Transparency of Health Costs: State Actions

Consumers are often in the dark when it comes to the cost of health care services and what they may have to pay prior to receiving care. Several studies have pointed to this lack of transparency leading to extreme price variation, where prices for the same procedure or service vary greatly within the same city or state. Moreover, health facilities may set higher prices for certain services than other facilities, raising overall health care costs and spending for payers and patients.

As spending on health care services continues to grow—particularly for hospital, physician and clinical services—state and federal policymakers are leveraging health care price transparency as a potential strategy to curb rising health care costs. Price transparency takes many forms, but the overall intent is to increase consumer knowledge of health care prices. The theory is essentially “knowledge is power”—if a patient has sufficient understanding of the costs for a health service prior to receiving care, they can seek high quality services at the lowest cost. Moreover, lawmakers and other stakeholders can utilize price information to pursue effective cost containment strategies and policies.

Some reports, however, have highlighted the potential drawbacks or limitations of such efforts. For example, consumers may struggle to shop for health services due to the complex nature of the health care system. Without corresponding quality data that is easy to interpret, patients often default to the highest cost provider even though health care quality is often not correlated with price. Even with accurate price information for a particular procedure, patients may be responsible for other costs—such as facility fees or subsequent prescriptions following the procedure or service. Furthermore, some studies have indicated increased transparency may have the perverse effect of raising health care costs. A hospital with low prices for health care services may increase their fees to match those of a competing hospital with higher prices. 

State Actions on Price Transparency

While the effectiveness of price transparency policies continues to be debated, states have enacted several laws aimed at improving access to health care price information. Common state strategies for improving price transparency include leveraging all-payer claims databases, establishing consumer-facing tools for patients to compare prices, and enacting right to shop laws. NCSL tracks enacted legislation relating to health care price transparency in the Health Innovations State Law Database, which can be found here.

All-Payer Claims Databases

All-Payer Claims Databases (APCDs) are large state-based databases which collect health care claims data from Medicare, Medicaid, state employee health plans and state-regulated private insurers. Policymakers, insurers, employers and other stakeholders can use claims data to make informed health policy decisions by identifying extreme price variation, analyzing health care market trends and spending, and quantifying wasteful and low-value spending. States can also use APCD information to develop consumer-facing price comparison tools, described below.

Currently, 18 states have operational APCDs and 4 states are in the process of establishing an APCD system. The scope of claims data collected and how states leverage their APCD system varies greatly. For example, while all states with operational APCDs collect medical claims data, only select states collect pharmaceutical and/or dental claims data. 

Consumer-Facing Price Comparison Tools

Consumer-facing price comparison tools often use APCD data to help patients better understand the costs for a particular procedure by a particular provider in their insurance network. Consumers can compare prices for shoppable services—such as a hip or knee replacement or a primary care office visit—and look for high-quality services at a lower cost.

The process for developing, implementing and maintaining price transparency tools typically involve multiple stakeholders, including payers, providers and consumers. States with these tools often leverage public-private partnerships when creating a price comparison tool in order to ensure accurate price information and a consumer-friendly experience. 

To date, at least 9 states maintain consumer-facing price comparison websites to provide cost and quality data from their APCDs system directly to consumers. The following table lists state examples of price comparison tools:

State

Consumer-Facing Website

Colorado

Center for Improving Value in Health Care – Shop for Care

Connecticut

Healthscore CT

Florida

Florida Health Price Finder

Maine

CompareMaine

Maryland

Wear the Cost

Massachusetts

CompareCare

New Hampshire

NH HealthCost

New York

New York Health Connector

Washington

Washington Health Care Compare

Right to Shop Programs

Right to Shop programs provide financial incentives for patients to seek lower cost, high quality providers and health services. Through Right to Shop programs, insurers typically share a portion of their cost savings with health plan enrollees to offset any pre-deductible or out-of-pocket expenses. Proponents of Right to Shop programs argue that financial incentive programs prompt health care consumers to utilize public price information and seek cost-effective care. However, some argue that Right to Shop programs are not necessarily effective, since patients often defer to physician referrals and recommendations when seeking health services rather than shop for services.

