Hospital price transparency

(a) Medicare (1) In general Part E of title XVIII of the Social Security Act (42 U.S.C. 1395x et seq.) is amended by adding at the end the following new section: 1899D. Hospital price transparency (a) Transparency requirement (1) In general Beginning January 1, 2028, each specified hospital that receives payment under this title for furnishing items and services shall comply with the price transparency requirement described in paragraph (2). (2) Requirement described (A) In general For purposes of paragraph (1), the price transparency requirement described in this paragraph is, with respect to a specified hospital, that such hospital, in accordance with a method and format established by the Secretary under subparagraph (C), compile and make public (without subscription and free of charge) for each year— (i) all of the hospital’s standard charges (including the information described in subparagraph (B)) for each item and service furnished by such hospital; (ii) information in a consumer-friendly format (as specified by the Secretary)— (I) on the hospital’s prices (including the information described in subparagraph (B)) for as many of the Centers for Medicare & Medicaid Services-specified shoppable services that are furnished by the hospital, and as many additional hospital-selected shoppable services (or all such additional services, if such hospital furnishes fewer than 300 shoppable services) as may be necessary for a combined total of at least 300 shoppable services; and (II) that includes, with respect to each Centers for Medicare & Medicaid Services-specified shoppable service that is not furnished by the hospital, an indication that such service is not so furnished; (iii) each type 2 national provider identifier associated with the hospital or a unit of the hospital; and (iv) an attestation that all information made public pursuant to this subparagraph is complete and accurate. (B) Information described For purposes of subparagraph (A), the information described in this subparagraph is, with respect to standard charges and prices, as applicable, made public by a specified hospital, the following: (i) A plain language description (as specified by the Secretary) of each item or service, accompanied by, as applicable, the Healthcare Common Procedure Coding System code, the diagnosis-related group, the national drug code, or other identifier used or approved by the Centers for Medicare & Medicaid Services. (ii) The gross charge, as applicable, expressed as a dollar amount, for each such item or service, when provided in, as applicable, the inpatient setting and outpatient department setting. (iii) For each such item or service when provided in, as applicable, the inpatient and outpatient department settings— (I) the discounted cash price, as applicable, expressed as a dollar amount; or (II) in the case no discounted cash price is available for such item or service, the median cash price charged by the hospital (not including charity care) to self-pay individuals for such item or service when provided in such settings for the previous three years, expressed as a dollar amount. (iv) With respect to prices made public pursuant to subparagraph (A)(ii), a link to a consumer-friendly document that clearly explains the hospital’s charity care policy that includes, if applicable, any sliding scale payment structure employed for determining prices. (v) The payer-specific negotiated charges, as applicable, clearly associated with the name of the third party payer and plan and expressed as a dollar amount, that apply to each such item or service when provided in, as applicable, the inpatient setting and outpatient department setting. (vi) The de-identified maximum and minimum negotiated charges, as applicable, for each such item or service, not including any such charge that is $0. (vii) Any other additional information the Secretary may require (in consultation with stakeholders) for the purpose of improving the accuracy of, or enabling consumers to easily understand and compare, standard charges and prices for an item or service, except information that is duplicative of any other reporting requirement under this subsection. (C) Uniform method and format Not later than January 1, 2028, the Secretary shall establish a standard, uniform method and format for specified hospitals to use in compiling and making public standard charges pursuant to subparagraph (A)(i) and a standard, uniform method and format for such hospitals to use in compiling and making public prices pursuant to subparagraph (A)(ii). Such methods and formats— (i) shall, in the case of such method and format for making public standard charges pursuant to subparagraph (A)(i), ensure that such charges are made available in a machine-readable format (or a successor technology specified by the Secretary); (ii) may be similar to any template made available by the Centers for Medicare & Medicaid Services as of the date of the enactment of this subparagraph; (iii) shall meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such charges and prices; and (iv) shall be updated as determined appropriate by the Secretary, in consultation with stakeholders. (3) Monitoring compliance The Secretary shall establish processes to monitor and assess specified hospitals’ compliance with this subsection. Such processes shall include processes relating to the following: (A) The evaluation and analysis of complaints made by individuals or other entities relating to such hospitals’ compliance with this subsection. (B) The use of audits to ensure such hospitals’ compliance with this subsection. (C) The obtaining of additional information from such hospitals to determine such hospitals’ compliance with this subsection (as determined appropriate