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State and Federal Actions Related to Transparency and Disclosure
of Health Charges and Provider Payments

Updated May 2013

The need for price "transparency" or disclosure has emerged as one of the hot topics in the area of consumer directed health care.  Such policies and programs also are a part of health cost containment and efficiencies efforts.   Both states and the federal government, as well as the private sector, have initiated programs and enacted some legal requirements, especially in the past seven years. The first half of 2013 has signaled a visible increase in interest and in public poloicy action to provide more information directly to the interested public.   The report describes a number of state, federal and private-sector or non-profit initiatives over the past two decades, including web links or citations to sources or more information.

Topics in this report:

2013 Published Report

Catalyst for Payment Reform and Health Care Incentives Improvements Institute
released the Report Card on State Price Transparency Laws on March 18, 2013.
It includes a 41-page table of state laws, with the scope of providers, prices,
services and levels of transparency. The report notes that the "objective of this research was
to determine how much pricing information each state makes accessible to the consumer."
 

In March 2006, the Bush Administration publicly announced a goal of seeking to make more information available to consumers on the price and quality of health services, with the hope that increased transparency will "inject more free-market principles into health care."1 According to CQ Today, Bush administration officials "repeatedly urged hospitals and doctor groups to move quickly and give consumers more data" and have "made it clear that they will push for legislation requiring health care providers to supply the information."2 In August 2006, President Bush issued an Executive Order to help promote efforts to improve transparency and quality in health care for health care programs administered or sponsored by the federal government. This Executive Order directed federal agencies that administer or sponsor federal health insurance programs to increase transparency in pricing and quality, encourage adoption of health information technology standards, and provide options that promote quality and efficiency in health care.

 Doctor's sachel and money

Recent Actions Related to Federal Health Reform

Administration offers consumers a detailed look at hospital charges.   On May 8, 2013 Health and Human Services (HHS) Secretary Kathleen Sebelius announced a three-part initiative that for the first time gives consumers detailed information on what hospitals charge.  New data released show significant variation across the country and within communities in what hospitals charge for common inpatient services. 

“Currently, consumers don’t know what a hospital is charging them or their insurance company for a given procedure, like a knee replacement, or how much of a price difference there is at different hospitals, even within the same city,” Secretary Sebelius said. “This data and new data centers will help fill that gap.”  The data posted as of May 8 on CMS’s website include information comparing the charges for services that may be provided during the 100 most common Medicare inpatient stays.  Hospitals determine what they will charge for items and services provided to patients and these “charges” are the amount the hospital generally bills for an item or service.  Read: News Release 5/8/13 | View the new hospital costs data

February 8, 2013: CMS Released Final Rules Regarding the Physician Payment Sunshine Act.3
Reporting Related to Covered Drug, Device, Biological or Medical Supply: The Patient Protection and Affordable Care Act (PPACA), Section 6002)   (CFR 42 §1128G(a)(1)(A)(vii) requires that “if a payment or other transfer of value is related to marketing, education, or research specific to a covered drug, device, biological, or medical supply,” applicable manufacturers must report the name of the covered product.  CMS finalized “that applicable manufacturers must report a related product name for all payments or transfers of value, unless the payment or other transfer of value is not related to a covered product.”   
However, CMS does not “believe applicable manufacturers should be required to report the name of associated non-covered products, since this may be misleading to consumers and would provide information that is beyond the goal of the statute.”  CMS said it “is useful to know the extent of payments or other transfers of value that are not associated with any product or not associated with a covered product.”  
Because this distinction will not be possible if applicable manufacturers leave the associated products fields blank in cases when it is not applicable, “the final rule directs applicable manufacturers to fill in associated product fields as appropriate.”  Thus, “if the payment or other transfer of value is not related to at least one covered product, then applicable manufacturers should report “none.”  
Conversely, “if the payment or other transfer of value is related to a specific product, which is not a covered product, then applicable manufacturers are to report “non-covered product.”   
Finally, if the payment or other transfer of value is related to at least one covered product, as well as at least one non-covered product, then applicable manufacturers must report the covered products by name (as required), and may include non-covered products in one of the fields for reporting associated product.” 
With respect to reporting multiple products, CMS finalized that applicable “manufacturers may report up to five related covered products for each interaction.” If the interaction “was related to more than five products, an applicable manufacturer should report the five products which were most closely related to the payment or other transfer of value.”  
Additionally, when aggregating payments or other transfers of value by product, CMS will not represent a single interaction related to multiple products as multiple interactions.  However, CMS does “not agree that the applicable manufacturer should report the percentage of the interaction dedicated to each product” because this will be “burdensome to the applicable manufacturers and would not be beneficial to consumers, since it will greatly increase the volume of the data.” 
CMS also agreed in allowing greater flexibility in reporting the product name, particularly for devices where the product name is less recognizable to consumers.  For drugs and biologicals, CMS finalized that applicable manufacturers must report the market name of the product and must include the NDC (if any).”  If a market name is not yet available, applicable manufacturers should use the name registered on clinicaltrials.gov.  CMS said that reporting the NDC will greatly help CMS aggregating the data by product.  However, if there is no NDC available for a product, it does not have to be reported.   
For devices and medical supplies, §403.904(c)(8)(ii) allows reporting of either the name under which the device or medical supply is marketed, or the therapeutic area or product category.  CMS believes that reporting devices and medical supplies in this manner is appropriate, since device names are less known to consumers and a single product may actually be comprised of multiple devices.  Whereas the names of drugs and biologicals are more readily available to consumers, since they are often listed on a prescription. 
Form of Payment and Nature of Payment:  CMS finalized that categories within both the form of payment and the nature of payment should be defined as distinct from one another.  Additionally, if a payment or other transfer of value for an activity is associated with multiple categories, such as travel to a meeting under a consulting contract, CMS proposed that the travel expenses should remain distinct from the consulting fee expenses and both categories would need to be reported to accurately describe the relationship.  In these cases, CMS proposed that for each payment or other transfer of value reported, applicable manufacturers may only report a single nature of payment and a single form of payment. 
For example, if a physician received meals and travel in association with a consulting fee, CMS proposed that each segregable payment be reported separately in the appropriate category.  The applicable manufacturer would have to report three separate line items, one for consulting fees, one for meals and one for travel.  The amount of the payment would be based on the amount of the consulting fee, and the payments for the meals and travel.  For lump sum payments or other transfers of value, CMS proposed that the applicable manufacturer break out the distinct parts of the payment that fall into multiple categories for both form of payment and nature of payment. 
CMS agreed that if a payment could fit within multiple possible categories, applicable manufacturers should have flexibility to select the category that best described the payment, in accordance with their own documented methodology.  However, this should “not be used to bundle payments of separate categories into a single payment.  For example, “a meal should be reported as a meal, even if associated with travel or a consulting contract.  Additionally, serving as a faculty for a medical education program should be reported separately from a consulting contract, even if the medical education program speech was similar in content to the consulting services provided by the covered recipient.” 
Form of Payment:  CMS agreed that "stock, stock option, or any other ownership investment interest, dividend, profit or other return on investment" category should be divided into two categories.  CMS did not add any additional categories to form of payment.   
Nature of Payment:  CMS stated that providing “precise precise definitions for applicable manufacturers to use in categorizing nature of payments will be too restrictive.”  CMS clarified that the nature of payment categories are simply used to “describe” these payments, and all payments must be reported unless they fall within an exception.  CMS recognized that “relationships between applicable manufacturers and covered recipients are extremely diverse;” and expressed concern that “providing specific, narrow definitions would not encompass every situation, forcing applicable manufacturers to describe payments or other transfers of value by less specific categories that do not accurately describe the relationship.” 
CMS recognized that an agreement to “appear as an author of a ghostwritten article is an important relationship that should be reported,” but said there are “sufficient existing nature of payment categories, such as compensation for services other than consulting, which can be used to describe the relationship.” 
CMS, however, added as a new nature of payment category “pace rental and facilities fees,” because the agency agreed that “space rental or facility fees are commonly part of hosting an event at a hospital and believe that including them in another category would inflate the amount in that category.”  
In providing additional explanation of the nature of payment categories, CMS noted that such “explanations are not exhaustive (unless specified as such), but rather are intended to provide additional guidance to applicable manufacturers when they are categorizing payments.” 
Charitable Contributions: CMS finalized this category as proposed.  However, CMS clarified that “charitable contribution” nature of payment category “should be used only in situations when an applicable manufacturer makes a payment or other transfer of value to a charity on behalf of a covered recipient and not in exchange for any service or benefit.”  For example, in circumstances where a physician provides consulting services to an applicable manufacturer, but requests that his payment for the services be made to a charity, this would not be a charitable contribution for purposes of this rule because the payment was not provided by the applicable manufacturer as a charitable contribution, but rather as a directed consulting fee.”  This payment would be reported as a consulting fee with the physician as the covered recipient, but the entity paid would be the charity. 
In the cases of teaching hospital covered recipients that have tax-exempt status under the Internal Revenue Code of 1986, “payments or other transfers of value made to these organizations (other than payments or other transfers of value made for expected services or benefits, such as consulting services or rental of space in a hospital for an event) would be considered and reported as charitable contributions for purposes of this rule.” 
Food and Beverage: CMS acknowledged the complications of reporting food, and noted that “tracking exactly what a person ate or drank may not be practical for purposes of the reporting requirements.”  CMS also recognized many concerns from commenters about attributing meals to all covered recipients in a practice “because it may be difficult for applicable manufacturers to identify all the physicians within a practice, and this methodology could implicate concerns of off-label marketing in large multispecialty practices.”  Accordingly, CMS made several revisions. 
For meals in a group setting (other than buffet meals provided at conferences or other similar large-scale settings), CMS will require applicable manufacturers to report the per person cost (not the per covered recipient cost) of the food or beverage for each covered recipient who actually partakes in the meals (that is, actually ate or drank a portion of the offerings).”  In other words, applicable manufacturers should divide the total value of the food provided by the number of people.
> In the News: Physician Sunshine Act 0 - legal analysis download PDF [14pp, 944KB]
> Summary Table of Reporting Requirements - Online
Includes material and analysis compiled by Thomas Sullivan of policymed.com:
 