Some states have initiated Right to Shop programs for state employee health plans; others have enacted legislation encouraging private insurers to develop shared savings incentive programs. The following are examples of state legislative actions establishing or promoting Right to Shop programs:

  • New Hampshire, Kentucky and Utah established Right to Shop programs as part of their state employee health plans to curb growing health care costs to state budgets. New Hampshire was the first state to establish a shared incentive program with 90 percent of enrollees using the Right to Shop program within the first three years of the program.
  • Florida, Maine, Nebraska, Tennessee, Utah and Virginia enacted legislation requiring or encouraging state-regulated private health plans to initiate Right to Shop programs for enrollees. For example, Virginia will require health insurers participating in the small group market to develop a Right to Shop program for health plan enrollees starting in January 2021. Florida enacted legislation authorizing, but no requiring, insurers participating in the individual and small group market to develop shared savings programs for enrollees.

Federal Actions

The Centers for Medicare and Medicaid Services (CMS) previously required hospitals to disclose standard charges—or the original list price of a hospital service or procedure—for all items and services in a machine-readable format. However, many argued large chargemaster spreadsheets of hundreds of services were of little use to consumers and standard charges often did not reflect what insurers—and consumers—paid for services. In November 2019, CMS issued a new final rule requiring hospitals to release pricing information for up to 300 shoppable services, as well as requiring posted charge information to be based on payer-specific negotiated rates. The rule goes into effect January 2021; however, various health system stakeholder groups are currently challenging the finalized rule in court.

Additional Resources

NCSL Resources

Other Resources

  • All-Payer Claims Database Council webpage
  • The National Association of Health Data Organizations webpage
Archived Information

2013-2015 Resources:

  • Inpatient Psychiatric Facilities Data Increase Transparency for Evaluating Facilities
    On April 17, 2014, the Centers for Medicare & Medicaid Services (CMS) announced that quality measures from inpatient psychiatric facilities across 50 states will be publicly reported for the first time on Hospital Compare: Psychiatric Facilities, a consumer-oriented website that provides information on the quality of care hospitals are providing to their patients. Hospital Compare features data from 1,753 inpatient psychiatric facilities on patient care for the period of October 1, 2012 through March 31, 2013. Public reporting will allow consumers to directly compare facilities based on data collected for the following measures:

    • Hours of Physical Restraint Use
    • Hours of Seclusion Use
    • Post-Discharge Continuing Care Plan Created
    • Post-Discharge Continuing Care Plan Transmitted to Next Level of Care Provider Upon Discharge
  • Uncovering Hospital Charges (State Legislatures Magazine, September 2013) - Hospitals are reporting their rates for various procedures in an effort to satisfy those who want more transparency in healthcare costs.
  • Hospital Provider Charge and Actual Payment Data (August 2013) -  A database from the Centers for Medicare and Medicaid Services (CMS) that compares the charges for the 100 most common inpatient services and 30 common outpatient services across the nation.  It includes the "list prices" on initial submitted bills, as well as the actual amounts paid by Medicare nationwide, covering 3,300 hospitals, with more than 170,000 listed price datapoints. [More]
  • Report Cards on State Price Transparency Laws  - The Catalyst for Payment Reform and Health Care Incentives Improvements Institute released a report in March of 2014 entitled, "2014: Report Card on State Transparency Laws" [84 pages, PDF]. This report includes tables of state laws with the scope of providers who report prices, services and levels of transparency. The report notes that the objective of the research "was to determine how much pricing information each state makes accessible to the consumer." 
  • 2015: Getting Accurate Price Estimates From Price Transparency Tools - [Full Report online] published February 2015.
    "For the insured, health care has become much more retail, in the traditional sense of the word, as patient-consumers shop around for health care the way they shop for other household items and services. Patient-consumers are partially or wholly financially responsible for everything from routine sick care to some of the most frequently performed procedures in the U.S. For example, the average total price of a pregnancy and delivery is about $6,500, a colonoscopy procedure (including pre and post-procedure prices) averages $2,500, and a knee arthroscopy procedure averages $7,000.  
           