by the Secretary). (4) Enforcement (A) In general In the case of a specified hospital that fails to comply with the requirements of this subsection— (i) not later than 30 days after the date on which the Secretary determines such failure exists, the Secretary shall submit to such hospital a notification of such determination (which may include, as determined appropriate by the Secretary, a request for a corrective action plan (to be submitted not later than 45 days after such request is made) to comply with such requirements); and (ii) in the case of a hospital that does not receive a request for a corrective action plan as part of a notification submitted by the Secretary under clause (i)— (I) the Secretary shall, not later than 60 days after such notification is sent, determine whether such hospital is in compliance with such requirements; and (II) if the Secretary determines under subclause (I) that such hospital is not in compliance with such requirements, the Secretary shall either— (aa) submit to such hospital a request for a corrective action plan (to be submitted not later than 45 days after such request is made) to comply with such requirements; or (bb) if the Secretary determines that such hospital has not taken meaningful actions to come into compliance since such notification was sent, impose a civil monetary penalty in accordance with subparagraph (B). (B) Civil monetary penalty (i) In general Subject to clause (vii), in addition to any other enforcement actions or penalties that may apply under another provision of Federal law, a specified hospital that has received a request for a corrective action plan under clause (i) or (ii) of subparagraph (A) and fails to comply with the requirements of this subsection by the date that is 90 days after such request is made (or, if such hospital has submitted such a corrective action plan not later than 45 days after the date such request was made, by the date that is 90 days after the date of the submission of such corrective action plan), and a specified hospital with respect to which the Secretary has made a determination described in clause (ii)(II)(bb) of such subparagraph, shall be subject to a civil monetary penalty of an amount specified by the Secretary for each day (beginning with the day on which the Secretary first determined that such hospital was not complying with such requirements) during which such failure was ongoing. Such amount shall not exceed— (I) in the case of a specified hospital with 30 or fewer beds, $300 per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $400 per day); (II) in the case of a specified hospital with more than 30 beds but fewer than 101 beds, $12.50 per bed per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $15 per bed per day); (III) in the case of a specified hospital with more than 100 beds but fewer than 201 beds, $17.50 per bed per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $20 per bed per day); (IV) in the case of a specified hospital with more than 200 beds but fewer than 501 beds, $20 per bed per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $25 per bed per day); and (V) in the case of a specified hospital with more than 500 beds, $25 per bed per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $35 per bed per day). (ii) Increase authority In applying this subparagraph with respect to violations occurring in 2029 or a subsequent year, the Secretary may through notice and comment rulemaking increase— (I) the limitation on the per day amount of any penalty applicable to a specified hospital under clause (i)(I); (II) the limitations on the per bed per day amount of any penalty applicable under any of subclauses (II) through (V) of clause (i); and (III) the amounts specified in clause (iii)(II). (iii) Persistent noncompliance (I) In general In the case of a specified hospital (other than a specified hospital with 30 or fewer beds) that the Secretary has determined to be knowingly and willfully noncompliant with the provisions of this subsection for two or more 6-month periods during any 3-year period, the Secretary may increase any penalty otherwise applicable under this subparagraph by the amount specified in subclause (II) with respect to such hospital and may require such hospital to complete such additional corrective actions plans as the Secretary may specify. (II) Specified amount For purposes of subclause (I), the amount specified in this subclause is, with respect to a specified hospital— (aa) with more than 30 beds but fewer than 101 beds, an amount that is not less than $500,000 and not more than $1,000,000; (bb) with more than 100 beds but fewer than 301 beds, an amount that is greater than $1,000,000 and not more than $2,000,000; (cc) with more than 300 beds but fewer than 501 beds, an amount that is greater than $2,000,000 and not more than $4,000,000; and (dd) with more than 500 beds, and amount that is not less than $5,000,000 and not more than $10,000,000. (iv) Authority to waive or reduce penalty (I) Hospitals located in rural or underserved areas (aa) In general Subject to item (bb), the Secretary may waive any penalty, or reduce any penalty by not more than 75 percent, otherwise applicable under this subparagraph with respect to a specified hospital located in a rural or underserved area if the Secretary certifies that imposition of such penalty would result in an immediate threat to access to care for individuals in the service area of such hospital. (bb) Limitation on application The Secretary may not elect to waive a penalty under item (aa) with respect to a specified hospital more than once in a 6-year period and may not elect to reduce such a penalty with respect to such a hospital more than once in such a period. Nothing in the preceding sentence