HB 2409 — Updating cooperative agreements

(D)(E) TheEnsure de-identifiedaccountability maximumof negotiatedthe charge;cost of care;

and(F) (E)Enhance Theacademic discountedengagement cashin price.regional health;

(15)(G) "ThirdPreserve partyand payor"improve meansmedical aneducation entityopportunities; that is, by statute, contract, or agreement, legally responsible for payment of a claim for a facility item or service.

§26-12-4.(H) Strengthen the workforce for health-related careers;

Publicand availability(I) ofImprove pricehealth informationentity required.collaboration and regional integration, where appropriate.

Notwithstanding(3) anyA otherqualified law,hospital located in this state may submit an application for approval of a facilityproposed mustcooperative makeagreement public:to the authority.

(a)The Aapplication digitalshall filestate in adetail machine-readablethe formatnature that contains a list of allthe standardproposed chargesarrangement forincluding allthe facilitygoals itemsand ormethods servicesfor asachieving: described by §26-12-5 of this Code;

and(A) (b)Population Ahealth consumer-friendlyimprovement; list of standard charges for a limited set of shoppable services as provided in §26-12-6 of this Code.

§26-12-5.(B) Improved access to health care services;

List(C) ofImproved standardquality; charges required.

(a)3 A(D) facilityCost must:efficiencies;

(1)(E) MaintainEnsuring aaffordability list of allcare; standard charges for all facility items or services in accordance with this section;

and(F) (2)Enhancing Ensureand thatpreserving themedical listeducation isprograms; available at all times to the public, including by posting the list electronically in the manner provided by this section.

(b)and The(G) standardSupporting charges contained in the listauthority’s requiredgoals toand bestrategic maintainedmission, by a facility under this section must reflect the standard charges applicable to that location of the facility, regardless of whether the facility operates in more than one location or operates under the same license as anotherapplicable. facility.

(c)(4) The(A) listAn requiredapplication underfor review of a cooperative agreement as provided in this section mustshall includebe submitted and approved prior to the followingfinalization items,of asthe applicable:cooperative agreement, if the cooperative agreement involves the merger, consolidation or acquisition of a hospital.

(1)located Awithin descriptiona distance of eachtwenty facilityhighway itemmiles orof servicethe providedmain bycampus of the facility;qualified hospital.

(2)(B) TheIn followingreviewing chargesan application for eachcooperative individualagreement, facilitythe itemauthority orshall servicegive whendeference providedto inthe eitherpolicy anstatements inpatientof settingthe orFederal anTrade outpatientCommission. department setting, as applicable:

Intr(C) HBIf 2025R2897an (A)application Thefor grossa charge;review of a cooperative agreement is not required the qualified hospital may apply to the authority for approval of the cooperative agreement either before or after the finalization of the cooperative agreement.

(B)(e) The(d) de-identifiedProcedure minimumfor negotiatedreview charge;of cooperative agreements.

(C)(1) TheUpon de-identifiedreceipt maximumof negotiatedan charge;application, the authority shall determine whether the application is complete.

(D)If Thethe discountedauthority cashdetermines price;the application is incomplete, it shall notify the applicant in writing of additional items required to complete the application.

andA (E)copy The payor-specific negotiated charge, listed by the name of the third-partycomplete payorapplication andshall planbe associatedprovided withby the chargeparties andto displayedthe inOffice aof mannerthe thatAttorney clearlyGeneral associatessimultaneous the charge with eachthe third-partysubmission payorto andthe plan;authority.

andIf (3)an Anyapplicant codebelieves used by the facilitymaterials forsubmitted purposescontain ofproprietary accountinginformation orthat billingis forrequired theto facilityremain itemconfidential, orsuch service,information includingmust thebe Currentclearly Proceduralidentified Terminologyand (CPT) code, the Healthcareapplicant Commonshall Proceduresubmit Codingduplicate Systemapplications, (HCPCS)one code,with thefull Diagnosisinformation Relatedfor Groupthe (DRG)authority’s code,use theand Nationalone Drugredacted Codeapplication (NDC),available orfor otherrelease commonto identifier.the public.

