By: Kolkhorst, Bettencourt S.B. No. 1137
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the required disclosure by hospitals of prices for
  hospital services and items; providing administrative penalties.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 311, Health and Safety Code, is amended
  by adding Subchapter A-1 to read as follows:
  SUBCHAPTER A-1. DISCLOSURE OF PRICES
         Sec. 311.011.  DEFINITIONS. In this subchapter:
               (1)  "Ancillary service" means a hospital item or
  service that a hospital customarily provides as part of a shoppable
  service.
               (2)  "Chargemaster" means the list of all hospital
  items or services maintained by a hospital for which the hospital
  has established a charge.
               (3)  "Commission" means the Health and Human Services
  Commission.
               (4)  "De-identified maximum negotiated charge" means
  the highest charge that a hospital has negotiated with all third
  party payors for a hospital item or service.
               (5)  "De-identified minimum negotiated charge" means
  the lowest charge that a hospital has negotiated with all third
  party payors for a hospital item or service.
               (6)  "Discounted cash price" means the charge that
  applies to an individual who pays cash, or a cash equivalent, for a
  hospital item or service.
               (7)  "Gross charge" means the charge for a hospital
  item or service that is reflected on a hospital's chargemaster,
  absent any discounts.
               (8)  "Hospital" means a hospital:
                     (A)  licensed under Chapter 241; or
                     (B)  owned or operated by this state or an agency
  of this state.
               (9)  "Hospital items or services" means all items and
  services, including individual items and services and service
  packages, that may be provided by a hospital to a patient in
  connection with an inpatient admission or an outpatient department
  visit for which the hospital has established a standard charge,
  including:
                     (A)  supplies and procedures;
                     (B)  room and board;
                     (C)  use of the facility and other areas,
  generally referred to as facility fees;
                     (D)  services of physicians and non-physician
  practitioners, generally referred to as professional charges; and
                     (E)  any other item or service for which a
  hospital has established a standard charge.
               (10)  "Machine-readable format" means a digital
  representation of information in a file that can be imported or read
  into a computer system for further processing. The term includes
  .XML, .JSON and .CSV formats.
               (11)  "Payor-specific negotiated charge" means the
  charge that a hospital has negotiated with a third party payor for a
  hospital item or service.
               (12)  "Service package" means an aggregation of
  individual hospital items or services into a single service with a
  single charge.
               (13)  "Shoppable service" means a service that may be
  scheduled by a health care consumer in advance.
               (14)  "Standard charge" means the regular rate
  established by the hospital for a hospital item or service provided
  to a specific group of paying patients. The term includes all of
  the following, as defined under this section:
                     (A)  the gross charge;
                     (B)  the payor-specific negotiated charge;
                     (C)  the de-identified minimum negotiated charge;
                     (D)  the de-identified maximum negotiated charge;
  and
                     (E)  the discounted cash price.
               (15)  "Third party payor" means an entity that is, by
  statute, contract, or agreement, legally responsible for payment of
  a claim for a hospital item or service.
         Sec. 311.012.  PUBLIC AVAILABILITY OF PRICE INFORMATION
  REQUIRED. Notwithstanding any other law, a hospital must make
  public:
               (1)  a digital file in a machine-readable format that
  contains a list of all standard charges for all hospital items or
  services as described by Section 311.013; and
               (2)  a consumer-friendly list of standard charges for a
  limited set of shoppable services as provided in Section 311.014.
         Sec. 311.013.  LIST OF STANDARD CHARGES REQUIRED. (a) A
  hospital shall:
               (1)  maintain a list of all standard charges for all
  hospital items or services in accordance with this section; and
               (2)  ensure the list required under Subdivision (1) is
  available at all times to the public, including by posting the list
  electronically in the manner provided by this section.
         (b)  The standard charges contained in the list required to
  be maintained by a hospital under Subsection (a) must reflect the
  standard charges applicable to that location of the hospital,
  regardless of whether the hospital operates in more than one
  location or operates under the same license as another hospital.
         (c)  The list required under Subsection (a) must include the
  following items, as applicable:
               (1)  a description of each hospital item or service
  provided by the hospital;
               (2)  the following charges for each individual hospital
  item or service when provided in either an inpatient setting or an
  outpatient department setting, as applicable:
                     (A)  the gross charge;
                     (B)  the de-identified minimum negotiated charge;
                     (C)  the de-identified maximum negotiated charge;
                     (D)  the discounted cash price; and
                     (E)  the payor-specific negotiated charge, listed
  by the name of the third party payor and plan associated with the
  charge and displayed in a manner that clearly associates the charge
  with each third party payor and plan; and
               (3)  any code used by the hospital for purposes of
  accounting or billing for the hospital item or service, including
  the Current Procedural Terminology (CPT) code, the Healthcare
  Common Procedure Coding System (HCPCS) code, the Diagnosis Related
  Group (DRG) code, the National Drug Code (NDC), or other common
  identifier.