shall be construed as prohibiting the Secretary from both waiving and reducing a penalty with respect to a specified hospital during a 6-year period. (II) Reduction if hearing waived The Secretary may reduce any penalty otherwise applicable under this subparagraph (as reduced, if applicable, under subclause (I)) by not more than 35 percent if the specified hospital that is the subject of such penalty agrees to waive any right of such hospital to a hearing before an administrative law judge with respect to the imposition of such penalty. (v) Hardship exemption Notwithstanding any limit on the waiver or reduction of a penalty under clause (iv), the Secretary may waive any penalty with respect to a specified hospital on a case-by-case basis if the Secretary determines that a circumstance exists interfering with such hospital’s ability to comply with the provisions of this subsection (such as a natural disaster (as defined in section 602(a) of the Robert T. Stafford Disaster Relief and Emergency Assistance Act), a public health emergency, or other similar or unexpected catastrophe or similar situation). (vi) Provision of technical assistance The Secretary shall, to the extent practicable, provide technical assistance relating to compliance with the provisions of this subsection to specified hospitals requesting such assistance. (vii) Application of certain provisions The provisions of section 1128A (other than subsections (a) and (b) of such section) shall apply to a civil monetary penalty imposed under this subparagraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section. (viii) Nonduplication of certain penalties (I) In general The Secretary may not subject a specified hospital to a civil monetary penalty under this subparagraph with respect to noncompliance with the provisions of this subsection for a period if the Secretary has imposed a civil monetary penalty on such hospital under section 2718(f) of the Public Health Service Act for failure to comply with the provisions of such section for such period. (II) Prioritization In the case of a hospital that the Secretary determines to be in violation of the provisions of this subsection and of section 2718(f) of the Public Health Service Act, the Secretary shall impose penalties as prescribed in such section 2718(f) in lieu of any penalties prescribed in this subsection. (C) Publication of hospital price transparency information Beginning on January 1, 2028, the Secretary shall make publicly available on the public website of the Centers for Medicare & Medicaid Services information with respect to compliance with the requirements of this subsection and enforcement activities undertaken by the Secretary under this subsection. Such information shall be updated in real time (if practicable) and include— (i) the number of reviews of compliance with this subsection undertaken by the Secretary; (ii) the number of notifications described in subparagraph (A)(i) sent by the Secretary; (iii) the identity of each specified hospital that was sent such a notification and a description of the nature of such hospital’s noncompliance with this subsection; (iv) the amount of any civil monetary penalty imposed on such hospital under subparagraph (B); (v) whether such hospital subsequently came into compliance with this subsection; (vi) any waivers or reductions of penalties made pursuant to a certification by the Secretary under subparagraph (B)(iv), including— (I) the name of any specified hospital that received such a waiver or reduction; (II) the dollar amount of each such penalty so waived or reduced; and (III) the rationale for the granting of each such waiver or reduction, but only to the extent that such rationale does not make public commercially sensitive information; and (vii) any other information as determined by the Secretary. (b) Ensuring accessibility through implementation In implementing this section, the Secretary shall through rulemaking ensure that a hospital making public charges and prices pursuant to this section takes reasonable steps (as specified by the Secretary) to ensure the accessibility of such charges and information to individuals with limited English proficiency. Such steps may include the hospital’s provision of interpretation services or the hospital’s provision of translations of charges and information. (c) Definitions For purposes of this section: (1) Discounted cash price The term discounted cash price means the charge that applies to an individual who pays cash, or cash equivalent, for an item or service. (2) Gross charge The term gross charge means the charge for an individual item or service that is reflected on a specified hospital’s chargemaster or provider of service or supplier’s, as applicable, chargemaster (or similar list of prices), absent any discounts. (3) Payer-specific negotiated charge The term payer-specific negotiated charge means the charge that a hospital has negotiated with a third party payer for an item or service. (4) Shoppable service The term shoppable service means a service that can be scheduled by a health care consumer in advance and includes all ancillary items and services customarily furnished as part of such service. (5) Specified hospital The term specified hospital means a hospital (as defined in section 1861(e)), a critical access hospital (as defined in section 1861(mmm)(1)), or a rural emergency hospital (as defined in section 1861(kkk)). (6) Third party payer The term third party payer means an entity that is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service.. (2) Rule of construction Nothing in the amendments made by this subsection may be construed to impede, prohibit, or prevent the Secretary of Health and Human Services from implementing, executing, carrying out, or enforcing