Provision of itemized bills

Part E of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–131 et seq.) is amended by adding at the end the following: 2799B–10. Provider requirements for itemized bills (a) Requirements (1) Itemized bill and other information required (A) In general A healthcare provider or healthcare facility that requests payment from an individual after providing a healthcare item or service to the patient shall include with such request a written, itemized bill of the cost of each reasonably expected item or service the healthcare provider or healthcare facility provided to the individual, including telehealth visits or visits by other electronic means. The healthcare provider or healthcare facility shall provide the itemized bill not later than 30 days after the healthcare provider or healthcare facility received a final payment on the provided service or supply from a third party. (B) Required information For each item or service provided by the healthcare provider or facility or for which the healthcare provider or facility is billing the individual, the itemized bill must include— (i) a plain language description of each distinct healthcare item or service; (ii) all applicable billing codes for each distinct healthcare item or service, including modifiers, using standard and commonly recognized billing code sets that are clearly identified; (iii) the price and billed amount, if different, of each distinct healthcare item or service or if the provider or facility is offering binding, all-in prices for bundled items and services, the total binding price for bundled items and services and billed amount; (iv) any payments made to the healthcare provider or healthcare facility by or on behalf of the individual (including payments by any health plan or insurance) for any healthcare item or service covered in the itemized bill; (v) information about the availability of language-assistance services for individuals with limited English proficiency (LEP); (vi) the identification of an office or individual at the healthcare provider or healthcare facility, including phone number and email address, that shall be able to discuss the specific details of the itemized statement and be authorized to make appropriate changes thereto; and (vii) information about the healthcare provider’s or healthcare facility’s charity care policies and instructions on how to apply for charity care. (2) Collections actions (A) In general A healthcare provider or healthcare facility shall not take any collections actions against an individual— (i) for any provided healthcare item or service unless the healthcare provider or healthcare facility has complied with paragraph (1); or (ii) with respect to any items or services for which the amount appearing on an itemized bill described above in paragraph (1) exceeds the amount disclosed pursuant to Federal healthcare price transparency regulations, including part 180 of title 45, Code of Federal Regulations, or provided in a good faith estimate that complies with section 2799B–6 of this Act and section 149.610 of title 45, Code of Federal Regulations, or another good faith estimate provided by a healthcare entity covered under this section but not otherwise covered under such section 2799B–6 unless the provider or facility documents that the additional items or services were medically necessary due to unforeseen complications or a patient-initiated change, and could not reasonably have been anticipated. (B) Burden of proof The burden of proof under subparagraph (A)(ii) shall rest with the provider, and absent the documentation described in such subparagraph, the good faith estimate shall be binding. (b) Failure To comply (1) Penalties The Secretary shall impose penalties on any healthcare provider or healthcare facility that fails to comply with the requirements of this section in an amount not to exceed $10,000 for each instance of failure to comply. (2) Presumption in favor of individual If a healthcare provider or healthcare facility fails to comply with the requirements of this section, the presumption shall be that charges were substantially in excess of the good faith estimate (as set forth in section 2799B–6) for the purpose of any patient-provider dispute, including in accordance with section 2799B–7 and regulations promulgated thereunder. (c) Regulations The Secretary shall implement this section through notice and comment rulemaking in accordance with section 553 of title 5, United States Code..