S.Amdt. 3686

1. Adds SEC. 1207. INCREASING THE TRANSPARENCY OF INFORMATION ON HOSPITAL CHARGES AND MAKING AVAILABLE INFORMATION ON ESTIMATED OUT-OF-POCKET COSTS FOR HEALTH CARE SERVICES at the end of subtitle C of title I

   Adds a section

   In H.R. 4872 · Placed on Calendar Senate

   (b) Effective Date.--The amendment made by subsection (a) shall take effect as if included in the enactment of the Patient Protection and Affordable Care Act.

   Inserted: SEC. 1207. INCREASING THE TRANSPARENCY OF INFORMATION ON HOSPITAL CHARGES AND MAKING AVAILABLE INFORMATION ON ESTIMATED OUT-OF-POCKET COSTS FOR HEALTH CARE SERVICES.

   Inserted: (a) In General.--Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as amended by section 3021(b) of the Patient Protection and Affordable Care Act, is amended--

   Inserted: (1) by striking "and" at the end of paragraph (82);

   Inserted: (2) by striking the period at the end of paragraph (83) and inserting "; and";

   Inserted: (3) by inserting after paragraph (83) the following new paragraph:

   Inserted: "(84) provide that the State will establish and maintain laws, in accordance with the requirements of section 1921A, to require disclosure of information on hospital charges, to make such information available to the public, and to provide individuals with information about estimated out-of-pocket costs for health care services."; and

   Inserted: (4) by inserting after section 1921 the following new section:

   Inserted: "increasing the transparency of information on hospital charges and

   Inserted: providing consumers with estimates of out-of-pocket costs for health care services

   Inserted: "Sec. 1921A. (a) In General.--The requirements referred to in section 1902(a)(84) are that the laws of a State must--

   Inserted: "(1) in accordance with subsection (b)--

   Inserted: "(A) require the disclosure of information on hospital charges; and

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   Inserted: "(B) provide for access to such information; and

   Inserted: "(2) in accordance with subsection (c), require the provision of a statement of the estimated out-of-pocket costs of an individual for anticipated future health care services.

   Inserted: "(b) Information on Hospital Charges.--The laws of a State must--

   Inserted: "(1) require disclosure, by each hospital located in the State, of information on the charges for certain inpatient and outpatient hospital services (as determined by the State) provided at the hospital; and

   Inserted: "(2) provide for timely access to such information by individuals seeking or requiring such services.

   Inserted: "(c) Estimated Out-of-Pocket Costs.--The laws of a State must require that, upon the request of any individual with health insurance coverage sponsored by a health insurance issuer, the issuer must provide a statement of the estimated out-of-pocket costs that are likely to be incurred by the individual if the individual receives particular health care items and services within a specified period of time.

   Inserted: "(d) Rules of Construction.--Nothing in this section shall be construed as--

   Inserted: "(1) authorizing or requiring the Secretary to establish uniform standards for the State laws required by subsections (b) and (c);

   Inserted: "(2) requiring any State with a law enacted on or before the date of the enactment of this section that--

   Inserted: "(A) meets the requirements of subsection (b) or subsection (c) to modify or amend such law; or

   Inserted: "(B) meets some but not all of the requirements of subsection (b) or subsection (c) to modify or amend such law except to the extent necessary to address the unmet requirements;

   Inserted: "(3) precluding any State in which a program of voluntary disclosure of information on hospital charges is in effect from adopting a law codifying such program (other than its voluntary nature) to satisfy the requirement of subsection (b)(1); or

   Inserted: "(4) guaranteeing that the out-of-pocket costs of an individual will not exceed the estimate of such costs provided pursuant to subsection (c).

   Inserted: "(e) Definitions.--For purposes of this section:

   Inserted: "(1) The term 'health insurance coverage' has the meaning given such term in section 2791(b)(1) of the Public Health Service Act.

   Inserted: "(2) The term 'health insurance issuer' has the meaning given such term in section 2791(b)(2) of the Public Health Service Act, except that such term also includes--

   Inserted: "(A) a Medicaid managed care organization (as defined in section 1903(m)); and

   Inserted: "(B) a Medicare Advantage organization (as defined in 1859(a)(1), taking into account the operation of section 201(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003).

   Inserted: Section 1856(b)(3) shall not preclude the application to a Medicare Advantage organization or a Medicare Advantage plan offered by such an organization of any State law adopted to carry out the requirements of subsection (b) or (c).

   Inserted: "(3) The term 'hospital' means an institution that meets the requirements of paragraphs (1) and (7) of section 1861(e) and includes those to which section 1820(c) applies.".

   Inserted: (b) Effective Date.--

   Inserted: (1) In general.--Except as provided in paragraph (2), the amendments made by subsection (a) shall take effect on October 1, 2010.

   Inserted: (2) Exception.--In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendment made by subsection (a), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

   Original wording

   At the end of subtitle C of title I, add the following:

Read automatically from the Congressional Record. Check the original before relying on it.

As printed