OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 49 Bill Analysis
135th General Assembly
Click here for H.B. 49’s Fiscal Note
Version: As Passed by the Senate
Primary Sponsors: Reps. Ferguson and Barhorst
Effective Date:
Logan Briggs, Attorney
SUMMARY
▪ Requires hospitals to comply with the federal price transparency law.
▪ Requires the hospital to maintain and make public a machine-readable file containing a
list of standard charges for the hospital’s shoppable services.
▪ Requires the Director of Health to monitor each hospital’s compliance with the bill’s
requirements and in cases of noncompliance, to impose penalties, including fines.
▪ Prohibits a medical creditor or medical debt collector from sharing or reporting any
patient medical debt to a consumer reporting agency for a period of one year after the
patient’s first bill.
▪ Prohibits a hospital or multi-hospital system that acquires or acquired an existing,
independent outpatient physician facility from requiring a third-party payor or self-pay
individual to pay facility fees in connection with any health care services or items provided
at that outpatient facility, beginning July 1, 2027.
TABLE OF CONTENTS
Availability of hospital price information ....................................................................................... 2
Definitions ................................................................................................................................... 2
Federal price transparency law....................................................................................................... 4
Shoppable services list .................................................................................................................... 5
Hospital selection of shoppable services .................................................................................... 5
Plain language requirement ........................................................................................................ 6
Price estimator tool ..................................................................................................................... 6
Federal requirements .................................................................................................................. 6
Required data elements ......................................................................................................... 6
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Office of Research and Drafting LSC Legislative Budget Office
Conditions ............................................................................................................................... 7
Machine-readable files ........................................................................................................... 7
Hospital website ..................................................................................................................... 8
Updates................................................................................................................................... 8
Violations ........................................................................................................................................ 8
Director of Health duties ................................................................................................................ 8
Monitoring................................................................................................................................... 8
List of noncompliant hospitals .................................................................................................... 9
Notice of violation and corrective action plan ............................................................................ 9
Administrative penalties ........................................................................................................... 10
Penalty amount ......................................................................................................................... 10
Reports ...................................................................................................................................... 10
Collection actions .......................................................................................................................... 11
Hospital price information list – current law background ............................................................ 11
Facility fees ................................................................................................................................... 12
DETAILED ANALYSIS
Availability of hospital price information
The bill directs each hospital located in this state to comply with the federal price
transparency law and establishes several state-level requirements respecting the list of standard
charges for the hospital’s shoppable services that must be compiled and made publicly available
under federal law. As part of establishing these requirements, the bill repeals current law
requiring every hospital to make available for public inspection a price information list, which
includes charges for certain hospital services.1
Definitions
The bill defines the following terms for the purposes of hospital price transparency:
▪ “Hospital” means an institution or facility that provides inpatient medical or surgical
services for a continuous period longer than twenty-four hours and includes a children’s
hospital.
▪ “Personal data” means any information that is linked or reasonably linkable to an
identified or identifiable person in Ohio. “Personal data” does not include publicly
available information or personal data that has been deidentified or aggregated using
commercially reasonable methods, so that neither the associated person, nor a device
linked to that person, can be reasonably identified.
1 R.C. 3727.42, 3727.44, and 3727.45.
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▪ “Process” or “processing” means any operation or set of operations that are performed
on personal data, whether or not by automated means, including the collection, use,
storage, disclosure, analysis, deletion, transfer, or modification of personal data.
▪ “Publicly available information” means information that is lawfully made available from
federal, state, or local government records or widely available media.
▪ “Shoppable service” means a service that a health care consumer may schedule in
advance.
▪ “Targeted advertising” means displaying an advertisement that is selected based on
personal data obtained from the use of a hospital’s internet-based price estimator tool
by a person in this state. “Targeted advertising” does not include any of the following:
 Advertising in response to the user’s request for information or feedback;
 Advertisements based on activities within a hospital’s own websites or online
applications;
 Advertisements based on the context of a user’s current search query, visit to a
website, or online application;
 Processing personal data solely for measuring or reporting advertising performance,
reach, or frequency.
▪ “Federal price transparency law” means section 2718(e) of the “Public Health Service
Act,” 42 U.S.C. 300gg-18, and hospital price transparency rules adopted by the United
States Department of Health and Human Services and the United States Centers for
Medicare and Medicaid Services implementing that section, including the rules and
requirements under 45 C.F.R. 180.2
The following terms are not defined in the bill, but are incorporated into the bill through
the federal price transparency law:
▪ “Standard charge” means the regular rate established by the hospital for an item or
service provided to a specific group of paying patients and includes the gross charge, the
payor-specific negotiated charge, the de-identified minimum negotiated charge, the de-
identified maximum negotiated charge, and the discounted cash price.
▪ “Hospital items or services” or “items or services” mean all items or services that may be
provided by a hospital to a patient in connection with an inpatient admission or
outpatient department visit for which the hospital has established a standard charge,
including supplies and procedures, room and board, hospital or facility fees, professional
charges, and other items or services for which the hospital has established a standard
charge.
2 R.C. 3727.31.
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▪ “Chargemaster” means the list maintained by the hospital of each hospital item or service
for which the hospital has established a charge.