(d)(2) The informationauthority containedshall inupon thereceipt listof requireda undercompleted subsectionapplication, (a)publish mustnotification beof publishedthe inapplication aon singleits digitalwebsite fileas thatwell isas provide notice of such application placed in athe machine-readableState format.Register.

(e) The listpublic requiredmay undersubmit subsectionwritten (a)comments mustregarding be displayed in a prominent location on the homeapplication pagewithin often thedays facility'sfollowing publiclypublication. accessible Internet website or accessible by selecting a dedicated link that is prominently displayed on the home page of the facility's publicly accessible Internet website.

IfFollowing the facilityclose operatesof multiple locations and maintains a single Internet website, the listwritten requiredcomment underperiod, subsection (a) must be posted for each location the facilityauthority operatesshall inreview a manner that clearly associates the list4 withapplication theas applicableset locationforth ofin thethis facility.section.

(f)Within Thethirty listdays requiredof underthe subsectionreceipt (a)of must:a complete application the authority may:

(1)(i) BeIssue available:a certificate of approval which shall contain any conditions the authority finds necessary for the approval;

(A)(ii) FreeDeny ofthe charge;application;

(B)or Without(iii) havingOrder a public hearing if the authority finds it necessary to establishmake aan userinformed accountdecision oron password;the application.

(C)(3) WithoutThe havingauthority toshall submitissue personala identifyingwritten information;decision within seventy-five days from receipt of the completed application.

andThe (D)authority Withoutmay havingrequest toadditional overcomeinformation anyin otherwhich impediment,case includingthey enteringshall ahave codean additional fifteen days following receipt of the supplemental information to accessapprove or deny the list;proposed cooperative agreement.

Intr(4) HBNotice 2025R2897 (2) Be accessible to a common commercial operator of anany Internethearing searchshall enginebe tosent theby extentcertified necessarymail for the search engine to index the listapplicants and displayall thepersons, listgroups asor aorganizations resultwho inhave responsesubmitted towritten acomments searchon query of a user of the searchproposed engine;cooperative agreement.

(3)Any Beindividual, formattedgroup inor aorganization mannerwho prescribedsubmitted bywritten comments regarding the Departmentapplication and wishes to present evidence at the public hearing shall request to be recognized as an affected party as set forth in article two-d of Healththis Facilities;chapter.

(4)The Behearing digitallyshall searchable;be held no later than forty-five days after receipt of the application.

andThe (5)authority Useshall thepublish followingnotice namingof conventionthe specifiedhearing byon the Centersauthority’s forwebsite Medicarefifteen anddays Medicaidprior Services,to specifically:the hearing.

<ein>_<facility-name>_standardcharges.[jsonxmlcsv]The (g)authority Inshall prescribingadditionally theprovide formattimely notice of thesuch listhearing requiredin by this section, the DepartmentState ofRegister. Health Facilities must:

(1)(5) DevelopParties amay templatefile thata eachmotion facilityfor mustan useexpedited indecision. formatting the list;

and(f) (2)(e) InStandards developingfor thereview templateof requiredcooperative byagreements. this section:

(A)— Consider(1) anyIn applicableits federalreview guidelinesof foran formattingapplication similarfor listsapproval requiredof bya federalcooperative lawagreement orsubmitted rulepursuant andto ensurethis thatsection, the designauthority ofmay consider the templateproposed enablescooperative healthagreement careand researchersany tosupporting comparedocuments thesubmitted chargesby containedthe inapplicant, theany listswritten maintainedcomments submitted by eachany facility;person and any written or oral comments submitted, or evidence presented, at any public hearing.

and(2) (B)The Designauthority theshall templateconsult towith be substantially similar to the templateAttorney usedGeneral byof thethis Centersstate forregarding Medicarehis andor Medicaidher Services5 forassessment similar purposes, if the Department of Healthwhether Facilitiesor determinesnot thatto designingapprove the templateproposed incooperative thatagreement. manner serves the purposes of this section and that the Department of Health Facilities benefits from developing and requiring that substantially similar design.

