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PATIENT Act of 2023
1/4/2025, 11:12 AM
Summary of Bill HR 3561
One key provision of the PATIENT Act is the expansion of telehealth services. This would allow patients to receive medical care remotely, through video calls or other virtual means, which can be especially beneficial for those in rural or underserved areas. The bill also aims to increase transparency in healthcare pricing, so that patients can make more informed decisions about their care.
Additionally, the PATIENT Act includes measures to address surprise medical billing, which can occur when patients receive care from out-of-network providers without their knowledge. The bill seeks to protect patients from these unexpected costs and ensure that they are only responsible for paying their in-network rates. Overall, the PATIENT Act of 2023 is focused on improving the healthcare system for patients, by increasing access to care, reducing costs, and promoting transparency. It is currently being debated in Congress, with supporters arguing that it will benefit patients and opponents raising concerns about potential impacts on healthcare providers.
Congressional Summary of HR 3561
Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023
This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps.
Specifically, the bill provides statutory authority for the requirement that hospitals publish an annual list of shoppable services they provide, including specified pricing information. Beginning in 2025, a hospital may not use an internet-based price estimator tool to meet the publication requirement for shoppable services.
The bill also modifies the health insurance plan disclosure requirements to include the rates for certain in-network services and prescription drug payment information.
The bill further requires providers of diagnostic laboratory tests under Medicare to publish online certain price information. Medicare Advantage (MA) organizations must report information about payments made to providers in which the MA organization has an ownership interest. Medicare prescription drug plan sponsors must report certain price information for covered drugs.
Additionally, the bill requires health insurance plan issuers (or the PBM providing services on behalf of the plan) to report to the plan sponsor specified information about prescription drugs dispensed under the plan. This includes rebates, fees, alternative discounts, or other remuneration the plan receives from drug manufacturers.
Finally, the bill requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with PBMs under Medicaid.