Background and History - 2006-2012
In 2006, then Health and Human Services Secretary Mike Leavitt wrote an op ed column about the need for better access to healthcare quality and cost information.  "Americans know the price of almost everything they pay for, except for one of the most important things they pay for— their healthcare,"  Secretary Leavitt pointed out.  He went on to say that, "People deserve to know, indeed they have a right to know, what their healthcare costs and how good it is.  Patients should also be able to see an estimate of the overall cost of the procedure, how much their insurer will pay and how much they will be expected to pay.  That kind of information will allow patients to become informed consumers making informed choices about one of the most 'priceless' things in life — their health." 3

The federal government push to increase people's awareness of their health care spending goes hand-in-hand with getting hospitals, physicians and health insurance companies to share more price information.  More people have a reason to know what they spend on health care, due in part to the increasing popularity of high-deductible health insurance (see NCSL's related online report, "State Legislation on Health Savings Accounts and Medical Savings Accounts") and the persistent rise in uninsured consumers.1  Secretary Leavitt, speaking during a White House conference call on August 22, 2006, indicated that states can play an important role in supporting quality initiatives that are already in place.  "Initiatives have to be local in order to gain the trust and respect [of residents].  We need to have a network of local systems," Leavitt said.

On May 21, 2009, the U.S. Congress referred H.R. 2566: Hospital Price Transparency and Disclosure Act of 2009 to the House Energy and Commerce Committee. The purpose of the bill was to amend the Public Health Service Act to provide for the public disclosure of charges for certain hospital and ambulatory surgical center services and drugs.

On February 25, 2010, H.R. 4700: Transparency in All Health Care Pricing Act of 2010, legislation that would require all health care providers and manufacturers to disclose publicly the prices of their services, procedures, and products, was introduced in the U.S. Congress. The House Energy and Commerce Health Subcommittee held a hearing on May 6, 2010 to discuss this bill, as well as the multiple pieces of legislation addressing transparency in health care pricing. Specifically, the hearing focused on H.R. 4700, the Transparency in All Health Care Pricing Act of 2010; H.R. 2249, the Health Care Price Transparency Promotion Act of 2009; and H.R. 4803, the Patients' Right to Know Act. H.R. 2249, the Health Care Price Transparency Promotion Act of 2009 and H.R. 4803, the Patients' Right to Know Act are sponsored by Republicans and have industry support. There were efforts to merge the two bills. The existence of such bills reflected steps at the federal level to improve transparency.

In March 2012 the GAO issed a new report: HEALTHCARE PRICE TRANSPARENCY: Meaningful Price Information Is Difficult for Consumers to Obtain Prior to Receiving Care—In this report GAO examined (1) how various factors affect the availability of health care price information for consumers and (2) the information selected public and private health care price transparency initiatives make available to consumers. 
 

State Efforts

Summaries of signed laws and proposed state legislation are provided in Table 1 below, including measures affecting disclosure, transparency, reporting and/or publication of health care, provider and hospital charges and fees.  It includes laws in at least thirty states, including: Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin.  Note that the structure and requirements vary widely by state and include some pilot programs and pre-implementation steps.  While a majority of states have some disclosure requirement in place, a majority of day-to-day actual charges for individual treatment may not be covered by these statutes.   