(h)(3) The facilityauthority mustshall updateapprove a proposed cooperative agreement and issue a certificate of approval if it determines, with the listwritten requiredconcurrence underof thisthe sectionAttorney atGeneral, leastthat oncethe eachbenefits year.likely to result from the proposed cooperative agreement outweigh the disadvantages likely to result from a reduction in competition from the proposed cooperative agreement.

The(4) facilityIn mustevaluating clearly indicate the datepotential onbenefits whichof thea listproposed wascooperative mostagreement, recentlythe updated,authority eithershall onconsider thewhether listone or inmore aof mannerthe thatfollowing isbenefits clearlymay associatedresult withfrom the list.proposed cooperative agreement:

§26-12-6.(A) Enhancement and preservation of existing academic and clinical educational programs;

Consumer-friendly(B) listEnhancement of shoppablethe services.quality of hospital and hospital-related care, including mental health services and treatment of substance abuse provided to citizens served by the authority;

(a)(C) ExceptEnhancement asof providedpopulation byhealth thisstatus section,consistent awith facility must maintain and make publicly available a list of the standardhealth chargesgoals describedestablished by this chapter for each of at least 300 shoppable services Intr HB 2025R2897 provided by the facility.authority;

The(D) facilityPreservation mayof selecthospital thefacilities shoppablein servicesgeographical proximity to bethe includedcommunities intraditionally theserved list,by exceptthose thatfacilities theto listensure mustaccess include:to care;

(1)(E) TheGains 70in servicesthe specifiedcost-efficiency asof shoppable services provided by the Centershospitals forinvolved; Medicare and Medicaid Services;

or(F) (2)Improvements Ifin the facilityutilization does not provide all of thehospital shoppableresources servicesand describedequipment; by subdivision (1), as many of those shoppable services the facility does provide.

(b)(G) InAvoidance selectingof aduplication shoppable service for purposes of inclusionhospital inresources; the list required under this section, a facility must:

(1)(H) ConsiderParticipation howin frequently the facilitystate providesMedicaid theprogram; service and the facility's billing rate for that service;

and (2)(I) PrioritizeConstraints theon selectionincreases ofin services that are among the servicestotal mostcost frequentlyof providedcare. by the facility.

(c)(5) IfThe aauthority’s facilityevaluation doesof notany providedisadvantages 300attributable shoppableto services,any thereduction facilityin mustcompetition maintainlikely ato listresult offrom the totalproposed numbercooperative ofagreement shoppableshall servicesinclude, thatbut theneed facilitynot providesbe inlimited ato, manner that otherwise complies with the requirementsfollowing offactors: this section.

(d)(A) The list,extent requiredof underany thislikely section,adverse asimpact applicable,of must:the proposed cooperative agreement on the ability of health maintenance organizations, preferred provider organizations, managed health 6 care organizations or other health care payors to negotiate reasonable payment and service arrangements with hospitals, physicians, allied health care professionals or other health care providers;

(1)(B) Include:The extent of any reduction in competition among physicians, allied health professionals, other health care providers or other persons furnishing goods or services to, or in competition with, hospitals that is likely to result directly or indirectly from the proposed cooperative agreement;

(A)(C) AThe plain-languageextent description of eachany shoppablelikely serviceadverse includedimpact on patients in the list;quality, availability and price of health care services;

(B)and (D) The payor-specificavailability negotiatedof chargearrangements that appliesare toless eachrestrictive shoppableto servicecompetition includedand onachieve the listsame andbenefits anyor ancillarya service,more listedfavorable bybalance the name of thebenefits third-partyover payordisadvantages andattributable planto associatedany withreduction the charge and displayed in acompetition mannerlikely thatto clearlyresult associatesfrom the chargeproposed withcooperative theagreement. third-party payor and plan;

