An Act To Implement the Recommendations of the Commission To Study Transparency, Costs and Accountability of Health Care System Financing

Sec. 1. 22 MRSA §1718,  as repealed and replaced by PL 2009, c. 71, §3, is amended to read:

§ 1718. Consumer information

Each hospital or ambulatory surgical center licensed under chapter 405 shall, upon request by an individual, provide the average charge for any inpatient service or outpatient procedure provided by the licensee. For emergency services, the hospital must provide the average charges for facility and physician services according to the level of emergency services provided by the hospital and based on the time and intensity of services provided. The hospital or ambulatory surgical center shall prominently display a notice informing individuals of an individual's authority to request information on the average charges described in this paragraph from the hospital or ambulatory surgical center.

Sec. 2. 22 MRSA §1718-A,  as enacted by PL 2013, c. 332, §1 and affected by §3, is amended to read:

§ 1718-A. Consumer information regarding health care practitioner prices

Each health care practitioner, as defined in section 1711-C, subsection 1, paragraph F, shall maintain a price list of the health care practitioner's most frequently provided health care services and procedures. The prices stated must be the prices that the health care practitioner charges clients directly, when there is no insurance coverage for the services or procedures or when reimbursement by an insurance company is denied. The prices stated must be accompanied by the applicable standard medical codes listed by diagnosis. For purposes of this section, "frequently provided health care services and procedures" means those health care services and procedures that were provided by the health care practitioner at least 50 times in the preceding calendar year. Health care practitioners shall inform clients about the availability of the price list and provide copies of the price list upon request. Health care practitioners shall make available written information on health claims data that may be obtained through the publicly accessible website of the Maine Health Data Organization established pursuant to chapter 1683 prominently display in a location that is readily accessible to clients information on the price transparency tools available from the publicly accessible website of the Maine Health Data Organization established pursuant to chapter 1683 to assist consumers with obtaining estimates of costs associated with health care services and procedures. Health care practitioners shall make printed copies of the information described in this paragraph available to clients upon their request. This section does not apply to pharmacists.

Sec. 3. 22 MRSA §1718-B  is enacted to read:

§ 1718-B.  Individualized health care cost estimate

Upon the request of a client, each health care practitioner and health care facility, as defined in section 1711-C, subsection 1, paragraphs F and D, respectively, shall provide an individualized cost estimate for the client's anticipated health care services and procedures that must include all health care charges that the practitioner or facility reasonably anticipates to charge directly to the client. For purposes of this section, "cost estimate" includes the practitioner's or facility's costs at the unit for which services and procedures are billed, as well as any negotiated discounts, and any costs reasonably anticipated to be charged by that practitioner or facility for the client associated with a service or procedure, including hospital, physician, pharmacy and laboratory fees, and must identify the client's out-of-pocket cost. The cost estimate must be accompanied by a description of the service or procedure and the applicable standard medical codes or current procedural terminology code.

Sec. 4. 22 MRSA §8704, sub-§7,  as amended by PL 2011, c. 494, §8, is further amended to read:

summary

This bill implements the recommendations of the Commission To Study the Transparency, Costs and Accounting of Health Care System Financing. The bill requires health care practitioners and health care facilities to provide clients, upon request, with an individualized cost estimate for anticipated health care services associated with that specific entity's services. It directs health care practitioners to expand public awareness of the Maine Health Data Organization and its website by displaying at practitioners' offices information on the Maine Health Data Organization and how consumers can become more informed of the costs associated with health care procedures. It amends the laws governing the information that hospitals and ambulatory surgical centers are required to make available to consumers by adding a requirement that these entities prominently display a notice informing consumers of their ability to request and receive information on the average charges for any inpatient service or outpatient procedure provided by the hospital or center upon request. It amends the annual statutory reporting requirement for the Maine Health Data Organization to include language requiring the Maine Health Data Organization to include in its report an update on its collaborative efforts with other health data organizations to improve consumer access to information on health care quality and price and health care transparency initiatives in this State. The bill also amends the statutory provisions governing the Maine Health Data Organization annual report to require that the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters, in addition to the joint standing committee of the Legislature having jurisdiction over health and human services matters, be provided with the annual report.