    However, these price averages are just estimates. Other experts have documented the variability in the total price of a medical episode of care. As a result, information on the predicted price for the treatment of an illness, injury, or condition has become all the more important for patient-consumers. Many employers have recognized this and worked with their third-party administrators or other vendors to deploy information on health care prices to their employees."‚Äč

    [NOTE: NCSL does not take a position for or against state or other actions included in report cards.]


In this report:

 

Enacted State Legislation: Transparency and Disclosure of Health Costs

Summaries of enacted cost transparency legislation are provided in the table below, including measures affecting disclosure, transparency, reporting or publication of charges and fees.

Statute

Summary

Years of Legislative Action

Arizona

 

 

Ariz. Rev. Stat. §36-125.05.

  • Requires the Arizona Department 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.
  • Reports are available at:compiled-health-facility-financial-reporting. 
  • Requirements http://www.azdhs.gov/plan/crr/cr/hospitals.htm

1983, 1988, 1990, 1994, 1996, 2005, 2010

Arkansas

 

 

Ark. Code Ann. §§20-7-301—307

  • Provides 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.
  • The reports are available at: http://www.hospitalconsumerassist.com/reports.htm

1994, 1995, 1997, 2003, 2005, 2007

California

 

 

Cal. Health and Safety Code §1339.55., 056, .58, .585  

  • Requires hospitals to file a master charge description with the Office of Statewide Health Planning and Development and to estimate future charge increases for patient services.
  • Requires hospitals to 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.
  • Allows for the provision of information regarding where data about hospital quality and health outcomes may be obtained.
  • 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.
  • Hospital chargemaster and pricing information are available at: http://www.oshpd.ca.gov/Chargemaster/
  • Healthcare Quality and Health Outcome Reports available at: http://www.oshpd.ca.gov/

2003, 2005

Cal. Health and Safety Code §1363.01
  • Requires health insurance carriers that provide coverage for prescription drugs to "provide notice in the evidence of coverage and disclosure form to enrollees regarding whether the plan uses a formulary."
  • Requires health insurance carriers to provide enrollees with information regarding whether specific prescription drugs are covered under the carrier's formulary upon request.
  • Requires health insurance carriers to inform enrollees that the presence of a prescription drug on the carrier's formulary does not guarantee that the enrollee with be prescribed that drug.

2014

From WestLaw: "Prior Version Limited on Preemption Grounds by Cal Ass'n of Health Plans v. Zingale, C.D.Cal. Aug. 29, 2001."

 

Cal. Health and Safety Code §1367.205
  • Requires health insurance carriers that provide coverage for prescription drugs and use a formulary to post the formulary on the carrier's website. The formularies used by the carrier are to kept up-to-date. The carrier is to use a standard formulary template to post formularies no later than 6 months after such a template is developed. The template will be developed by January 1, 2017.
2014, 2015
Cal. Health and Safety Code §1368.016
  • Requires health insurance carriers that provide coverage for mental health services to post a variety of information online pertaining to mental health benefits, such as links to prescription drug formularies and a telephone number that enrollees may call to receive information about their mental health benefits.
2009, 2014
Cal.Insurance Code §10123.192, .199
  • Requires health insurance carriers that provide coverage for prescription drugs and use a formulary to post the formulary on the carrier's website. The formularies used by the carrier are to kept up-to-date. The carrier is to use a standard formulary template to post formularies no later than 6 months after such a template is developed. The template will be developed by January 1, 2017.
  • Requires certain health insurance carriers that provide coverage for behavioral health treatment to post information online.
2014, 2015
Cal. Government Code §100503.1
  • Requires the Covered California website to provide "a direct link to the formulary, or formularies, for each qualified health plan offered through the Exchange."
2014

Colorado

 

 

Colo. Rev. Stat. Ann. § 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.

2003, 2004

Colo. Rev. Stat. Ann. § 10-16-133., 10-16-134

  • Requires the development of a website to disclose price information for health insurance plans. 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.

