[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4828 Introduced in House (IH)]

<DOC>






118th CONGRESS
  1st Session
                                H. R. 4828

   To amend title XVIII of the Social Security Act to promote price 
       transparency for imaging tests under the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 24, 2023

  Mr. Carey introduced the following bill; which was referred to the 
Committee on Ways and Means, 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 amend title XVIII of the Social Security Act to promote price 
       transparency for imaging tests under the Medicare program.

    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 ``Imaging Services Price Transparency 
Act of 2023''.

SEC. 2. PROMOTING PRICE TRANSPARENCY FOR IMAGING TESTS UNDER THE 
              MEDICARE PROGRAM.

    Part E of title XVIII of the Social Security Act (42 U.S.C. 1395x 
et seq.) is amended by adding at the end the following new section:

``SEC. 1899C. IMAGING TEST PRICE TRANSPARENCY REQUIREMENT.

    ``(a) In General.--Beginning January 1, 2025, each provider of 
services and supplier that receives payment under this title for 
furnishing a specified imaging service shall--
            ``(1) make publicly available (in a form and manner 
        specified by the Secretary) on an Internet website the 
        information described in subsection (b) with respect to each 
        such service that such provider of services or supplier 
        furnishes; and
            ``(2) ensure that such information is updated not less 
        frequently than annually.
    ``(b) Information Described.--For purposes of subsection (a), the 
information described in this subsection is, with respect to a provider 
of services or supplier and a specified imaging service, the following:
            ``(1) The discounted cash price for such service (or, if no 
        such price exists, the gross charge for such service).
            ``(2) If required by the Secretary, 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 service and the deidentified 
        maximum negotiated rate in effect between such provider or 
        supplier and any such plan or coverage for such service.
    ``(c) Method and Format.--Not later than January 1, 2028, the 
Secretary shall establish one or more methods and formats for each 
provider of services and supplier to use in compiling and making public 
standard charges and prices (as applicable) pursuant to subsection (a). 
Any such method and format--
            ``(1) may be similar to any template made available by the 
        Centers for Medicare & Medicaid Services as of the date of the 
        enactment of this subsection;
            ``(2) shall meet such standards as determined appropriate 
        by the Secretary in order to ensure the accessibility and 
        usability of such charges and prices; and
            ``(3) shall be updated as determined appropriate by the 
        Secretary, in consultation with stakeholders.
    ``(d) Monitoring Compliance.--The Secretary shall, through notice 
and comment rulemaking and in consultation with the Inspector General 
of the Department of Health and Human Services, establish a process to 
monitor compliance with this section.
    ``(e) Specification of Services.--Not later than January 1, 2025, 
the Secretary shall publish a list of at least 50 imaging services that 
the Secretary determines are shoppable (or all such services, if the 
Secretary determines that fewer than 50 such services are shoppable) 
between providers of services and suppliers of such services. The 
Secretary shall update such list as determined appropriate by the 
Secretary.
    ``(f) Enforcement.--
            ``(1) In general.--In the case that the Secretary 
        determines that a provider of services or supplier is not in 
        compliance with subsection (a)--
                    ``(A) not later than 30 days after such 
                determination, the Secretary shall notify such provider 
                or supplier of such determination;
                    ``(B) upon request of the Secretary, such provider 
                or supplier shall submit to the Secretary, not later 
                than 45 days after the date of such request, a 
                corrective action plan to comply with such subsection; 
                and
                    ``(C) 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 (or, in the 
                case of such a provider or supplier that has submitted 
                a corrective action plan described in subparagraph (B) 
                in response to a request so described, after the date 
                that is 90 days after such submission), the Secretary 
                may impose a civil monetary penalty in an amount not to 
                exceed $300 for each subsequent day during which such 
                failure to comply or failure to submit is ongoing.
            ``(2) Increase authority.--In applying this paragraph with 
        respect to violations occurring in 2027 or a subsequent year, 
        the Secretary may through notice and comment rulemaking 
        increase the amount of the civil monetary penalty under 
        paragraph (1)(C).
            ``(3) 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 subsection in the same manner as such provisions apply to 
        a civil monetary penalty imposed under subsection (a) of such 
        section.
            ``(4) Authority to waive or reduce penalty.--The Secretary 
        may waive or reduce any penalty otherwise applicable with 
        respect to a provider of services or supplier under this 
        paragraph if the Secretary determines that imposition of such 
        penalty would result in a significant hardship for such 
        provider or supplier (such as in the case of a provider or 
        supplier located in a rural or underserved area where 
        imposition of such penalty may result in, or contribute to, a 
        lack of access to care for individuals in such area).
            ``(5) Clarification of nonapplicability of other 
        enforcement provisions.--Notwithstanding any other provision of 
        this title, this subsection shall be the sole means of 
        enforcing the provisions of this section.
    ``(g) Definitions.--In this section:
            ``(1) 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.
            ``(2) Specified imaging service.--The term `specified 
        imaging service' means an imaging service that is included on 
        the list published by the Secretary under subsection (e).''.
                                 <all>