Oklahoma price transparency bill becomes effective Nov. 1

Posted on:10/22/21

OHA has received several questions from hospitals about HB 1006, the Transparency in Health Care Prices Act that goes into effect Nov. 1. Please recall that HB 1006 only impacts cash pricing. We do not expect any guidance from the state as there is no state agency named in the statute to enforce the law. Therefore, no rulemaking authority exists for any agency.

There are differences between HB 1006 and CMS’ Price Transparency requirements, so hospitals may have to have to separate cash price listings posted on their websites by Nov. 1, 2021. The differences are:  
• In HB 1006, through a document/website, each provider (physician and facility) is to publish “health care prices” for the top 20 CPTs in plain English and update at least annually.
• In HB 1006, through a document/website, each facility is to publish “health care prices” for the top 20 DRGs and top 20 CPTs by specialty in plain English and update at least annually. This bill includes not only physicians and providers, but also ASCs. It excludes nursing care, assisted living, and home care.  
• In HB 1006, Section 2, 4. “Health care price” means the cash price that a health care provider or health care facility will charge a recipient for health care services that will be rendered. Health care price is the price charged for the standard service for the particular diagnosis and does not include any amount that may be charged for complications or exceptional treatment.
• HB 1006 can be found here. 
 
In contrast to HB 1006, CMS’ Price Transparency rule includes:  
• CMS only addresses physician services that are billed under the hospital’s NPI.
• CMS’ price transparency only addressed hospitals.
• CMS requires the top 300 services/procedures for hospitals.
• CMS is focused on the “Standard Charge” that has six different components, which most notably includes the payer allowable.
• This CMS resource link provides the eight steps to ensure compliance with the price transparency rules. 

(Mitzi McCullock)