2008

Colo. Rev. Stat. Ann. §§ 25-3-701—705

 

2006, 2008, 2010, 2011

Delaware

 

 

Del. Code Ann. tit. 16 §§2001—2009

  • Requires the Division of Public Health to “periodically compile and disseminate reports on the data collected such as, but not limited to: charge levels, age-specific utilization patterns, morbidity patterns, patient origin and trends in health care charges.”

1989, 1994, 1995, 2003, 2008, 2009

Florida

 

 

Fla. Stat. §381.026 

  • Lists the rights and responsibilities of patients. Among these rights are the patients’ rights to be treated with dignity, and to receive information. Patients are entitled to financial information including, but not limited to, financial resources available for the patients’ treatment, and, upon a patient’s request, an estimation of the costs of treatment. Hospitals may choose to post a schedule of treatment charges conspicuously.  Non-state facilities must post financial information on a website available to the public.

1991, 1992, 1995, 1998, 1999, 2001, 2004, 2006, 2008, 2011, 2012, 2016

Fla. Stat. §395.301 

  • Requires licensed, non-state healthcare facilities to provide patients with itemized bills upon request.

1982, 1991, 1992, 1995, 1998, 2004, 2006, 2008, 2015, 2016

Fla. Stat. §408.05, .061, .063

  • Establishes the Florida Center for Health Information and Policy Analysis. Defines the duties of the Center, including, but not limited to, administrating a comprehensive health information system.
  • Requires “health care facilities, health care providers, and health insurers” to provide data to the state.
  • Requires the state to “publish and disseminate information to the public which will enhance informed decisionmaking in the selection of health care providers, facilities, and services.”
  • Requires the collection and coordination of healthcare data by the state.

1988, 1990, 1991, 1992, 1993, 1995, 1997, 1998, 1999, 2000, 2003, 2004, 2005, 2006, 2007, 2008, 2010, 2013, 2015, 2016

Fla. Stat. §465.0244 

  • Requires pharmacies to inform customers of the availability of the Agency’s quality and cost information.

2004, 2006, 2016

Fla. Stat. §641.54 

  • Requires HMOs to disclose financial data to customers and to provide customers with estimated costs for services.

1985, 1987, 1997, 2003, 2004, 2006, 2016

Illinois

 

 

20 Ill. Comp. Stat. 2215/4-1, 4-2, 4-4

  • Requires the state to collect, analyze, and disseminate healthcare cost information via a uniform system.
  • Requires the provision of data to the state.
  • Requires the state to publish a consumer guide.
  • Requires hospitals to provide prospective patients with the normal costs of service(s) prior to treatment.
  • Requires hospitals to post the price of certain healthcare services.

1984, 1985, 1990, 1993, 1994, 1996, 1998, 2000, 2002, 2003, 2005, 2012

Indiana

 

 

Ind. Code §§16-21-6-1—3; 16-21-6-5--12

  • Requires hospitals to prepare and submit fiscal reports and patient information reports. Requires the state to publish a consumer guide to healthcare.

1993, 1994, 2002, 2003, 2007, 2011, 2015

Kentucky

 

 

Ky. Rev. Stat. §216.2929

  • 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.

1994, 1996, 1998, 2005, 2008, 2015

Maine

 

 

Me. Rev. Stat. tit. 22, §§ 8701—8704; 8705-a—8712; 8714—8717

  • Establishes a uniform system of healthcare data reporting.

1995, 1997, 1999, 2001, 2003, 2005, 2007, 2009, 2011, 2013, 2015

Massachusetts    

M.G.L.A. 111 § 228

2012 Mass. Acts Chapter 224, Sec. 228

 

Effective Jan. 1, 2014

§ 228(a): Prior to an admission, procedure or service and upon request by a patient or prospective patient, a health care provider shall, within 2 working days, disclose the allowed amount or charge of the admission, procedure or service, including the amount for any facility fees required; provided, however, that if a health care provider is unable to quote a specific amount in advance due to the health care provider’s inability to predict the specific treatment or diagnostic code, the health care provider shall disclose the estimated maximum allowed amount or charge for a proposed admission, procedure or service, including the amount for any facility fees required.