  • In 2003, New Hampshire enacted a statute [Title XXXVII, Chapter 420-G, Section 11a]  that created the New Hampshire Comprehensive Health Information System (CHIS) with data used to provide information for consumers and employers on an interactive website called New Hampshire HealthCost (www.nhhealthcost.org).  The site provides comparative information about the estimated amount that a hospital, surgery center, physician, or other health care professional receives for its services. For an insured individual, HealthCost provides information that is specific to that person’s health benefits coverage. It also shows health costs for uninsured patients. Employers can use the Benefit Index Tool on the website to compare different carriers' health plan premiums versus benefit richness. For a discussion of price transparency state implementation, see the online article "Texas Legislates Medical Price Transparency" by the Heartland Institute, 11/1/07.  "Having witnessed the recent years' incredible growth in the cost of health care, it's become clear we need more transparency for Texans considering their medical needs," Senator Duncan said. "This new law will move the Texas health care industry toward becoming a more market-driven entity, which will ultimately benefit consumers and practitioners."

  • South Dakota SB 182 of 2008  expands the state's existing hospital pricing Web site, which lists the median prices for the top 25 inpatient procedures at each of the state's hospitals, to include outpatient procedures. They "could could be a pioneer in transparency of health care costs."

  • New Jersey's law, A 2609 of 2008, caps hospital charges at no more than 15 percent above the Medicare payment rate for residents with a gross family income less than 500 percent of the federal poverty level. The law also requires that the state Department of Health and Human Services develop a sliding fee scale based on family income to be used in order to determine reasonable costs for hospital services. 9/20/08.

  • Minnesota approved SF 3780 to extend health care coverage to families with children earning up to 275% of the poverty line.  The bill also gives patients more information on the cost and quality of care, offers incentives to providers to cut costs and improve quality.  It was signed into law on May  29, 2008.  Minnesota's Web portal [http://mnhealthscores.org/] allows consumers to compare the average amount insurance plans pay to Minnesota health care providers for various medical procedures. The portal lists the average amount health plans pay to 110 Minnesota health care providers for 103 common medical procedures. It covers about 85% of primary care services in Minnesota. The tool is an expansion of MN Community Measurement's existing site on quality measurements. Gov. Tim Pawlenty said he hopes the comparison portal will help the state curb rising health care costs. Source:  New Minnesota Web Tool Helps Patients Compare Cost of Care, Minneapolis Star Tribune, 8/26/09.
  • In California, the regulation "Payers' Bill of Rights" requires all hospitals to provide their charge description master (CDM) to the state, which then posts them online for the public.  State of California Office of Statewide Health Planning and Development desribes the state process in (August 8, 2012). "Healthcare Information Division: Annual Financial Data – General Information About the Hospital Chargemaster Program", published August 8, 2012. [link updated 3/15/2013]
  • Maryland is the only state that retains ongoing regulation of Hospital charge procedures.   Author Peter Reid Kongstvedt notes in Essentials of Managed Care, "Of particular importance, other than in Maryland, hospitals are generally free to charge whatever they want in their chargemaster."[9]
  • As a result of a major legal action against New York health plans, $100 million has been collected from health plans that operate in New York state to be used for the creation of a new public database that can be used to determine usual, customary and reasonable (UCR) rates for out-of-network providers, which N.Y. Attorney General Andrew Cuomo (D) announced would be housed at Syracuse University. 11/6/09. 

All-Payer Claims Databases

In recent years, several states have established databases that collect health insurance claims information from all health care payers into a statewide information repository. Known as “all-payer claims databases” or “all-payer, all claims databases,” they are designed to inform cost containment and quality improvement efforts. Payers include private health insurers, Medicaid, children’s health insurance and state employee health benefit programs, prescription drug plans, dental insurers, self-insured employer plans and Medicare (where it is available to a state). The databases contain eligibility and claims data (medical, pharmacy and dental) and are used to report cost, use and quality information. The data consist of “service-level” information based on valid claims processed by health payers. Service-level information includes charges and payments, the provider(s) receiving payment, clinical diagnosis and procedure codes, and patient demographics. To mask the identity of patients and ensure privacy, states usually encrypt, aggregate and suppress patient identifiers. For more information please visit NCSL's Cost Containment brief about the subject, Collecting Health Data: All-Payer Claims Databases.

Disclosure of Prescription Drug Prices

A prescription drug price report issued by the AARP back in 2005, found that the manufacturer prices for brand name prescription drugs continue to rise at an average rate that greatly outpaces general inflation.6  Public posting of drug prices is one way in which states have sought to increase accessibility and affordability of prescription medications.  Many states already have programs in place that help those in need (see NCSL reports on State Pharmaceutical Assistance Programs ).  To help consumers help themselves, many states are using comparative drug research. Often the most expensive drug isn't always more effective. Giving consumers information about the comparative cost and effectiveness of medications is helping people learn more about lower cost treatments.

Several states have launched drug pricing Web sites to help consumers shop for common prescription drugs.  In January 2007, Missouri unveiled a drug price comparison Web site called Price Compare that allows users to compare the price of prescription and over-the-counter drugs.  The site is managed by the Department of Social Services and is a component of the state's 2005 prescription drug program.  Florida has seen success in lowering drug prices and increasing consumer awareness with its Web site called MyFloridaRx.com.  The site was created with data that were already being collected from pharmacies, with prices updated monthly, of the 100 most commonly sold brand-name drugs in the state.  Maryland's Attorney General created that state's Prescription Drug Price Finder to help consumers comparison shop among pharmacies.  The site provides information on the 26 most commonly used drugs in Maryland, as reported by the state's Medical Assistance Program.  New York also has a drug price comparison Web site created by statute in 2006 and maintained by the Office of the Attorney General.  The New Jersey Prescription Drug Retail Price Registry, created by 2006 Assembly Bill 2537, will allow consumers to compare the retail prices of the state's 150 most commonly prescribed drugs.  Governor Corzine signed the bill into law in August 2006 and the Registry is operational as of 2007.  See Table 2 below for examples of proposed legislation.

Web-based Provider and Hospital Price Disclosure Plans

  • Arizona hospitals and nursing home facilities cost information can be found on the Department of Health Services, Division of Public Health Services web page.

  • California currently posts hospital cost comparisons on its state government website and on the Office of Statewide Health Planning and Development Healthcare Quality and Analysis Division Web page for prices of all services, goods and procedures for California hospitals. California also has Common Surgeries and Price Comparison a state Web tool allowing healthcare consumers to view and compare the price of 28 common elective inpatient procedures at hospitals across California. Posted 10/09.

