Hospital price transparency

AN ACT Relating to hospital price transparency; amending RCW 1
70.01.030, 70.41.130, and 70.41.250; adding a new chapter to Title 70 2
RCW; and providing an effective date. 3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
NEW SECTION. Sec. 1. The definitions in this section apply 5
throughout this chapter unless the context clearly requires 6
otherwise.7
(1) "Department" means the department of health.8
(2) "Hospital" means a hospital licensed under chapter 70.41 RCW.9
(3) "Item or service" means an item or service, including 10
individual items and services and service packages, that could be 11
provided by a hospital to a patient in connection with an inpatient 12
admission or an outpatient department visit for which the hospital 13
has established a standard charge, including any of the following:14
(a) A supply or procedure; 15
(b) Room and board; 16
(c) The use of the hospital or other item, which is generally 17
described as a facility fee; 18
(d) The service of a health care practitioner, which is generally 19
described as a professional fee; or 20
S-0747.1
SENATE BILL 5493
State of Washington 69th Legislature 2025 Regular Session
By Senators Riccelli, Robinson, Conway, Nobles, Ramos, Stanford,
Valdez, and C. Wilson
Read first time 01/24/25. Referred to Committee on Health & Long-
Term Care.
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(e) Any other item or service for which a hospital has 1
established a standard charge. 2
(4) "Machine-readable format" means a digital representation of 3
information in a file that can be easily imported or read into a 4
computer system for further processing without any additional 5
preparation. 6
(5) "Shoppable service" means a service that may be scheduled by 7
an individual in advance. 8
(6) "Third-party payor" means an entity that is legally 9
responsible for payment of a claim for a hospital item or service.10
NEW SECTION. Sec. 2. (1) By July 1, 2027, hospitals shall 11
publish all data and comply with all rules related to hospital price 12
transparency pursuant to 45 C.F.R. Part 180, subparts A and B, as 13
they existed on January 1, 2025.14
(2)(a) Beginning July 1, 2027, hospitals shall submit the most 15
recent machine-readable file containing a list of all standard 16
charges for all hospital items or services and the most recent 17
consumer-friendly list of standard charges for a limited set of 18
shoppable services, as required in federal rule, to the department at 19
least once a year. 20
(b) If at any time, a charge for an item or service included in 21
the lists submitted to the department pursuant to (a) of this 22
subsection increases by more than 20 percent, a hospital shall submit 23
an updated list to the department within 30 days of the increase.24
NEW SECTION. Sec. 3. (1)(a) The department shall evaluate 25
whether a hospital has complied with the requirements of this 26
chapter.27
(b) To monitor and assess hospital compliance with this chapter, 28
the department may: 29
(i) Evaluate complaints made by individuals or entities to the 30
department pursuant to section 4 of this act; 31
(ii) Review individuals' or entities' analysis of noncompliance;32
(iii) Conduct audits and comprehensive reviews;33
(iv) Confirm that each hospital submitted the lists required by 34
section 2 of this act; 35
(v) Require submission of certification by an authorized hospital 36
official as to the accuracy and completeness of the standard charge 37
information in the machine-readable files; and 38
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(vi) Require submission of additional documentation as may be 1
necessary to make a determination of hospital compliance.2
(2) The department shall make all reports and lists available on 3
its publicly accessible internet website within 60 days of receipt of 4
each report. 5
(3)(a) Upon determining that a hospital has violated the 6
provisions of this chapter or the rules adopted under this chapter, 7
the department may take administrative action in accordance with the 8
provisions of RCW 70.41.130. 9
(b) The department may consult with the office of the attorney 10
general and the office of the insurance commissioner, as applicable, 11
regarding violations for which the office of the attorney general or 12
the office of the insurance commissioner has jurisdiction and may 13
refer those violations to the appropriate agency as necessary.14
NEW SECTION. Sec. 4. The department shall establish an 15
electronic form for individuals to submit complaints for alleged 16
violations of this chapter. The department shall post the electronic 17
form on its publicly accessible internet website. The department 18
shall also accept complaints via a department customer service 19
telephone number. The department may refer complaints related to the 20
consumer protection act to the office of the attorney general.21
NEW SECTION. Sec. 5. By January 1, 2028, the department shall 22
develop a tool to allow individuals to search hospital data submitted 23
pursuant to this chapter and compare charges and shoppable services 24
among hospitals.25
NEW SECTION. Sec. 6. (1) Except as provided under subsection 26
(4) of this section, a hospital that is in violation of the 27
requirements of this chapter on the date when an item or service is 28
purchased from or provided to a patient by the hospital may not 29
initiate or pursue a collection action against the patient or patient 30
guarantor for a debt owed for the item or service.31
(2) If a patient believes that a hospital is in violation of the 32
requirements of this chapter on the date when an item or service is 33
purchased from or provided to the patient and the hospital takes a 34
collection action against the patient or patient guarantor, the 35
