Amendment ID: S2143-4

Amendment 4

Health Care Cost Transparency Compliance

Mr. Tarr moves to amend the amendment by inserting after Section __, the following new section:

Section__. Section 1. Chapter 224 of the Acts of 2012 is hereby amended in section 15 by adding the following new section:

Section 5A. The commission shall develop and promulgate regulations to facilitate the expeditious and effective compliance with the provisions of this act, which shall include but not be limited to: (i) prototype forms for the request by consumers and provision by providers of pricing information in easily understood language; (ii) protocols for the training of personnel in the proper and effective response to requests for pricing information by consumers by health care providers; (iii) one or more tools for analyzing the effectiveness of a provider's response to a request for pricing information by a consumer.

Section 2. Chapter 224 of the Acts of 2012 is hereby amended in section 36 by adding the following new section:-

Section 27A. Each carrier, as defined herein, shall submit annually to the division of insurance a report regarding its compliance with the provision of this act relative to the transparency, availability, and accessibility of information pertaining to pricing and available procedures and its efforts to achieve such compliance. If, based on said report, the division determines that the carrier is not making inadequate progress toward such compliance, then it shall conduct an audit of the carrier’s efforts to achieve compliance. Subsequent to that audit, the carrier shall develop and submit a remediation plan that shall be submitted to the division of its approval.

Section 3. The Board of Registration in Medicine and the Board of Registration in Dentistry shall promulgate additional requirements for the issuance or renewal of professional licenses which include standards to ensure, as a condition of licensure or re-licensure, compliance with the transparency provisions of Chapter 224 of the Acts of 2012, and reasonable sanctions and/or remedies, including remediation plans, for the failure to so comply.

Section 4. Notwithstanding any general or special law to the contrary, the Group Insurance Commission shall require, in any future contracts, one or more provisions requiring timely and effective compliance with the transparency provisions of Chapter 224 of the Acts of 2012.

Section 5. Chapter 224 of the Acts of 2012 is hereby amended in section 36 by adding at the end thereof:-

A carrier or third party administrator shall notify consumers of their right to request and obtain pricing and cost estimate information in clear language and in an open and conspicuous manner, including but not limited to: (i) signage and other physical displays; (ii) notice prominently placed on website and other electronic communication; and (iii) notification on forms and documents, provided that all such notifications shall provide all relevant mechanisms such as telephone numbers, websites, and e-mail addresses for making such requests.