PRINTER'S NO. 1956
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 1344
Session of
2024
INTRODUCED BY COLEMAN, COLLETT, SAVAL, HAYWOOD, COSTA, DiSANTO,
CAPPELLETTI, DUSH AND KANE, OCTOBER 18, 2024
REFERRED TO HEALTH AND HUMAN SERVICES, OCTOBER 18, 2024
AN ACT
1 Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An
2 act relating to health care; prescribing the powers and
3 duties of the Department of Health; establishing and
4 providing the powers and duties of the State Health
5 Coordinating Council, health systems agencies and Health Care
6 Policy Board in the Department of Health, and State Health
7 Facility Hearing Board in the Department of Justice;
8 providing for certification of need of health care providers
9 and prescribing penalties," providing for hospital price
10 transparency and for prohibition on collection action of debt
11 against patients for noncompliant hospitals.
12 The General Assembly of the Commonwealth of Pennsylvania
13 hereby enacts as follows:
14 Section 1. The act of July 19, 1979 (P.L.130, No.48), known
15 as the Health Care Facilities Act, is amended by adding chapters
16 to read:
17 CHAPTER 8-C
18 HOSPITAL PRICE TRANSPARENCY
19 Section 801-C. Purpose.
20 The purpose of this chapter is to require hospitals to
21 disclose prices for certain items and services provided by
22 hospitals and to provide for enforcement by the department.
 1 Section 802-C. Definitions.
2 The following words and phrases when used in this chapter
3 shall have the meanings given to them in this section unless the
4 context clearly indicates otherwise:
5 "Ancillary service." A hospital item or service that a
6 hospital customarily provides as part of a shoppable service.
7 "Chargemaster." The list of all hospital items or services
8 maintained by a hospital for which the hospital has established
9 a charge.
10 "CMS." The Centers for Medicare and Medicaid Services.
11 "De-identified maximum negotiated charge." The highest
12 charge that a hospital has negotiated with all third-party
13 payors for a hospital item or service.
14 "De-identified minimum negotiated charge." The lowest charge
15 that a hospital has negotiated with all third-party payors for a
16 hospital item or service.
17 "Discounted cash price." The charge that applies to an
18 individual who pays cash or a cash equivalent for a hospital
19 item or service.
20 "Facility fee." A fee charged or billed by a hospital for
21 outpatient services provided in an off-campus health care
22 facility, regardless of the modality through which the health
23 care service is provided, that is:
24 (1) Intended to compensate the health system or hospital
25 for health care expenses.
26 (2) Separate and distinct from a professional fee.
27 "Gross charge." The charge for a hospital item or service
28 that is reflected on the hospital's chargemaster, absent any
29 discount.
30 "Health care facility." As defined in section 802.1.
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 1 "Health system." As defined in section 809.2.
2 "Hospital." As defined in section 802.1.
3 "Item or service." An item or service, including an
4 individual items or services package, that could be provided by
5 a hospital to a patient in connection with an inpatient
6 admission or an outpatient department visit for which the
7 hospital has established a standard charge, including any of the
8 following:
9 (1) A supply or procedure.
10 (2) Room and board.
11 (3) The use of the hospital or other item, which is
12 generally described as a facility fee.
13 (4) The service of a health care practitioner, which is
14 generally described as a professional fee.
15 (5) Any other item or service for which a hospital has
16 established a standard charge.
17 "Machine-readable format." A digital representation of
18 information in a file that can be easily imported or read into a
19 computer system for further processing without any additional
20 preparation.
21 "Payor-specific negotiated charge." The charge that a
22 hospital has negotiated with a third-party payor for a hospital
23 item or service.
24 "Professional fee." A fee charged by a health care
25 practitioner for medical services.
26 "Shoppable service." A service that may be scheduled by an
27 individual in advance.
28 "Standard charge." The regular rate established by the
29 hospital for a hospital item or service provided to a specific
30 group of paying patients. The term includes any of the
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 1 following:
2 (1) The gross charge.
3 (2) The payor-specific negotiated charge.
4 (3) The de-identified minimum negotiated charge.
5 (4) The de-identified maximum negotiated charge.
6 (5) The discounted cash price.
7 "Third-party payor." An entity that is legally responsible
8 for payment of a claim for a hospital item or service.
9 Section 803-C. Public availability of price information
10 required.