(b) If a patient or prospective patient is covered by a health plan, a health care provider who participates as a network provider shall, upon request of a patient or prospective patient, provide, based on the information available to the provider at the time of the request, sufficient information regarding the proposed admission, procedure or service for the patient or prospective patient to use the applicable toll-free telephone number and website of the health plan established to disclose out-of-pocket costs, under section 23 of chapter 176O. A health care provider may assist a patient or prospective patient in using the health plan’s toll-free number and website.

2012

Minnesota

 

 

Minn. Stat. §62J.81, .82, .823

  • Requires healthcare providers to provide patients with an estimate of the costs of treatment and the costs that must be paid by the patient.
  • 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. Creates the Hospital Pricing Transparency Act.
  • Requires hospitals and outpatient surgical clinics to provide patients, their representatives, or doctors with a cost estimate prior to treatment upon request.

2004, 2005, 2006, 2007, 2011, 2016

Minn. Stat. §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.

2008, 2009, 2010, 2011, 2012, 2014, 2015, 2016

Missouri

 

 

Mo. Rev. Stat. §192.667

 

  • Requires all hospitals and health care providers to provide charge data to the Department of Health and Senior Services.

1992, 1993, 1995, 2004, 2016

Nebraska

 

 

Neb. Rev. Stat. §71-2075.

  • Requires hospitals and ambulatory surgical centers to provide a written estimate of the average charges for health services.

1985, 1994

Nevada

 

 

Nev. Rev. Stat. §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.

1987

New Hampshire

 

 

N.H. Rev. Stat. Ann. §420-G:11, G:11-a

  • Requires disclosure of pricing information by health carriers.
  • 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."  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.

2003, 2005, 2006, 2015, 2016

North Carolina

 

 

N.C. Gen. Stat. Ann. § 131E-214.4. 

  • Requires the statewide data processor to compile a report comparing the prices of the 35 most common surgical procedures using data from hospitals and freestanding ambulatory surgical facilities.

1995, 1997

N.C. Gen. Stat. Ann. § 131E-214.11—.14

  • The Health Care Cost Reduction and Transparency Act of 2013. Requires the provision of “information to the public on the costs of the most frequently reported diagnostic related groups (DRGs) for hospital inpatient care and the most common surgical procedures and imaging procedures provided in hospital outpatient settings and ambulatory surgical facilities.”
  • Requires “each hospital shall provide to the Department of Health and Human Services, utilizing electronic health records software, information about the 100 most frequently reported admissions by DRG for inpatients as established by the Commission.”
  • 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.

2013, 2014, 2015

Ohio

 

 

Ohio Rev. Code Ann. §3727.33—45

  • Requires hospitals to submit reports to the director health. Reports must include hospital charge information.
  • Authorizes the director of health to audit hospital reports.
  • Requires hospitals to inform the director of health of charge data for the 60 most frequently provided outpatient service categories.
  • Requires the director of health to publish information submitted by hospitals online.
  • Requires the director to make information submitted by hospitals available for sale to any person or government entity 90 days after submission.
  • Requires hospitals to compile a list of charges for a variety of services and to inform patients of the existence of the list at the time of admission.
  • Requires hospitals to inform patients of the hospitals’ duty to refund overcharges.

1992, 1995, 2001, 2006, 2006, 2008, 2012, 2016

Oregon

 

 

Oregon Rev. Stat. §442.405, .420, .425, .450, .460, .463

  • Declaration of legislative policy to require health facilities to disclose charge data.
  • Requires the Administrator of the Office for Oregon Health Policy and Research to conduct studies on health care facilities costs.
  • Authorizes the Administrator to create uniform systems of cost reporting.
  • Exempts certain health care providers from cost reporting requirements.
  • Authorizes the acceptance of cost information data from a variety of sources.
  • Requires licensed health care facilities to submit annual reports.

