What is the legal framework for pricing health care services?

In California, the legal framework for pricing health care services is governed by state and federal laws. California has enacted several pieces of legislation that regulate how health care providers may set prices for services. At the state level, California Assembly Bill 1627, also known as the “Health Care Pricing Transparency,” requires health care providers to make their prices readily available. Prices must be posted prominently in any place of service and must be included in any billing statement. Also, health care providers are required to provide an estimate of the total cost of services prior to performing any service. At the federal level, the Affordable Care Act (ACA) requires that health care providers participating in the marketplace exchange must display a standardized chart of prices for all services they offer. This chart must be posted in places of service and must also be made available to patients in advance. Finally, many health care providers in California choose to use a standard fee schedule that is set by the California Medical Association. This fee schedule sets the maximum amount that health care providers may charge for any particular service. In sum, California state and federal laws provide a legal framework for pricing health care services. Health care providers must make their prices readily available, must provide an estimate of costs in advance, and must adhere to a standard fee schedule.

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What is the legal framework for pricing health care services?

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