11 Notwithstanding any other provision of law, a hospital shall
12 publish all of the following on its publicly accessible Internet
13 website and provide hard copies upon request:
14 (1) A digital file in a machine-readable format and
15 printable format that contains a list of all standard charges
16 for all hospital items or services as specified under section
17 804-C.
18 (2) A consumer-friendly and printable list of standard
19 charges for a limited set of shoppable services as provided
20 for under section 805-C.
21 Section 804-C. List of standard charges.
22 (a) List.--A hospital shall have the following duties:
23 (1) Maintain a list of all standard charges for all
24 hospital items or services in accordance with this chapter.
25 (2) Ensure that the list is always available to the
26 public, including publishing the list electronically in the
27 manner specified under section 803-C.
28 (b) Standard charges.--The standard charges contained in the
29 list under subsection (a) shall reflect the standard charges
30 applicable to the location of the hospital, regardless of
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 1 whether the hospital operates in more than one location or
2 operates under the same license as another hospital.
3 (c) Contents.--A hospital shall include all of the following
4 information in the list under subsection (a):
5 (1) A description of each hospital item or service
6 provided by the hospital.
7 (2) The following charges for each individual hospital
8 item or service when provided in either an inpatient setting
9 or an outpatient department setting, as applicable,
10 including:
11 (i) The gross charge.
12 (ii) The de-identified minimum negotiated charge.
13 (iii) The de-identified maximum negotiated charge.
14 (iv) The discounted cash price.
15 (v) The payor-specific negotiated charge, delineated
16 by the name of the third-party payor and plan associated
17 with the charge and displayed in a manner that clearly
18 associates the charge with the third-party payor and
19 plan. A hospital must include all payors and all plans
20 accepted by the hospital in a manner clearly associated
21 with the name of the third-party payor and specific plan.
22 (vi) A code used by the hospital for the purpose of
23 accounting or billing for the hospital item or service,
24 including the Current Procedural Terminology (CPT) code,
25 the Healthcare Common Procedure Coding System (HCPCS)
26 code, the Diagnosis Related Group (DRG) code, the
27 National Drug Code (NDC) or other common identifier.
28 (d) Format.--A hospital shall publish the information
29 contained in the list under subsection (a) in a single digital
30 file that is in a machine-readable format.
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 1 (e) Display.--A hospital shall display the list under
2 subsection (a) by posting the list in a prominent location on
3 the home page of the hospital's publicly accessible Internet
4 website or making the list accessible by a dedicated link that
5 is prominently displayed on the home page of the hospital's
6 publicly accessible Internet website. If the hospital operates
7 multiple locations and maintains a single Internet website, the
8 hospital shall post the list for each location that the hospital
9 operates in a manner that clearly associates the list with the
10 applicable location of the hospital and includes charges
11 specific to each individual hospital location.
12 (f) Availability.--
13 (1) A hospital shall ensure that the list under
14 subsection (a) complies with the following requirements:
15 (i) Be available free of charge.
16 (ii) Be accessible to a common commercial operator
17 of an Internet search engine to the extent necessary for
18 the search engine to index the list and display the list
19 in response to a search query of a user of the search
20 engine.
21 (iii) Be formatted in a manner specified under this
22 chapter and by the department via a notice submitted to
23 the Legislative Reference Bureau for publication in the
24 next available issue of the Pennsylvania Bulletin.
25 (iv) Be digitally searchable and printable by
26 service description, billing code and third-party payor.
27 (v) Use a format and a naming convention specified
28 by the department via a notice submitted to the
29 Legislative Reference Bureau for publication in the next
30 available issue of the Pennsylvania Bulletin. The
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 1 department shall consider a naming convention as may be
2 specified by CMS.
3 (2) The department shall ensure the list under
4 subsection (a) does not require any of the following:
5 (i) The establishment of a user account or password
6 or other information of the user.
7 (ii) The submission of personal identifying
8 information.
9 (iii) Any other impediment, including entering a
10 code to access the list.
11 (g) Template.--In determining the format of the list under
12 subsection (a) as required under subsection (f)(1), the
13 department shall develop a template that each hospital shall use
14 in formatting the list and publish the template via a notice
15 submitted to the Legislative Reference Bureau for publication in
16 the next available issue of the Pennsylvania Bulletin. In
17 developing the template as required under this subsection, the
18 department shall have the following duties:
19 (1) Take into consideration applicable Federal
20 guidelines for formatting similar lists required by Federal
21 law and ensure that the design of the template enables an
22 individual to compare the charges contained in the lists
23 maintained by each hospital.
