103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB2609

 

Introduced 2/15/2023, by Rep. Jed Davis

 

SYNOPSIS AS INTRODUCED:
 
New Act
30 ILCS 105/5.990 new
110 ILCS 330/11 new
210 ILCS 85/6.14a
210 ILCS 85/9.9 new

    Creates the Hospital Price Transparency Act. Provides that, notwithstanding any other provision of law, a facility (a hospital licensed under the Hospital Licensing Act, organized under the University of Illinois Hospital Act, or licensed under the Ambulatory Surgical Treatment Center Act) must make specified information public. Requires facilities to maintain lists of standard charges and shoppable services and ensure that the lists are available at all times to the public. Contains reporting requirements. Requires the Department of Public Health to monitor each facility's compliance with the requirements of the Act and to enforce compliance with the Act. Provides that facilities that violate the Act must submit and implement a corrective action plan. Establishes the Hospital Price Transparency Fund as a special fund in the State treasury and makes a conforming change in the State Finance Act. Requires administrative penalties collected under the Act to be deposited into the Fund. Provides that moneys in the Fund shall be used by the Department for expenses relating to the implementation, administration, and enforcement of the Act. Contains other provisions. Amends the University of Illinois Hospital Act. Requires the University of Illinois Hospital to comply with the Hospital Price Transparency Act. Amends the Hospital Licensing Act. Provides that any report submitted to the Department under the Hospital Price Transparency Act and any information or data contained in such a report is subject to disclosure to the public by the Department. Requires hospitals licensed under the Act to comply with the Hospital Price Transparency Act. Effective January 1, 2024.


LRB103 05300 CPF 53530 b

 

 

A BILL FOR

 

HB2609LRB103 05300 CPF 53530 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the
5Hospital Price Transparency Act.
 
6    Section 5. Definitions.
7    "Ancillary service" means a facility item or service that
8a facility customarily provides as part of a shoppable
9service.
10    "Chargemaster" means a list of all facility items or
11services maintained by a facility for which the facility has
12established a charge.
13    "De-identified maximum negotiated charge" means the
14highest charge that a facility has negotiated with all
15third-party payors for a facility item or service.
16    "De-identified minimum negotiated charge" means the lowest
17charge that a facility has negotiated with all third-party
18payors for a facility item or service.
19    "Department" means the Department of Public Health.
20    "Director" means the Director of Public Health.
21    "Discounted cash price" means the charge that applies to
22an individual who pays cash, or a cash equivalent, for a
23facility item or service.

 

 

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1    "Facility" means a hospital licensed under the Hospital
2Licensing Act, organized under the University of Illinois
3Hospital Act, or licensed under the Ambulatory Surgical
4Treatment Center Act.
5    "Facility item or service" means an item, service, or
6service package, including, but not limited to, an item,
7service, or service package that may be provided by a facility
8to a patient in connection with an inpatient admission or an
9outpatient department visit, for which the facility has
10established a standard charge. "Facility item or service"
11includes, but is not limited to, the following:
12        (1) Supplies and procedures.
13        (2) Room and board.
14        (3) Use of the facility and facility areas, the
15    charges for which are generally referred to as facility
16    fees.
17        (4) Services of physicians and nonphysician
18    practitioners employed by a facility, the charges for
19    which are generally referred to as professional charges.
20        (5) Any other item or service for which a facility has
21    established a standard charge.
22    "Fund" means the Hospital Price Transparency Fund
23established under subsection (f) of Section 40.
24    "Gross charge" means the charge for a facility item or
25service that is reflected on a facility's chargemaster, absent
26any discounts.

 

 

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1    "Hospital Licensing Board" means the Hospital Licensing
2Board created under Section 10 of the Hospital Licensing Act.
3    "Machine-readable format" means a digital representation
4of information in a file that can be imported or read into a
5computer system for further processing. "Machine-readable
6format" includes PDF, .XML, .JSON, and .CSV formats.
7    "Payor-specific negotiated charge" means the charge that a
8facility has negotiated with a third-party payor for a
9facility item or service.
10    "Service package" means an aggregation of individual
11facility items or services into a single service with a single
12charge.
13    "Shoppable service" means a service that may be scheduled
14by a patient in advance.
15    "Standard charge" means a regular rate established by a
16facility for a facility item or service provided to a specific
17group of paying patients. "Standard charge" includes all of
18the following:
19        (1) A gross charge.
20        (2) A payor-specific negotiated charge.
21        (3) A de-identified minimum negotiated charge.
22        (4) A de-identified maximum negotiated charge.
23        (5) A discounted cash price.
24    "Third-party payor" means a person or entity who is
25legally responsible for payment of a claim for a facility item
26or service by contract or agreement.
 

