PRINTER'S NO. 574
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
549
Session of
2017
INTRODUCED BY READSHAW, D. COSTA, DEASY, MATZIE, MURT, JAMES,
WARD, KORTZ AND THOMAS, FEBRUARY 17, 2017
REFERRED TO COMMITTEE ON HEALTH, FEBRUARY 17, 2017
AN ACT
Establishing pricing disclosures for certain health care
providers; and prohibiting certain discounts and kickbacks.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Patient
Medical Access and Affordability Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Health care provider." An entity or individual who provides
health care but is not licensed by a professional licensing
board of the Department of State. This term shall include
hospitals, long-term care facilities, outpatient diagnostic
facilities, medical equipment providers, medical practices not
owned by private practitioners or outpatient surgical centers.
The term shall not include physicians who are private
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practitioners, private duty nurses, chiropractors, dentists,
podiatrists or independent psychologists.
"Third-party payor." An entity that pays for medical
treatments on behalf of the patient. This may include insurance
companies. The term shall not include a private individual or
charity that is not regularly in the business of handling
medical payments.
Section 3. Pricing disclosures.
(a) Health care providers.--A health care provider shall
establish a set price for all services, supplies and charges. A
health care provider shall report its charges using the
Healthcare Common Procedure Coding System and the diagnosis-
related grouping system. The Secretary of Health may designate
other reporting systems as needed for implementation of this
act. These prices shall be posted on a publicly accessible
Internet website.
(b) Third-party payors.--A third-party payor shall establish
a fee schedule applicable to all covered individuals. A third-
party payor shall utilize the same coding system which is
utilized by health care providers. The fee schedule shall be
posted on a publicly accessible Internet website.
(c) Individuals.--An individual shall be responsible to pay
any remaining balance after the third-party payor has submitted
the established fee for any service, supply or charge to the
health care provider.
Section 4. Discounts.
(a) Individuals.--A health care provider may allow for
discounts to be given to individuals who prepay or provide early
payment based on financial need or other criteria that is
applied on a uniform basis to all individuals.
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(b) Prohibited discounts.--A health care provider may not
give discounts of any type to a third-party payor. These
prohibited discounts include rebates and kickbacks.
Section 5. Limitation.
Services provided by a health care provider for programs
administered, regulated or paid for by government entities are
exempt from the requirements of this act. The services that
qualify under this section shall include Medicare, Medicaid, the
Chronic Renal Disease Program, the Workers' Compensation Program
and any successor programs.
Section 6. Effective date.
This act shall take effect in 60 days.
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