patient or patient guarantor may initiate a civil action in a court 36
of competent jurisdiction to determine if the hospital is not in 37
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material compliance with this chapter and the noncompliance is 1
related to the item or service. The hospital may not take a 2
collection action against the patient or patient guarantor or submit 3
a report to a patient's or patient guarantor's credit report while 4
the civil action is pending. 5
(3) If a judge or jury finds a hospital to be materially out of 6
compliance with the requirements of this chapter, the hospital shall:7
(a) Refund the payor any amount of the debt the payor has paid 8
and pay a penalty to the patient or patient guarantor in an amount 9
equal to the total amount of the debt; 10
(b) Dismiss or cause to be dismissed with prejudice a civil 11
action under subsection (2) of this section and pay any attorney fees 12
and costs incurred by the patient or patient guarantor relating to 13
the action; and 14
(c) Remove or cause to be removed from the patient's or patient 15
guarantor's credit report a report made to a consumer reporting 16
agency relating to the debt. 17
(4) Nothing in this section shall be construed to:18
(a) Prohibit a hospital from billing a patient, patient 19
guarantor, or third-party payor, including a health insurer, for an 20
item or service provided to the patient in a manner that is not in 21
violation of this chapter; or 22
(b) Require a hospital to refund a payment made to the hospital 23
for an item or service provided to the patient if no collection 24
action is taken in violation of this chapter. 25
(5) The definitions in this subsection apply throughout this 26
section unless the context clearly requires otherwise.27
(a) "Collection action" means any of the following actions taken 28
with respect to a debt for an item or service that was purchased from 29
or provided to a patient by a hospital on a date during which the 30
hospital was not in material compliance with this chapter:31
(i) Attempting to collect a debt from a patient or patient 32
guarantor by referring the debt, directly or indirectly, to a 33
collection agency or other third party retained by or on behalf of 34
the hospital; 35
(ii) Suing the patient or patient guarantor or enforcing an 36
arbitration or mediation clause in a hospital document, including any 37
contract, agreement, statement, or bill; or 38
(iii) Directly or indirectly causing a report to be made to a 39
consumer reporting agency. 40
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(b) "Collection agency" has the same meaning as provided in RCW 1
19.16.100. 2
(c) "Consumer reporting agency" has the same meaning as provided 3
in RCW 19.182.010. 4
NEW SECTION. Sec. 7. The department may adopt rules necessary 5
to implement this chapter.6
Sec. 8. RCW 70.01.030 and 2009 c 529 s 1 are each amended to 7
read as follows: 8
(1) Health care providers licensed under Title 18 RCW and health 9
care facilities licensed under Title 70 RCW shall provide the 10
following to a patient upon request: 11
(a) An estimate of fees and charges related to a specific 12
service, visit, or stay; and 13
(b) Information regarding other types of fees or charges a 14
patient may receive in conjunction with their visit to the provider 15
or facility. Hospitals licensed under chapter 70.41 RCW may fulfill 16
this requirement by providing a statement and contact information as 17
described in RCW 70.41.400 and directing the patient toward hospital 18
charge information published by the hospital in accordance with 19
chapter 70.--- RCW (the new chapter created in section 11 of this 20
act). 21
(2) Providers and facilities listed in subsection (1) of this 22
section may, after disclosing estimated charges and fees to a 23
patient, refer the patient to the patient's insurer, if applicable, 24
for specific information on the insurer's charges and fees, any cost-25
sharing responsibilities required of the patient, and the network 26
status of ancillary providers who may or may not share the same 27
network status as the provider or facility. 28
(3) Except for hospitals licensed under chapter 70.41 RCW, 29
providers and facilities listed in subsection (1) of this section 30
shall post a sign in patient registration areas containing at least 31
the following language: "Information about the estimated charges of 32
your health services is available upon request. Please do not 33
hesitate to ask for information." 34
Sec. 9. RCW 70.41.130 and 2023 c 114 s 7 are each amended to 35
read as follows: 36
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(1) The department is authorized to take any of the actions 1
identified in this section against a hospital's license or 2
provisional license in any case in which it finds that there has been 3
a failure or refusal to comply with the requirements of this chapter 4
or the standards or rules adopted under this chapter ((or)), the 5
requirements of RCW 71.34.375 on the basis of findings by the 6
department of labor and industries under RCW 70.41.425(6)(b), the 7
requirements of chapter 70.--- RCW (the new chapter created in 8
section 11 of this act), or the standards or rules adopted under 9
chapter 70.--- RCW (the new chapter created in section 11 of this 10
act). 11
(a) When the department determines the hospital has previously 12
been subject to an enforcement action for the same or similar type of 13
violation of the same statute or rule, or has been given any previous 14
statement of deficiency that included the same or similar type of 15
violation of the same or similar statute or rule, or when the 16
hospital failed to correct noncompliance with a statute or rule by a 17
date established or agreed to by the department, the department may 18
