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SF 3870

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/10/2022 09:22am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to health care; requiring hospital pricing transparency; amending Minnesota
Statutes 2020, section 62J.823.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2020, section 62J.823, is amended to read:


62J.823 HOSPITAL PRICING TRANSPARENCY.

Subdivision 1.

Short title.

This section may be cited as the "Hospital Pricing
Transparency Act."

Subd. 2.

deleted text begin Definitiondeleted text end new text begin Definitionsnew text end .

new text begin (a) new text end For the purposes of this section, new text begin the terms defined
in this subdivision have the meanings given.
new text end

new text begin (b) "Chargemaster" means the list of all individual items and services maintained by a
hospital for which the hospital has established a charge.
new text end

new text begin (c) "De-identified maximum negotiated charge" means the highest charge that a hospital
has negotiated with all third-party payers for an item or service.
new text end

new text begin (d) "De-identified minimum negotiated charge" means the lowest charge that a hospital
has negotiated with all third-party payers for an item or service.
new text end

new text begin (e) "Discounted cash price" means the charge that applies to an individual who pays
cash or cash equivalent for a hospital item or service.
new text end

new text begin (f) new text end "Estimate" means the actual price expected to be billed to the individual or to the
individual's health plan company based on the specific diagnostic-related group code or
specific procedure code or codes, reflecting any known discounts the individual would
receive.

new text begin (g) "Gross charge" means the charge for an individual item or service that is reflected
on a hospital's chargemaster, absent discounts.
new text end

new text begin (h) "Hospital" has the meaning given in section 144.696, subdivision 3.
new text end

new text begin (i) "Items and services" means any item or service, including individual items or services
or service packages, that could be provided by a hospital to a patient in connection with an
inpatient admission or an outpatient visit for which the hospital has established a standard
charge. This definition includes but is not limited to:
new text end

new text begin (1) supplies and procedures;
new text end

new text begin (2) room and board;
new text end

new text begin (3) use of the facility and other items, including facility fees; and
new text end

new text begin (4) services performed by physicians and nonphysician practitioners employed by the
hospital.
new text end

new text begin (j) "Machine-readable file" means a digital representation of data or information in a
file that can be imported or read into a computer system for further processing, and includes
but is not limited to XML, JSON, and CSV machine-readable formats.
new text end

new text begin (k) "Outpatient surgical center" has the meaning given in section 144.696, subdivision
4.
new text end

new text begin (l) "Payer-specific negotiated charges" means charges that a hospital has negotiated with
a third-party payer, and includes charges negotiated by a health plan company as a third-party
payer and charges negotiated by a Medicare Advantage plan or managed care plan under
section 256B.69.
new text end

new text begin (m) "Service package" means an aggregation of individual items and services into a
single service with a single charge.
new text end

new text begin (n) "Shoppable service" means a service that can be scheduled by a health care consumer
in advance.
new text end

new text begin (o) "Standard charge" means the regular rate established by a hospital for an item or
service provided to a specific group of paying patients. A standard charge includes the
following:
new text end

new text begin (1) gross charge;
new text end

new text begin (2) payer-specific negotiated charge;
new text end

new text begin (3) de-identified minimum negotiated charge;
new text end

new text begin (4) de-identified maximum negotiated charge; and
new text end

new text begin (5) discounted cash price.
new text end

new text begin (p) "Third-party payer" means an entity that is by statute, contract, or agreement legally
responsible for payment of a claim for a health care item or service.
new text end

Subd. 3.

deleted text begin Applicability and scopedeleted text end new text begin Required disclosure of written examplenew text end .

deleted text begin Anydeleted text end new text begin (a)
A
new text end hospitaldeleted text begin , as defined in section 144.696, subdivision 3, anddeleted text end new text begin ornew text end outpatient surgical centerdeleted text begin ,
as defined in section 144.696, subdivision 4, shall
deleted text end new text begin mustnew text end provide a written new text begin or electronic
new text end estimate of the cost of a specific service or stay upon the request of a patient, doctor,
advanced practice registered nurse, or the patient's representative. The request must include:

(1) the health coverage status of the patient, including the specific health plan or other
health coverage under which the patient is enrolled, if any; and

(2) at least one of the following:

(i) the specific diagnostic-related group code;

(ii) the name of the procedure or procedures to be performed;

(iii) the type of treatment to be received; or

(iv) any other information that will allow the hospital or outpatient surgical center to
determine the specific diagnostic-related group or procedure code or codes.

new text begin (b) An estimate provided by the hospital or outpatient surgical center must contain:
new text end

new text begin (1) the method used to calculate the estimate;
new text end

new text begin (2) the specific diagnostic-related group or procedure code or codes used to calculate
the estimate, and a description of the diagnostic-related group or procedure code or codes
that is reasonably understandable to a patient; and
new text end

new text begin (3) a statement indicating that the estimate, while accurate, may not reflect the actual
billed charges and that the final bill may be higher or lower depending on the patient's
specific circumstances.
new text end

new text begin (c) The estimate may be provided in any method that meets the needs of the patient and
the hospital or outpatient surgical center, including electronically. A paper copy must be
provided if specifically requested by the patient or the patient's representative.
new text end

Subd. 4.

deleted text begin Estimatedeleted text end new text begin Required public disclosure of pricing informationnew text end .

deleted text begin (a) An estimate
provided by the hospital or outpatient surgical center must contain:
deleted text end

deleted text begin (1) the method used to calculate the estimate;
deleted text end

deleted text begin (2) the specific diagnostic-related group or procedure code or codes used to calculate
the estimate, and a description of the diagnostic-related group or procedure code or codes
that is reasonably understandable to a patient; and
deleted text end

deleted text begin (3) a statement indicating that the estimate, while accurate, may not reflect the actual
billed charges and that the final bill may be higher or lower depending on the patient's
specific circumstances.
deleted text end

deleted text begin (b) The estimate may be provided in any method that meets the needs of the patient and
the hospital or outpatient surgical center, including electronically; however, a paper copy
must be provided if specifically requested.
deleted text end

new text begin (a) A hospital must make public:
new text end

new text begin (1) a machine-readable file containing a list of the hospital's standard charges, including
payer-specific negotiated charges, for all items and services provided by the hospital in
compliance with the requirements of United States Code, title 42, section 300gg-18,
established under Code of Federal Regulations, title 45, part 180, as finalized on November
27, 2019, in that they are at least as transparent as required on that date; and
new text end

new text begin (2) a list of standard charges for shoppable services in compliance with the requirements
under Code of Federal Regulations, title 45, part 180.60, as finalized on November 27,
2019. The list must provide a description of each shoppable service required to be included
and must be made available in plain language and in a format that is easily accessible by
the public.
new text end

new text begin (b) As part of complying with the requirements of Code of Federal Regulations, title
45, part 180, a hospital must make available to the public machine-readable files for the
previous five years in a form and manner specified by Minnesota IT Services, in consultation
with the commissioner of health.
new text end

new text begin (c) Failure to make standard charges public as required under this subdivision is grounds
for regulatory action against a hospital. A hospital that fails to comply with this subdivision
shall be subject to a fine of not less than a daily penalty of $300 for hospitals with 30 or
fewer beds, a daily penalty of $10 per bed for hospitals with at least 31 and up to and
including 550 beds, and a maximum daily penalty of $5,500 for hospitals with greater than
550 beds. Any fine issued under this paragraph is in addition to any civil monetary penalties
imposed by the Centers for Medicare and Medicaid Services under Code of Federal
Regulations, title 45, part 180. The commissioner may suspend a hospital's license if the
hospital fails to make standard charges public for two consecutive years.
new text end