Requiring certain facilities under the Medicare program to disclose certain information relating to charges and prices

(a) 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. Health care provider price transparency (a) Hospitals (1) In general Beginning January 1, 2027, 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— (i) in accordance with a method and format established by the Secretary under subparagraph (C), compile and make public (without subscription and free of charge), and update not less frequently than annually (or at such greater frequency as may be specified by the Secretary)— (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— (aa) 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 (bb) 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; (ii) post in a publicly accessible location of such hospital (in a form and manner specified by the Secretary) the discounted cash price, as applicable, expressed as a dollar amount, for each Centers for Medicare & Medicaid Services-specified shoppable service that is furnished by the hospital when provided in, as applicable, the inpatient setting and outpatient department setting (or, in the case no discounted cash price is available for such service, the median cash price charged by the hospital to self-pay individuals for such service when provided in such settings for the previous three years, expressed as a dollar amount); and (iii) submit to the Secretary (in a form and manner specified by the Secretary and on an annual basis) an attestation, signed by the chief executive officer, chief financial officer, or other comparable official (as specified by the Secretary) of such hospital, 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, commonly recognized billing code sets, including the Healthcare Common Procedure Coding System code, the diagnosis-related group, the national drug code, or other applicable identifier determined appropriate by the Secretary. (ii) For each such item or service when provided in, as applicable, the inpatient and outpatient department settings— (I) the gross charge, as applicable, expressed as a dollar amount; (II) each payer-specific negotiated charge in effect between such hospital and a third party payer, expressed as a dollar amount; (III) the deidentified maximum and minimum payer-specific negotiated charges in effect between such hospital and any third party payer; and (IV) the discounted cash price, as applicable, expressed as a dollar amount (or, 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). (iii) 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. (iv) 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 (which may include, in the case that charges described in clause (iii) for an item or service are unable to be expressed as a dollar amount, such information relating to past allowed charges for such item or service as may be specified by the Secretary), except information that is duplicative of any other reporting requirement under this subsection. In the case of standard charges and prices for an item or service included as part of a bundled, per diem, episodic, or other similar arrangement, the information described in this subparagraph shall be made available as determined appropriate by the Secretary. (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)(I) and a standard, uniform method and format for such hospitals to use in compiling and making public prices pursuant to subparagraph (A)(i)(II). Such methods and formats— (i) shall, in the case of such method and format for making public— (I) standard charges pursuant to subparagraph (A)(i)(I), ensure that such charges are made available in a machine-readable format (or a successor technology specified by the Secretary); and (II) prices pursuant to subparagraph (A)(i)(II), ensure that such prices are made available in a consumer-friendly format (as 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. (D) Deemed compliance with shoppable services requirement for hospitals with a price estimator tool (i) In general Before the effective date of regulations implementing the provisions of sections 2799A–1(f) and 2799B–6 of the Public Health Service Act (relating to advanced explanations of benefits), including regulations on establishing data transfer standards to effectuate such provisions, a specified hospital shall be deemed to have compiled and made public information described in subparagraph (A)(i)(II) (relating to shoppable services) in accordance with a method and format specified by the Secretary under subparagraph (C) if such hospital maintains a price estimator tool described in clause (ii). (ii) Price estimator tool described For purposes of clause (i), a price estimator tool described in this subparagraph is, with respect to a specified hospital, a tool that meets the following requirements: (I) Such tool allows an individual to immediately obtain a price estimate (taking into account whether such individual is covered under any plan, coverage, or program described in subclause (IV)(cc)) and the discounted cash price charged by a specified hospital for each Centers for Medicare & Medicaid Services-specified shoppable service that is furnished by such hospital, and for each additional shoppable service as such hospital may select, such that price estimates are available through such tool for at least 300 shoppable services (or for all such services, if such hospital furnishes fewer than 300 shoppable services). (II) Such tool allows an individual to obtain such an estimate by billing code and by service description. (III) Such tool is prominently displayed on the public internet website of such hospital. (IV) Such tool does not require an individual seeking such an estimate to create an account or otherwise input personal information, except that such tool may require that such individual provide information specified by the Secretary, which may include the following: (aa) The name of such individual. (bb) The date of birth of such individual. (cc) In the case such individual is covered under a group health plan, group or individual health insurance coverage, a Federal health care program, or the program established under chapter 89 of title 5, United States Code, an identifying number assigned by such plan, coverage, or program to such individual. (dd) In the case of an individual described in item (cc), an indication as to whether such individual is the primary insured individual under such plan, coverage, or program (and, if such individual is not the primary insured individual, a description of the individual’s relationship to such primary insured individual). (ee) Any other information specified by the Secretary. (V) Such tool contains a statement confirming the accuracy and completeness of information presented through such tool as of the date such request is made. (VI) Such tool meets any other requirement specified by the Secretary. (3) Monitoring compliance The Secretary shall establish processes to monitor and assess specified hospitals’ compliance with this subsection. Such processes shall ensure that each specified hospital’s compliance with this subsection is reviewed not less frequently than once every 3 years and 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, $342 per day; (II) in the case of a specified hospital with more than 30 beds but fewer than 550 beds, $11 per bed per day; and (III) in the case of a specified hospital with 550 beds or more, $6,277 per day. (ii) Increase