the requirements of section 2718(f) of the Public Health Service Act. (b) PHSA (1) In general Section 2718 of the Public Health Service Act (42 U.S.C. 300gg–18) is amended by adding at the end the following new subsection: (f) Hospital transparency requirement (1) In general Beginning January 1, 2028, each hospital operating within the United States (including a specified hospital (as defined in section 1899D of the Social Security Act)) shall comply with the price transparency requirement described in paragraph (2). (2) Requirement described (A) In general For purposes of paragraph (1), the price transparency requirement described in this paragraph is, with respect to a hospital, that such hospital, in accordance with a method and format established by the Secretary under subparagraph (C), compile and make public (without subscription and free of charge) for each year— (i) all of the hospital’s standard charges (including the information described in subparagraph (B)) for each item and service furnished by such hospital; (ii) information in a consumer-friendly format (as specified by the Secretary)— (I) on the hospital’s prices (including the information described in subparagraph (B)) for as many of the Centers for Medicare & Medicaid Services-specified shoppable services that are furnished by the hospital, and as many additional hospital-selected shoppable services (or all such additional services, if such hospital furnishes fewer than 300 shoppable services) as may be necessary for a combined total of at least 300 shoppable services; and (II) that includes, with respect to each Centers for Medicare & Medicaid Services-specified shoppable service that is not furnished by the hospital, an indication that such service is not so furnished; (iii) each type 2 national provider identifier associated with the hospital or a unit of the hospital; and (iv) an attestation that all information made public pursuant to this subparagraph is complete and accurate. (B) Information described For purposes of subparagraph (A), the information described in this subparagraph is, with respect to standard charges and prices, as applicable, made public by a hospital, the following: (i) A plain language description (as specified by the Secretary) of each item or service, accompanied by, as applicable, the Healthcare Common Procedure Coding System code, the diagnosis-related group, the national drug code, current procedure terminology codes, or other identifier used or approved by the Centers for Medicare & Medicaid Services. (ii) The gross charge, as applicable, expressed as a dollar amount (as specified by the Secretary), for each such item or service, when provided in, as applicable, the inpatient setting and outpatient department setting. (iii) For each such item or service when provided in, as applicable, the inpatient and outpatient department settings— (I) the discounted cash price, as applicable, expressed as a dollar amount; or (II) in the case no discounted cash price is available for such item or service, the median cash price charged by the hospital (not including charity care) to self-pay individuals for such item or service when provided in such settings for the previous three years, expressed as a dollar amount. (iv) With respect to prices made public pursuant to subparagraph (A)(ii), a link to a consumer-friendly document that clearly explains the hospital’s charity care policy that includes, if applicable, any sliding scale payment structure employed for determining prices. (v) The payer-specific negotiated charges, as applicable, clearly associated with the name of the third party payer and plan and expressed as a dollar amount, that apply to each such item or service when provided in, as applicable, the inpatient setting and outpatient department setting. (vi) The de-identified maximum and minimum negotiated charges, as applicable, for each such item or service, not including any such charge that is $0. (vii) Any other additional information the Secretary may require (in consultation with stakeholders) for the purpose of improving the accuracy of, or enabling consumers to easily understand and compare, standard charges and prices for an item or service, except information that is duplicative of any other reporting requirement under this subsection. (C) Uniform method and format Not later than January 1, 2028, the Secretary shall establish a standard, uniform method and format for hospitals to use in compiling and making public standard charges pursuant to subparagraph (A)(i) and a standard, uniform method and format for such hospitals to use in compiling and making public prices pursuant to subparagraph (A)(ii). Such methods and formats— (i) shall, in the case of such method and format for making public standard charges pursuant to subparagraph (A)(i), ensure that such charges are made available in a machine-readable format (or a successor technology specified by the Secretary); (ii) may be similar to any template made available by the Centers for Medicare & Medicaid Services as of the date of the enactment of this subparagraph; (iii) shall meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such charges and prices; and (iv) shall be updated as determined appropriate by the Secretary, in consultation with stakeholders. (3) Monitoring compliance The Secretary shall establish processes to monitor and assess specified hospitals’ compliance with this subsection. Such processes shall include processes relating to the following: (A) The evaluation and analysis of complaints made by individuals or other entities relating to such hospitals’ compliance with this subsection. (B) The use of audits to ensure such hospitals’ compliance with this subsection. (C) The obtaining of additional information from such