(C)(6) The(A) discountedAfter casha pricecomplete thatreview appliesof tothe eachrecord, shoppableincluding, servicebut includednot onlimited to, the listfactors set out in subsection (e) of this section, any commitments made by the applicant or applicants and any ancillaryconditions serviceimposed or,by the authority, if the facilityauthority doesdetermines notthat offerthe abenefits discountedlikely cashto priceresult forfrom onethe orproposed morecooperative ofagreement outweigh the shoppabledisadvantages orlikely ancillaryto servicesresult onfrom thea list,reduction in competition from the grossproposed chargecooperative foragreement, the shoppableauthority serviceshall orapprove ancillarythe service,proposed ascooperative applicable;agreement.

Intr(B) HB 2025R2897 (D) The de-identifiedauthority minimummay negotiatedreasonably chargecondition thatapproval appliesupon to each shoppable service included on the listparties’ andcommitments anyto: ancillary service;

(E)(i) TheAchieving de-identifiedimprovements maximumin negotiatedpopulation chargehealth; that applies to each shoppable service included on the list and any ancillary service;

and(ii) (F)Access Anyto codehealth usedcare byservices; the facility for purposes of accounting or billing for each shoppable service included on the list and any ancillary service, including the Current Procedural Terminology (CPT) code, the Healthcare Common Procedure Coding System (HCPCS) code, the Diagnosis Related Group (DRG) code, the National Drug Code (NDC), or other common identifier;

(iii) Quality and (2)cost Ifefficiencies applicable:identified by the parties in support of their application for approval of the proposed cooperative agreement;

(A) State each location at which the facility provides the shoppable service and whether(iv) theAny standardadditional chargescommitments includedmade inby the listparties apply at that location to the provisioncooperative ofagreement. that shoppable service in an inpatient setting, an outpatient department setting, or in both of those settings, as applicable;

andAny (B)conditions Indicateset if one or more of the shoppable services specified by the Centersauthority forshall Medicarebe andfully Medicaidenforceable Services is not provided by the facility.authority.

(e)No Thecondition listimposed requiredby underthe subsectionauthority, (a)however, shall limit or (c),interfere aswith applicable,the mustright be:of a hospital to adhere to 7 religious or ethical directives established by its governing board.

(1)(7) DisplayedThe inauthority’s thedecision mannerto prescribedapprove byor §26-12-5deny ofan thisapplication codeshall forconstitute a final order or decision pursuant to the listWest requiredVirginia underAdministrative thatProcedure section;Act (§ 29A-1-1, et seq.).

(2)The Available:authority may enforce commitments and conditions imposed by the authority in the circuit court of Kanawha County or the circuit court where the principal place of business of a party to the cooperative agreement is located.

(A)(g) Free(f) Enforcement and supervision of charge;cooperative agreements.

(B)— WithoutThe havingauthority toshall registerenforce orand establishsupervise aany userapproved accountcooperative oragreement password;for compliance.

(C)(1) WithoutThe havingauthority is authorized to submitpromulgate personallegislative identifyingrules information;in furtherance of this section.

andAdditionally, (D)the Withoutauthority havingshall promulgate emergency rules pursuant to overcomethe anyprovisions otherof impediment,section includingfifteen, enteringarticle athree, chapter twenty-nine-a of this code to accessaccomplish the list;goals of this section.

(3)These Searchablerules byshall serviceinclude, description,at billinga code,minimum: and payor;

Intr(A) HBAn 2025R2897annual (4)report Updated in the manner prescribed by §26-12-5 of this code for the listparties requiredto undera thatcooperative section;agreement.