  • Colorado Hospital System To Post Out-of-Pocket Costs Online - Catholic Health Initiatives in Denver is partnering with Centura Health to test hospital software that will allow patients to see what their out-of-pocket charges will be before they register to become patients, the Rocky Mountain News reported.  The system analyzes copayments, deductibles, coverage and the 10% to 20% of hospital costs that the patient is charged. The software, developed by Financial Healthcare Systems, estimates the cost for patients based on specific procedures and the patient's insurance. 

  • Florida has established a Web site that enables consumers to obtain data on hospitals' charges and readmission rates.(http://www.floridahealthfinder.gov/CompareCare/SelectChoice.aspx).

  • The Iowa Hospital Association has a Web site that provides information on every charge for any type of inpatient procedure in all Iowa hospitals. Iowa Hospital PricePoint is also the access point for aggregate discount information  for private insurance, Medicare, and Medicaid, allowing users to compare charges to revenue for hospital services. 

  • Louisiana has a voluntary reporting program called, "Louisiana Hospital Inform" that is maintained by the Louisiana Hospital Association.  The website provides pricing data on the most common Medicare inpatient and outpatient services, as well as quality data, demographic information and services offered at Louisiana hospitals. 4

  • The Maryland Health Care Commission provides consumers with an online hospital pricing guide that lists, for each acute care hospital in Maryland, the number of cases, the average charge per case, and the average charge per day for the 15 most common diagnoses.

  • Massachusetts, as part of its health care reform law, established a website that allows consumers to compare the quality of hospitals and clinics, as well as the average payment each charges for a range of services.  Massachusetts already had a website, but the new site will have much more information, including prices for hospitals and for the cost of prescriptions at individual pharmacies.  

  • Michigan Hospital Association lauched an online website in January 2008 with non-profit hospital prices for at least 50 medical test, procedures and operations. See:  http://www.mihospitalinform.org/

  • Some Minnesota health insurers unveiled or updated websites that allow their members to compare pricing and quality information for a variety of procedures and services.  Medica has a members-only comparison website listing the charges for common inpatient and outpatient procedures.  HealthPartners maintains a members-only site that provides cost data for over 50 treatments and 100 services.  Blue Cross Blue Shield of Minnesota will launch an updated site in mid-July.  The Minnesota Hospital Association maintains a website called Minnesota Hospital Price Check that provides patients with the cost of the 50 most common inpatient and the 25 most common outpatient procedures at specific hospitals. 

  • New Hampshire has a hospital price website called "New Hampshire PricePoint," which is sponsored and maintained by the New Hampshire Hospital Association.  There is also a voluntary effort in Oregon called "Oregon Pricepoint," which is sponsored and maintained by the Oregon Association of Hospitals and Health Systems.  These sites allow health care consumers to receive basic, facility-specific information about services and charges.4

  • New Jersey -Two Web sites have been launched to help consumers make informed choices regarding price and quality of hospital services in New Jersey. The site www.njhospitalpricecompare.com includes a Top 25 DRG Search; a separate site, www.njhospitalcarecompare.com covers quality of care.

  • The Utah Public Employee Health Plans (PEHP) published an online Treatment Cost Estimator Home and a separate PEHP Average Costs list for infant deliveries, effective 2008. 

  • Virginia issued a "Health Reform Commission Road Map" Report in September 2007.  Their chapter on Transparency (see pages 70-76), is a detailed and timely summary of issues and recommendations that may be addressed in the 2008 legislative session.

  • In Wisconsin, information on hospital charges for common procedures is available online; basic price information is available on a Web site run by the Wisconsin Hospital Association that draws on data collected by the state.  Price Point, displays typical charges and lengths of stay for individual hospitals, alongside state and county averages.  Wisconsin lawmakers were among the first in the country to require hospitals to report their prices to the state, but that information remained difficult for the general public to use for a decade until the state gave the job of making it public to the hospital association in 2003.5

Private Insurance Company Price Disclosure Websites

  • Aetna: Hospital costs compared; hopes tool will turn patients into savvy health shoppers. Sacramento Business Journal, 12/7/07.
     
  • North Carolina BCBS Posts Cost Data Online. Blue Cross and Blue Shield of North Carolina has posted cost information on medical procedures, prescription drugs, office visits and other services for its members. The insurer hopes the data will increase physician-patient discussions about costs, but some health care stakeholders warn that knowing the cost of procedures could deter patients from seeking treatment.  Raleigh News & Observer Article, 1/18/08.
     
  • Cigna posts cost and quality data for inpatient services performed at hospitals, as well as outpatient procedures performed at stand-alone surgical centers.  The website includes cost and quality information for 21 inpatient, 16 outpatient and 3 medical imaging services performed by specific health care facilities (this information is currently for Cigna members only). 
     
  • In 2006, Humana launched a feature on its website that allows its members to compare the average negotiated prices of more than 30 procedures in 10 disease categories at local hospitals.
     
  • In 2006, Grand Rapids, Michigan-based Spectrum Health began posting prices for more than 100 inpatient and outpatient services.  The prices are approximate and include only what hospitals charge; no physician charges are outlined.
     
  • United HealthCare offers its members online access to a cost estimator that provides an average national cost for common health and dental procedures.
     
  • WellPoint launched a website in 2006 that allows members to compare hospital prices for the total care associated with several common procedures.

Additional Resources

Table 1: Enacted State Legislation Relating to Health Care Price Disclosure

**Links are included for laws and initiatives where available.  Listed measures are examples, not necessarily a comprehensive tabulation 

State
State Statutes/Laws - with citations, summaries
AZ

SB 1142, Arizona Revised Stat. 36-125.05.  (Sen. Leff)- Requires the Arizona Dept. of Human Services to implement a uniform patient reporting system for all hospitals, outpatient surgical centers and emergency departments, including average charge per patient, average charge per physician. Also requires the state to publish a semiannual comparative report of patient charges, and simplified average charges per confinement for the most common diagnoses and procedures. (Signed into law by governor 4/18/05.)
AR

A.C.A. § 20-7-305 (HB 1513)- Would provide data to the Arkansas Hospital Association for its price transparency and consumer-driven health care project that will make price and quality information about Arkansas hospitals available to the public. (Signed into law by governor as chapter 616, 3/28/07.)
CA

CA Health & Safety Code §1339.56. AB 1045- Requires that hospitals disclose prices for the top 25 most common outpatient services or procedures, and requires, upon request, a person to be provided with a written estimate of charges for the health care services that are reasonably expected to be provided and billed to the person if the person does not have health coverage. (Signed into law by governor on 10/5/05 as Chapter 532, Statutes of 2005.)

CA Health & Safety Code §1339.585- Upon the request of a person without health coverage, a hospital shall provide the person with a written estimate of the amount the hospital will require the person to pay for the health care services, procedures, and supplies that are reasonably expected to be provided to the person by the hospital, based upon an average length of stay and services provided for the person's diagnosis. (Signed law 2004.)
CO

C.R.S. 6-20-101- Requires hospitals and other licensed or certified health facilities to disclose the average facility charge for treatment that is a frequently performed inpatient procedure prior to admission for such procedure. (Signed into law 2003 and 2004.)