 

 

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1    Section 10. Public availability of price information.
2Notwithstanding any other provision of law, a facility must
3make public:
4        (1) a digital file that contains a list of all
5    standard charges for all facility items or services as
6    required under Section 15 in PDF format or another
7    machine-readable format;
8        (2) a consumer-friendly list of standard charges for a
9    limited set of shoppable services as required under
10    Section 20; and
11        (3) 8 physical copies of the digital file in paragraph
12    (1) which are available in the public area of the facility
13    and can be taken by members of the public for their
14    reference.
 
15    Section 15. List of standard charges.
16    (a) A facility shall:
17        (1) maintain a list of all standard charges for all
18    facility items or services in accordance with this
19    Section; and
20        (2) ensure that the list is available at all times to
21    the public, including, but not limited to, by posting the
22    list electronically in accordance with this Section.
23    (b) The standard charges contained in the list required to
24be maintained by a facility under subsection (a) must reflect

 

 

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1the standard charges applicable to that facility location,
2regardless of whether the facility operates in more than one
3location or operates under the same license as another
4facility.
5    (c) The list required under subsection (a) must include
6the following items, as applicable:
7        (1) A description of each facility item or service
8    provided by the facility.
9        (2) Standard charges for each facility item or service
10    provided in either an inpatient or outpatient setting. If
11    a standard charge is a payor-specific negotiated charge,
12    it must be listed by the name of the third-party payor and
13    the plan associated with the charge and displayed in a
14    manner that clearly associates the charge with each
15    third-party payor and plan.
16        (3) Any code used by the facility for purposes of
17    accounting or billing for the facility item or service,
18    including the Current Procedural Terminology (CPT) code,
19    the Healthcare Common Procedure Coding System (HCPCS)
20    code, the Diagnosis Related Group (DRG) code, the National
21    Drug Code (NDC), or another common identifier.
22    (d) The information contained in the list required under
23subsection (a) must be published in a single digital file in
24PDF format. Facilities may post identical information in a
25separate file in any machine-readable format.
26    (e) The list required under subsection (a) must be

 

 

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1displayed in a prominent location, or accessible by selecting
2a dedicated link that is prominently displayed on the home
3page of the facility's publicly accessible website. If the
4facility operates multiple locations and maintains a single
5website, the list required under subsection (a) must be posted
6for each location the facility operates in a manner that
7clearly associates the list with the applicable location of
8the facility. Physical copies must also be made available in
9the lobby or other public areas of the facility for members of
10the public to take with them.
11    (f) The list required under subsection (a) must:
12        (1) be available:
13            (A) free of charge;
14            (B) without having to establish a user account or
15        password;
16            (C) without having to submit personal identifying
17        information; and
18            (D) without having to overcome any other
19        impediment, including entering a code to access the
20        list;
21        (2) be accessible to a common commercial operator of
22    an Internet search engine to the extent necessary for the
23    search engine to index the list and display the list as a
24    result in response to a search query of a user of the
25    search engine;
26        (3) be formatted in a manner prescribed by the

 

 

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1    Department;
2        (4) be digitally searchable; and
3        (5) use the naming convention specified by the federal
4    Centers for Medicare and Medicaid Services.
5    (g) In prescribing the format of the list as required
6under paragraph (3) of subsection (f), the Department shall
7develop a template that each facility must use in formatting
8the list. In developing the template, the Department shall:
9        (1) consider any applicable federal guidelines for
10    formatting similar lists required by federal law or rule
11    and ensure that the design of the template enables health
12    care researchers to compare the charges contained in the
13    lists maintained by each facility; and
14        (2) design the template to be substantially similar to
15    the template used by the Centers for Medicare and Medicaid
16    Services for purposes similar to those of this Act, if the
17    Department determines that designing the template in that
18    manner serves the purposes of paragraph (1) and that the
19    Department benefits from developing and requiring that
20    substantially similar design.
21    (h) A facility must update the list required under
22subsection (a) at least once each year. The facility must
23clearly indicate the date on which the list was most recently
24updated, either on the list or in a manner that is clearly
25associated with the list.
 

