Title 23
Health and Safety

Chapter 103
Disclosure of Prices — Medical Facility Items

§ 23-103-1. Definitions.

As used in this chapter:

(1) “Ancillary service” means a facility item or service that a facility customarily provides as part of a shoppable service.

(2) “Chargemaster” means the list of all facility items or services maintained by a facility for which the facility has established a charge.

(3) “Commission” means the health and human services commission.

(4) “De-identified maximum negotiated charge” means the highest charge that a facility has negotiated with all third-party payors for a facility item or service.

(5) “De-identified minimum negotiated charge” means the lowest charge that a facility has negotiated with all third-party payors for a facility item or service.

(6) “Discounted cash price” means the charge that applies to an individual who pays cash, or a cash equivalent, for a facility item or service.

(7) “Facility” means a hospital licensed under chapter 17 of this title.

(8) “Facility items or services” means all items and services, including individual items and services and service packages, that may be provided by a facility to a patient in connection with an inpatient admission or an outpatient department visit, as applicable, for which the facility has established a standard charge, including:

(i) Supplies and procedures;

(ii) Room and board;

(iii) Use of the facility and other areas, the charges for which are generally referred to as facility fees;

(iv) Services of physicians and non-physician practitioners, employed by the facility, the charges for which are generally referred to as professional charges; and

(v) Any other item or service for which a facility has established a standard charge.

(9) “Gross charge” means the charge for a facility item or service that is reflected on a facility’s chargemaster, absent any discounts.

(10) “Machine-readable format” means a digital representation of information in a file that can be imported or read into a computer system for further processing. The term includes .XML, .JSON, and .CSV formats.

(11) “Payor-specific negotiated charge” means the charge that a facility has negotiated with a third-party payor for a facility item or service.

(12) “Service package” means an aggregation of individual facility items or services into a single service with a single charge.

(13) “Shoppable service” means a service that may be scheduled by a healthcare consumer in advance.

(14) “Standard charge” means the regular rate established by the facility for a facility item or service provided to a specific group of paying patients. The term includes all of the following, as defined under this section:

(i) The gross charge;

(ii) The payor-specific negotiated charge;

(iii) The de-identified minimum negotiated charge;

(iv) The de-identified maximum negotiated charge; and

(v) The discounted cash price.

(15) “Third-party payor” means an entity that is, by statute, contract, or agreement, legally responsible for payment of a claim for a facility item or service.