hospitals to determine such hospitals’ compliance with this subsection (as determined appropriate by the Secretary). (4) Enforcement (A) In general In the case of a hospital that fails to comply with the requirements of this subsection— (i) not later than 30 days after the date on which the Secretary determines such failure exists, the Secretary shall submit to such hospital a notification of such determination (which may include, as determined appropriate by the Secretary, a request for a corrective action plan (to be submitted not later than 45 days after such request is made) to comply with such requirements); and (ii) in the case of a hospital that does not receive a request for a corrective action plan as part of a notification submitted by the Secretary under clause (i)— (I) the Secretary shall, not later than 60 days after such notification is sent, determine whether such hospital is in compliance with such requirements; and (II) if the Secretary determines under subclause (I) that such hospital is not in compliance with such requirements, the Secretary shall either— (aa) submit to such hospital a request for a corrective action plan (to be submitted not later than 45 days after such request is made) to comply with such requirements; or (bb) if the Secretary determines that such hospital has not taken meaningful actions to come into compliance since such notification was sent, impose a civil monetary penalty in accordance with subparagraph (B). (B) Civil monetary penalty (i) In general In addition to any other enforcement actions or penalties that may apply under another provision of Federal law, a hospital that has received a request for a corrective action plan under clause (i) or (ii) of subparagraph (A) and fails to comply with the requirements of this subsection by the date that is 90 days after such request is made (or, if such hospital has submitted such a corrective action plan not later than 45 days after the date such request was made, by the date that is 90 days after the date of the submission of such corrective action plan), and a hospital with respect to which the Secretary has made a determination described in clause (ii)(II)(bb) of such subparagraph, shall be subject to a civil monetary penalty of an amount specified by the Secretary for each day (beginning with the day on which the Secretary first determined that such hospital was not complying with such requirements) during which such failure was ongoing. Such amount shall not exceed— (I) in the case of a hospital with 30 or fewer beds, $300 per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $400 per bed per day); (II) in the case of a hospital with more than 30 beds but fewer than 101 beds, $12.50 per bed per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $15 per bed per day); (III) in the case of a hospital with more than 100 beds but fewer than 201 beds, $17.50 per bed per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $20 per bed per day); (IV) in the case of a hospital with more than 200 beds but fewer than 501 beds, $20 per bed per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $25 per bed per day); and (V) in the case of a hospital with more than 500 beds, $25 per bed per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $35 per bed per day). (ii) Increase authority In applying this subparagraph with respect to violations occurring in 2029 or a subsequent year, the Secretary may through notice and comment rulemaking increase— (I) the limitation on the per day amount of any penalty applicable to a hospital under clause (i)(I); (II) the limitations on the per bed per day amount of any penalty applicable under any of subclauses (II) through (V) of clause (i); and (III) the amounts specified in clause (iii)(II). (iii) Persistent noncompliance (I) In general In the case of a hospital (other than a hospital with 30 or fewer beds) that the Secretary has determined to be knowingly and willfully noncompliant with the provisions of this subsection for two or more 6-month periods during any 3-year period, the Secretary may increase any penalty otherwise applicable under this subparagraph by the amount specified in subclause (II) with respect to such hospital and may require such hospital to complete such additional corrective actions plans as the Secretary may specify. (II) Specified amount For purposes of subclause (I), the amount specified in this subclause is, with respect to a hospital— (aa) with more than 30 beds but fewer than 101 beds, an amount that is not less than $500,000 and not more than $1,000,000; (bb) with more than 100 beds but fewer than 301 beds, an amount that is greater than $1,000,000 and not more than $2,000,000; (cc) with more than 300 beds but fewer than 501 beds, an amount that is greater than $2,000,000 and not more than $4,000,000; and (dd) with more than 500 beds, and amount that is not less than $5,000,000 and not more than $10,000,000. (iv) Authority to waive or reduce penalty (I) Hospitals located in rural or underserved areas (aa) In general Subject to item (bb), the Secretary may waive any penalty, or reduce any penalty by not more than 75 percent, otherwise applicable under this subparagraph with respect to a hospital located in a rural or underserved area if the Secretary certifies that imposition of such penalty would result in an immediate threat to access to care for individuals in the service area of such hospital. (bb) Limitation on application The Secretary may not elect to waive a penalty under item (aa) with respect to a hospital more than once in a 6-year period and may not elect to reduce such a penalty with respect to such a hospital more than once in such a period. Nothing in the preceding sentence shall be construed as prohibiting the Secretary from both waiving