AB353: Bill Text

2025 - 2026 LEGISLATURE

LRB-3835/1

JPC&SWB:emw&cjs

2025 ASSEMBLY BILL 353

July 8, 2025 - Introduced by Representatives Wittke, Donovan, Brooks, Behnke, Gustafson, Knodl, Maxey, Murphy, Mursau, O'Connor, Sortwell and Tusler, cosponsored by Senators Bradley, Felzkowski, Wimberger, Hutton, Larson, Nass and Tomczyk. Referred to Committee on Health, Aging and Long-Term Care.     ***AUTHORS SUBJECT TO CHANGE***

AB353,1,4 An Act to amend 50.32, 50.33 (intro.), 50.33 (3), 50.34, 50.36 (1), 50.39 (1), 50.39 (2), 50.39 (3), 50.39 (4) and 51.036 (2) (b) 1.; to create 50.40 and 50.42 of the statutes; relating to: price transparency in hospitals, restricting certain debt collection actions against patients, and providing a penalty.

Analysis by the Legislative Reference Bureau

This bill creates several requirements for a hospital to provide cost information for certain items and services provided by the hospital and restricts certain legal actions against a patient that seek judgment for debts owed on hospital items and services provided to the patient if the hospital that provided the item or service is not in compliance with applicable price transparency requirements.

The bill provides that the Department of Health Services must enforce federal hospital price transparency requirements for hospitals. If the secretary of health services determines that the federal hospital price transparency requirements are no longer substantially enforceable in this state, the bill directs the secretary of health services to submit a notice to the Legislative Reference Bureau for publication in the Wisconsin Administrative Register that the federal hospital price transparency requirements are no longer substantially enforceable in this state. If the secretary of health services submits such a notice, the bill provides that DHS must instead enforce the other hospital price transparency requirements established in the bill, beginning on the first day of the fourth month beginning after the notice is published in the Wisconsin Administrative Register. The hospital price transparency requirements established in the bill would require each hospital to make publicly available a digital file in a machine-readable format that contains a list of standard charges for certain items and services provided by the hospital and a consumer-friendly list of standard charges for certain shoppable services. “Standard charge” is defined to mean the regular rate established by the hospital for an item or service provided to a specific group of paying patients and includes certain price information, including the gross charge, the payer-specific negotiated charge, and the discounted cash price. “Shoppable service” is defined to mean a service that may be scheduled by a health care consumer in advance. Every time a hospital updates the list of standard charges or the consumer-friendly list of standard charges for shoppable services, the hospital must submit the updated list to DHS.

The list of standard charges must be available at all times to the public in a machine-readable format, must be displayed in a prominent location on the home page of the hospital’s website, and must include certain information, including a description of each hospital item or service provided and any code used by the hospital for purposes of accounting or billing. Further, the list of standard charges must meet certain criteria, including that the list must be available free of charge and without having to establish a user account or password, that the list is available without having to submit personal identifying information, that the list is digitally searchable, and that the list is accessible to a commercial operator of an Internet search engine as 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. The list of standard charges must be updated at least once each year.

The consumer-friendly list of standard charges for shoppable services must be publicly available and must contain standard charge information for each of at least 300 shoppable services provided by the hospital. The bill allows a hospital to select the shoppable services to be included in the list, except that the list must include either the 70 services specified as shoppable services by the federal Centers for Medicare and Medicaid Services (CMS) or, if the hospital does not provide all of the shoppable services specified by CMS, as many of the 70 services specified as shoppable services by CMS as the hospital provides. If a hospital does not provide at least 300 shoppable services, the bill requires the hospital to maintain a list of all shoppable services that the hospital provides. The consumer-friendly list of standard charges for shoppable services must include certain information, including certain price information and a plain-language description of each shoppable service included on the list, whether each hospital location provides the shoppable service and whether the standard charges included in the list apply at that location, and whether one or more of the shoppable services specified by CMS is not provided by the hospital. The consumer-friendly list of standard charges for shoppable services must meet certain criteria, including that the list is available free of charge without having to establish a user account or password, that the list is searchable by service description, billing code, and payer, and that the list is accessible to a common commercial operator of an Internet search engine as 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. The consumer-friendly list of standard charges for shoppable services must be updated at least once each year.

Under the bill, regardless of whether the federal hospital price transparency requirements or the requirements established in the bill apply, DHS must monitor each hospital’s compliance with the applicable price transparency requirements specified in the bill by evaluating complaints, reviewing any analysis prepared regarding noncompliance, auditing the websites of hospitals, or confirming that each hospital submitted the required lists. If DHS determines that a hospital is not in compliance with any of the price transparency requirements specified in the bill, the bill requires DHS to take certain actions, including providing a written notice to the hospital, requesting a corrective action plan from the hospital, or imposing a penalty. The bill requires DHS to maintain a publicly available list of any hospital that has been found to have violated any of the price transparency requirements specified in the bill, including the dates that the hospital was not in compliance.

Finally, the bill provides that any party seeking judgment against a patient for a debt owed for hospital items or services that are purchased for or provided to the patient by a hospital shall file a certification under oath to the court stating that the hospital that provided the hospital items or services to the patient is not, according to the publicly available list maintained by DHS, out of compliance with the applicable price transparency requirements as of the date of the certification before judgment may be entered in favor of the party seeking judgment.