(5)This Accessiblereport tois arequired common commercial operator of an Internet search engine to theinclude: extent 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;

and(i) (6)Information Formattedabout inthe aextent mannerof that is consistent with the formatbenefits prescribedrealized byand thecompliance Departmentwith ofother Healthterms Facilitiesand underconditions §26-12-5 of thisthe code.approval;

§26-12-7.(ii) A description of the activities conducted pursuant to the cooperative agreement, including any actions taken in furtherance of commitments made by the parties or terms imposed by the authority as a condition for approval of the cooperative agreement;

Reporting(iii) Requirement.Information relating to price, cost, quality, access to care and population health improvement;

Each(iv) timeDisclosure of any reimbursement contract between a facilityparty updatesto a listcooperative asagreement requiredapproved underpursuant to this article,section theand facilitya mustcommercial submithealth theplan updatedor listinsurer entered into subsequent to the Departmentfinalization of Healththe Facilities.cooperative agreement.

TheThis Departmentshall include the amount, if any, by which an increase in the average rate of Healthreimbursement Facilitiesexceeds, mustwith prescriberespect to inpatient services for such year, the formincrease in whichthe Consumer Price Index for all Urban Consumers for hospital inpatient 8 services as published by the updatedBureau listof mustLabor beStatistics submittedfor such year and, with respect to outpatient services, the Departmentincrease ofin Healththe Facilities.Consumer Price Index for all Urban Consumers for hospital outpatient services for such year;

§26-12-8.and (v) Any additional information required by the authority to ensure compliance with the cooperative agreement.

Monitoring(B) If an approved application involves the combination of hospitals, disclosure of the performance of each hospital with respect to a representative sample of quality metrics selected annually by the authority from the most recent quality metrics published by the Centers for Medicare and enforcement.Medicaid Services.

(a) The Departmentrepresentative ofsample Healthshall Facilitiesbe mustpublished monitorby each facility's compliance with the requirementsauthority ofon thisits chapterwebsite. using any of the following methods:

(1)(C) EvaluatingA complaintsprocedure madefor bya personscorrective toaction plan where the Departmentaverage performance score of Healththe Facilitiesparties regardingto noncompliancethe cooperative agreement in any calendar year is below the fiftieth percentile for all United States hospitals with respect to the quality metrics as set forth in (B) of this chapter;subsection.

(2)The Reviewingcorrective anyaction analysisplan preparedis regardingrequired noncomplianceto: with this chapter;

(3)(i) AuditingBe thesubmitted Internetone websiteshundred oftwenty facilitiesdays forfrom compliancethe withcommencement thisof chapter;the next calendar year;

and (4)(ii) ConfirmingProvide thatfor a rebate to each facilitycommercial submittedhealth theplan listsor requiredinsurer underwith §26-12-7which they have contracted an amount not in excess of thisone code.percent of the amount paid to them by such commercial health plan or insurer for hospital services during such two-year period if in any two consecutive- year period the average performance score is below the fiftieth percentile for all United States hospitals.

(b)The Ifamount theto Departmentbe ofrebated Healthshall Facilitiesbe determinesreduced thatby athe facilityamount isof notany reduction in compliancereimbursement withwhich may be imposed by a provisioncommercial ofhealth thisplan chapter,or theinsurer Departmentunder ofa Healthquality Facilitiesincentive mustor takeawards program in which the followinghospital actions:is a participant.

(1)(D) ProvideA aprocedure writtenwhere noticeif tothe excess above the facilityincrease thatin clearlythe explainsConsumer Price Index for all Urban Consumers for hospital inpatient services or hospital outpatient services is two percent or greater the mannerauthority inmay order the rebate of the amount which exceeds the facilityrespective isindices not9 inby compliancetwo withpercent thisor chapter;more to all health plans or insurers which paid such excess unless the party provides written justification of such increase satisfactory to the authority taking into account case mix index, outliers and extraordinarily high cost outpatient procedure utilizations.