and reducing a penalty with respect to a hospital during a 6-year period. (II) Reduction if hearing waived The Secretary may reduce any penalty otherwise applicable under this subparagraph (as reduced, if applicable, under subclause (I)) by not more than 35 percent if the specified hospital that is subject of such penalty agrees to waive any right of such hospital to a hearing before an administrative law judge with respect to the imposition of such penalty. (v) Provision of technical assistance The Secretary shall, to the extent practicable, provide technical assistance relating to compliance with the provisions of this subsection to hospitals requesting such assistance. (vi) Hardship exemption Notwithstanding any limit on the waiver or reduction of a penalty under clause (iv), the Secretary may waive any penalty with respect to a hospital on a case-by-case basis if the Secretary determines that a circumstance exists interfering with such hospital’s ability to comply with the provisions of this subsection (such as a natural disaster (as defined in section 602(a) of the Robert T. Stafford Disaster Relief and Emergency Assistance Act), a public health emergency, or other similar or unexpected catastrophe or similar situation). (vii) Application of certain provisions The provisions of section 1128A of the Social Security Act (other than subsections (a) and (b) of such section) shall apply to a civil monetary penalty imposed under this subparagraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section. (viii) Nonduplication of penalties (I) In general The Secretary may not subject a hospital to a civil monetary penalty under this subparagraph with respect to noncompliance with the provisions of this subsection for a period if the Secretary has imposed a civil monetary penalty on such hospital under section 1899D of the Social Security Act for failure to comply with the provisions of such section for such period. (II) Prioritization In the case of a hospital that the Secretary determines to be in violation of the provisions of this subsection and of section 1899D of the Social Security Act, the Secretary shall impose penalties as prescribed in this subsection in lieu of any penalties prescribed in such section 1899D. (C) Publication of hospital price transparency information Beginning on January 1, 2028, the Secretary shall make publicly available on the public website of the Centers for Medicare & Medicaid Services information with respect to compliance with the requirements of this subsection and enforcement activities undertaken by the Secretary under this subsection. Such information shall be updated in real time (if practicable) and include— (i) the number of reviews of compliance with this subsection undertaken by the Secretary; (ii) the number of notifications described in subparagraph (A)(i) sent by the Secretary; (iii) the identity of each hospital that was sent such a notification and a description of the nature of such hospital’s noncompliance with this subsection; (iv) the amount of any civil monetary penalty imposed on such hospital under subparagraph (B); (v) whether such hospital subsequently came into compliance with this subsection; (vi) any waivers or reductions of penalties made pursuant to a certification by the Secretary under subparagraph (B)(iv), including— (I) the name of any hospital that received such a waiver or reduction; (II) the dollar amount of each such penalty so waived or reduced; and (III) the rationale for the granting of each such waiver or reduction, but only to the extent that such rationale does not make public commercially sensitive information; and (vii) any other information as determined by the Secretary. (5) Ensuring accessibility through implementation In implementing this subsection, the Secretary shall through rulemaking ensure that a hospital making public charges and prices pursuant to this section takes reasonable steps (as specified by the Secretary) to ensure the accessibility of such charges and information to individuals with limited English proficiency. Such steps may include the hospital’s provision of interpretation services or the hospital’s provision of translations of charges and information. (6) Definitions For purposes of this subsection: (A) Discounted cash price The term discounted cash price means the charge that applies to an individual who pays cash, or cash equivalent, for a hospital-furnished item or service. (B) Gross charge The term gross charge means the charge for an individual item or service that is reflected on a hospital’s chargemaster, absent any discounts. (C) Payer-specific negotiated charge The term payer-specific negotiated charge means the charge that a hospital has negotiated with a third party payer for an item or service. (D) Shoppable service The term shoppable service means a service that can be scheduled by a health care consumer in advance and includes all ancillary items and services customarily furnished as part of such service. (E) Third party payer The term third party payer means an entity that is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service.. (2) Conforming amendments Section 2718 of the Public Health Service Act (42 U.S.C. 300gg–18) is amended— (A) in subsection (b)(3), by inserting (other than the provisions of subsection (f)) after this section; and (B) in subsection (e), by adding at the end the following new sentence: The preceding provisions of this subsection shall not apply beginning on January 1, 2028.. (3) Rule of construction Nothing in the amendments made by this subsection may be construed to impede, prohibit, or prevent the Secretary of Health and Human Services from implementing, executing, carrying out, or enforcing the requirements of section 1899D of the Social Security Act.