HB2609 103RD GENERAL ASSEMBLY

LRB103 05300 CPF 53530 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB2609

Introduced 2/15/2023, by Rep. Jed Davis

SYNOPSIS AS INTRODUCED:

New Act
30 ILCS 105/5.990 new
110 ILCS 330/11 new
210 ILCS 85/6.14a
210 ILCS 85/9.9 new

Creates the Hospital Price Transparency Act. Provides that, notwithstanding any other provision of law, a facility (a hospital licensed under the Hospital Licensing Act, organized under the University of Illinois Hospital Act, or licensed under the Ambulatory Surgical Treatment Center Act) must make specified information public. Requires facilities to maintain lists of standard charges and shoppable services and ensure that the lists are available at all times to the public. Contains reporting requirements. Requires the Department of Public Health to monitor each facility's compliance with the requirements of the Act and to enforce compliance with the Act. Provides that facilities that violate the Act must submit and implement a corrective action plan. Establishes the Hospital Price Transparency Fund as a special fund in the State treasury and makes a conforming change in the State Finance Act. Requires administrative penalties collected under the Act to be deposited into the Fund. Provides that moneys in the Fund shall be used by the Department for expenses relating to the implementation, administration, and enforcement of the Act. Contains other provisions. Amends the University of Illinois Hospital Act. Requires the University of Illinois Hospital to comply with the Hospital Price Transparency Act. Amends the Hospital Licensing Act. Provides that any report submitted to the Department under the Hospital Price Transparency Act and any information or data contained in such a report is subject to disclosure to the public by the Department. Requires hospitals licensed under the Act to comply with the Hospital Price Transparency Act. Effective January 1, 2024.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Hospital Price Transparency Act.

Section 5. Definitions.

"Ancillary service" means a facility item or service that a facility customarily provides as part of a shoppable service.

"Chargemaster" means a list of all facility items or services maintained by a facility for which the facility has established a charge.

"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.

"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.

"Department" means the Department of Public Health.

"Director" means the Director of Public Health.

"Discounted cash price" means the charge that applies to an individual who pays cash, or a cash equivalent, for a facility item or service.

"Facility" means a hospital licensed under the Hospital Licensing Act, organized under the University of Illinois Hospital Act, or licensed under the Ambulatory Surgical Treatment Center Act.

"Facility item or service" means an item, service, or service package, including, but not limited to, an item, service, or service package that may be provided by a facility to a patient in connection with an inpatient admission or an outpatient department visit, for which the facility has established a standard charge. "Facility item or service" includes, but is not limited to, the following:

(1) Supplies and procedures.

(2) Room and board.

(3) Use of the facility and facility areas, the charges for which are generally referred to as facility fees.

(4) Services of physicians and nonphysician practitioners employed by a facility, the charges for which are generally referred to as professional charges.

(5) Any other item or service for which a facility has established a standard charge.

"Fund" means the Hospital Price Transparency Fund established under subsection (f) of Section 40.

"Gross charge" means the charge for a facility item or service that is reflected on a facility's chargemaster, absent any discounts.

"Hospital Licensing Board" means the Hospital Licensing Board created under Section 10 of the Hospital Licensing Act.

"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. "Machine-readable format" includes PDF, .XML, .JSON, and .CSV formats.

"Payor-specific negotiated charge" means the charge that a facility has negotiated with a third-party payor for a facility item or service.

"Service package" means an aggregation of individual facility items or services into a single service with a single charge.

"Shoppable service" means a service that may be scheduled by a patient in advance.

"Standard charge" means a regular rate established by a facility for a facility item or service provided to a specific group of paying patients. "Standard charge" includes all of the following:

(1) A gross charge.

(2) A payor-specific negotiated charge.

(3) A de-identified minimum negotiated charge.

(4) A de-identified maximum negotiated charge.

(5) A discounted cash price.

"Third-party payor" means a person or entity who is legally responsible for payment of a claim for a facility item or service by contract or agreement.

Section 10. Public availability of price information. Notwithstanding any other provision of law, a facility must make public:

(1) a digital file that contains a list of all standard charges for all facility items or services as required under Section 15 in PDF format or another machine-readable format;

(2) a consumer-friendly list of standard charges for a limited set of shoppable services as required under Section 20; and

(3) 8 physical copies of the digital file in paragraph (1) which are available in the public area of the facility and can be taken by members of the public for their reference.

Section 15. List of standard charges.

(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 that the list is available at all times to the public, including, but not limited to, by posting the list electronically in accordance with 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 facility location, 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) Standard charges for each facility item or service provided in either an inpatient or outpatient setting. If a standard charge is a payor-specific negotiated charge, it must be listed by the name of the third-party payor and the plan associated with the charge and displayed in a manner that clearly associates the charge with each third-party payor and plan.