▪ “Ancillary service” means a hospital item or service that a hospital customarily provides
as part of a shoppable service.
▪ “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.
▪ “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.
▪ “Discounted cash price” means the charge that applies to an individual who pays cash, or
a cash equivalent, for a hospital item or service.
▪ “Gross charge” means the charge for a hospital item or service that is reflected on a
hospital’s chargemaster, absent any discounts.
▪ “Machine-readable format” means a digital representation of data or information in a
file that can be imported or read into a computer system for further processing.
▪ “Payor-specific negotiated charge” means the charge that a hospital has negotiated with
a third-party payor for a hospital item or service.
▪ “Service package” means an aggregation of individual hospital items or services into a
single service with a single charge.
▪ “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.3
Federal price transparency law
Since January 1, 2021, each hospital operating in the U.S. is required to make public both
of the following under the federal price transparency law:
▪ A machine-readable file containing a list of all standard charges for all items and services;
▪ A consumer-friendly list of standard charges for a limited set of shoppable services.4
The list of standard charges must include – for each item or service – the item’s or
service’s description, gross charge, payor-specific negotiated charge, de-identified minimum
negotiated charge, de-identified maximum negotiated charge, discounted cash price, and any
billing or accounting code. The list must be updated annually.
In the case of shoppable services, a hospital must make public the standard charges for
as many of the 70 CMS-specified shoppable services it provides. It also must make public as many
additional hospital-selected shoppable services for a combined total of at least 300 shoppable
3 R.C. 3727.31; 45 Code of Federal Regulations (C.F.R.) 180.20, not in the bill.
4 45 C.F.R. 180.40.
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services. CMS requires the standard charge information for shoppable services to be updated
annually.
Should a hospital fail to comply with the federal hospital price transparency rule, CMS
may provide written notice to the hospital of a specific violation, request a corrective action plan
from the hospital, or impose a civil monetary penalty on the hospital and publicize the penalty
on a CMS website. Monetary penalties range from $300 per day for smaller hospitals with a bed
count of 30 or fewer to $10 per bed per day for hospitals with a bed count greater than 30, for a
maximum daily amount of $5,500.5
The bill establishes an affirmative requirement under Ohio law that each hospital in the
state comply with the federal price transparency law. In the event of noncompliance, a hospital
may be subject to administrative penalties by both CMS and by the Ohio Department of Health
(see “Administrative penalties” below).6
Shoppable services list
The bill restates that each hospital must maintain and make publicly available a list of
certain standard charges for the hospital’s shoppable services, as required by the federal price
transparency law. It also includes several state-level requirements about the list, which are
discussed in more detail below.7
Hospital selection of shoppable services
Under the federal price transparency law and the bill, subject to certain conditions, a
hospital may select the shoppable services to be included on its list. The bill requires that, during
the period beginning two years after the bill’s effective date and ending four years after the bill’s
effective date, the list must include at least 400 shoppable services, unless the hospital provides
fewer than 400 shoppable services, in which case the list must include the number of shoppable
services the hospital provides. Beginning four years after the bill’s effective date, the list must
include at least 500 shoppable services, unless the hospital provides fewer than 500 shoppable
services, in which case the list must include the number of shoppable services the hospital
provides.8
Pursuant to the federal price transparency law, the list must include the 70 services that
CMS specifies as shoppable services. If the hospital does not provide all 70 of those services, the
list must include as many of them as the hospital provides.9
5 45 C.F.R. 180.50 through 180.90, not in the bill.
6 R.C. 3727.32(A).
7 R.C. 3727.32(B)(1); 45 C.F.R. 180.60, not in the bill.
8 R.C. 3727.32(B)(2).
9 45 C.F.R. 180.60, not in the bill.
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Plain language requirement
The bill requires that the list be readable in plain language without the use of software.
So while a hospital must publish the list as a machine-readable file, as required by the federal
price transparency law, it must also ensure that the file can be read in plain language, or publish
the same information in a format which can be read in plain language. 10
Price estimator tool
As an alternative to the list of standard charges for shoppable services, the bill allows a
hospital to make available an internet-based price estimator tool. The price estimator tool must
fulfill the requirements established in the federal price transparency law. Additionally, the bill
requires a hospital to take reasonable steps to improve the accuracy and performance of the
tool, to regularly update the underlying data used by the tool, and to audit price estimates
generated by the tool for quality assurance purposes.
The bill prohibits hospitals from selling the personal data of a person in this state acquired
from an internet-based price estimator tool. Furthermore, the bill prohibits hospitals from using,
selling, or processing that personal data for the purposes of targeted advertising.11
Federal requirements
By requiring hospitals located in this state to comply with the federal price transparency
law, the bill incorporates certain federal requirements related to the list of standard charges for
shoppable services. These requirements are discussed in more detail below. But, to be clear, they
are not restated in the bill or anywhere in the Revised Code.
Required data elements
Pursuant to the federal price transparency law, each hospital’s list must contain the
following information:
▪ A plain-language description of each shoppable service the list includes;
▪ The following charges for each shoppable service included on the list and any ancillary
service: the payor-specific negotiated charge, the discounted cash price or gross charge,
the de-identified minimum negotiated charge, the de-identified maximum negotiated
price, and any billing or accounting code