87R21308 JCG-D
 
  By: Kolkhorst, et al. S.B. No. 1137
 
  (Oliverson)
 
  Substitute the following for S.B. No. 1137:  No.
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the required disclosure of prices for certain items and
  services provided by certain medical facilities; providing
  administrative penalties.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle G, Title 4, Health and Safety Code, is
  amended by adding Chapter 327 to read as follows:
  CHAPTER 327. DISCLOSURE OF PRICES
         Sec. 327.001.  DEFINITIONS. In this chapter:
               (1)  "Ancillary service" means a facility item or
  service that a facility customarily provides as part of a shoppable
  service.
               (2)  "Chargemaster" means the list of all facility
  items or services maintained by a facility for which the facility
  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 facility has negotiated with all third
  party payors for a facility item or service.
               (5)  "De-identified minimum negotiated charge" means
  the lowest charge that a facility has negotiated with all third
  party payors for a facility item or service.
               (6)  "Discounted cash price" means the charge that
  applies to an individual who pays cash, or a cash equivalent, for a
  facility item or service.
               (7)  "Facility" means a hospital licensed under Chapter
  241.
               (8)  "Facility items or services" means all items and
  services, including individual items and services and service
  packages, that may be provided by a facility to a patient in
  connection with an inpatient admission or an outpatient department
  visit, as applicable, for which the facility has established a
  standard charge, including:
                     (A)  supplies and procedures;
                     (B)  room and board;
                     (C)  use of the facility and other areas, the
  charges for which are generally referred to as facility fees;
                     (D)  services of physicians and non-physician
  practitioners, employed by the facility, the charges for which are
  generally referred to as professional charges; and
                     (E)  any other item or service for which a
  facility has established a standard charge.
               (9)  "Gross charge" means the charge for a facility
  item or service that is reflected on a facility's chargemaster,
  absent any discounts.
               (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 facility has negotiated with a third party payor for a
  facility item or service.
               (12)  "Service package" means an aggregation of
  individual facility 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 facility for a facility 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 facility item or service.
         Sec. 327.002.  PUBLIC AVAILABILITY OF PRICE INFORMATION
  REQUIRED. Notwithstanding any other law, a facility must make
  public:
               (1)  a digital file in a machine-readable format that
  contains a list of all standard charges for all facility items or
  services as described by Section 327.003; and
               (2)  a consumer-friendly list of standard charges for a
  limited set of shoppable services as provided in Section 327.004.
         Sec. 327.003.  LIST OF STANDARD CHARGES REQUIRED. (a) A
  facility shall:
               (1)  maintain a list of all standard charges for all
  facility 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 facility under Subsection (a) must reflect the
  standard charges applicable to that location of the facility,
  regardless of whether the facility operates in more than one
  location or operates under the same license as another facility.
         (c)  The list required under Subsection (a) must include the
  following items, as applicable:
               (1)  a description of each facility item or service
  provided by the facility;
               (2)  the following charges for each individual facility
  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 facility for purposes of
  accounting or billing for the facility 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 facility's publicly
  accessible Internet website or accessible by selecting a dedicated
  link that is prominently displayed on the home page of the
  facility's publicly accessible Internet website. If the facility
  operates multiple locations and maintains a single Internet
  website, the list required under Subsection (a) must be posted for
  each location the facility operates in a manner that clearly
  associates the list with the applicable location of the facility.
         (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 accessible to a common commercial operator of
  an Internet search engine to the extent necessary for the search
  engine to index the list and display the list as a result in
  response to a search query of a user of the search engine;
               (3)  be formatted in a manner prescribed by the
  commission;
               (4)  be digitally searchable; and
               (5)  use the following naming convention specified by
  the Centers for Medicare and Medicaid Services, specifically:
         <ein>_<facility-name>_standardcharges.[jsonxmlcsv]
         (g)  In prescribing the format of the list under Subsection
  (f)(3), the commission shall:
               (1)  develop a template that each facility must use in
  formatting the list; and
               (2)  in developing the template under Subdivision (1):
                     (A)  consider any applicable federal guidelines
  for formatting similar lists required by federal law or rule and
  ensure that the design of the template enables health care
  researchers to compare the charges contained in the lists
  maintained by each facility; and
                     (B)  design the template to be substantially
  similar to the template used by the Centers for Medicare and
  Medicaid Services for purposes similar to those of this chapter, if
  the commission determines that designing the template in that
  manner serves the purposes of Paragraph (A) and that the commission
  benefits from developing and requiring that substantially similar
  design.
         (h)  The facility must update the list required under
  Subsection (a) at least once each year. The facility 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. 327.004.  CONSUMER-FRIENDLY LIST OF SHOPPABLE
  SERVICES. (a) Except as provided by Subsection (c), a facility
  shall maintain and make publicly available a list of the standard
  charges described by Sections 327.003(c)(2)(B), (C), (D), and (E)
  for each of at least 300 shoppable services provided by the
  facility. The facility 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 facility does not provide all of the
  shoppable services described by Subdivision (1), as many of those
  shoppable services the facility does provide.
         (b)  In selecting a shoppable service for purposes of
  inclusion in the list required under Subsection (a), a facility
  must:
               (1)  consider how frequently the facility provides the
  service and the facility's billing rate for that service; and
