any such plan or coverage for such test.(3)

Inclusion of ancillary services

Any price or rate for a specified clinical diagnostic laboratory test available to be furnished by a provider of services or supplier made publicly available in accordance with paragraph (1) shall include the price or rate (as applicable) for any ancillary item or service (such as specimen collection services) that would normally be furnished by such provider or supplier as part of such test, as specified by the Secretary.(4)

Enforcement

(A)

In general

In the case that the Secretary determines that a provider of services or supplier is not in compliance with paragraph (1)—(i)not later than 30 days after such determination, the Secretary shall notify such provider or supplier of such determination; (ii)not later than 90 days after such notification is sent, such provider or supplier shall complete a corrective action plan to comply with such paragraph and submit such plan to the Secretary; and(iii)if such provider or supplier continues to fail to comply with such paragraph after the date that is 90 days after such notification is sent, the Secretary may impose a civil monetary penalty in an amount not to exceed $300 for each day (beginning with the date that is 91 days after such notification was sent) during which such failure is ongoing.(B)

Application of certain provisions

The provisions of section 1128A (other than subsections (a) and (b) of such section) shall apply to a civil monetary penalty imposed under this paragraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section.(5)

Definitions

In this subsection:(A)

Group health plan; group health insurance coverage; individual health insurance coverage

The terms group health plan, group health insurance coverage, and individual health insurance coverage have the meaning given such terms in section 2791 of the Public Health Service Act.(B)

Specified clinical diagnostic laboratory test

The term specified clinical diagnostic laboratory test means a clinical diagnostic laboratory test that is included on the list of shoppable services specified by the Centers for Medicare & Medicaid Services (as described in section 180.60 of title 42, Code of Federal Regulations (or a successor regulation)).