(2)(E) RequestThe aability correctiveof action plan from the facilityauthority ifto theinvestigate, facilityas hasneeded, materiallyto violatedensure acompliance provisionwith ofthe thiscooperative chapter,agreement. as determined under §26-12-9 of this code;

and(F) IntrThe HBability 2025R2897 (3) Impose an administrative penalty, as determined in §26-12-10 of this code on the facilityauthority andto publicizetake theappropriate penaltyaction, onincluding therevocation Department of Healtha Facilitiescertificate Internetof websiteapproval, if theit facilitydetermines failsthat: to:

(A)(i) RespondThe parties to the Departmentagreement are not complying with the terms of Healththe Facilitiesagreement requestor tothe submitterms aand correctiveconditions actionof plan;approval;

or(ii) (B)The Complyauthority’s withapproval thewas requirementsobtained ofas a correctiveresult actionof planan submittedintentional tomaterial themisrepresentation; Department of Health Facilities.

(c)(iii) BeginningThe notparties laterto than 90 days after the dateagreement of the enactment of this Act, the Department of Health Facilities must create and maintain a publicly available list on its website of hospitals that have beenfailed found to havepay violated the hospital price transparency rule, that has been issued an administrative penalty or sent a warning notice, a request for a corrective action plan, or any otherrequired writtenfee; communication from the Department of Health Facilities.

Suchor penalties,(iv) notices,The andbenefits communicationsresulting mustfrom bethe subjectapproved agreement no longer outweigh the disadvantages attributable to publicthe disclosurereduction underin 5competition U.S.C.resulting from the agreement.

552,(G) notwithstandingIf anythe exemptionsauthority determines the parties to an approved cooperative agreement have engaged in conduct that is contrary to state policy or exclusionsthe public interest, including the failure to take action required by state policy or the contrary,public ininterest, fullthe withoutauthority redaction.may initiate a proceeding to determine whether to require the parties to refrain from taking such action or requiring the parties to take such action, regardless of whether or not the benefits of the cooperative agreement continue to outweigh its disadvantages.

SuchAny listdetermination willby bethe updatedauthority atshall leastbe everyfinal. 30 days thereafter.

(d)The Notwithstandingauthority anyis provisionspecifically ofauthorized law to theenforce contrary,its determination in consideringthe ancircuit applicationcourt for renewal of aKanawha hospital'sCounty license or certification, the departmentcircuit mustcourt considerwhere whether the hospitalprincipal isplace orof hasbusiness beenof ina complianceparty withto hospitalthe pricecooperative transparencyagreement laws.is located.

§26-12-9.(H) Fees as set forth in subsection (h).

Material(2) violation;Until the promulgation of the emergency rules, the authority shall monitor and regulate cooperative agreements to ensure that their conduct is in the public interest and shall have the 10 powers set forth in subdivision (1) of this subsection, including the power of enforcement set forth in paragraph (G), subdivision (1) of this subsection.

corrective(h) actionFees. plan.

(a)— The Departmentauthority ofmay Healthset Facilitiesfees mustfor imposethe anapproval administrativeof penalty on a facilitycooperative inagreement. accordance with §16-5B-1 et seq.

ofThese thisfees codeshall ifbe for all reasonable and actual costs incurred by the facilityauthority failsin to:its review and approval of any cooperative agreement pursuant to this section.

(1)These Respondfees toshall thenot Departmentexceed of$75,000. Health Facilities request to submit a corrective action plan;

orAdditionally, (2)the Complyauthority withmay assess an annual fee not to exceed $75,000 for the requirementssupervision of aany correctivecooperative actionagreement planapproved submittedpursuant to this section and to support the Departmentimplementation and administration of Healththe Facilities.provisions of this section.

(b)(i) TheMiscellaneous Departmentprovisions. of Health Facilities must impose an administrative penalty on a facility Intr HB 2025R2897 for a violation of each requirement of this chapter.

The— Department(1) of(A) HealthAn Facilitiesagreement mustentered setinto theby penaltya inhospital anparty amountto sufficienta tocooperative ensureagreement complianceand byany facilitiesstate official or state agency imposing certain restrictions on rate increases shall be enforceable in accordance with theits provisionsterms ofand thismay chapterbe subjectconsidered toby the limitationsauthority prescribedin bydetermining subsectionwhether (c).to approve or deny the application.

