LRB-3039/1
JPC:amn
2023 - 2024 LEGISLATURE
June 30, 2023 - Introduced by Representatives Brooks, Rozar, Allen, Bodden,
Brandtjen, Dittrich, Donovan, Duchow, Goeben, Green, Gundrum,
Gustafson, Macco, Rettinger, Schraa, Shankland, Sortwell and Wichgers,
cosponsored by Senators Felzkowski, Bradley, Hutton, Knodl, Larson,
Nass, Stroebel and Wimberger. Referred to Committee on Health, Aging and
Long-Term Care.
AB338,1,2 1An Act to create 50.40 of the statutes; relating to: price transparency in
2hospitals and providing a penalty.
Analysis by the Legislative Reference Bureau
This bill creates several requirements for hospitals to provide cost information
for certain items and services provided by the hospital. Under the bill, each hospital
must make publicly available a digital file in a machine-readable format that
contains a list of standard charges for certain items and services provided by the
hospital and a consumer-friendly list of standard charges for certain shoppable
services. “Standard charge” is defined to mean the regular rate established by the
hospital for an item or service provided to a specific group of paying patients and
includes certain price information, including the gross charge, the payor-specific
negotiated charge, and the discounted cash price. “Shoppable service” is defined to
mean a service that may be scheduled by a health care consumer in advance. If the
Department of Health Services determines that a hospital is not in compliance with
any of the price transparency requirements specified in the bill, the bill requires DHS
to take certain actions, including providing a written notice to the hospital,
requesting a corrective action plan from the hospital, or imposing a penalty. The bill
establishes escalating penalties for violations of the hospital price transparency
requirements specified in the bill based on the hospital's bed count, from $600 for
each day in which a hospital with 30 beds or fewer violates the hospital price
transparency requirements under the bill up to $10,000 for each day in which a
hospital with greater than 550 beds violates the hospital price transparency
requirements under the bill. The bill also requires DHS to maintain a publicly

available list of hospitals that have been found to have violated any of the price
transparency requirements specified in the bill.
Under the bill, the list of standard charges must be available at all times to the
public in a machine-readable format, must be displayed in a prominent location on
the home page of the hospital's website, and must include certain information,
including a description of each hospital item or service provided and any code used
by the hospital for purposes of accounting or billing. Further, the list of standard
charges must meet certain criteria, including that it must be available free of charge
and without having to establish a user account or password, that the list is available
without having to submit personal identifying information, that the list is digitally
searchable, and that the list is accessible to a commercial operator of an Internet
search engine as necessary for the search engine to index the list and display the list
as a result in response to a search query of a user of the search engine. The list of
standard charges must be updated at least once each year.
Further, under the bill, the consumer-friendly list of standard charges for
shoppable services must be publicly available and must contain standard charge
information for each of at least 300 shoppable services provided by the hospital. The
bill allows a hospital to select the shoppable services to be included in the list, except
that the list must include either the 70 services specified as shoppable services by
the federal Centers for Medicare and Medicaid Services (CMS) or, if the hospital does
not provide all of the shoppable services specified by CMS, as many of the 70 services
specified as shoppable services by CMS as the hospital provides. If a hospital does
not provide at least 300 shoppable services, the bill requires the hospital to maintain
a list of all shoppable services that the hospital provides. The consumer-friendly list
of standard charges for shoppable services must include certain information,
including certain price information and a plain-language description of each
shoppable service included on the list, whether each hospital location provides the
shoppable service and whether the standard charges included in the list apply at that
location, and whether one or more of the shoppable services specified by CMS is not
provided by the hospital. The consumer-friendly list of standard charges for
shoppable services must meet certain criteria, including that the list is available free
of charge without having to establish a user account or password, that the list is
searchable by service description, billing code, and payor, and that the list is
accessible to a common commercial operator of an Internet search engine as
necessary for the search engine to index the list and display the list as a result in
response to a search query of a user of the search engine. The consumer-friendly list
of standard charges for shoppable services must be updated at least once each year.
The bill provides that every time a hospital updates the list of standard charges
or the consumer-friendly list of standard charges for shoppable services, the hospital
must submit the updated list to DHS. Under the bill, DHS must monitor each
hospital's compliance with the price transparency requirements specified in the bill
by evaluating complaints, reviewing any analysis prepared regarding
noncompliance, auditing the websites of hospitals, or confirming that each hospital
submitted the required lists.

