Title 23
Health and Safety

Chapter 103
Disclosure of Prices — Medical Facility Items

§ 23-103-4. Consumer-friendly list of shoppable services.

(a) Except as provided by subsection (c) of this section, a facility shall maintain and make publicly available a list of the standard charges described by § 23-103-3(c)(2)(ii), (iii), (iv), and (v) for each of at least three hundred (300) shoppable services provided by the facility. The facility may select the shoppable services to be included in the list, except that the list shall include:

(1) The seventy (70) services specified as shoppable services by the Centers for Medicare and Medicaid Services; or

(2) If the facility does not provide all of the shoppable services described by subsection (a)(1) of this section, as many of those shoppable services as the facility does provide.

(b) In selecting a shoppable service for purposes of inclusion in the list required under subsection (a) of this section, a facility shall:

(1) Consider how frequently the facility provides the service and the facility’s billing rate for that service; and

(2) Prioritize the selection of services that are among the services most frequently provided by the facility.

(c) If a facility does not provide three hundred (300) shoppable services, the facility shall maintain a list of the total number of shoppable services that the facility provides in a manner that otherwise complies with the requirements of subsection (a) of this section.

(d) The list required under subsection (a) or (c) of this section, as applicable, shall:

(1) Include:

(i) A plain-language description of each shoppable service included on the list;

(ii) The payor-specific negotiated charge that applies to each shoppable service included on the list and any ancillary service, listed by the name of the third-party payor and plan associated with the charge and displayed in a manner that clearly associates the charge with the third-party payor and plan;

(iii) The discounted cash price that applies to each shoppable service included on the list and any ancillary service or, if the facility does not offer a discounted cash price for one or more of the shoppable or ancillary services on the list, the gross charge for the shoppable service or ancillary service, as applicable;

(iv) The de-identified minimum negotiated charge that applies to each shoppable service included on the list and any ancillary service;

(v) The de-identified maximum negotiated charge that applies to each shoppable service included on the list and any ancillary service; and

(vi) Any code used by 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; and

(2) If applicable:

(i) State each location at which the facility provides the shoppable service and whether the standard charges included in the list apply at that location to the provision of that shoppable service in an inpatient setting, an outpatient department setting, or in both of those settings, as applicable; and

(ii) Indicate if one or more of the shoppable services specified by the Centers for Medicare and Medicaid Services is not provided by the facility.

(e) The list required under subsection (a) or (c) of this section, as applicable, shall be:

(1) Displayed in the manner prescribed by § 23-103-3(e) for the list required under that section;

(2) Available:

(i) Free of charge;

(ii) Without having to register or establish a user account or password;

(iii) Without having to submit personal identifying information; and

(iv) Without having to overcome any other impediment, including entering a code to access the list;

(3) Searchable by service description, billing code, and payor;

(4) Updated in the manner prescribed by § 23-103-3(g) for the list required under that section;

(5) Accessible to a common commercial operator of an internet search engine to the 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

(6) Formatted in a manner that is consistent with the format prescribed by the commission under § 23-103-3(f)(3).

(f) Notwithstanding any other provision of this section, a facility is considered to meet the requirements of this section if the facility maintains, as determined by the commission, an internet-based price estimator tool that:

(1) Provides a cost estimate for each shoppable service and any ancillary service included on the list maintained by the facility under subsection (a) of this section;

(2) Allows a person to obtain an estimate of the amount the person will be obligated to pay the facility if the person elects to use the facility to provide the service; and

(3) Is:

(i) Prominently displayed on the facility’s publicly accessible internet website; and

(ii) Accessible to the public:

(A) Without charge; and

(B) Without having to register or establish a user account or password.