 

 

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1    Section 20. Consumer-friendly list of shoppable services.
2    (a) Except as provided under subsection (c), a facility
3shall maintain and make publicly available a list of the
4standard charges described under paragraph (2) of subsection
5(c) of Section 15 for each of at least 300 shoppable services
6provided by the facility. Physical copies must also be made
7available in the lobby or other public areas of the facility
8for members of the public to take with them. The facility may
9select the shoppable services to be included in the list,
10except that the list must include:
11        (1) the 70 services specified as shoppable services by
12    the Centers for Medicare and Medicaid Services; or
13        (2) if the facility does not provide all of the
14    shoppable services described under paragraph (1), as many
15    of those shoppable services that the facility does
16    provide.
17    (b) In selecting a shoppable service for purposes of
18inclusion in the list required under subsection (a), a
19facility must:
20        (1) consider how frequently the facility provides the
21    service and the facility's billing rate for that service;
22    and
23        (2) prioritize the selection of services that are
24    among the services most frequently provided by the
25    facility.
26    (c) If a facility does not provide at least 300 shoppable

 

 

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1services, the facility must maintain a list of the total
2number of shoppable services that the facility provides in a
3manner that otherwise complies with the requirements of
4subsection (a).
5    (d) The lists required under subsections (a) and (c) must:
6        (1) include:
7            (A) a plain-language description of each shoppable
8        service included on the list;
9            (B) the payor-specific negotiated charge that
10        applies to each shoppable service included on the list
11        and any ancillary service, listed by the name of the
12        third-party payor and plan associated with the charge
13        and displayed in a manner that clearly associates the
14        charge with the third-party payor and plan;
15            (C) the discounted cash price that applies to each
16        shoppable service included on the list and any
17        ancillary service or, if the facility does not offer a
18        discounted cash price for one or more of the shoppable
19        or ancillary services on the list, the gross charge
20        for the shoppable service or ancillary service, as
21        applicable;
22            (D) the de-identified minimum negotiated charge
23        that applies to each shoppable service included on the
24        list and any ancillary service;
25            (E) the de-identified maximum negotiated charge
26        that applies to each shoppable service included on the

 

 

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1        list and any ancillary service; and
2            (F) any code used by the facility for purposes of
3        accounting or billing for each shoppable service
4        included on the list and any ancillary service,
5        including the Current Procedural Terminology (CPT)
6        code, the Healthcare Common Procedure Coding System
7        (HCPCS) code, the Diagnosis Related Group (DRG) code,
8        the National Drug Code (NDC), or another common
9        identifier; and
10        (2) if applicable:
11            (A) state each location at which the facility
12        provides the shoppable service and whether the
13        standard charges included in the list apply at that
14        location to the provision of that shoppable service in
15        an inpatient setting, an outpatient department
16        setting, or in both of those settings, as applicable;
17        and
18            (B) indicate if one or more of the shoppable
19        services specified by the Centers for Medicare and
20        Medicaid Services is not provided by the facility.
21    (e) The lists required under subsections (a) and (c) must
22be:
23        (1) displayed in the manner prescribed under
24    subsection (e) of Section 15 for the list required under
25    that subsection;
26        (2) available:

 

 

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1            (A) free of charge;
2            (B) without having to register or establish a user
3        account or password;
4            (C) without having to submit personal identifying
5        information; and
6            (D) without having to overcome any other
7        impediment, including, but not limited to, entering a
8        code to access the list;
9        (3) searchable by service description, billing code,
10    and payor;
11        (4) updated in the manner prescribed under subsection
12    (h) of Section 15;
13        (5) accessible to a common commercial operator of an
14    Internet search engine to the extent necessary for the
15    search engine to index the list and display the list as a
16    result in response to a search query of a user of the
17    search engine; and
18        (6) formatted in a manner that is consistent with the
19    format prescribed by the Department under paragraph (3) of
20    subsection (f) of Section 15.
21    (f) Notwithstanding any other provision of this Section, a
22facility meets the requirements of this Section if the
23facility maintains, as determined by the Department, an
24Internet-based price estimator tool that:
25        (1) provides a cost estimate for each shoppable
26    service and any ancillary service included on the list

 

 

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1    maintained by the facility under subsection (a);
2        (2) allows a person to obtain an estimate of the
3    amount the person will be obligated to pay the facility if
4    the person elects to use the facility to provide the
5    service; and
6        (3) is:
7            (A) prominently displayed on the facility's
8        publicly accessible website; and
9            (B) accessible to the public:
10                (i) without charge; and
11                (ii) without having to register or establish a
12            user account or password.
 
13    Section 25. Reporting requirement. Each time a facility
14updates a list as required under subsection (h) of Section 15
15and paragraph (4) of subsection (e) of Section 20, the
16facility shall submit the updated list to the Department. The
17Department shall prescribe the form in which the updated list
18must be submitted to the Department.
 
