Annual Financial Data General Information About the Hospital Chargemaster Program
A hospital charge description master, also known as a chargemaster or CDM, contains the prices of all services, goods, and procedures for which a separate charge exists. It is used to generate a patient's bill. As required by the Payers' Bill of Rights, each hospital is required to submit a copy of its chargemaster, a list of average charges for 25 common outpatient procedures, and the estimated percentage change in gross revenue due to price changes each July 1.
It is important to note that the State of California does not currently possess the authority to set or limit the prices that are included on the submitted hospital chargemasters. Furthermore, the submitted chargemasters are reviewed for compliance with the statutes specified below, and a full audit of this information is not performed. Therefore, the Office of Statewide Health Planning & Development (OSHPD) is not able to provide an assessment on the accuracy of the submitted information and is not responsible for this information in any manner. The responsibility for any of the submitted data provided regarding the chargemasters rests with hospital management.
The chargemasters are currently not required to be provided in a standardized format. Therefore, it is currently not possible to generate an aggregate statewide chargemaster.
Hospital chargemasters and related pricing information are available on-line. To purchase/order a copy of hospital chargemaster information on CD/DVD, please call the Healthcare Information Resource Center (HIRC) at (916) 326-3802 and staff will assist you with your order.
AB 1045 and the Payers′ Bill of Rights
AB 1045 (Chapter 532, Statutes of 2005) amended the Payers′ Bill of Rights established by AB 1627 (Chapter 582, Statutes of 2003). These statutes require all licensed general acute care hospitals, psychiatric acute hospitals, and special hospitals in California to make certain pricing information available to the public and to submit this information annually to OSHPD. Health facilities licensed as a Chemical Dependency Recovery Hospital or a Psychiatric Health Facility are exempt from these requirements.
The Payers′ Bill of Rights still requires each licensed hospital to make a written or electronic copy of its chargemaster available at the hospital′s location or on its website. A hospital that is statutorily classified as "small and rural" is exempt from making its chargemaster available on-site.
To view the Payers' Bill of Rights visit the California Law website. Follow the prompts to search for Health and Safety Code 1339.50 - 1339.59.
OSHPD has adopted regulations for reporting hospital chargemasters and related pricing documents in compliance with AB 1627 and AB 1045.
If any person feels that a hospital is in violation of the Payers' Bill of Rights, they may file a claim with the California Department of Public Health (CDPH), who is responsible for investigating such claims and informing that person of its determination on whether a violation has occurred and what actions it will take. This process would also pertain to any person who has no healthcare coverage and requested a written estimate from a hospital for healthcare services, procedures and supplies or requested information and/or an application for financial assistance or charity care and received no response from the hospital. You can visit the Licensing and Certification Division contact page to determine which CDPH location to contact (the local district office in the county where the hospital is located).
Major Changes to Payers' Bill of Rights
Effective January 1, 2006, AB 1045 requires each hospital to provide upon request a written estimate of the amount the hospital will require an uninsured person to pay for hospital services that are reasonably expected to be provided, based on average length of stay and services provided for the person's diagnosis. Estimates are not required for emergency services. Each hospital is also required to provide information about the hospital's financial assistance and charity care policies to uninsured patients, along with contact information for a hospital representative, to obtain more information about these policies.
In addition, AB 1045 adds the provision that a hospital may be liable for a $100 per day civil penalty if it does not file the required information to OSHPD.
Lastly, each hospital is required to provide a list of charges for 25 common outpatient procedures and an OSHPD-developed list of charges for common inpatient DRGs to any person upon request.
AB 1045 repealed the requirement that each hospital annually submit a list of 25 services or procedures commonly charged to patients. Instead, each hospital is required to annually submit a list of charges for 25 common outpatient procedures beginning July 1, 2006. OSHPD has developed an optional reporting form for hospitals to report the list of average charges for 25 common outpatient procedures including instructions for completing the form. Hospitals are encouraged to use the optional form to report the required list of average charges for 25 common outpatient procedures. Instructions can be found here. To download Statewide Benchmark Top 25 DRGs based on a hospitals inpatient services, click here.
Two reporting requirements established by AB 1627 remain intact. Each hospital is still required to annually submit a copy of its chargemaster and an estimate of the percentage change in the hospital's gross revenue due to any price change during the 12-month period beginning with the effective date of the previous chargemaster filed. The initial reporting of the estimate calculation and supporting documentation will commence July 1, 2006, using the prices in effect on June 1, 2005 as the beginning date.
Each hospital must submit the above documents together as attachments to one e-mail to OSHPD at email@example.com, or submit on one Compact Disc (CD) by mail to: Office of Statewide Health Planning and Development, Accounting and Reporting Systems Section, 400 R Street, Suite 250, Sacramento, CA 95811-6213.
To obtain modifications to the requirements specified for electronic file formats, effective date of the documents, submission date of the documents, or methods of submitting electronic files, hospitals must file written requests for modification with OSHPD. Hospitals must have an OSHPD-approved modification prior to implementation of any change to the applicable requirements. Modification requests shall specify the precise changes being requested and the reason(s) the changes are needed. OSHPD will either approve or disapprove requests for modification on a case-by-case basis.
For more detailed information, read the FAQs.
To obtain hospital pricing information submitted to OSHPD as required by the Payers′ Bill of Rights, click here. For questions about these reporting requirements, you can send e-mail inquiries to firstname.lastname@example.org, or call (916) 326-3854.
Accounting and Reporting Systems Section
400 R Street, Suite 250
Sacramento, CA 95811-6213
Attention Data Users: Please exercise caution when interpreting OSHPD data. The use of improper assumptions and analytical methods may result in erroneous or misleading conclusions. Conclusions drawn from OSHPD data are the sole responsibility of the user.
The submitted pricing information reflects hospital charges in effect on June 1. As a result, a patient's bill for hospital services provided at a different date may contain different charges. Because each hospital is allowed to determine which 25 outpatient procedures to report to OSHPD, comparisons between hospitals' lists of charges for outpatient procedures may not always be possible.
OSHPD does not have the authority to intervene between patients and hospitals involving billing issues. If you are experiencing problems or have questions regarding your hospital bill that the hospital is not able to fully address, then it is recommended that you contact a not-for-profit patient advocacy group, such as Health Access California for assistance.