Summary
Sens. Roger Marshall (R-KS) and John Hickenlooper (D-CO), both members of the Senate Health, Education, Labor and Pensions (HELP) Committee, recently introduced the bipartisan Patients Deserve Price Tags Act (S. 2355), which would codify and strengthen hospital and insurer price transparency rules. Other cosponsors include Sens. Chuck Grassley (R-IA), Maggie Hassan (D-NH), Tim Sheehy (R-MT), and Joni Ernst (R-IA).
Key bill provisions:
- Codifies the Hospital Price Transparency (HPT) rule, requires the disclosure of actual prices and not estimates, imposes greater civil monetary penalties, and expands price transparency requirements to clinical diagnostic laboratories, imaging centers, and ambulatory surgical centers (Secs. 2-5);
- Codifies the Transparency in Coverage (TiC) rules, holds members harmless for the amount of any difference in excess of the cost-sharing information generated by a self-service tool and the amount ultimately billed, addresses challenges related to data size and accuracy, requires a plan executive to attest that prices are accurate and complete, requires audits, and imposes civil monetary penalties (Sec. 6);
- Strengthens the gag clause prohibition on group health plans and tightens requirements for the attestation of compliance (Sec. 7);
- Requires third-party administrators to disclose detailed price and rate information – including de-identified claims and encounter data, provider reimbursement methodologies, and rebate amounts – to group health plans, health insurance issuers, and self-funded non-Federal governmental plans on a quarterly basis (Sec. 8);
- Clarifies that federal price transparency requirements for hospitals, clinical diagnostic laboratories, imaging centers, and ambulatory surgical centers do not preempt states laws unless those laws conflict with federal requirements, and state price transparency laws do not affect group health plans established under ERISA (Sec. 9);
- Requires group health plans and issuers offering group or individual health insurance coverage to furnish patients with an Explanation of Benefits after services are rendered (Sec. 10); and
- Requires health care providers and facilities to include an itemized bill in any request for payment and prohibits them from pursuing collections actions against patients if the prices disclosed under price transparency requirements or good faith estimates exceed the prices in the itemized bill (Sec. 11).
Looking ahead, we are hearing that the Senate HELP Committee may hold a markup focused on price transparency, possibly including this bill, in September, but it has not been formally announced. In a recent opinion piece published in STAT, Sen. Marshall urged Republicans and Democrats “to put aside partisan tensions and do its job to deliver for American patients, workers, and businesses” by “passing the Patients Deserve Price Tags Act [to] “restore trust and faith in the American health care system – and in Congress.”