Ambulatory surgical center price transparency

Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection: (bb) Ambulatory surgical center price transparency (1) In general Beginning January 1, 2028, each ambulatory surgical center that receives payment under this title for furnishing items and services shall comply with the price transparency requirement described in paragraph (2). (2) Requirement described (A) In general For purposes of paragraph (1), the price transparency requirement described in this subsection is, with respect to an ambulatory surgical center, that such surgical center in accordance with a method and format established by the Secretary under subparagraph (C), compile and make public (without subscription and free of charge), for each year— (i) all of the ambulatory surgical center’s standard charges (including the information described in subparagraph (B)) for each item and service furnished by such surgical center; (ii) information in a consumer-friendly format (as specified by the Secretary) on the ambulatory surgical center’s prices (including the information described in subparagraph (B)) for as many of the Centers for Medicare & Medicaid Services-specified shoppable services (as specified by the Secretary) that are furnished by such surgical center, and as many additional ambulatory surgical center-selected shoppable services (or all such additional services, if such surgical center furnishes fewer than 300 shoppable services) as may be necessary for a combined total of at least 300 shoppable services; (iii) with respect to each Centers for Medicare & Medicaid Services-specified shoppable service that is not furnished by the ambulatory surgical center, an indication that such service is not so furnished; and (iv) an attestation that all standard charges described in clause (i), information described in clause (ii), and indications described in clause (iii) are complete and accurate. (B) Information described For purposes of subparagraph (A), the information described in this subparagraph is, with respect to standard charges and prices, as applicable, made public by an ambulatory surgical center, the following: (i) A plain language description (as specified by the Secretary) of each item or service, accompanied by, as applicable, the Healthcare Common Procedure Coding System code, the national drug code, or other identifier used or approved by the Centers for Medicare & Medicaid Services. (ii) The gross charge, as applicable, expressed as a dollar amount, for each such item or service. (iii) For each such item or service— (I) the discounted cash price, as applicable, expressed as a dollar amount; or (II) in the case no discounted cash price is available for an item or service, the median cash price charged to self-pay individuals for such item or service for the previous three years, expressed as a dollar amount. (iv) Any other additional information the Secretary may require (in consultation with stakeholders) for the purpose of improving the accuracy of, or enabling consumers to easily understand and compare, standard charges and prices for an item or service, except information that is duplicative of any other reporting requirement under this subsection. (C) Uniform method and format Not later than January 1, 2028, the Secretary shall establish a standard, uniform method and format for ambulatory surgical centers to use in making public standard charges pursuant to subparagraph (A)(i) and a standard, uniform method and format for such centers to use in making public prices pursuant to subparagraph (A)(ii). Any such method and format— (i) shall, in the case of such charges made public by an ambulatory surgical center, ensure that such charges are made available in a machine-readable format (or successor technology); (ii) may be similar to any template made available by the Centers for Medicare & Medicaid Services (as described in section 1899D(a)(2)(C)(ii)); (iii) shall meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such charges and prices; and (iv) shall be updated as determined appropriate by the Secretary, in consultation with stakeholders. (3) Monitoring compliance The Secretary shall establish processes to monitor and assess ambulatory surgical centers’ compliance with this subsection. Such processes shall include processes relating to the following: (A) The evaluation and analysis of complaints made by individuals or other entities relating to such centers’ compliance with this subsection. (B) The use of audits to ensure such centers’ compliance with this subsection. (C) The obtaining of additional information from such centers to determine such centers’ compliance with this subsection (as determined appropriate by the Secretary). (4) Enforcement (A) In general In the case of an ambulatory surgical center that fails to comply with the requirements of this subsection— (i) the Secretary shall notify such ambulatory surgical center of such failure not later than 30 days after the date on which the Secretary determines such failure exists; and (ii) upon request of the Secretary, the ambulatory surgical center shall submit to the Secretary, not later than 45 days after the date of such request, a corrective action plan to comply with such requirements. (B) Civil monetary penalty (i) In general In addition to any other enforcement actions or penalties that may apply under another provision of Federal law, an ambulatory surgical center that has received a notification under subparagraph (A)(i) and fails to comply with the requirements of this subsection by the date that is 90 days after such notification (or, in the case of an ambulatory surgical center that has submitted a corrective action plan described in subparagraph (A)(ii) in response to a request so described and has failed to comply with such requirements by the date that is 90 days after such submission) shall be subject to a civil monetary penalty of an amount specified by the Secretary for each day (beginning with the day on which the Secretary first determined that such center was not complying with such requirements) during which such failure is ongoing (not to exceed $300 per day). (ii) Increase authority In applying this subparagraph with respect to violations occurring in 2029 or a subsequent year, the Secretary may through notice and comment rulemaking increase the limitation on the per day amount of any penalty applicable to an ambulatory surgical center under clause (i). (iii) Application of certain provisions The provisions of section 1128A (other than subsections (a) and (b) of such section) shall apply to a civil monetary penalty imposed under this subparagraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section. (iv) Authority to waive or reduce penalty (I) Centers located in rural or underserved areas (aa) In general Subject to item (bb), the Secretary may waive any penalty, or reduce any penalty by not more than 75 percent, otherwise applicable under this subparagraph with respect to an ambulatory surgical center located in a rural or underserved area if the Secretary certifies that imposition of such penalty would result in an immediate threat to access to care for individuals in the service area of such center. (bb) Limitation on application The Secretary may not elect to waive a penalty under item (aa) with respect to an ambulatory surgical center more than once in a 6-year period and may not elect to reduce such a penalty with respect to such a center more than once in such a period. Nothing in the preceding sentence shall be construed as prohibiting the Secretary from both waiving and reducing a penalty with respect to an ambulatory surgical center during a 6-year period. (II) Reduction if hearing waived The Secretary may reduce any penalty otherwise applicable under this subparagraph (as reduced, if applicable, under subclause (I)) by not more than 35 percent if the ambulatory surgical center that is the subject of such penalty agrees to waive any right of such center to a hearing before an administrative law judge with respect to the imposition of such penalty. (5) Provision of technical assistance The Secretary shall, to the extent practicable, provide technical assistance relating to compliance with the provisions of this subsection to ambulatory surgical centers requesting such assistance. (6) Definitions For purposes of this subsection: (A) Discounted cash price The term discounted cash price means the charge that applies to an individual who pays cash, or cash equivalent, for an item or service furnished by an ambulatory surgical center. (B) Gross charge The term gross charge means the charge for an individual item or service that is reflected on an ambulatory surgical center’s chargemaster, absent any discounts. (C) Shoppable service The term shoppable service means a service that can be scheduled by a health care consumer in advance and includes all ancillary items and services customarily furnished as part of such service..