(c)Nothing Forin athis facilitychapter withshall oneundermine of the followingvalidity totalof grossany revenuessuch asagreement reportedbetween toa thehospital Centersparty for Medicare and Medicaid Services or to another entity designated by Department of Health Facilities rule in the yearAttorney precedingGeneral theentered yearbefore in which a penalty is imposed, the penaltyeffective imposeddate by the Department of Healththis Facilitieslegislation. must not be lower than:

(1)(B) InAt least ninety days prior to the caseimplementation of aany increase in rates for inpatient and outpatient hospital services and at least sixty days prior to the execution of any reimbursement agreement with a six-bedthird countparty payor, a hospital party to a cooperative agreement involving the combination of 30two or fewer,more $600hospitals forthrough eachmerger, dayconsolidation inor acquisition which has been approved by the authority shall submit any proposed increase in rates for inpatient and outpatient hospital failsservices and any such reimbursement agreement to complythe Office of the West Virginia Attorney General together with such requirements;information concerning costs, patient volume, acuity, payor mix and other data as the Attorney General may request.

(2)Should Inthe Attorney General determine that the caseproposed ofrates amay hospitalinappropriately withexceed acompetitive bedrates countfor thatcomparable isservices greaterin thanthe 30hospital’s andmarket equalarea towhich would result in unwarranted consumer harm or fewerimpair thanconsumer 550,access $20to perhealth bedcare, forthe eachAttorney dayGeneral inmay whichrequest the hospitalauthority failsto evaluate the 11 proposed rate increase and to complyprovide withits suchrecommendations requirements;to the Office of the Attorney General.

orThe (3)Attorney InGeneral themay caseapprove, ofreject aor hospitalmodify withthe aproposed bedrate countincrease thatand isshall greatercommunicate thanhis 550,or $11,000her fordecision eachto day in which the hospital failsno tolater complythan with30 suchdays requirementsprior (d)to Eachthe dayproposed aimplementation violationdate. continues is considered a separate violation.

(e)The Inhospital determiningmay thethen amountonly ofimplement the penalty,increase theapproved Departmentby ofthe HealthAttorney FacilitiesGeneral. must consider:

(1)Should Previousthe violationsAttorney byGeneral determine that a reimbursement agreement with a third party payor includes pricing terms at anti-competitive levels, the facility'sAttorney operator;General may reject the reimbursement agreement and communicate such rejection to the parties thereto together with the rationale therefor in a timely manner.

(2) The seriousnessauthority ofshall maintain on file all cooperative agreements the violation;authority has approved, including any conditions imposed by the authority.

(3) TheAny demonstratedparty goodto faitha cooperative agreement that terminates its participation in such cooperative agreement shall file a notice of termination with the facility'sauthority operator;thirty days after termination.

and (4) AnyNo otherhospital matterswhich asis justicea party to a cooperative agreement for which approval is required pursuant to this section may require.knowingly bill or charge for health services resulting from, or associated with, such cooperative agreement until approved by the authority.

(f)Additionally, Anno administrativehospital penaltywhich collectedis undera thisparty chapterto musta becooperative depositedagreement tomay theknowingly creditbill ofor ancharge accountfor inhealth theservices generalresulting revenuefrom, fundor administeredassociated bywith, thesuch Departmentcooperative ofagreement Healthfor Facilities.which approval has been revoked or terminated.

Money(5) inBy submitting an application for review of a cooperative agreement pursuant to this section, the accounthospitals mustor health care providers shall be appropriateddeemed onlyto have agreed to submit to the Departmentregulation and supervision of Healththe Facilities.authority as provided in this section.

§26-12-10.(j) To ensure protection from antitrust action under state and federal antitrust laws a hospital which has merged, consolidated or acquired a hospital after January 1, 2017 shall file a cooperative agreement under the provisions of this section before January 1, 2026.

