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Bill

Bill

SB 316

Lower Healthcare Costs.

2025-2026 Session Introduced by Ted Alexander and 19 co-sponsors

Require public, standardized reporting of hospital and ambulatory facility charges and payments to publish aggregated price data for consumer price comparison.

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Bill Summary · SB 316

SB 316 — "Lower Healthcare Costs" (Price Transparency Act) — Summary

Status: Passed first reading (introduced Feb 11, 2025)
Primary objective: increase healthcare price transparency to help patients, employers and purchasers compare costs and reduce surprise billing and overall health spending.

This summary describes the bill’s purpose, main provisions, who must comply, likely impacts, and key procedural points.

Main purpose and intent

SB 316 is designed to make hospital and ambulatory surgical facility prices and insurer payment information publicly available and comparable. By requiring routine, standardized reporting of charges, negotiated payments and public-payer reimbursements, the bill seeks to empower consumers to shop for care, foster competition among providers, and reduce unexpected medical bills — with the broader goal of lowering health care costs.

Key provisions

  • Reporting by hospitals (quarterly): each hospital must submit data on the 100 most‑frequent inpatient DRGs (Diagnostic Related Groups), including for each DRG:
    • the full charge to an uninsured/self‑pay patient;
    • the hospital’s average negotiated settlement amount;
    • Medicare and Medicaid reimbursement amounts (including supplemental payments); and
    • payment ranges and averages for the hospital’s five largest commercial payers (insurer identities redacted before submission).
  • Reporting by ambulatory surgical facilities (quarterly): facilities must report comparable data for the most common outpatient surgical and imaging procedures (by CPT and HCPCS codes), including facility charges, payer payments and public‑payer reimbursements.
  • Standardization and publication:
    • The Medical Care Commission (or comparable state authority) must adopt rules to ensure uniform reporting.
    • A designated statewide data processor / Department of Health & Human Services (DHHS) will receive the submissions and post aggregated, non‑identifiable data on a public website for consumer access.
  • Privacy protections: hospitals are not required to report items that would risk violating HIPAA or otherwise identifying individual patients.
  • Rulemaking & implementation details: the Commission/Department must specify categorization, grouping of hospitals for public display, and technical reporting formats to support comparability.
  • (Existing statutory language is updated/expanded — the bill amends Article 11B of the state health code to broaden and modernize disclosure requirements.)

Who is affected

  • Hospitals and ambulatory surgical facilities: must collect, format and submit required datasets on a recurring basis.
  • Health plans / insurers: indirectly affected (their negotiated payment ranges will be reported, though insurer names are redacted for submission).
  • State agencies: DHHS (or designated statewide data processor) and the Medical Care Commission — responsible for receiving data, rulemaking, and public posting.
  • Patients, employers, researchers and policymakers: intended beneficiaries who will gain accessible pricing data for comparison and oversight.

Potential impacts

  • Consumer benefits: better ability to estimate costs; more informed choice of provider; reduced surprise billing.
  • Market dynamics: improved price visibility may pressure high‑cost providers to lower prices or justify higher quality.
  • Administrative burden: hospitals/facilities and state agencies will incur implementation and ongoing reporting costs (data extraction, standardization, IT interfaces).
  • Privacy and data quality issues: the law limits reporting that risks patient identification; accurate, comparable reporting will depend on consistent coding and hospital compliance.
  • Fiscal: potential state costs for managing the data portal and rulemaking; potential downstream savings if greater transparency reduces prices.

Procedural / timeline notes

  • The bill revises existing transparency statutes and relies on Commission rulemaking and DHHS/data‑processor implementation to operationalize reporting and public posting.
  • The text invokes quarterly reporting cycles; implementation hinges on rule deadlines specified in the statute (the Commission is directed to adopt implementing rules and specify technical standards).
  • As introduced, the bill has progressed through initial legislative steps; readers should consult the legislative status page for the latest committee actions and amendments.

If you’d like, I can:
- Extract the exact statutory language changes and list them line‑by‑line;
- Produce a short FAQ for hospitals about compliance steps; or
- Draft a one‑page explainer for consumers on how to use the posted price data.

Compiled from official sources — confirm details with the bill’s official record.

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