SB 581 - Under this act, no contract provision between a health carrier and a health care provider shall be enforceable if such provision prohibits, conditions, or in any way restricts any party to such contract from disclosing to an enrollee, patient, or potential patient the contractual payment amount for a health care service if such payment amount is less than the health care provider's usual charge for the health care service, and if such contractual provision prevents the determination of the potential out-of-pocket cost for the health care service by the enrollee, patient, or potential patient.
This act also contains what shall be known as the "Health Care Cost Reduction and Transparency Act," requiring hospitals to submit to the Department of Health and Senior Services prices for 140 of the most common procedures, including 100 of the most common procedures in hospital inpatient settings as well as 20 of the most common surgery and 20 of the most common imaging procedures conducted in outpatient hospital settings.
Additionally, health care providers and health carriers must provide, within 5 days of a written patient or consumer request, an estimate of cost of health care services. This estimate shall be accompanied by specified language. If a hospital provides the reporting data to the Department and such data is placed on the Department's website, the hospital does not have to provide cost estimates to patients upon written request. Health care providers must also make available the percentage or amount of any discounts for cash payment of incurred charges through the provider's website or at the provider's location.
Any data disclosed to the Department by a hospital under this act shall be the sole property of the hospital or center that submitted the data. Any data or product derived from the data disclosed pursuant to this act, including a consolidation or analysis of the data, shall be the sole property of the state. The Department shall not allow proprietary information it receives pursuant to this act to be used by any person or entity for commercial purposes.
The information regarding hospital inpatient procedures and outpatient surgical and imaging procedures shall be submitted beginning with the quarter ending June 30, 2017, and quarterly thereafter. The Department shall provide such information on its website in a manner that is easily understood by the public. Information for each hospital shall be listed separately and hospitals shall be listed in groups by category as determined by the Department through the promulgation of rules.
This act contains provisions identical to SB 900 (2016), SB 46 (2015), and SCS/SB 8 (2015) and substantially similar to SB 307 (2013) and provisions substantially similar to provisions in SS/SB 608 (2016), SCS/SB 167 (2015), SB 847 (2014), SCS/SB 739 (2014), and HB 1793 (2014).