               (2)  prioritize the selection of services that are
  among the services most frequently provided by the facility.
         (c)  If a facility does not provide 300 shoppable services,
  the facility must maintain a list of the total number of shoppable
  services that the facility 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 facility 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 facility 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 facility
  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, as applicable; and
                     (B)  indicate if one or more of the shoppable
  services specified by the Centers for Medicare and Medicaid
  Services is not provided by the facility.
         (e)  The list required under Subsection (a) or (c), as
  applicable, must be:
               (1)  displayed in the manner prescribed by Section
  327.003(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;
               (4)  updated in the manner prescribed by Section
  327.003(h) for the list required under that section;
               (5)  accessible to a common commercial operator of an
  Internet search engine to the extent necessary for the search
  engine to index the list and display the list as a result in
  response to a search query of a user of the search engine; and
               (6)  formatted in a manner that is consistent with the
  format prescribed by the commission under Section 327.003(f)(3).
         (f)  Notwithstanding any other provision of this section, a
  facility is considered to meet the requirements of this section if
  the facility 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 facility under Subsection (a);
               (2)  allows a person to obtain an estimate of the amount
  the person will be obligated to pay the facility if the person
  elects to use the facility to provide the service; and
               (3)  is:
                     (A)  prominently displayed on the facility'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. 327.005.  REPORTING REQUIREMENT.  Each time a facility
  updates a list as required under Sections 327.003(h) and
  327.004(e)(4), the facility shall submit the updated list to the
  commission.  The commission may prescribe the form in which the
  updated list must be submitted to the commission.
         Sec. 327.006.  MONITORING AND ENFORCEMENT. (a) The
  commission shall monitor each facility's compliance with the
  requirements of this chapter using any of the following methods:
               (1)  evaluating complaints made by persons to the
  commission regarding noncompliance with this chapter;
               (2)  reviewing any analysis prepared regarding
  noncompliance with this chapter;
               (3)  auditing the Internet websites of facilities for
  compliance with this chapter; and
               (4)  confirming that each facility submitted the lists
  required under Section 327.005.
         (b)  If the commission determines that a facility is not in
  compliance with a provision of this chapter, the commission may
  take any of the following actions, without regard to the order of
  the actions:
               (1)  provide a written notice to the facility that
  clearly explains the manner in which the facility is not in
  compliance with this chapter;
               (2)  request a corrective action plan from the facility
  if the facility has materially violated a provision of this
  chapter, as determined under Section 327.007; and
               (3)  impose an administrative penalty on the facility
  and publicize the penalty on the commission's Internet website if
  the facility 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. 327.007.  MATERIAL VIOLATION; CORRECTIVE ACTION PLAN.
  (a) A facility materially violates this chapter if the facility
  fails to:
               (1)  comply with the requirements of Section 327.002;
  or
               (2)  publicize the facility's standard charges in the
  form and manner required by Sections 327.003 and 327.004.
         (b)  If the commission determines that a facility has
  materially violated this chapter, the commission may issue a notice
  of material violation to the facility and request that the facility
  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 facility
  must submit the plan.
         (c)  A facility 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
  facility 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 facility 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 facility's corrective action plan, the commission may
  monitor and evaluate the facility's compliance with the plan.
         (f)  A facility is considered to have failed to respond to
  the commission's request to submit a corrective action plan if the
  facility 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 facility is considered to have failed to comply with a
  corrective action plan if the facility fails to address a violation
  within the specified period of time contained in the plan.
         Sec. 327.008.  ADMINISTRATIVE PENALTY. (a) The commission
  may impose an administrative penalty on a facility in accordance
  with Chapter 241 if the facility 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
  facility for a violation of each requirement of this chapter.  The
  commission shall set the penalty in an amount sufficient to ensure
  compliance by facilities with the provisions of this chapter
  subject to the limitations prescribed by Subsection (c).
         (c)  For a facility with one of the following total gross
  revenues as reported to the Centers for Medicare and Medicaid
  Services or to another entity designated by commission rule in the
  year preceding the year in which a penalty is imposed, the penalty
  imposed by the commission may not exceed: 
               (1)  $10 for each day the facility violated this
  chapter, if the facility's total gross revenue is less than
  $10,000,000;
               (2)  $100 for each day the facility violated this
  chapter, if the facility's total gross revenue is $10,000,000 or
  more and less than $100,000,000; and
               (3)  $1,000 for each day the facility violated this
  chapter, if the facility's total gross revenue is $100,000,000 or
  more. 
         (d)  Each day a violation continues is considered a separate
  violation.
         (e)  In determining the amount of the penalty, the commission
  shall consider: 
               (1)  previous violations by the facility's operator;
               (2)  the seriousness of the violation;
               (3)  the demonstrated good faith of the facility's
  operator; and
               (4)  any other matters as justice may require.
         (f)  An administrative penalty collected under this chapter
  shall be deposited to the credit of an account in the general
  revenue fund administered by the commission.  Money in the account
  may be appropriated only to the commission.
         Sec. 327.009.  LEGISLATIVE RECOMMENDATIONS.  The commission
  may propose to the legislature recommendations for amending this
  chapter, 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.