1977, 1981, 1983, 1985, 1995, 1997, 1999, 2009, 2015

Pennsylvania

 

 

35 Pa. Stat. Ann. §449.1; §§.3—.16; .17a—.19

  • The Health Care Cost Containment Act.  Requires health care facilities to submit a report containing charge and payment data. The Council will compile a report using this data.
  • Requires the Council to use the data for the benefit of the public. Requires an annual report to be made to the Senate Appropriations Committee.

1986, 1993, 2003, 2009

Rhode Island

 

 

R.I. Gen. Laws §§ 23-17.17-1—6; 8—11

  • Requires the development of a “health care quality performance measure and reporting system.”
  • Requires the reporting of health care quality and cost data, and the creation of a health care quality and value database. Requires carriers to submit data.

1998, 2000, 2002, 2005, 2006, 2008, 2010

South Dakota

 

 

S.D. Codified Laws §34-12E-8., .11—13

  

  • All fees and charges for health care procedures shall be disclosed by a health care provider or facility upon request of a patient.
  • Requires hospitals to provide charge information annually to the South Dakota Association of Healthcare Organizations.
  • Requires the South Dakota Association of Healthcare Organizations to publish hospital charge information online to be freely available to the public.
  • Requires the Dept. of Health to provide a link to the web based system. “charge information…includes the number of discharges; average length of stay; average charge; median charge; demographic information; payer mix; charges not paid and charges paid by Medicare, Medicaid, and other government programs, and private insurance; and uncompensated care.”

1994, 2005, 2008

Texas

 

 

Tex. Health & Safety Code §324.051. 

  • Requires the Department to make a website containing a consumer guide to health care.

2007

Tex. Health & Safety Code §324.101. 

  • Requires health care facilities to inform patients at the time of admission of whether the facility is covered by the patient’s insurance.
  • Requires facilities to “provide an estimate of the facility's charges for any elective inpatient admission or nonemergency outpatient surgical procedure or other service on request and before the scheduling of the admission or procedure or service. “
  • Requires facilities to provide patients with an itemized bill upon request.

2007, 2009

Utah

 

 

Utah Code Ann. §§26-33a-101—111; 115

  • The Utah Health Data Authority Act. Requires the establishment of a Committee to collect health care data. Data collected must include charge and quality data. The data must be published in a report.
  • Requires the development of a demonstration project designed to create consumer-based health care delivery and payment reform

1990,1992, 1995, 1996, 1999, 2002, 2005, 2006, 2007, 2008, 2010, 2011, 2012, 2013, 2014, 2016

Virginia

 

 

Va. Code Ann. §32.1-276.2—.11

  • Requires providers to submit data on the utilization of “reviewable services.” 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 Healthcare Effectiveness Data and Information Set (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. Continues the Virginia Patient Level Data System.
  • Requires hospitals to report inpatient and outpatient services data, including charge information.
  • Requires a comparison between data submitted by providers in Virginia and national and regional providers.
  • Creates the Virginia All-Payer Claims Database.
  • Authorizes information collected in the database to be used to create reports on various health conditions.

1996, 2000, 2001, 2003, 2006, 2008, 2009, 2012, 2013

Vermont

 

 

Vt. Stat. Ann. tit. 18, § 9410.

  • Requires the creation of a health care database containing cost data for services charged to patients in Vermont facilities, as well as to patients who choose to receive treatment in another state.

1991, 1995, 2005, 2007, 2009, 2011, 2013, 2015

From WestLaw: "Limited on Preemption Grounds by Gobeille v. Liberty Mut. Ins. Co. U.S.Mar. 01, 2016."

Vt.  Stat. Ann. tit. 33, §2010.

  • Requires pharmaceutical manufacturers to submit information regarding how pharmaceuticals are priced to the state.

2007, 2009, 2011, 2015

Washington

 

 

Wash. Rev. Code §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.