(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 another common identifier.

(d) The information contained in the list required under subsection (a) must be published in a single digital file in PDF format. Facilities may post identical information in a separate file in any machine-readable format.

(e) The list required under subsection (a) must be displayed in a prominent location, or accessible by selecting a dedicated link that is prominently displayed on the home page of the facility's publicly accessible website. If the facility operates multiple locations and maintains a single 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. Physical copies must also be made available in the lobby or other public areas of the facility for members of the public to take with them.

(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 Department;

(4) be digitally searchable; and

(5) use the naming convention specified by the federal Centers for Medicare and Medicaid Services.

(g) In prescribing the format of the list as required under paragraph (3) of subsection (f), the Department shall develop a template that each facility must use in formatting the list. In developing the template, the Department shall:

(1) 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

(2) 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 Act, if the Department determines that designing the template in that manner serves the purposes of paragraph (1) and that the Department benefits from developing and requiring that substantially similar design.

(h) A 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.

Section 20. Consumer-friendly list of shoppable services.

(a) Except as provided under subsection (c), a facility shall maintain and make publicly available a list of the standard charges described under paragraph (2) of subsection (c) of Section 15 for each of at least 300 shoppable services provided by the facility. Physical copies must also be made available in the lobby or other public areas of the facility for members of the public to take with them. 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 under paragraph (1), as many of those shoppable services that 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 at least 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 lists required under subsections (a) and (c) 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 another 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 lists required under subsections (a) and (c) must be:

(1) displayed in the manner prescribed under subsection (e) of Section 15 for the list required under that subsection;

(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, but not limited to, entering a code to access the list;

(3) searchable by service description, billing code, and payor;

(4) updated in the manner prescribed under subsection (h) of Section 15;

(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 Department under paragraph (3) of subsection (f) of Section 15.

(f) Notwithstanding any other provision of this Section, a facility meets the requirements of this Section if the facility maintains, as determined by the Department, 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 website; and

(B) accessible to the public:

(i) without charge; and

(ii) without having to register or establish a user account or password.

Section 25. Reporting requirement. Each time a facility updates a list as required under subsection (h) of Section 15 and paragraph (4) of subsection (e) of Section 20, the facility shall submit the updated list to the Department. The Department shall prescribe the form in which the updated list must be submitted to the Department.

Section 30. Monitoring and enforcement.

(a) The Department shall monitor each facility's compliance with the requirements of this Act using any of the following methods:

(1) evaluating complaints made by persons to the Department regarding noncompliance with this Act;

(2) reviewing any analysis prepared regarding noncompliance with this Act;

(3) auditing the websites of facilities for compliance with this Act; and

(4) confirming that each facility submitted the lists required under Section 25.

(b) If the Department determines that a facility is not in compliance with any provision of this Act, the Department may take any of the following actions in any order:

(1) Provide a written notice to the facility that clearly explains the manner in which the facility is not in compliance with this Act.

(2) Request a corrective action plan from the facility if the facility has materially violated a provision of this Act, as determined under Section 35.

(3) Impose an administrative penalty on the facility and publicize the penalty on the Department's website if the facility fails to:

(A) respond to the Department's request to submit a corrective action plan; or

(B) comply with the requirements of a corrective action plan submitted to the Department.

Section 35. Material violation; corrective action plan.

(a) A facility materially violates this Act if the facility fails to:

(1) comply with the requirements of Section 10; or

(2) publicize the facility's standard charges in the form and manner required under Sections 15 and 20.

(b) If the Department determines that a facility has materially violated this Act, the Department shall issue a notice of material violation to the facility and request that the facility submit a corrective action plan within 30 days of the date of the notice. The notice must indicate the form and manner in which the corrective action plan must be submitted to the Department 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) complete the steps in the corrective actions plan within 30 days of the Department's acceptance of the corrective action plan.

(d) A corrective action plan submitted to the Department under subsection (c) must:

(1) describe in detail the corrective action the facility will take to address any violation identified by the Department in the notice provided under subsection (b); and

(2) confirm that the facility will complete the corrective action described under paragraph (1) within 30 days of the Department's acceptance of the corrective action plan.

(e) A corrective action plan submitted under this Section is subject to review and approval by the Department. After the Department reviews and approves a facility's corrective action plan, the Department shall notify the facility and shall monitor and evaluate the facility's compliance with the corrective action plan.

(f) A facility fails to respond to the Department'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 fails to comply with a corrective action plan if the facility fails to address a violation within the specified period of time contained in the corrective action plan.

Section 40. Administrative penalty.

(a) The Department shall impose an administrative penalty on a facility in accordance with Section 7 of the Hospital Licensing Act if the facility fails to:

(1) respond to the Department's request to submit a corrective action plan within the timeline in subsection (b) of Section 35; or

(2) comply with the requirements of a corrective action plan submitted to the Department.

