AB 353

This bill creates several requirements for a hospital to provide cost information for certain items and services provided by the hospital and restricts certain legal actions against a patient that seek judgment for debts owed on hospital items and services provided to the patient if the hospital that provided the item or service is not in compliance with applicable price transparency requirements.

The bill provides that the Department of Health Services must enforce federal hospital price transparency requirements for hospitals. If the secretary of health services determines that the federal hospital price transparency requirements are no longer substantially enforceable in this state, the bill directs the secretary of health services to submit a notice to the Legislative Reference Bureau for publication in the Wisconsin Administrative Register that the federal hospital price transparency requirements are no longer substantially enforceable in this state. If the secretary of health services submits such a notice, the bill provides that DHS must instead enforce the other hospital price transparency requirements established in the bill, beginning on the first day of the fourth month beginning after the notice is published in the Wisconsin Administrative Register. The hospital price transparency requirements established in the bill would require each hospital to make publicly available a digital file in a machine-readable format that contains a list of standard charges for certain items and services provided by the hospital and a consumer-friendly list of standard charges for certain shoppable services. “Standard charge” is defined to mean the regular rate established by the hospital for an item or service provided to a specific group of paying patients and includes certain price information, including the gross charge, the payer-specific negotiated charge, and the discounted cash price. “Shoppable service” is defined to mean a service that may be scheduled by a health care consumer in advance. Every time a hospital updates the list of standard charges or the consumer-friendly list of standard charges for shoppable services, the hospital must submit the updated list to DHS.

The list of standard charges must be available at all times to the public in a machine-readable format, must be displayed in a prominent location on the home page of the hospital’s website, and must include certain information, including a description of each hospital item or service provided and any code used by the hospital for purposes of accounting or billing. Further, the list of standard charges must meet certain criteria, including that the list must be available free of charge and without having to establish a user account or password, that the list is available without having to submit personal identifying information, that the list is digitally searchable, and that the list is accessible to a commercial operator of an Internet search engine as 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. The list of standard charges must be updated at least once each year.

The consumer-friendly list of standard charges for shoppable services must be publicly available and must contain standard charge information for each of at least 300 shoppable services provided by the hospital. The bill allows a hospital to select the shoppable services to be included in the list, except that the list must include either the 70 services specified as shoppable services by the federal Centers for Medicare and Medicaid Services (CMS) or, if the hospital does not provide all of the shoppable services specified by CMS, as many of the 70 services specified as shoppable services by CMS as the hospital provides. If a hospital does not provide at least 300 shoppable services, the bill requires the hospital to maintain a list of all shoppable services that the hospital provides. The consumer-friendly list of standard charges for shoppable services must include certain information, including certain price information and a plain-language description of each shoppable service included on the list, whether each hospital location provides the shoppable service and whether the standard charges included in the list apply at that location, and whether one or more of the shoppable services specified by CMS is not provided by the hospital. The consumer-friendly list of standard charges for shoppable services must meet certain criteria, including that the list is available free of charge without having to establish a user account or password, that the list is searchable by service description, billing code, and payer, and that the list is accessible to a common commercial operator of an Internet search engine as 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. The consumer-friendly list of standard charges for shoppable services must be updated at least once each year.

Under the bill, regardless of whether the federal hospital price transparency requirements or the requirements established in the bill apply, DHS must monitor each hospital’s compliance with the applicable price transparency requirements specified in the bill by evaluating complaints, reviewing any analysis prepared regarding noncompliance, auditing the websites of hospitals, or confirming that each hospital submitted the required lists. If DHS determines that a hospital is not in compliance with any of the price transparency requirements specified in the bill, the bill requires DHS to take certain actions, including providing a written notice to the hospital, requesting a corrective action plan from the hospital, or imposing a penalty. The bill requires DHS to maintain a publicly available list of any hospital that has been found to have violated any of the price transparency requirements specified in the bill, including the dates that the hospital was not in compliance.

Finally, the bill provides that any party seeking judgment against a patient for a debt owed for hospital items or services that are purchased for or provided to the patient by a hospital shall file a certification under oath to the court stating that the hospital that provided the hospital items or services to the patient is not, according to the publicly available list maintained by DHS, out of compliance with the applicable price transparency requirements as of the date of the certification before judgment may be entered in favor of the party seeking judgment.