Senate committee debates state enforcement for federal hospital price‑transparency rule; amendment to exempt state hospital passes

The Senate Human Services Committee on Tuesday debated House Bill 1594, a measure that would mirror federal rules requiring hospitals to post price data, but add state enforcement provisions.

Supporters and opponents agreed the federal rule requires hospitals to publish a ChargeMaster and a list of so‑called "shoppable services," but hospital officials and administrators told the committee that converting those federal requirements into a usable consumer tool is technically complex and operationally burdensome.

"Hospitals are required to post their charges... I believe, a list of and don't quote me on this but I think 300 shoppable services," Tim Blaso, president of the North Dakota Hospital Association, told the committee, describing how the federal requirement is structured and why the posted data can be confusing for patients. Blaso said many hospitals post ChargeMaster files and use vendors or consultants to validate submissions against the CMS validator tool.

Alan O'Neil, chief executive officer of Unity Medical Center in Grafton, said producing an "out‑the‑door" price that consumers could rely on is difficult because many variables affect final cost. "It is so complex because there's so many moving parts," O'Neil said, noting variability from additional procedural time to independent physician charges and recoveries.

Hospital representatives also told lawmakers they sometimes take price‑transparency files offline to correct format or validation errors; they described ChargeMaster files with thousands of item entries and annual updates tied to implants, supplies and payer contracts. Jerry Criswell, who identified himself as a surgery director at a hospital in Bismarck, said hospitals must staff IT and accounting resources to prepare compliant files.

Committee members pressed witnesses on whether the state should add a separate enforcement layer to a federal rule. Blaso said the bill largely mirrors CMS requirements and that the chief new state consequence he identified in the bill text would allow certain commercial payers to terminate contracts with providers for noncompliance — language he said would be new for hospitals.

The committee adopted a technical amendment to the bill that would add an explicit exemption for the state hospital from the statutory definition of "healthcare facility." The amendment was moved by John Olm and seconded; the roll call showed six ayes and no nays, and the amendment passed 6‑0.

After extended discussion about implementation burdens, data quality and whether a separate state enforcement regime is needed, a senator moved a do‑not‑pass motion on House Bill 1594 as amended. The committee voted to recommend do not pass by a 5‑1 margin.

The committee's deliberations highlighted two recurring themes: (1) hospitals say they generally meet the federal posting requirement but that posted data are often hard for consumers to interpret without standardized, bundled prices; and (2) some committee members and the Department of Insurance testified there is renewed federal interest in enforcement, but technical gaps on CMS's public portal led witnesses to report that listing compliance statuses is inconsistent.

The chair indicated the measure may be reworked rather than advanced in its current form; a senator volunteered to carry the bill if the sponsor requests it. The committee then moved to other agenda items.

Votes

- Amendment (exempt state hospital from definition of "healthcare facility"): Passed, 6‑0 (roll call: Senator Lee — Aye; Senator Weston — Aye; Senator Rohrs — Aye; Senator Hogan — Aye; Senator Van Oosteen — Aye; Senator Clemens — Aye).

- Motion: Do not pass on House Bill 1594 as amended: Passed, 5‑1 (committee recorded the motion and carried a majority to recommend do not pass).