SB2277 HD1

SECTION 1. Chapter 323D, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part . Hospital Price Transparency

§323D-A Short title. This part shall be known and may be cited as the "Hospital Price Transparency Act".

§323D-B Definitions. As used in this part:

"Chargemaster" means the list of all hospital items or services maintained by a hospital for which the hospital has established charges.

"Collection action" means any of the following actions taken with respect to a debt for an item or service that was purchased by or provided to a patient by a hospital on a date during which the hospital was in violation of this part:

(1) Attempting to collect a debt from a patient or patient guarantor by referring the debt, directly or indirectly, to a debt collector, collection agency, or other third party retained by or on behalf of the hospital;

(2) Suing the patient or patient guarantor or enforcing an arbitration or mediation clause in a hospital document, including any contract, agreement, statement, or bill; or

(3) Directly or indirectly causing a report to be made to a consumer reporting agency.

"Collection agency" means a person that:

(1) Engages in a business for the principal purpose of collecting debts; or

(2) Performs any of the following:

(A) Regularly collects or attempts to collect, directly or indirectly, debts owed or due, or asserted to be owed or due, to another;

(B) Accepts the assignment of debts for collection purposes; or

"Consumer reporting agency" means a person that, for a monetary fee or dues on a cooperative nonprofit basis, regularly engages in the practice of assembling or evaluating consumer credit information or other consumer information for the purpose of furnishing consumer reports to third parties. "Consumer reporting agency" does not include business entities that only provide check verification or check guarantee services.

"Debt" means the obligation or alleged obligation of a consumer to pay money arising out of a transaction, regardless of whether the obligation has been reduced to a judgment. "Debt" does not include a debt for business, investment, commercial, or agricultural purposes or a debt incurred by a business.

"Debt collector" means a person employed or engaged by a collection agency to perform the collection of debts owed or due or debts asserted to be owed or due to another.

"De-identified maximum negotiated charge" means the highest charge that a hospital has negotiated with all third-party payors for a hospital item or service.

"De-identified minimum negotiated charge" means the lowest charge that a hospital has negotiated with all third-party payors for a hospital item or service.

"Discounted cash price" means the charge that applies to a person who pays cash or a cash equivalent for a hospital item or service.

"Gross charge" means the charge for a hospital item or service as reflected on the hospital's chargemaster, excluding any discount.

"Hospital" means a public hospital, for-profit or nonprofit private hospital, or general or special hospital that is licensed as a hospital by the department of health pursuant to section 321-14.5.

"Item or service" means an item or service that a hospital could provide to a patient in connection with an inpatient admission or an outpatient visit for which the hospital has established a standard charge, including:

(1) A supply or procedure;

(2) Room and board;

(3) A facility fee; or

(4) A professional fee.

"Patient guarantor" means a person or entity legally responsible for paying a patient's medical bills, including the patient, a parent, legal guardian, or spouse.

"Payor-specific negotiated charge" means the charge that a hospital has negotiated with a third-party payor for a hospital item or service.

"Professional fee" means a fee charged by a health care practitioner for medical services.

"Standard charge" means the regular rate established by a hospital for a hospital item or service provided to a specific group of paying patients. "Standard charge" includes the:

(1) Gross charge;

(2) Payor-specific negotiated charge;

(3) De-identified maximum negotiated charge;

(4) De-identified minimum negotiated charge; or

(5) Discounted cash price.

"Third party payor" means an entity other than the patient that reimburses for and manages health care expenses incurred by a contracted beneficiary, including an insurance company, a governmental payer, or a self-insured employer plan.

§323D-C Hospital price transparency; compliance. (a) Each hospital licensed in the State shall submit a report to the state agency in a form and manner approved by the state agency attesting that the hospital is in compliance with federal hospital price transparency requirements under title 45 Code of Federal Regulations part 180. The state agency may rely on the hospital's attestation and publicly available federal compliance determinations in determining compliance with this part.

(b) No hospital shall be considered in violation of this part if the hospital is participating in a compliance or corrective action process with the Centers for Medicare and Medicaid Services to remedy any alleged noncompliance with federal hospital price transparency requirements, including through a corrective action plan or other documented compliance process recognized by the Centers for Medicare and Medicaid Services.

§323D-D Collection actions; counterclaims permitted. A patient subject to a lawsuit from a hospital for the collection of medical debt may file a counterclaim to determine whether:

(1) The hospital was noncompliant with any provision of the federal hospital price transparency requirements under title 45 Code of Federal Regulations part 180 or related rules adopted by the state agency on the date that the items or services were provided or purchased; and

(2) The noncompliance was related to the items or services.

§323D-E Patient rights. Before initiating a collection action against a patient, a hospital or a debt collector acting on behalf of a hospital shall provide the patient with:

(1) An easy-to-understand itemized statement of the medical debt owed by the patient to the hospital, including the applicable billing codes for each item or service, using commonly recognized billing code sets;

(2) A copy of the detailed receipts of any payments made to the hospital or debt collector by the patient or the patient's guarantor within thirty calendar days of each payment;

(3) Information about the availability of language‑assistance services for persons with limited English proficiency; and

(4) The contact information for a designated office or administrator at the hospital who can:

(A) Discuss the specific details of an itemized statement; and

(B) Make appropriate changes to the statement, if warranted.

§323D-F Rulemaking. The state agency may adopt rules pursuant to chapter 91 as necessary to implement and administer this part."

SECTION 2. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 3. In codifying the new sections added by section 1 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

SECTION 4. This Act shall take effect on January 30, 2050.

THE SENATE	S.B. NO.	2277
THIRTY-THIRD LEGISLATURE, 2026		S.D. 1
STATE OF HAWAII		H.D. 1