For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB353,1 Section 1. 50.32 of the statutes is amended to read:

AB353,2,3 50.32 Hospital regulation and approval act. Sections 50.32 to 50.39 50.42 shall constitute the “Hospital Regulation and Approval Act”.

AB353,2 Section 2. 50.33 (intro.) of the statutes is amended to read:

AB353,2,5 50.33 Definitions. (intro.) Whenever used in ss. 50.32 to 50.39 50.42:

AB353,3 Section 3. 50.33 (3) of the statutes is amended to read:

AB353,3,3 50.33 (3) “Requirements for hospitals” means all of the rules, standards, and requirements described in or promulgated under ss. 50.32 to 50.39 50.42 that apply to hospitals, including the standards described under s. 50.36 (1).

AB353,4 Section 4. 50.34 of the statutes is amended to read:

AB353,3,9 50.34 Purpose. The purpose of ss. 50.32 to 50.39 50.42 is to provide for the development, establishment and enforcement of rules and standards for the construction, maintenance and operation of hospitals which, in the light of advancing knowledge, will promote safe and adequate care and treatment of patients in such hospitals.

AB353,5 Section 5. 50.36 (1) of the statutes is amended to read:

AB353,4,7 50.36 (1) The department may use and enforce the conditions in 42 CFR 482.60 as standards that apply to psychiatric hospitals, which are hospitals primarily engaged in providing psychiatric services for the diagnosis and treatment of persons who have mental illness. Beginning on July 1, 2016, except as otherwise provided under ss. 50.32 to 50.39 50.42, the department shall use and enforce the conditions for Medicare participation for hospitals as the minimum standards that apply to hospitals. The department shall interpret the conditions for Medicare participation for hospitals using guidelines adopted by the federal centers for medicare and medicaid services, unless the department determines that a different interpretation is reasonably necessary to protect public health and safety. The department may promulgate, adopt, amend, and enforce additional rules and standards for the construction, maintenance, and operation of hospitals that the department determines are necessary to provide safe and adequate care and treatment of hospital patients and to protect the health and safety of the patients and employees. The building codes and construction standards of the department of safety and professional services shall apply to all hospitals to the extent that they are not incompatible with any building codes or construction standards required by the conditions for Medicare participation for hospitals. Except for the construction codes and standards of the department of safety and professional services and except as provided in s. 50.39 (3), the department shall be the sole agency to adopt and enforce rules and standards pertaining to hospitals.

AB353,6 Section 6. 50.39 (1) of the statutes is amended to read:

AB353,4,11 50.39 (1) The requirements for hospitals apply to all facilities coming under the definition of a “hospital” which are not specifically exempt by ss. 50.32 to 50.39 50.42.

AB353,7 Section 7. 50.39 (2) of the statutes is amended to read:

AB353,4,16 50.39 (2) The use of the title “hospital” to represent or identify any facility which does not meet the definition of a “hospital” as provided herein or is not subject to approval under ss. 50.32 to 50.39 50.42 is prohibited, except that institutions governed by s. 51.09 are exempt.

AB353,8 Section 8. 50.39 (3) of the statutes is amended to read:

AB353,5,3 50.39 (3) Facilities governed by ss. 45.50, 48.62, 49.70, 49.72, 50.02, 51.09, and 252.10, juvenile correctional facilities as defined in s. 938.02 (10p), correctional institutions governed by the department of corrections under s. 301.02, and the offices and clinics of persons licensed to treat the sick under chs. 446, 447, and 448 are exempt from ss. 50.32 to 50.39 50.42. Sections 50.32 to 50.39 50.42 do not abridge the rights of the medical examining board, physician assistant affiliated credentialing board, physical therapy examining board, podiatry affiliated credentialing board, dentistry examining board, pharmacy examining board, chiropractic examining board, and board of nursing in carrying out their statutory duties and responsibilities.

AB353,9 Section 9. 50.39 (4) of the statutes is amended to read:

AB353,5,8 50.39 (4) All orders issued by the department pursuant to ss. 50.32 to 50.39 50.42 shall be enforced by the attorney general. The circuit court of Dane County shall have jurisdiction to enforce such orders by injunctional and other appropriate relief.

AB353,10 Section 10. 50.40 of the statutes is created to read:

AB353,5,10 50.40 Hospital price transparency. (1) Definitions. In this section:

AB353,5,12 (a) “Ancillary service” means a hospital item or service that a hospital customarily provides as part of a shoppable service.

AB353,5,14 (b) “Chargemaster” means the list of all hospital items or services maintained by a hospital for which the hospital has established a charge.

AB353,5,17 (c) “De-identified maximum negotiated charge” means the highest charge that a hospital has negotiated with all 3rd-party payers for a hospital item or service.

AB353,5,19 (d) “De-identified minimum negotiated charge” means the lowest charge that a hospital has negotiated with all 3rd-party payers for a hospital item or service.

AB353,5,21 (e) “Discounted cash price” means the charge that applies to an individual who pays cash, or a cash equivalent, for a hospital item or service.

