Bill Text: TX SB1137 | 2021-2022 | 87th Legislature | Enrolled
Bill Title: Relating to the required disclosure of prices for certain items and services provided by certain medical facilities; providing administrative penalties.
Spectrum: Slight Partisan Bill (Republican 17-6)
Status: (Passed) 2021-06-18 - Effective on 9/1/21 [SB1137 Detail]
Download: Texas-2021-SB1137-Enrolled.html
S.B. No. 1137 |
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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. | ||
______________________________ | ______________________________ | |
President of the Senate | Speaker of the House | |
I hereby certify that S.B. No. 1137 passed the Senate on | ||
March 31, 2021, by the following vote: Yeas 31, Nays 0; and that | ||
the Senate concurred in House amendment on May 27, 2021, by the | ||
following vote: Yeas 31, Nays 0. | ||
______________________________ | ||
Secretary of the Senate | ||
I hereby certify that S.B. No. 1137 passed the House, with | ||
amendment, on May 20, 2021, by the following vote: Yeas 145, | ||
Nays 0, one present not voting. | ||
______________________________ | ||
Chief Clerk of the House | ||
Approved: | ||
______________________________ | ||
Date | ||
______________________________ | ||
Governor |