(b) The Department shall impose an administrative penalty on a facility for each violation of a requirement under this Act. The Department shall set the penalty in an amount sufficient to ensure compliance with this Act, 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 the Department by rule in the year preceding the year in which a penalty is imposed, the penalty imposed by the Department shall not exceed:

(1) $1,000 for each day the facility violated this Act, if the facility's total gross revenue is less than $10,000,000;

(2) $3,000 for each day the facility violated this Act, if the facility's total gross revenue is at least $10,000,000 and less than $100,000,000; and

(3) $5,000 for each day the facility violated this Act, if the facility's total gross revenue is $100,000,000 or more.

(d) Each day a violation continues is a separate violation.

(e) In determining the amount of an administrative penalty under this Section, the Department 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 matter justice may require.

(f) The Hospital Price Transparency Fund is established as a special fund in the State treasury. Administrative penalties collected under this Act shall be deposited into the Fund. Moneys in the Fund shall be used by the Department for expenses relating to the implementation, administration, and enforcement of this Act.

Section 45. Legislative recommendations. The Department may propose recommendations to the General Assembly for amendments to this Act, including, but not limited to, recommendations in response to amendments by the federal Centers for Medicare and Medicaid Services to 45 CFR 180.

Section 50. Hearings; Illinois Administrative Procedure Act.

(a) The procedure governing hearings under this Act shall be in accordance with rules adopted by the Department and approved by the Hospital Licensing Board. A full and complete record shall be kept of all proceedings, including the notice of hearing, complaint, and all other documents in the nature of pleadings, written motions filed in the proceedings, and the report and orders of the Director and hearing officer. All testimony shall be reported but need not be transcribed unless the decision is appealed. A copy or copies of the transcript may be obtained by any interested party on payment of the cost of preparing such copy or copies.

(b) The provisions of the Illinois Administrative Procedure Act are hereby expressly adopted and shall apply to all administrative rules and procedures of the Department under this Act, except that Section 5-35 of the Illinois Administrative Procedure Act relating to procedures for rulemaking does not apply to the adoption of any rule required by federal law in connection with which the Department is precluded by law from exercising any discretion.

Section 65. The State Finance Act is amended by adding Section 5.990 as follows:

(30 ILCS 105/5.990 new)

Sec. 5.990. The Hospital Price Transparency Fund.

Section 70. The University of Illinois Hospital Act is amended by adding Section 11 as follows:

(110 ILCS 330/11 new)

Sec. 11. Compliance with the Hospital Price Transparency Act. The University of Illinois Hospital shall comply with the Hospital Price Transparency Act.

Section 75. The Hospital Licensing Act is amended by changing Section 6.14a and by adding Section 9.9 as follows:

(210 ILCS 85/6.14a)

Sec. 6.14a. Public disclosure of information. The following information is subject to disclosure to the public from the Department:

(1) Information submitted under Section 5 of this Act;

(2) Final records of license and certification inspections, surveys, and evaluations of hospitals; and

(3) Investigated complaints filed against a hospital and complaint investigation reports, except that a complaint or complaint investigation report shall not be disclosed to a person other than the complainant or complainant's representative before it is disclosed to a hospital, and except that a complainant or patient's name shall not be disclosed; and .

(4) Reports, and any information or data contained in a report, submitted to the Department under the Hospital Price Transparency Act.

The Department shall disclose information under this Section in accordance with provisions for inspection and copying of public records required by the Freedom of Information Act.

However, the disclosure of information described in subsection (1) shall not be restricted by any provision of the Freedom of Information Act.

Notwithstanding any other provision of law, under no circumstances shall the Department disclose information obtained from a hospital that is confidential under Part 21 of Article VIII of the Code of Civil Procedure.

No Any records or reports of inspections, surveys, or evaluations of hospitals may be disclosed until only after the acceptance of a plan of correction by the Health Care Financing Administration of the U.S. Department of Health and Human Services or the Department, as appropriate, or at the conclusion of any administrative review of the Department's decision, or at the conclusion of any judicial review of such administrative decision. Whenever any record or report is subject to disclosure under this Section, the Department shall permit the hospital to provide a written statement pertaining to such report which shall be included as part of the information to be disclosed. The Department shall not divulge or disclose any record or report in a manner that identifies or would permit the identification of any natural person.

(Source: P.A. 98-463, eff. 8-16-13.)

(210 ILCS 85/9.9 new)

Sec. 9.9. Compliance with the Hospital Price Transparency Act. A hospital licensed under this Act shall comply with the Hospital Price Transparency Act.

Section 99. Effective date. This Act takes effect January 1, 2024.