         (d)  The information contained in the list required under
  Subsection (a) must be published in a single digital file that is in
  a machine-readable format.
         (e)  The list required under Subsection (a) must be displayed
  in a prominent location on the home page of the hospital's publicly
  accessible Internet website or accessible by selecting a dedicated
  link that is prominently displayed on the home page of the
  hospital's publicly accessible Internet website. If the hospital
  operates multiple locations and maintains a single Internet
  website, the list required under Subsection (a) must be posted for
  each location the hospital operates in a manner that clearly
  associates the list with the applicable location of the hospital.
         (f)  The list required under Subsection (a) must:
               (1)  be available:
                     (A)  free of charge;
                     (B)  without having to establish a user account or
  password;
                     (C)  without having to submit personal
  identifying information; and
                     (D)  without having to overcome any other
  impediment, including entering a code to access the list;
               (2)  be digitally searchable; and
               (3)  use the following naming convention specified by
  the Centers for Medicare and Medicaid Services, specifically:
         <ein>_<hospital-name>_standardcharges.[jsonxmlcsv]
         (g)  The hospital must update the list required under
  Subsection (a) at least once each year. The hospital must clearly
  indicate the date on which the list was most recently updated,
  either on the list or in a manner that is clearly associated with
  the list.
         Sec. 311.014.  CONSUMER-FRIENDLY LIST OF SHOPPABLE
  SERVICES. (a) Except as provided by Subsection (c), a hospital
  shall maintain and make publicly available a list of the standard
  charges described by Sections 311.013(c)(2)(B), (C), (D), and (E)
  for each of at least 300 shoppable services provided by the
  hospital. The hospital may select the shoppable services to be
  included in the list, except that the list must include:
               (1)  the 70 services specified as shoppable services by
  the Centers for Medicare and Medicaid Services; or
               (2)  if the hospital does not provide all of the
  shoppable services described by Subdivision (1), as many of the
  shoppable services described by that subdivision that the hospital
  does provide.
         (b)  In selecting a shoppable service for purposes of
  inclusion in the list required under Subsection (a), a hospital
  must consider how frequently the hospital provides the service and
  the hospital's billing rate for that service.
         (c)  If a hospital does not provide 300 shoppable services,
  the hospital must maintain a list of the total number of shoppable
  services that the hospital provides in a manner that otherwise
  complies with the requirements of Subsection (a).
         (d)  The list required under Subsection (a) or (c), as
  applicable, must:
               (1)  include:
                     (A)  a plain-language description of each
  shoppable service included on the list;
                     (B)  the payor-specific negotiated charge that
  applies to each shoppable service included on the list and any
  ancillary service, listed by the name of the third party payor and
  plan associated with the charge and displayed in a manner that
  clearly associates the charge with the third party payor and plan;
                     (C)  the discounted cash price that applies to
  each shoppable service included on the list and any ancillary
  service or, if the hospital does not offer a discounted cash price
  for one or more of the shoppable or ancillary services on the list,
  the gross charge for the shoppable service or ancillary service, as
  applicable;
                     (D)  the de-identified minimum negotiated charge
  that applies to each shoppable service included on the list and any
  ancillary service;
                     (E)  the de-identified maximum negotiated charge
  that applies to each shoppable service included on the list and any
  ancillary service; and
                     (F)  any code used by the hospital for purposes of
  accounting or billing for each shoppable service included on the
  list and any ancillary service, including the Current Procedural
  Terminology (CPT) code, the Healthcare Common Procedure Coding
  System (HCPCS) code, the Diagnosis Related Group (DRG) code, the
  National Drug Code (NDC), or other common identifier; and
               (2)  if applicable:
                     (A)  state each location at which the hospital
  provides the shoppable service and whether the standard charges
  included in the list apply at that location to the provision of that
  shoppable service in an inpatient setting, an outpatient department
  setting, or in both of those settings; and
                     (B)  indicate if one or more of the shoppable
  services specified by the Centers of Medicare and Medicaid Services
  is not provided by the hospital.
         (e)  The list required under Subsection (a) or (c), as
  applicable, must be:
               (1)  displayed in the manner prescribed by Section
  311.013(e) for the list required under that section;
               (2)  available:
                     (A)  free of charge;
                     (B)  without having to register or establish a
  user account or password;
                     (C)  without having to submit personal
  identifying information; and
                     (D)  without having to overcome any other
  impediment, including entering a code to access the list;
               (3)  searchable by service description, billing code,
  and payor; and
               (4)  updated in the manner prescribed by Section
  311.013(g) for the list required under that section.