AB353,5,23 (f) “Gross charge” means the charge for a hospital item or service that is reflected on a hospital’s chargemaster, absent any discounts.

AB353,6,4 (g) “Hospital items or services” means all items and services, including individual items and services and service packages, that may be provided by a hospital to a patient in connection with an inpatient admission or an outpatient department visit for which the hospital has established a standard charge, including all of the following:

AB353,6,5 1. Supplies and procedures.

AB353,6,6 2. Room and board.

AB353,6,7 3. Use of the hospital and other areas.

AB353,6,9 4. Services of physicians and nonphysician practitioners employed by the hospital.

AB353,6,11 5. Any other item or service for which a hospital has established a standard charge.

AB353,6,14 (gm) “Hospital price transparency laws” means 42 USC 300gg-18 and any regulations adopted by the federal department of health and human services implementing 42 USC 300gg-18, including 45 CFR part 180.

AB353,6,17 (h) “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. “Machine-readable format” includes .XML, .JSON, and .CSV formats.

AB353,6,19 (i) “Payer-specific negotiated charge” means the charge that a hospital has negotiated with a 3rd-party payer for a hospital item or service.

AB353,6,21 (j) “Service package” means an aggregation of individual hospital items or services into a single service with a single charge.

AB353,6,23 (k) “Shoppable service” means a service that may be scheduled by a health care consumer in advance.

AB353,7,3 (L) “Standard charge” means the regular rate established by the hospital for a hospital item or service provided to a specific group of paying patients and includes all of the following:

AB353,7,4 1. The gross charge.

AB353,7,5 2. The payer-specific negotiated charge.

AB353,7,6 3. The de-identified minimum negotiated charge.

AB353,7,7 4. The de-identified maximum negotiated charge.

AB353,7,8 5. The discounted cash price.

AB353,7,10 (m) “Third-party payer” means an entity that is, by statute, contract, or agreement, legally responsible for payment of a claim for a hospital item or service.

AB353,7,14 (1m) Adoption of federal standards. (a) Except as provided in par. (b), the department shall enforce hospital price transparency laws for hospitals as if the department were the secretary of the federal department of health and human services and the federal centers for medicare and medicaid services.

AB353,7,19 (b) 1. If the secretary determines that hospital price transparency laws are no longer substantially enforceable in this state, the secretary shall send a notice to the legislative reference bureau for publication in the Wisconsin Administrative Register that states that hospital price transparency laws are no longer substantially enforceable in this state.

AB353,7,22 2. Subsections (2) to (5), (7), and (8) apply only after the first day of the 4th month beginning after a notice described under subd. 1. is published in the Wisconsin Administrative Register, and from that date par. (a) does not apply.

AB353,7,24 (2) Public availability of price information required. A hospital shall make publicly available all of the following:

AB353,8,2 (a) A digital file in a machine-readable format that contains a list of all standard charges for all hospital items or services described under sub. (3).

AB353,8,4 (b) A consumer-friendly list of standard charges for a limited set of shoppable services as provided in sub. (4).

AB353,8,6 (3) List of standard charges required. (a) A hospital shall do all of the following:

AB353,8,8 1. Maintain a list of all standard charges for all hospital items or services in accordance with this section.

AB353,8,11 2. Ensure the list required under subd. 1. is available at all times to the public, including by posting the list electronically in the manner provided in this section.

AB353,8,15 (b) The standard charges contained in the list required to be maintained by a hospital under par. (a) 1. shall reflect the standard charges applicable to that location of the hospital, regardless of whether the hospital operates in more than one location or operates under the same license as another hospital.

AB353,8,17 (c) The list required under par. (a) 1. shall include all of the following information:

AB353,8,18 1. A description of each hospital item or service provided by the hospital.

AB353,8,20 2. The following charges for each individual hospital item or service when provided in either an inpatient setting or an outpatient department setting:

AB353,8,21 a. The gross charge.

AB353,8,22 b. The de-identified minimum negotiated charge.

AB353,8,23 c. The de-identified maximum negotiated charge.

AB353,9,1 d. The discounted cash price.

AB353,9,4 e. The payer-specific negotiated charge, listed by the name of the 3rd-party payer and plan associated with the charge and displayed in a manner that clearly associates the charge with each 3rd-party payer and plan.

AB353,9,8 3. Any code used by the hospital for purposes of accounting or billing for the hospital item or service, including the current procedural terminology code, the healthcare common procedure coding system code, the diagnosis related group code, the national drug code, or any other common identifier.

AB353,9,10 (d) The information contained in the list required under par. (a) 1. shall be published in a single digital file that is in a machine-readable format.

AB353,9,16 (e) The list required under par. (a) 1. shall be displayed in a prominent location on the home page of the hospital’s website or accessible by selecting a dedicated link that is prominently displayed on the hospital’s website. If the hospital operates multiple locations and maintains a single website, the list required under par. (a) 1. shall be posted for each location the hospital operates in a manner that clearly associates the list with the applicable location of the hospital.

AB353,9,17 (f) The list required under par. (a) 1. shall satisfy all of the following criteria: