Legislative Analysis
Phone: (517) 373-8080
HOSPITAL PRICE TRANSPARENCY
http://www.house.mi.gov/hfa
House Bill 4349 as reported from committee Analysis available at
Sponsor: Rep. Ryan Berman http://www.legislature.mi.gov
Committee: Health Policy
Complete to 3-22-21
SUMMARY:
House Bill 4349 would amend Part 215 (Hospitals) of the Public Health Code to incorporate
into Michigan law five sections (45 CFR 180.20 through 180.60) of a federal rule issued by
the Centers for Medicare & Medicaid Services concerning hospital price transparency. The
rule was issued in November 2019 and took effect January 1, 2021. It currently applies to all
state-licensed hospitals in the United States. This summary describes those sections of the
federal rule that the bill would republish as state law.
Under the rule, hospitals must publish their standard charges both as a comprehensive data
file and as a more selective consumer-friendly list.1
A standard charge is the regular rate established by a hospital for an item or service
provided to a specific group of paying patients.
An item or service is one that could be provided to a patient in connection with an
inpatient admission or outpatient visit, such as supplies, procedures, room and board,
facility fees, and charges for the services of physicians or other practitioners.
The following apply to the publication of both the file and the list:
• The hospital must publish the information prominently on a publicly available website
and clearly identify the applicable hospital location.
• The information must be accessible without charge, without having to set up a user
account or password, and without having to submit personal identifying information.
• The information must be updated at least annually, and the hospital must indicate the
date of the most recent update.
Other requirements specific to either the file or the list are described below.
Data file
45 CFR 180.50 requires a hospital to establish, update, and publish online (in a single digital
file that is in a machine-readable format2) a searchable list of all standard charges for all items
and services. If different hospital locations operating under a single license have different
standard charges, each location must separately publish its charges. The list of charges must
include all of the following:
• A description of each item or service provided by the hospital.
1
https://www.govinfo.gov/content/pkg/FR-2019-11-27/pdf/2019-24931.pdf
See also https://www.cms.gov/hospital-price-transparency
2
That is, it can be imported or read into a computer system for further processing. The rule offers .XML, .JSON, and
.CSV as examples of machine-readable formats.
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 • The gross charge that applies to each individual item or service when provided in an
inpatient setting and in an outpatient setting, as applicable.
• The charge the hospital has negotiated with a third-party payer that applies to each item
or service when provided in an inpatient setting and in an outpatient setting, as
applicable. Each charge must be clearly associated with the name of the third-party
payer and plan with which it was negotiated.
• The de-identified minimum negotiated charge (the lowest charge negotiated among all
third-party payers) that applies to each item or service when provided in an inpatient
setting and in an outpatient setting, as applicable. (“De-identified” means that the
information is presented without indicating a specific third-party payer.)
• The de-identified maximum negotiated charge (the highest charge negotiated among
all third-party payers) that applies to each item or service when provided in an inpatient
setting and in an outpatient setting, as applicable.
• The discounted cash price (the charge for someone paying cash or its equivalent) that
applies to each item or service when provided in an inpatient setting and in an
outpatient setting, as applicable.
• Any code used by the hospital for purposes of accounting or billing for the item or
service.
Consumer-friendly list
Except for hospitals that maintain an internet-based price estimator tool as described below, 45
CFR 180.60 requires a hospital to publish a plain-language list of standard charges for at least
300 shoppable services. (Shoppable services are those that can be scheduled by a health care
consumer in advance.) The CMS has specified 70 services that must be included on a hospital’s
list if the hospital provides them.3 The hospital must then include enough additional shoppable
services to total at least 300 services on its list, and it must select those additional services with
consideration for the rate at which it provides and bills for them. If a hospital provides fewer
than 300 shoppable services, it must make public the information described below for all of
the services it provides. The list of standard charges for shoppable services may be in a format
chosen by the hospital and must include all of the following:
• A plain-language description of each shoppable service.
• An indicator for any of the 70 CMS-specified services that are not offered by the
hospital.
• The charge the hospital has negotiated with a third-party payer that applies to each
shoppable service and any corresponding ancillary service. (An ancillary service is an
item or service a hospital customarily provides as part of, or in conjunction with, a
shoppable primary service.) Each charge must be clearly associated with the name of
the third-party payer and plan with which it was negotiated.
• The de-identified minimum negotiated charge (the lowest charge negotiated among all
third-party payers) that applies to each shoppable service and any corresponding
ancillary service. (“De-identified” means that the information is presented without
indicating a specific third-party payer.)
• The de-identified maximum negotiated charge (the highest charge negotiated among
all third-party payers) that applies to each shoppable service and any corresponding
ancillary service.
3
See pages 3 to 6 of this document (which also provides an overview of the shoppable services requirement):
https://www.cms.gov/files/document/steps-making-public-standard-charges-shoppable-services.pdf
House Fiscal Agency HB 4349 as reported Page 2 of 3
 • The discounted cash price (the charge for someone paying cash or its equivalent) that
applies to each shoppable service and any corresponding ancillary service. If the
hospital does not offer a discounted cash price for a shoppable service or corresponding
ancillary service, it must list its undiscounted gross charge for the service in question.
• The location at which the shoppable service is provided, including whether the
indicated standard charge applies at that location to provision of the service in the
inpatient setting, the outpatient department setting, or both.
• Any primary code for the service that the hospital uses for accounting or billing
services.4
Internet-based price estimator tool
The CMS considers a hospital to meet the above requirements for a consumer-friendly list of
shoppable services if the hospital maintains an internet-based price estimator tool that meets
all of the following:
• It provides estimates for as many of the 70 CMS-specified shoppable services as are
provided by the hospital and as many additional services as needed to reach a combined
total of at least 300 shoppable services.
• It allows health care consumers to obtain a real-time estimate of the amount they will
have to pay for the shoppable service.
• It is prominently displayed on the hospital’s website and accessible to the public
without charge and without having to register or establish a user account or password.
Proposed MCL 333.21517
FISCAL IMPACT:
House Bill 4349 would not have a significant fiscal impact on any unit of state or local
government. The bill may result in minor cost increases for hospitals, but these costs are not
anticipated to be significant.
POSITIONS:
The following entities indicated support for the bill:
• Mackinac Center for Public Policy (3-16-21)
• Michigan Manufacturers Association (3-18-21)
The Department of Licensing and Regulatory Affairs indicated a neutral position on the bill.
(3-16-21)
Legislative Analyst: Rick Yuille
Fiscal Analyst: Marcus Coffin
■ This analysis was prepared by nonpartisan House Fiscal Agency staff for use by House members in their
deliberations, and does not constitute an official statement of legislative intent.
4
The rule offers the Current Procedural Terminology (CPT) code, the Healthcare Common Procedure Coding System
(HCPCS) code, and the Diagnosis Related Group (DRG) as examples of common service billing codes.
House Fiscal Agency HB 4349 as reported Page 3 of 3


Statutes affected:
House Introduced Bill: 333.1101, 333.25211
As Passed by the House: 333.1101, 333.25211