         (f)  Notwithstanding any other provision of this section, a
  hospital is considered to meet the requirements of this section if
  the hospital maintains, as determined by the commission, an
  Internet-based price estimator tool that:
               (1)  provides a cost estimate for each shoppable
  service and any ancillary service included on the list maintained
  by the hospital under Subsection (a);
               (2)  allows a person to obtain an estimate of the amount
  the person will be obligated to pay the hospital if the person
  elects to use the hospital to provide the service; and
               (3)  is:
                     (A)  prominently displayed on the hospital's
  publicly accessible Internet website; and
                     (B)  accessible to the public:
                           (i)  without charge; and
                           (ii)  without having to register or
  establish a user account or password.
         Sec. 311.015.  MONITORING AND ENFORCEMENT. (a) The
  commission may monitor hospital compliance with the requirements of
  this subchapter using any of the following methods:
               (1)  evaluating complaints made by persons to the
  commission regarding noncompliance with this subchapter;
               (2)  reviewing any analysis prepared regarding
  noncompliance with this subchapter; and
               (3)  auditing the Internet websites of hospitals for
  compliance with this subchapter.
         (b)  If the commission determines that a hospital is not in
  compliance with a provision of this subchapter, the commission may
  take any of the following actions, without regard to the order of
  the actions:
               (1)  provide a written notice to the hospital that
  clearly explains the manner in which the hospital is not in
  compliance with this subchapter;
               (2)  request a corrective action plan from the hospital
  if the hospital has materially violated a provision of this
  subchapter, as determined under Section 311.016; and
               (3)  impose an administrative penalty on the hospital
  and publicize the penalty on the commission's Internet website if
  the hospital fails to:
                     (A)  respond to the commission's request to submit
  a corrective action plan; or
                     (B)  comply with the requirements of a corrective
  action plan submitted to the commission.
         Sec. 311.016.  MATERIAL VIOLATION; CORRECTIVE ACTION PLAN.
  (a) A hospital materially violates this subchapter if the
  hospital:
               (1)  fails to comply with the requirements of Section
  311.012; or
               (2)  fails to publicize the hospital's standard charges
  in the form and manner required by Sections 311.013 and 311.014.
         (b)  If the commission determines that a hospital has
  materially violated this subchapter, the commission may issue a
  notice of material violation to the hospital and request that the
  hospital submit a corrective action plan. The notice must indicate
  the form and manner in which the corrective action plan must be
  submitted to the commission, and clearly state the date by which the
  hospital must submit the plan.
         (c)  A hospital that receives a notice under Subsection (b)
  must:
               (1)  submit a corrective action plan in the form and
  manner, and by the specified date, prescribed by the notice of
  violation; and
               (2)  as soon as practicable after submission of a
  corrective action plan to the commission, act to comply with the
  plan.
         (d)  A corrective action plan submitted to the commission
  must:
               (1)  describe in detail the corrective action the
  hospital will take to address any violation identified by the
  commission in the notice provided under Subsection (b); and
               (2)  provide a date by which the hospital will complete
  the corrective action described by Subdivision (1).
         (e)  A corrective action plan is subject to review and
  approval by the commission. After the commission reviews and
  approves a hospital's corrective action plan, the commission may
  monitor and evaluate the hospital's compliance with the plan.
         (f)  A hospital is considered to have failed to respond to
  the commission's request to submit a corrective action plan if the
  hospital fails to submit a corrective action plan:
               (1)  in the form and manner specified in the notice
  provided under Subsection (b); or
               (2)  by the date specified in the notice provided under
  Subsection (b).
         (g)  A hospital is considered to have failed to comply with a
  corrective action plan if the hospital fails to address a violation
  within the specified period of time contained in the plan.
         Sec. 311.017.  ADMINISTRATIVE PENALTY. (a) The commission
  may impose an administrative penalty on a hospital in accordance
  with Section 241.059 if the hospital fails to:
               (1)  respond to the commission's request to submit a
  corrective action plan; or
               (2)  comply with the requirements of a corrective
  action plan submitted to the commission.
         (b)  The commission may impose an administrative penalty on a
  hospital for a violation of each requirement of this subchapter in
  an amount not to exceed $300 for each day in which one or more
  violations occurred, regardless of whether the hospital violated
  multiple requirements of this subchapter in the same day.
         Sec. 311.018.  LEGISLATIVE RECOMMENDATIONS.  The commission
  may propose to the legislature recommendations for amending this
  subchapter, including recommendations in response to amendments by
  the Centers for Medicare and Medicaid Services to 45 C.F.R. Part
  180.
         SECTION 2.  This Act takes effect September 1, 2021.