impose reasonable conditions on a license. Conditions may include 19
correction within a specified amount of time, training, or hiring a 20
department-approved consultant if the hospital cannot demonstrate to 21
the department that it has access to sufficient internal expertise. 22
If the department determines that the violations constitute immediate 23
jeopardy, the conditions may be imposed immediately in accordance 24
with subsection (3) of this section. 25
(b)(i) In accordance with the authority the department has under 26
RCW 43.70.095, the department may assess a civil fine of up to 27
$10,000 per violation, not to exceed a total fine of $1,000,000, on a 28
hospital licensed under this chapter when the department determines 29
the hospital has previously been subject to an enforcement action for 30
the same or similar type of violation of the same statute or rule, or 31
has been given any previous statement of deficiency that included the 32
same or similar type of violation of the same or similar statute or 33
rule, or when the hospital failed to correct noncompliance with a 34
statute or rule by a date established or agreed to by the department.35
(ii) Proceeds from these fines may only be used by the department 36
to offset costs associated with licensing hospitals.37
(iii) The department shall adopt in rules under this chapter 38
specific fine amounts in relation to: 39
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(A) The severity of the noncompliance and at an adequate level to 1
be a deterrent to future noncompliance; and 2
(B) The number of licensed beds and the operation size of the 3
hospital. The licensed hospital beds will be categorized as:4
(I) Up to 25 beds; 5
(II) 26 to 99 beds; 6
(III) 100 to 299 beds; and 7
(IV) 300 beds or greater. 8
(iv) If a licensee is aggrieved by the department's action of 9
assessing civil fines, the licensee has the right to appeal under RCW 10
43.70.095. 11
(c) The department may suspend a specific category or categories 12
of services or care or recovery units within the hospital as related 13
to the violation by imposing a limited stop service. This may only be 14
done if the department finds that noncompliance results in immediate 15
jeopardy. 16
(i) Prior to imposing a limited stop service, the department 17
shall provide a hospital written notification upon identifying 18
deficient practices or conditions that constitute an immediate 19
jeopardy, and upon the review and approval of the notification by the 20
secretary or the secretary's designee. The hospital shall have 24 21
hours from notification to develop and implement a department-22
approved plan to correct the deficient practices or conditions that 23
constitute an immediate jeopardy. If the deficient practice or 24
conditions that constitute immediate jeopardy are not verified by the 25
department as having been corrected within the same 24 hour period, 26
the department may issue the limited stop service.27
(ii) When the department imposes a limited stop service, the 28
hospital may not admit any new patients to the units in the category 29
or categories subject to the limited stop service until the limited 30
stop service order is terminated. 31
(iii) The department shall conduct a follow-up inspection within 32
five business days or within the time period requested by the 33
hospital if more than five business days is needed to verify the 34
violation necessitating the limited stop service has been corrected.35
(iv) The limited stop service shall be terminated when:36
(A) The department verifies the violation necessitating the 37
limited stop service has been corrected or the department determines 38
that the hospital has taken intermediate action to address the 39
immediate jeopardy; and 40
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(B) The hospital establishes the ability to maintain correction 1
of the violation previously found deficient. 2
(d) The department may suspend new admissions to the hospital by 3
imposing a stop placement. This may only be done if the department 4
finds that noncompliance results in immediate jeopardy and is not 5
confined to a specific category or categories of patients or a 6
specific area of the hospital. 7
(i) Prior to imposing a stop placement, the department shall 8
provide a hospital written notification upon identifying deficient 9
practices or conditions that constitute an immediate jeopardy, and 10
upon the review and approval of the notification by the secretary or 11
the secretary's designee. The hospital shall have 24 hours from 12
notification to develop and implement a department-approved plan to 13
correct the deficient practices or conditions that constitute an 14
immediate jeopardy. If the deficient practice or conditions that 15
constitute immediate jeopardy are not verified by the department as 16
having been corrected within the same 24 hour period, the department 17
may issue the stop placement. 18
(ii) When the department imposes a stop placement, the hospital 19
may not admit any new patients until the stop placement order is 20
terminated. 21
(iii) The department shall conduct a follow-up inspection within 22
five business days or within the time period requested by the 23
hospital if more than five business days is needed to verify the 24
violation necessitating the stop placement has been corrected.25
(iv) The stop placement order shall be terminated when:26
(A) The department verifies the violation necessitating the stop 27
placement has been corrected or the department determines that the 28
hospital has taken intermediate action to address the immediate 29
jeopardy; and 30
(B) The hospital establishes the ability to maintain correction 31
of the violation previously found deficient. 32
(e) The department may deny an application for a license or 33