For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB338,1 1Section 1. 50.40 of the statutes is created to read:
AB338,3,2 250.40 Hospital price transparency. (1) Definitions. In this section:
AB338,3,43 (a) “Ancillary service” means a hospital item or service that a hospital
4customarily provides as part of a shoppable service.
AB338,3,65 (b) “Chargemaster” means the list of all hospital items or services maintained
6by a hospital for which the hospital has established a charge.
AB338,3,87 (c) “De-identified maximum negotiated charge” means the highest charge that
8a hospital has negotiated with all 3rd-party payors for a hospital item or service.
AB338,3,109 (d) “De-identified minimum negotiated charge” means the lowest charge that
10a hospital has negotiated with all 3rd-party payors for a hospital item or service.
AB338,3,1211 (e) “Discounted cash price” means the charge that applies to an individual who
12pays cash, or a cash equivalent, for a hospital item or service.
AB338,3,1413 (f) “Gross charge” means the charge for a hospital item or service that is
14reflected on a hospital's chargemaster, absent any discounts.
AB338,3,1915 (g) “Hospital items or services” means all items and services, including
16individual items and services and service packages, that may be provided by a
17hospital to a patient in connection with an inpatient admission or an outpatient
18department visit for which the hospital has established a standard charge, including
19all of the following:
AB338,3,2020 1. Supplies and procedures.
AB338,3,2121 2. Room and board.
AB338,4,1
13. Use of the hospital and other areas.
AB338,4,32 4. Services of physicians and nonphysician practitioners employed by the
3hospital.
AB338,4,54 5. Any other item or service for which a hospital has established a standard
5charge.
AB338,4,86 (h) “Machine-readable format” means a digital representation of information
7in a file that can be imported or read into a computer system for further processing.
8“Machine-readable format” includes .XML, .JSON, and .CSV formats.
AB338,4,109 (i) “Payor-specific negotiated charge” means the charge that a hospital has
10negotiated with a 3rd-party payor for a hospital item or service.
AB338,4,1211 (j) “Service package” means an aggregation of individual hospital items or
12services into a single service with a single charge.
AB338,4,1413 (k) “Shoppable service” means a service that may be scheduled by a health care
14consumer in advance.
AB338,4,1715 (L) “Standard charge” means the regular rate established by the hospital for
16a hospital item or service provided to a specific group of paying patients and includes
17all of the following:
AB338,4,1818 1. The gross charge.
AB338,4,1919 2. The payor-specific negotiated charge.
AB338,4,2020 3. The de-identified minimum negotiated charge.
AB338,4,2121 4. The de-identified maximum negotiated charge.
AB338,4,2222 5. The discounted cash price.
AB338,4,2423 (m) “Third-party payor” means an entity that is, by statute, contract, or
24agreement, legally responsible for payment of a claim for a hospital item or service.
AB338,5,2
1(2) Public availability of price information required. A hospital shall make
2publicly available all of the following:
AB338,5,43 (a) A digital file in a machine-readable format that contains a list of all
4standard charges for all hospital items or services described under sub. (3).
AB338,5,65 (b) A consumer-friendly list of standard charges for a limited set of shoppable
6services as provided in sub. (4).
AB338,5,8 7(3) List of standard charges required. (a) A hospital shall do all of the
8following:
AB338,5,109 1. Maintain a list of all standard charges for all hospital items or services in
10accordance with this section.
AB338,5,1211 2. Ensure the list required under subd. 1. is available at all times to the public,
12including by posting the list electronically in the manner provided in this section.
AB338,5,1613 (b) The standard charges contained in the list required to be maintained by a
14hospital under par. (a) 1. shall reflect the standard charges applicable to that location
15of the hospital, regardless of whether the hospital operates in more than one location
16or operates under the same license as another hospital.
AB338,5,1817 (c) The list required under par. (a) 1. shall include all of the following
18information:
AB338,5,1919 1. A description of each hospital item or service provided by the hospital.
AB338,5,2120 2. The following charges for each individual hospital item or service when
21provided in either an inpatient setting or an outpatient department setting:
AB338,5,2222 a. The gross charge.
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