24 (2) Design the template to be substantially like the
25 template used by CMS for the purposes specified in this
26 chapter.
27 (h) Updates.--A hospital shall update the list under
28 subsection (a) no less than once each year. The hospital shall
29 clearly indicate the date when the list was most recently
30 updated, either on the list or in a manner that is clearly
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 1 associated with the list. The hospital shall make available no
2 less than the three most recent versions of the list as required
3 under this chapter.
4 Section 805-C. List of shoppable services.
5 (a) List.--Except as provided under subsection (c), a
6 hospital shall maintain and make publicly available a list of
7 the standard charges for each of at least 300 shoppable services
8 provided by the hospital with charges specific to that
9 individual hospital location. The hospital may select the
10 shoppable services to be included in the list, except that the
11 list shall include the 70 services specified as shoppable
12 services by CMS. If the hospital does not provide all the
13 shoppable services specified by CMS, the hospital shall include
14 all the shoppable services provided by the hospital.
15 (b) Selection.--In selecting a shoppable service for the
16 purpose of inclusion in the list under subsection (a), a
17 hospital shall have following duties:
18 (1) Consider how frequently the hospital provides the
19 service and the hospital's billing rate for the service.
20 (2) Prioritize the selection of services that are among
21 the services most frequently provided by the hospital.
22 (c) Exception.--If a hospital does not provide 300 shoppable
23 services in the list under subsection (a), the hospital shall
24 include the total number of shoppable services that the hospital
25 provides in a manner that otherwise complies with the
26 requirements of subsection (a).
27 (d) Contents.--A hospital shall include all of the following
28 information in the list under subsection (a):
29 (1) A plain-language description of each shoppable
30 service included on the list.
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 1 (2) The payor-specific negotiated charge that applies to
2 each shoppable service included on the list and any ancillary
3 service, delineated by the name of the third-party payor and
4 plan associated with the charge and displayed in a manner
5 that clearly associates the charge with the third-party payor
6 and plan.
7 (3) The discounted cash price that applies to each
8 shoppable service included on the list and any ancillary
9 service or, if the hospital does not offer a discounted cash
10 price for a shoppable service or an ancillary service on the
11 list, the gross charge for the shoppable service or ancillary
12 service, as applicable.
13 (4) The de-identified minimum negotiated charge that
14 applies to each shoppable service included on the list and
15 any ancillary service.
16 (5) The de-identified maximum negotiated charge that
17 applies to each shoppable service included on the list and
18 any ancillary service.
19 (6) A code used by the hospital for purposes of
20 accounting or billing for each shoppable service included on
21 the list and any ancillary service, including the Current
22 Procedural Terminology (CPT) code, the Healthcare Common
23 Procedure Coding System (HCPCS) code, the Diagnosis Related
24 Group (DRG) code, the National Drug Code (NDC) or other
25 common identifier.
26 (7) If applicable, each location where the hospital
27 provides a shoppable service and whether the standard charges
28 included in the list apply at the location to the provision
29 of the shoppable service in an inpatient setting or an
30 outpatient department setting.
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 1 (8) If applicable, an indication if a shoppable service
2 specified by CMS is not provided by the hospital.
3 (e) Availability.--
4 (1) A hospital shall ensure that the list under
5 subsection (a) complies with the following requirements:
6 (i) Be available free of charge.
7 (ii) Be accessible to a common commercial operator
8 of an Internet search engine to the extent necessary for
9 the search engine to index the list and display the list
10 in response to a search query of a user of the search
11 engine.
12 (iii) Be formatted in a manner specified under this
13 chapter and by the department via a notice submitted to
14 the Legislative Reference Bureau for publication in the
15 next available issue of the Pennsylvania Bulletin.
16 (iv) Be digitally searchable and printable by
17 service description, billing code and third-party payor.
18 (v) Use a format and a naming convention specified
19 by the department via a notice submitted to the
20 Legislative Reference Bureau for publication in the next
21 available issue of the Pennsylvania Bulletin. The
22 department shall consider a naming convention as may be
23 specified by CMS.
24 (vi) Nothing in this section shall preclude a
25 hospital from using a price estimator tool as provided
26 for in 45 CFR 180.60 (relating to requirements for
27 displaying shoppable services in a consumer-friendly
28 manner) in addition to th