suspend, revoke, or refuse to renew a license. 34
(2) The department shall adopt in rules under this chapter a fee 35
methodology that includes funding expenditures to implement 36
subsection (1) of this section. The fee methodology must consider:37
(a) The operational size of the hospital; and 38
(b) The number of licensed beds of the hospital.39
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(3)(a) Except as otherwise provided, RCW 43.70.115 governs notice 1
of actions taken by the department under subsection (1) of this 2
section and provides the right to an adjudicative proceeding. 3
Adjudicative proceedings and hearings under this section are governed 4
by the administrative procedure act, chapter 34.05 RCW. The 5
application for an adjudicative proceeding must be in writing, state 6
the basis for contesting the adverse action, including a copy of the 7
department's notice, be served on and received by the department 8
within 28 days of the licensee's receipt of the adverse notice, and 9
be served in a manner that shows proof of receipt.10
(b) When the department determines a licensee's noncompliance 11
results in immediate jeopardy, the department may make the imposition 12
of conditions on a licensee, a limited stop placement, stop 13
placement, or the suspension of a license effective immediately upon 14
receipt of the notice by the licensee, pending any adjudicative 15
proceeding. 16
(i) When the department makes the suspension of a license or 17
imposition of conditions on a license effective immediately, a 18
licensee is entitled to a show cause hearing before a presiding 19
officer within 14 days of making the request. The licensee must 20
request the show cause hearing within 28 days of receipt of the 21
notice of immediate suspension or immediate imposition of conditions. 22
At the show cause hearing the department has the burden of 23
demonstrating that more probably than not there is an immediate 24
jeopardy. 25
(ii) At the show cause hearing, the presiding officer may 26
consider the notice and documents supporting the immediate suspension 27
or immediate imposition of conditions and the licensee's response and 28
must provide the parties with an opportunity to provide documentary 29
evidence and written testimony, and to be represented by counsel. 30
Prior to the show cause hearing, the department must provide the 31
licensee with all documentation that supports the department's 32
immediate suspension or imposition of conditions. 33
(iii) If the presiding officer determines there is no immediate 34
jeopardy, the presiding officer may overturn the immediate suspension 35
or immediate imposition of conditions. 36
(iv) If the presiding officer determines there is immediate 37
jeopardy, the immediate suspension or immediate imposition of 38
conditions shall remain in effect pending a full hearing.39
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(v) If the presiding officer sustains the immediate suspension or 1
immediate imposition of conditions, the licensee may request an 2
expedited full hearing on the merits of the department's action. A 3
full hearing must be provided within 90 days of the licensee's 4
request. 5
Sec. 10. RCW 70.41.250 and 1993 c 492 s 265 are each amended to 6
read as follows: 7
(1) The legislature finds that the spiraling costs of health care 8
continue to surmount efforts to contain them, increasing at 9
approximately twice the inflationary rate. The causes of this 10
phenomenon are complex. By making physicians and other health care 11
providers with hospital admitting privileges more aware of the cost 12
consequences of health care services for consumers, these providers 13
may be inclined to exercise more restraint in providing only the most 14
relevant and cost-beneficial hospital services, with a potential for 15
reducing the utilization of those services. The requirement of the 16
hospital to inform physicians and other health care providers of the 17
charges of the health care services that they order may have a 18
positive effect on containing health costs. Further, the option of 19
the physician or other health care provider to inform the patient of 20
these charges may strengthen the necessary dialogue in the provider-21
patient relationship that tends to be diminished by intervening 22
third-party payers. 23
(2) The chief executive officer of a hospital licensed under this 24
chapter and the superintendent of a state hospital shall establish 25
and maintain a procedure for disclosing to physicians and other 26
health care providers with admitting privileges the charges of all 27
health care services ordered for their patients. Copies of hospital 28
charges shall be made available to any physician and/or other health 29
care provider ordering care in hospital inpatient/outpatient 30
services. The physician and/or other health care provider may inform 31
the patient of these charges and may specifically review them. 32
Hospitals are also directed to study methods for making daily charges 33
available to prescribing physicians through the use of interactive 34
software and/or computerized information , including standard charge 35
information published in accordance with chapter 70.--- RCW (the new 36
chapter created in section 11 of this act), thereby allowing 37
physicians and other health care providers to review not only the 38
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costs of present and past services but also future contemplated costs 1
for additional diagnostic studies and therapeutic medications.2
NEW SECTION. Sec. 11. Sections 1 through 7 of this act 3
constitute a new chapter in Title 70 RCW.4
NEW SECTION. Sec. 12. This act takes effect January 1, 2027.5
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