HB 1278- Creates a comprehensive hospital information system to increase health care transparency. (Signed into law 6/2/06.)

HB 1385- Requires the Commissioner of Insurance to maintain a website that displays a consumer guide on insurance provided to the division by health insurance carriers; creates an exception for information that is proprietary pursuant to CO open laws; requires insurance producers, when soliciting or negotiating an application for coverage, to disclose financial information to consumers. (Session Law Chaptered - Chapter No. 409. 6/20/08.)

C.R.S.A. § 10-16-134- On or before March 1, 2009, and on or before March 1 each year thereafter, each carrier shall submit to the division a list of the average reimbursement rates, either statewide or by geographic area, as defined by rule of the commissioner for the average inpatient day or the average reimbursement rate for the twenty-five most common inpatient procedures based upon the most commonly reported diagnostic-related groups. The commissioner shall post the information on the division's web site. The web site and information is easy to navigate, contains consumer-friendly language. (Laws 2008, Ch. 294, § 4, eff. May 27, 2008.)

C.R.S.A. § 25-3-705 (HB 1393)- Requires the Insurance Commissioner with the Association of Hospitals to approve an information system that records charges for common inpatient procedures and diagnostic-related groups; requires the hospital charges to be available on an internet website; requires each health insurance carrier to report certain information, including reimbursement rates and includes that information on the website; requires the Health Care Task Force to study the submission of data by ambulatory surgical centers. (Law Chaptered as Chapter No. 294, 6/20/08.)
CT

Statute and regulations- Require reporting of hospital charge information for inpatient and outpatient services, in addition to negotiated payment rates with third party payers, government payment rate information and hospital costs.**
DE

Del. Code Title 16, Ch. 20- Requires periodic compilation and dissemination of reports on charge levels, age-specific utilization patterns, morbidity patterns, patient origin and trends in health care charges.
FL

F.S.A. § 395.1051- A licensed facility not operated by the state shall notify each patient during admission and at discharge of his or her right to receive an itemized bill upon request. (Signed law, amended 2004.)

HB 7073- Would establish the "Coordinated Health Care Information & Transparency Act," which would provide better coordination of information for transparency purposes. (Signed law, 6/20/06.)
GA

Statute- Requires hospitals to report UB-92 claims data for all inpatient services.  Outpatient claims are reported for emergency room and ambulatory surgery services.**
IL

HB 2343- Requires ambulatory surgical treatment centers and hospitals to adopt a uniform system for submitting patient charges for payment from public and private payers. Amends 20 ILCS 2215/4-4(a), which required hospitals to make available to prospective patients information on the normal charge incurred for any procedure or operation the prospective patient is considering. (Signed into law by governor on 6/14/05 as Public Act 94-0027.)
IN

IC 16-21-6- The Indiana Hospital Financial Disclosures Law requires hospitals to provide the state with audited financial statements, Medicare Cost Reports, and gross charge information.
IA

HB 2539- Institutes reporting requirements of annual compensation of certain officers and medical staff of non-profit health care providers to the state.  A health care quality and cost transparency work group is created to recommend legislation to provide transparency to health care consumers. (Signed into law by governor, 5/13/08.)
KY

KRS 216.2929(1) - Requires that the Cabinet for Health and Family Services prepare and publish, in understandable language with sufficient explanation to allow consumers to draw meaningful comparisons, a report on health care charges, quality, and outcomes that includes diagnosis-specific or procedure-specific comparisons for each hospital and ambulatory facility.
ME

22 M.R.S.A. § 8712- The Onpoint Health Data Organization must distribute reports on a publicly accessible site on the Internet or via mail or e-mail. They must make reports available to members of the public upon request. The organization, must promote public transparency of the quality and cost of health care in the State in conjunction with the Maine Quality Forum, and shall develop and produce annual quality reports collect, synthesize and publish information and reports on an annual basis that are easily understandable by the average consumer and in a format that allows the user to compare the information listed in this section to the extent practicable.  At a minimum, the organization shall develop and produce an annual report that compares the 15 most common diagnosis-related groups and the 15 most common outpatient procedures for all hospitals in the State and the 15 most common procedures for nonhospital health care facilities in the State to similar data for medical care rendered in other states,when such data are available. The organization shall distribute this report to all physician practices in the State. The first report must be produced by July 1, 2004. (Approved April 7, 2010.)
MD

Statute and regulations- Require monthly reporting of hospital charge information and hospital costs for inpatient and outpatient services.**
MA

H 490, §101 (Chapter 58 of 2006)- As part of universal health plan, establishes the Commonwealth Health Insurance Connector, to "facilitate the purchase of health care insurance products at an affordable price by eligible individuals, groups and other plan enrollees," by publishing a commonwealth care health insurance program consumer price schedule. (Passed House and Senate 4/4/06; signed into law by governor 4/12/06.)

MN

M.S.A. § 62J.82- Requires the development of a web-based system for reporting charge information,  including average charge, average charge per day and median charge, for each of the 50 most common inpatient diagnosis-related groups and the 25 most common outpatient surgical. The site must be established by 10/1/06. (Signed into law by governor, 2005.)

SF 3780 gives patients more information on the cost and quality of care, establishes electronic prescription drug program and offers incentives to providers to cut costs and improve quality.  (Signed into law by governor on 5/29/08.)

M.S.A. § 62U.04- The commissioner of health shall develop a plan to create transparent prices, encourage greater provider innovation and collaboration across points on the health continuum in cost-effective, high-quality care delivery, reduce the administrative burden on providers and health plans associated with submitting and processing claims, and provide comparative information to consumers on variation in health care cost and quality across providers. (Laws 2008, c. 358, art. 4, § 7, eff. July 1, 2008. Amended by Laws 2009, c. 101, art. 2, § 109, eff. July 1, 2009; Laws 2010, c. 344, §§ 1, 2, eff. Aug. 1, 2010.)
MO

Missouri Rev. Stats. §192.667- Requires all hospitals and health care providers to provide charge data to the Department of Health and Senior Services.
NE

Neb. Rev. St. § 71-2075- Requires hospitals and ambulatory surgical centers to provide a written estimate of the average charges for health services. (Signed into law, 1984, 1995.)
NV

NRS 439B.400 - Requires all hospitals to maintain and use a uniform list of billed charges for units of service or goods provided to all inpatients.  A hospital may not use a billed charge for an inpatient that is different from the billed charge used for another inpatient for the same service or goods provided.
NH

Statute and regulations- Require reporting of information for all inpatient services and all outpatient ambulatory surgery and emergency room services.**
NJ

A. 2609 of 2008 caps hospital charges at no more than 15 percent above the Medicare payment rate for residents with a gross family income less than 500 percent of the federal poverty level. The law also requires that the state Department of Health and Human Services develop a sliding fee scale based on family income to be used in order to determine reasonable costs for hospital services. (Note - this is not a transparency requirement but its impact would parallel several goals of disclosure laws.)
NM

House Memorial 43 of 2005 (Rep. Payne)- Non-binding resolution, requests that hospitals work with state agencies to develop a process to post hospital charges, hospital quality, and annual increases in hospital charges.(Approved by Senate 4/05.)

Statute- Requires reporting of information for inpatient services based on UB-92 claims data that is reported to the state Health Policy Commission and the hospital association on a quarterly basis.  The hospital association will implement a public reporting initiative modeled after Wisconsin's Pricepoint project in Fall 2006.**
NC

NC Gen. Stats. Ch. 131E-214.4- Requires that a report that includes a comparison of the 35 most frequently reported charges of hospitals and freestanding ambulatory surgical facilities be made available to the Division of Facility Services of the Department of Health and Human Services.
OH

Ohio Rev. Code § 3727.12- Requires reporting of hospital charges for the top 100 Diagnosis Related Groups, operating room costs, emergency procedures, physical therapy, and the top 30 x-rays and laboratory procedures.

HB 197- Requires a hospital to make its price information list available free of charge on its web site to any person and post an announcement of the list's availability in each of the hospital's billing offices and admission, patient waiting, and reception areas. (Signed into law by governor on 8/9/06.) 

OK

HB 1884- Creates a 19-member Health Care Consumer Transparency Task Force that is responsible for making a final report containing recommendations related to a system for hospitals, ambulatory surgical centers and physicians to disclose to consumers the average charges for the treatment of common medical diagnosis and procedures. (Signed into law by governor, 5/25/07.)
OR

Statute- Requires reporting of information on all inpatient and outpatient services to the state Office of Health Policy and Research.  The information is based on inpatient and ambulatory surgery discharge records collected from hospitals.**

SB 329- Would ensure transparency of the costs of and charges by accountable health plans and providers. (Signed into law as chapter 697 by governor, 6/28/07.)
PA

35 P.S. §§449.5-449.7- Requires the Health Care Cost Containment Council to develop a computerized system for the collection, analysis and dissemination of health care quality and cost information.  Requires the Council to collect patient data, including total charges of health care facilities.  Requires the Council to make available the top 65% of all covered inpatient and outpatient hospital services and provide comparisons.
RI Gen.Laws 1956, § 23-17.17-9- Requires the establishment and maintenance of a unified health care quality and value database. It shall be designed to make available to consumers transparent health care price information, quality information and such other information determined necessary to empower individuals, including uninsured individuals, to make economically sound and medically appropriate decisions. (P.L. 2008, ch. 114, § 1, eff. June 30, 2008; P.L. 2008, ch. 207, § 1, eff. July 4, 2008.)
SC

Statute and regulations- Require reporting of UB-92 claims data, including charges on all hospital inpatient discharges and some outpatient services, such as outpatient surgery, emergency department services, labor and delivery, radiation therapy, chemotherapy, imaging, lithotripsy and observation claims.**
SD

SB 169- Requires hospitals to report the charges for the 25 most common inpatient diagnostic groups to the Dept of Health, which must post the charges on its Web site. (Signed into law by governor on 3/1/05.)

SDCL § 34-12E-8- All fees and charges for health care procedures shall be disclosed by a health care provider or facility upon request of a patient.(Signed law, 1994.)

SB 182 of 2008  would expand the state's existing hospital pricing Web site, which lists the median prices for the top 25 inpatient procedures at each of the state's hospitals, to include outpatient procedures. (Signed into law by governor, 3/13/08.)
TN

Statute and regulations- Require reporting of information on all inpatient services to the Tennessee Hospital Association, as well as on such outpatient services as ambulatory surgery, emergency room visits, observations and selected procedures consistent with state Certificate of Need guidelines.**
TX

SB 1731 of 2007 standardizes billing requirements for physicians, insurers and hospitals and must disclose billing policies. Care providers must give estimates of expected charges and itemized statements on request by patients. Requires a consumer web site where patients will be able to access physician billing information and find average charges for procedures. (Signed into law as Ch. 997, effective 9/1/07.)

(2005) Statute and regulations- Require reporting of information on all inpatient services based on UB-92 claims.**
UT

Statute and regulation- Require reporting of information on all inpatient and outpatient services based on hospital discharge data.  Utah is planning to implement a public reporting initiative modeled after Wisconsin's Pricepoint project in Fall 2006.**

HB 9, Session Law Chapter 29 of 2007 (U.C.A. 1953 § 26-33a-106.1)- Authorizes the Health Data Committee, as funding is available, to collect data on the costs of episodes of health care.
VT

Statute- Requires reporting of information on inpatient services (average charge by hospital for the top 10 services) and on outpatient services (average charge for top 10 procedures and outpatient diagnostic tests).**

Act 191 (H.861) and Act 190 (H.895) of 2006: Multi-payer Database & Consumer Price and Quality Information- requires insurers and third party administrators to report data in order for BISHCA to provide price and quality information to consumers.

S 115- Increases transparency in prescription drug information and pricing; limits fraudulent advertising of prescription drugs to consumers and health care professionals; requires notice to clients by pharmacy benefit managers that certain types of contracts are available; strengthens the Medicaid preferred drug list; establishes an evidence-based education program; provides additional pricing information to the Medicaid program from drug manufacturers; requires marketers to disclose pricing information. (Signed into law by governor, 6/9/07.) 
VA

Statute and regulation- Require reporting of information on all inpatient services and selected outpatient services.  Hospital costs are also reported from annual financial filings and UB-92 forms.**

Va. Code Ann. § 32.1-276.5:1- The Commissioner shall negotiate and contract with a nonprofit organization for an annual survey of carriers offering private group health insurance policies, which are subject to HEDIS reporting, to determine the reimbursement that is paid for a minimum of 25 most frequently reported health care services which may include inpatient and outpatient diagnostic services, surgical services or the treatment of certain conditions or diseases. Each carrier shall report the average reimbursement paid for a specific service from all providers and provider types, to include hospitals, outpatient or ambulatory surgery centers and physician offices. (Acts 2008, c. 71; Acts 2008, c. 102.)
WA

RCW 70.41.250- Requires procedures for disclosing to physicians and other health care providers the charges of all health care services ordered for their patients.  Copies of hospital charges shall be made available to any physician and/or other health care provider ordering care in hospital inpatient/outpatient services.  The physician and/or other health care provider may inform the patient of these charges and may specifically review them.  Hospitals are also directed to study methods for making daily charges available to prescribing physicians using interactive software and/or computerized information thereby allowing physicians and other health care providers to review not only the costs of present and past services but also future contemplated costs for additional diagnostic studies and therapeutic medications.

Also, see SB 5930 of 2007.
WV

Statute and regulations- Require reporting of information on all inpatient and outpatient services by department and payer.  Other reported information includes negotiated payment rates with third party payers, government payment rate information and hospital costs.**
WI                                                                           

Wis. Stats. Ch. 153 (Health Care Information) - Requires hospitals and ambulatory surgery centers to report patient-level data, including charges assessed for specific procedure codes. (Signed law, 1992.)

AB 907 (Act 228)- Dedicates state funds to the WI Health Information Organization (WHIO), a coalition of managed care companies, employer groups, health plans, physician associations, hospitals and doctors, to analyze and publicly report the health care claims information with respect to the cost, quality, and effectiveness of health care, in language that is understandable by laypersons.   This new law is designed to collect credible and useful data for the purposes of quality improvement, health care provider performance comparisons, ready understandability and consumer decision-making. (Signed law, 2006.) 

 

** As reported in the "American Hospital Association's Hospital Pricing Transparency Survey," April 26, 2006.

Table 2 Archive: Examples of Prescription Drug Price Disclosure State Legislation from 2006-08

State Disclosure of Prescription Drug Prices:  Proposed Legislation
HI                                                                            
                                                                           		 HB 6 (also SB 818)- Would require a prescription drug manufacturer to report pharmaceutical pricing data to the director for each of its drugs, including the average wholesale price, the wholesale acquisition cost, the average manufacturer price, and the best price. (Filed and referred to committee 1/19/07, bills did not pass before end of 2007 regular session.)
IL HB 1082- Would create the Prescription Drug Price Finder Act to identify the 50 most commonly prescribed drugs in Illinois and their usual and customary prices. (Filed and referred to committee 2/8/07; passed House 3/22/07; postponed in Senate; did not pass before end of session.)
IA HB 506 (also SB 111)- Would provide for prescription drug retail price comparisons. (Filed and referred to committee 2/22/07; did not pass before end of session.)
NJ
 		 A 2537 (also S 1396)- Establishes the New Jersey Prescription Drug Retail Price Registry in the Department of Health and Senior Services (DHSS) for the purpose of making retail price information for the 150 most frequently prescribed prescription drugs readily available to New Jersey consumers.(A 2537 filed and referred to committee 2/23/06; passed Assembly 72y-3n, 6/8/06; substituted for S 1396 and passed Senate 40y-0n, 6/22/06; signed into law by governor 8/21/06.) Consumer web site: https://www6.state.nj.us/LPSCA_DRUG/index.jsp
NM  HB 320- Would require that the current retail price of a prescription drug be provided upon request. (Filed and referred to committee 1/18/07; passed House 63y-2n; did not pass Senate before end of 2007 regular session.)
RI SB 251- Would allow pharmacies to provide a list of 20 prescribed drugs to the Department of Health, in electronic format, with current selling prices.  The list would then be used to create a Web site accessible by the general public for pricing information. (Filed and referred to committee 2/7/07; held in committee 2/07, as of 11/07.)
TX HB 533- Would create a prescription drug retail price registry and require disclosure of a list of prescription drug retail prices for the 150 most commonly used medications; must be updated at least weekly. (Filed and referred to committee 1/10/07; did not pass by end of regular session 5/16/07.)
VT SB 115- Would increase transparency in prescription drug information and pricing by limiting fraudulent advertising of prescription drugs to consumers and health care professionals, requiring notice to clients by pharmacy benefit managers that certain types of contracts are available, strengthening the Medicaid preferred drug list, establishing an evidence-based education program, providing additional pricing information to the Medicaid program from drug manufacturers, requiring disclosure of education programs funded by drug manufacturers, and providing enforcement for prescription drug provisions under the Consumer Fraud Act. (Filed and referred to committee 2/23/07; passed Senate 28y-1n, 4/4/07; passed House 89y-44n, 5/4/07; signed into law by governor as Chapter 80, 6/9/07.)

 

Archived Legislation - Examples from 2005-2008

State

 Legislation

AK                                                                            

2005: SB 11 - A hospital that receives government money shall disclose the price that the hospital charges other patients who pay negotiated rates for the same medical service items and an itemized description of the costs used to calculate the price of each medical service item on the patient billing. (Did not pass by end of 2006 regular session).

2008: HB 337- Creates the Alaska Health Care Information Office and a related Internet site to provide consumers consistently updated information about all health care facilities in the state. (Did not pass House 3/1/0/08.)                                                                                                                            

AR

2005: HB 2575- Would require hospitals and medical professionals to disclose the costs of the most common services and procedures. (Did not pass committee by the end of 2005 regular session.)

CA

2005: SB 917- Would establish the Hospital Transparency Act of 2005, which amends the Payers' Bill of Rights to require the Office of Statewide Health Planning and Development (OSHPD) to compile and publish on its Web site the top 25 most common Medicare DRGs and the average charge for each by hospital. (Vetoed by governor on 10/6/05.)

2006: AB 2281 (Assm. Chan) - Would require health plans/insurers to provide specified information including disclosure of charges consumers can expect to pay for contracting and non-contracting providers, and what percent of premiums plans/insurers actually spend on health care services, as part of facilitating use of Health Savings Accounts. (Filed and referred to committee 3/06; passage refused 5/31/06.)

CO

2006: SB 141- Would establish the "Health Care Transparency Act," which would require hospitals and ambulatory surgical centers to report on any Medicare/Medicaid funds or reimbursements received. (Filed and referred to committee 2/06; passed Senate 20y-15n, 4/19/06; did not pass House before end of 2006 regular session.)

CT

2005: SB 117- Would require hospitals to inform consumers about the cost of hospital goods and services. (Did not pass committee by end of 2005 regular session.)

2009: S 295- Establishes medical loss ratio transparency; provides transparency of medical loss ratio information to consumers. (Filed 1/22/09; did not pass, 3/12/09.)

FL

2006: HB 1409- Would establish the "Florida Health Information Network Act," which would implement a statewide electronic medical records network to increase individual’s access to his or her own health care information and increase transparency in the health care system. (Filed and referred to committee 3/3/06; passed House 120y-0n, 4/27/06; did not pass Senate committee by end of 2006 regular session.)

GA

2005: SB 83- Would require hospitals and medical facilities to provide estimates of charges to patients and requires hospital authorities to make certain information available on their Internet websites. (Filed and referred to committee 1/28/05; no further action taken.)

2007: HB 628- Would provide for health care data to be made available to consumers; would create a Web site that supports health care transparency so that consumers of the State of Georgia may access information to perform a comparative analysis of the cost and quality of health care. (Filed and referred to committee 2/28/07; did not pass at the end of session.)

IN

2005: HB 1716- Would require hospitals and ambulatory outpatient surgical centers to provide billing information to patients and the public, establish an appeal procedure for disputed patient bills, and establish programs that provide reduced cost of care to eligible individuals and alternative payment options to other individuals. (Did not pass committee by end of 2005 regular session.)

KS

2007: HB 2272- Would create the Health Care Price Transparency Act, providing disclosure and availability of prices charged by certain health care providers and reimbursed by health insurance carriers for health or medical care services. (Filed and referred to committee 1/29/07; did not pass at the end of session)

2009: H 2291- Would enact the health care price transparency act; would prescribe disclosure and availability of prices charged by certain health care providers and reimbursed by health insurance carriers for health or medical care services. (Filed 2/5/09; carried over to 2010.)

KY

2006: HB 622 - Would require the Cabinet for Health and Family Services to make health data on the cost and quality of health care available to consumers. (Filed and referred to committee 2/21/06; did not pass by end of 2006 regular session.) 

2006, 2007: HB 445 - Would require the Cabinet for Health and Family Services to make information on charges for health care services available on its Web site.  This information would allow the public to make meaningful comparisons between hospitals, ambulatory facilities, and provider groups. (Filed and referred to committee 1/24/06; passed House 95y-1n, 2/7/06 did not pass Senate by end of 2006 regular session; Refiled (Passed House; did not pass Senate, 2007.)

ME

2005: LD 211 (LR 2121) - Would require hospitals to disclose to the public the amounts charged to the 10 most frequent payers for each service or procedure. (Referred to committee, Died in committee 5/18/05.)

2005: LD 1307- Would require health care practitioners to provide the same consumer price information required of hospitals and ambulatory surgical centers.  (Referred to committee, Died in committee 5/20/05.)

MA

2008: S 2517- Promoting healthcare transparency and consumer-provider partnerships. (Favorable redraft report, 2/28/08; did not pass at the end of session.)

2009: S 316- Would protect against unfair prescription drug prices; would ensure transparency in contracts and in prescription drug pricing.  (Filed 1/19/09; carried over to 2010.)

MN

2005: HF 2438 - Would require the MN Hospital Assoc. to develop a Web-based system for reporting and displaying cost information reported by hospitals to the association. (In committee as of 4/18/05; no 2006 action taken.)

2005: SF 1162- Would require and provide for the disclosure of certain hospital costs to the commissioner of health. (In committee as of 4/6/05; no 2006 action taken.)

MO

2005: SB 359- Would provide for price and performance comparisons of health care facilities to be posted on a state Web site. (Did not pass committee by end of 2005 regular session.)

NV

2005: AB 545 - Would require medical facilities to provide estimate of cost of medical procedure to patient before procedure occurs. (Did not pass committee by end of 2005 regular session.)

2005: AB 353- Would require hospitals to submit to the Dept of Health and Human Services their charges and the hospitals' provision for discounted prices for the uninsured. (Did not pass committee before end of 2005 regular session.)

OK

2009: S 642- Would direct the state department of health to publish a guide with billing practices of health care facilities; would require health care facilities to provide estimates. (Carried over to 2010 session, 2/09.)

OR

2005: SB 1040- Would modify the duties of the Administrator of Office for Oregon Health Policy, Research regarding obtaining, and reporting health care data. (Did not pass committee by end of 2005 regular session.) 

RI

2005: SB 788- Would require every health care facility that has an emergency medical unit post a notice of average or minimum facility and professional charges and costs per patient visit. (Did not pass by end of 2005 regular session.)

TX

2005: HB 3276- Would require health care facilities to report and disclose estimated charges. (Did not pass committee by end of 2005 regular session.)

UT

2006: HB 203 (Rep. Hutchings)- Would require hospital and related medical billing to include plain English explanation of charges. (Filed 1/19/06; did not pass committee by end of 2006 regular session.) 

2006: HB 246  (Rep. Morley)- Would authorize the state Health Data Committee to collect data on the costs of episodes of health care and develop a plan to measure and compare costs of care, as part of easing use of Health Savings Accounts. (Filed 1/11/06; passed House 2/22/06; did not pass Senate by end of 2006 regular session.)

2006: HB 301 (Rep. Hutchings) - Would provide Consumer Access to Health Care Provider Charges, as part of consumer-driven and HSA health initiative. (Filed 1/19/06; did not pass committee by end of 2006 regular session.)

2009: HB188- Health reform plan includes requiring insurers who offer health benefit plans on the Internet portal to provide greater transparency and disclose information about the plan benefits. (Signed into law 3/11/09.)

WA

2007: SB 5930- Provides cost and quality data for consumers and providers by creating a blue ribbon commission on health care costs and access. (Passed Senate 48y-0n, 3/9/07; passed House; signed into law by governor as Chapter 259, 5/2/07.)

WI

2008: AB 729 of 2008 - requires health care providers to give health consumers charge and payment rate information on request and at no cost, with the information treated as a "legally binding estimate."  Also requires a public listing of 25 frequently used test and procedures as specified by the state Dept. of Health and Family Services. (Filed 1/24/08; failed to pass at end of session.)

 

Notes &  Sources:

1  "Health Costs:  The Medical-Bill Mystery," by Sara Lueck, in The Denver Post (March 12, 2006, Wall St. West, p. WSJ-2)

2  "Health Care Marketplace:  Bush Administration Expected to Announce Plan to Increase Transparency of Health Care Prices," Daily Health Policy Report, www.kaisernetwork.org (March 14, 2006, p. 1).

3  "Transparency in Health Care a Priority," by Secretary Michael Leavitt, in http://thehill.com/healthcare-may-2006/transparency-in-healthcare-a-priority-2006-05-10.html (May 10, 2006).

4  "Hospital Pricing Transparency Survey," by the American Hospital Association (April 26, 2006).

5  "Moves afoot to shed light on hospital costs," by Daniel C. Vock, in www.stateline.org (March 22, 2006, p. 1).

6  "AARP Continues National Assault on High Drug Prices," AARP Press Center News Release, in http://www.aarp.org/research/press-center/presscurrentnews/high_drug_prices.html (November 2, 2005).

Out of Network Charges- an AHIP Infographic, published 2013: 

Physician Out-of-Network Charges






























Authors & research staff: This report was initially compiled by Madeline Kreischer, under the direction of Richard Cauchi.  Further research and additions provided by Andrew Thangasamy (2008), Richard Cauchi (2008-2013), Katie Mason (2010), Kara Hinkley (2012-13) and Holly Valverde (2013) of the NCSL Health Program, Denver.
 

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