19    Section 30. Monitoring and enforcement.
20    (a) The Department shall monitor each facility's
21compliance with the requirements of this Act using any of the
22following methods:
23        (1) evaluating complaints made by persons to the
24    Department regarding noncompliance with this Act;

 

 

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1        (2) reviewing any analysis prepared regarding
2    noncompliance with this Act;
3        (3) auditing the websites of facilities for compliance
4    with this Act; and
5        (4) confirming that each facility submitted the lists
6    required under Section 25.
7    (b) If the Department determines that a facility is not in
8compliance with any provision of this Act, the Department may
9take any of the following actions in any order:
10        (1) Provide a written notice to the facility that
11    clearly explains the manner in which the facility is not
12    in compliance with this Act.
13        (2) Request a corrective action plan from the facility
14    if the facility has materially violated a provision of
15    this Act, as determined under Section 35.
16        (3) Impose an administrative penalty on the facility
17    and publicize the penalty on the Department's website if
18    the facility fails to:
19            (A) respond to the Department's request to submit
20        a corrective action plan; or
21            (B) comply with the requirements of a corrective
22        action plan submitted to the Department.
 
23    Section 35. Material violation; corrective action plan.
24    (a) A facility materially violates this Act if the
25facility fails to:

 

 

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1        (1) comply with the requirements of Section 10; or
2        (2) publicize the facility's standard charges in the
3    form and manner required under Sections 15 and 20.
4    (b) If the Department determines that a facility has
5materially violated this Act, the Department shall issue a
6notice of material violation to the facility and request that
7the facility submit a corrective action plan within 30 days of
8the date of the notice. The notice must indicate the form and
9manner in which the corrective action plan must be submitted
10to the Department and clearly state the date by which the
11facility must submit the plan.
12    (c) A facility that receives a notice under subsection (b)
13must:
14        (1) submit a corrective action plan in the form and
15    manner, and by the specified date, prescribed by the
16    notice of violation; and
17        (2) complete the steps in the corrective actions plan
18    within 30 days of the Department's acceptance of the
19    corrective action plan.
20    (d) A corrective action plan submitted to the Department
21under subsection (c) must:
22        (1) describe in detail the corrective action the
23    facility will take to address any violation identified by
24    the Department in the notice provided under subsection
25    (b); and
26        (2) confirm that the facility will complete the

 

 

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1    corrective action described under paragraph (1) within 30
2    days of the Department's acceptance of the corrective
3    action plan.
4    (e) A corrective action plan submitted under this Section
5is subject to review and approval by the Department. After the
6Department reviews and approves a facility's corrective action
7plan, the Department shall notify the facility and shall
8monitor and evaluate the facility's compliance with the
9corrective action plan.
10    (f) A facility fails to respond to the Department's
11request to submit a corrective action plan if the facility
12fails to submit a corrective action plan:
13        (1) in the form and manner specified in the notice
14    provided under subsection (b); or
15        (2) by the date specified in the notice provided under
16    subsection (b).
17    (g) A facility fails to comply with a corrective action
18plan if the facility fails to address a violation within the
19specified period of time contained in the corrective action
20plan.
 
21    Section 40. Administrative penalty.
22    (a) The Department shall impose an administrative penalty
23on a facility in accordance with Section 7 of the Hospital
24Licensing Act if the facility fails to:
25        (1) respond to the Department's request to submit a

 

 

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1    corrective action plan within the timeline in subsection
2    (b) of Section 35; or
3        (2) comply with the requirements of a corrective
4    action plan submitted to the Department.
5    (b) The Department shall impose an administrative penalty
6on a facility for each violation of a requirement under this
7Act. The Department shall set the penalty in an amount
8sufficient to ensure compliance with this Act, subject to the
9limitations prescribed by subsection (c).
10    (c) For a facility with one of the following total gross
11revenues as reported to the Centers for Medicare and Medicaid
12Services or to another entity designated by the Department by
13rule in the year preceding the year in which a penalty is
14imposed, the penalty imposed by the Department shall not
15exceed:
16        (1) $1,000 for each day the facility violated this
17    Act, if the facility's total gross revenue is less than
18    $10,000,000;
19        (2) $3,000 for each day the facility violated this
20    Act, if the facility's total gross revenue is at least
21    $10,000,000 and less than $100,000,000; and
22        (3) $5,000 for each day the facility violated this
23    Act, if the facility's total gross revenue is $100,000,000
24    or more.
25    (d) Each day a violation continues is a separate
26violation.