1993

Wisconsin

 

 

Wis. Stat. §153.05, .08, .20--.22, .45, .46

  • Requires providers, except hospitals and ambulatory surgical centers, to submit data to the state. The state must analyze this data and disseminate information in a manner that is readily understandable to laypersons.
  • Requires hospitals that wish to increase their prices beyond those established in the 1992 consumer price index to publish a notice of the proposed price increase prior to its implementation.
  • Requires the department to compile and submit a report containing data from providers, not including hospitals or ambulatory surgical centers.
  • Requires “an annual report setting forth the number of patients to whom uncompensated health care services were provided by each hospital and the total charges for the uncompensated health care services provided to the patients for the preceding year, together with the number of patients and the total charges that were projected by the hospital for that year.”
  • Requires the creation of a consumer guide “to assist consumers in selecting health care providers and health care plans.”
  • Requires a list of hospital charge data for the 75 most common diagnoses groups requiring inpatient care and the 75 most common outpatient procedures to be distributed to hospitals.
  • Requires a report to be submitted to the department containing “utilization, charge, and quality data on patients treated by hospitals and ambulatory surgery centers.”
  • Requires the department to release data.
  • Requires the entity charged with data collection to release data.
  • Requires measures to protect patient privacy when releasing information.

2010, 2011, 2013, 2016

 

 

 

Examples of State Health Price Information Disclosure Websites

  • California’s Common Surgeries and Price Comparison is a website allowing healthcare consumers to view and compare the price of 28 common elective inpatient procedures at hospitals across California.
  • Florida has established a Website that enables consumers to obtain data on hospitals' charges and readmission rates (http://www.floridahealthfinder.gov/CompareCare/SelectChoice.aspx).
  • Maryland’s 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.
  • Oregon’s website "Oregon Pricepoint," is sponsored and maintained by the Oregon Association of Hospitals and Health Systems and allows health care consumers to receive basic, facility-specific information about services and charges.
  • New Jersey launched www.njhospitalpricecompare.com to help consumers make informed choices regarding price and quality of hospital services in New Jersey.


NCSL Related Resources

NCSL's Cost Containment brief about the related subject, Collecting Health Data: All-Payer Claims Databases - Initial brief published 2011; with updates for 2013.

Other Resources

Balance Billing: How are States Protecting Consumers from Unexpected Charges? Written by Kevin Lucia, Jack Hoadley and Sandy Ahn at the Georgetown Center on Health Insurance Reform, and supported by the Commonwealth Fund, this report looks at how seven states have approached protecting consumers from certain types of balance billing. June 2017

All Over the Map: Medical Procedure Rates in California Vary Widely. The California Healthcare Foundation has created a map that allows users to compare prices for health care among California counties. November 2014.

Federal Web Site offers consumers a detailed look at hospital charges.   On May 8, 2013 Health and Human Services (HHS) 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.   The data posted on CMS’s website include information comparing the charges and the widely varying actual payments 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: HHS News Release 5/8/13 | View: the HHS hospital charge and costs data [updated 8/15/2013]

Price Transparency For MRIs Increased Use Of Less Costly Providers And Triggered Provider Competition The survey of the program showed a $220 cost reduction (18.7 percent) per test and a decrease in use of hospital-based facilities from 53 percent in 2010 to 45 percent in 2012.  - a report published in Health Affairs, September 2014.

Federal Rules Released Implementing the Pharmaceutical "Physician Payment Sunshine Act" on February 8, 2013.  This less-know provision within the Affordable Care Act (ACA) sets nationwide standards for "Reporting Related to Covered Drug, Device, Biological or Medical Supply," contained in Section 6002.  The regulations, cited as CFR 42 §1128G(a)(1)(A)(vii) require 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.  The rules define reporting a related product name for all payments or transfers of value. Reporting began in August 2013, with transactions to be disclosed on a public website beginning July 2014.  Supporters anticipate that the payment disclosures may show financial relationships that influence prescribing of particular prescription drugs.  The law is based in part on state laws in Maine New Hampshire and the District of Columbia with similar intent.

GAO Price Transparency Report:  Health Care Price Transparency: Meaningful Price Information Is Difficult for Consumers to Obtain Prior to Receiving Care, Government Accountability Office-11-791, October 20, 2011.

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