The Fair Pricing Act establishes fair pricing for routine medical care that can be safely delivered in a doctor’s office or a medical facility that does not require an overnight stay, providing the same procedure at the same price, regardless of setting.

Capping Prices for Healthcare Services

CAP PRICES for certain routine services at 150% of Medicare’s prices. Doctors’ offices already provide these services at 130% of Medicare’s prices, on average.

PATIENTS are protected from high prices on low-complexity covered services, regardless of insurance status.

FACILITY FEES—which are an additional bill on top of the amount considered to compensate for the total cost of providing the service in a doctor’s office—would be banned for covered services

HOSPITALS AND OTHER HEALTHCARE PROVIDERS cannot charge and INSURERS cannot reimburse more than the cap on covered services, and cannot hold patients accountable for prices that exceed the cap.

EXEMPTIONS Public hospitals, critical access hospitals, sole community hospitals, rural emergency hospitals, safety net hospitals, and federally qualified health centers are excluded.

Establishing Accountability and Enforcement

HOSPITALS AND OTHER HEALTHCARE PROVIDERS are held accountable by the Department of Health for data collection and annual reporting on rates charged and paid for covered services.

INSURERS are held to compliance and reporting standards by the Department of Financial Services.

PATIENTS AND PAYERS (including employers and unions) are entitled to consumer protection if they suffer losses due to violations under The Fair Pricing Act.