 

 

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1    (e) In determining the amount of an administrative penalty
2under this Section, the Department shall consider:
3        (1) previous violations by the facility's operator;
4        (2) the seriousness of the violation;
5        (3) the demonstrated good faith of the facility's
6    operator; and
7        (4) any other matter justice may require.
8    (f) The Hospital Price Transparency Fund is established as
9a special fund in the State treasury. Administrative penalties
10collected under this Act shall be deposited into the Fund.
11Moneys in the Fund shall be used by the Department for expenses
12relating to the implementation, administration, and
13enforcement of this Act.
 
14    Section 45. Legislative recommendations. The Department
15may propose recommendations to the General Assembly for
16amendments to this Act, including, but not limited to,
17recommendations in response to amendments by the federal
18Centers for Medicare and Medicaid Services to 45 CFR 180.
 
19    Section 50. Hearings; Illinois Administrative Procedure
20Act.
21    (a) The procedure governing hearings under this Act shall
22be in accordance with rules adopted by the Department and
23approved by the Hospital Licensing Board. A full and complete
24record shall be kept of all proceedings, including the notice

 

 

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1of hearing, complaint, and all other documents in the nature
2of pleadings, written motions filed in the proceedings, and
3the report and orders of the Director and hearing officer. All
4testimony shall be reported but need not be transcribed unless
5the decision is appealed. A copy or copies of the transcript
6may be obtained by any interested party on payment of the cost
7of preparing such copy or copies.
8    (b) The provisions of the Illinois Administrative
9Procedure Act are hereby expressly adopted and shall apply to
10all administrative rules and procedures of the Department
11under this Act, except that Section 5-35 of the Illinois
12Administrative Procedure Act relating to procedures for
13rulemaking does not apply to the adoption of any rule required
14by federal law in connection with which the Department is
15precluded by law from exercising any discretion.
 
16    Section 65. The State Finance Act is amended by adding
17Section 5.990 as follows:
 
18    (30 ILCS 105/5.990 new)
19    Sec. 5.990. The Hospital Price Transparency Fund.
 
20    Section 70. The University of Illinois Hospital Act is
21amended by adding Section 11 as follows:
 
22    (110 ILCS 330/11 new)

 

 

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1    Sec. 11. Compliance with the Hospital Price Transparency
2Act. The University of Illinois Hospital shall comply with the
3Hospital Price Transparency Act.
 
4    Section 75. The Hospital Licensing Act is amended by
5changing Section 6.14a and by adding Section 9.9 as follows:
 
6    (210 ILCS 85/6.14a)
7    Sec. 6.14a. Public disclosure of information. The
8following information is subject to disclosure to the public
9from the Department:
10        (1) Information submitted under Section 5 of this Act;
11        (2) Final records of license and certification
12    inspections, surveys, and evaluations of hospitals; and
13        (3) Investigated complaints filed against a hospital
14    and complaint investigation reports, except that a
15    complaint or complaint investigation report shall not be
16    disclosed to a person other than the complainant or
17    complainant's representative before it is disclosed to a
18    hospital, and except that a complainant or patient's name
19    shall not be disclosed; and .
20        (4) Reports, and any information or data contained in
21    a report, submitted to the Department under the Hospital
22    Price Transparency Act.
23    The Department shall disclose information under this
24Section in accordance with provisions for inspection and

 

 

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1copying of public records required by the Freedom of
2Information Act.
3    However, the disclosure of information described in
4subsection (1) shall not be restricted by any provision of the
5Freedom of Information Act.
6    Notwithstanding any other provision of law, under no
7circumstances shall the Department disclose information
8obtained from a hospital that is confidential under Part 21 of
9Article VIII of the Code of Civil Procedure.
10    No Any records or reports of inspections, surveys, or
11evaluations of hospitals may be disclosed until only after the
12acceptance of a plan of correction by the Health Care
13Financing Administration of the U.S. Department of Health and
14Human Services or the Department, as appropriate, or at the
15conclusion of any administrative review of the Department's
16decision, or at the conclusion of any judicial review of such
17administrative decision. Whenever any record or report is
18subject to disclosure under this Section, the Department shall
19permit the hospital to provide a written statement pertaining
20to such report which shall be included as part of the
21information to be disclosed. The Department shall not divulge
22or disclose any record or report in a manner that identifies or
23would permit the identification of any natural person.
24(Source: P.A. 98-463, eff. 8-16-13.)
 
25    (210 ILCS 85/9.9 new)

 

 

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1    Sec. 9.9. Compliance with the Hospital Price Transparency
2Act. A hospital licensed under this Act shall comply with the
3Hospital Price Transparency Act.
 
4    Section 99. Effective date. This Act takes effect January
51, 2024.