Administrative12 penalty.

(a) The Department of Health Facilities must impose an administrative penalty on a facility in accordance with §16-5B-1 et seq.

of this code if the facility fails to:

Intr HB 2025R2897 (1) Respond to the Department of Health Facilities request to submit a corrective action plan;

or (2) Comply with the requirements of a corrective action plan submitted to the Department of Health Facilities.

(b) The Department of Health Facilities must impose an administrative penalty on a facility for a violation of each requirement of this chapter.

The Department of Health Facilities must set the penalty in an amount sufficient to ensure compliance by facilities with the provisions of this article.

(c) For a facility with one of the following total gross revenues as reported to the Centers for Medicare and Medicaid Services or to another entity designated by Department of Health Facilities rule in the year preceding the year in which a penalty is imposed, the penalty imposed by the Department of Health Facilities must not be lower than:

(1) In the case of a hospital with a six-bed count of 30 or fewer, $600 for each day in which the hospital fails to comply with such requirements;

(2) In the case of a hospital with a bed count that is greater than 30 and equal to or fewer than 550, $20 per bed for each day in which the hospital fails to comply with such requirements;

or (3) In the case of a hospital with a bed count that is greater than 550, $11,000 for each day in which the hospital fails to comply with such requirements.

(d) Each day a violation continues is considered a separate violation.

(e) In determining the amount of the penalty, the Department of Health Facilities must consider:

(1) Previous violations by the facility's operator;

(2) The seriousness of the violation;

(3) The demonstrated good faith of the facility's operator;

and (4) Any other matters as justice may require.

(f) An administrative penalty collected under this chapter must be deposited to the credit of an account in the general revenue fund administered by the Department of Health Facilities.

Intr HB 2025R2897 Money in the account must be appropriated only to the Department of Health Facilities.

§26-12-11.

Legislative recommendations.

The Department of Health Facilities must propose to the legislature recommendations for amending this chapter, including recommendations in response to amendments by the Centers for Medicare and Medicaid Services to 45 C.F.R.

Part 180.

§26-12-12.

Failure to comply with hospital price transparency laws;

prohibiting collection of debt;

penalties.

(a) Except as provided in §26-12-12(1)(b) of this code, on and after the effective date of this section, a hospital that is not in material compliance with hospital price transparency laws on the date that items or services are purchased from or provided to a patient by the hospital must not initiate or pursue a collection action against the patient or patient guarantor for a debt owed for the items or services.

(b) If a patient believes that a hospital was not in material compliance with hospital price transparency laws on a date on or after the effective date of this section that items or services were purchased by or provided to the patient, and the hospital takes a collection action against the patient or patient guarantor, the patient or patient guarantor may file suit to determine if the hospital was materially out of compliance with the hospital price transparency laws and rules and regulations on the date of service, and the noncompliance is related to the items or services.

The hospital must not take a collection action against the patient or patient guarantor while the lawsuit is pending.

(c) A hospital that has been found by a judge or jury, considering compliance standards issued by the Federal Centers for Medicare and Medicaid Services, to be materially out of compliance with hospital price transparency laws and rules and regulations:

(1) Must refund the payer any amount of the debt the payer has paid and must pay a penalty to the patient or patient guarantor in an amount equal to the total amount of the debt;

(2) Must dismiss or cause to be dismissed any court action with prejudice and pay any Intr HB 2025R2897 attorney fees and costs incurred by the patient or patient guarantor relating to the action;

and (3) Remove or cause to be removed from the patient's or patient guarantor's credit report any report made to a consumer reporting agency relating to the debt.

(d) Nothing in this article:

(1) Prohibits a hospital from billing a patient, patient guarantor, or third-party payer, including health insurer, for items or services provided to the patient;

or (2) Requires a hospital to refund any payment made to the hospital for items or services provided to the patient, so long as no collection action is taken.

NOTE:

The purpose of this bill is to create the Hospital Transparency Act and providing for the administration of the Act.

Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.

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