authority In applying this subparagraph with respect to failures to comply 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 subclause (I) or (III) of clause (i); (II) the limitations on the per bed per day amount of any penalty applicable under clause (i)(II); 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) In general Subject to subclause (II), 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 area (as defined by the Federal Office of Rural Health Policy for the purpose of rural health grant programs administered by such Office) or an underserved area if the Secretary determines that imposition of such penalty would result in an immediate threat to access to care for individuals in the service area of such hospital. (II) Limitation on application The Secretary may not elect to waive a penalty under subclause (I) 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. (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 unique or unexpected event). (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. (C) Publication of hospital price transparency information Beginning on January 1, 2028, the Secretary shall make publicly available on the 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) Clinical diagnostic laboratory services (1) In general Beginning January 1, 2028, any applicable laboratory that receives payment under this title for furnishing any specified clinical diagnostic laboratory test under this title shall— (A) make publicly available, in accordance with a method and format established by the Secretary under paragraph (3), the information described in paragraph (2) with respect to each such specified clinical diagnostic laboratory test that such laboratory so furnishes; (B) update such information not less frequently than annually (or at such greater frequency as the Secretary may specify); (C) submit to the Secretary on an annual basis an attestation, signed by the chief executive officer, chief financial officer, or other comparable official (as specified by the Secretary) of such laboratory, that all such information is complete and accurate; and (D) post in a publicly accessible location of such laboratory (in a form and manner specified by the Secretary) the discounted cash price, as applicable, expressed as a dollar amount, for each Centers for Medicare & Medicaid Services-specified shoppable service that is furnished by the laboratory (or, in the case no discounted cash price is available for such service, the median cash price charged by the laboratory to self-pay individuals for such service for the previous three years, expressed as a dollar amount). (2) Information described For purposes of paragraph (1), the information described in this paragraph is, with respect to an applicable laboratory and a specified clinical diagnostic laboratory test, the discounted cash price for such test (or, if no such price exists, the gross charge for such test). (3) Uniform method and format Not later than January 1, 2028, the Secretary shall establish a standard, uniform method and format for applicable laboratories to use in compiling and making public information pursuant to paragraph (1). Such method and format— (A) may be similar to any template made available by the Centers for Medicare & Medicaid Services (as described in subsection (a)(2)(C)(ii)); (B) shall meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such information; and (C) shall be updated as determined appropriate by the Secretary, in consultation with stakeholders. (4) Inclusion of ancillary services Any price or charge for a specified clinical diagnostic laboratory test furnished by an applicable laboratory made publicly available in accordance with paragraph (1) shall include the price or charge (as applicable) for any ancillary item or service (such as specimen collection services) that would normally be furnished by such laboratory as part of such test, as specified by the Secretary. (5) Monitoring compliance The Secretary shall, through notice and comment rulemaking, establish a process to monitor compliance with this subsection. (6) Enforcement (A) In general In the case that the Secretary determines that an applicable laboratory is not in compliance with the requirements of paragraph (1)— (i) not later than 30 days after such determination, the Secretary shall notify such laboratory 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)); and (ii) in the case of a laboratory that does not receive a request for a corrective action plan as part of a notification under clause (i)— (I) the Secretary shall, not later than 90 days after such notification is sent, determine whether such laboratory is in compliance with such requirements; and (II) if the Secretary determines under subclause (I) that such laboratory is not in compliance with such requirements, the Secretary shall either— (aa) submit to such laboratory 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 laboratory 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 An applicable laboratory 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 paragraph (1) by the date that is 90 days after such request is made, and an applicable laboratory 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 in an amount not to exceed $300 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. (C) Increase authority In applying this paragraph with respect to failures to comply occurring in 2029 or a subsequent year, the Secretary may through notice and comment rulemaking increase the per day limitation on civil monetary penalties under subparagraph (B). (D) 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 paragraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section. (E) Authority to waive or reduce penalty (i) In general Subject to clause (ii), the Secretary may waive or reduce any penalty otherwise applicable with respect to an applicable laboratory under this paragraph if the Secretary determines that imposition of such penalty would result in an immediate threat to access to care for individuals in the service area of such laboratory. (ii) Limitation The Secretary may not elect to waive or reduce a penalty under clause (i) with respect to an applicable laboratory more than 3 times in a 10 year period. (F) Hardship exemption Notwithstanding any limit on the waiver or reduction of a penalty under subparagraph (E), the Secretary may waive any penalty with respect to an applicable laboratory on a case-by-case basis if the Secretary determines that a circumstance exists interfering with such laboratory’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 unique or unexpected event). (7) Provision of technical assistance The Secretary shall, to the extent practicable, provide technical assistance relating to compliance with the provisions of this subsection to applicable laboratories requesting such assistance. (8) Definitions In this subsection: (A) Applicable laboratory The term applicable laboratory has the meaning given such term in section 414.502, of title 42, Code of Federal Regulations (or a successor regulation), except that such term does not include a laboratory with respect to which standard charges and prices for specified clinical diagnostic laboratory tests furnished by such laboratory are made available by— (i) a specified hospital pursuant to subsection (a); or (ii) an ambulatory surgical center pursuant to subsection (d). (B) Specified clinical diagnostic laboratory test the term specified clinical diagnostic laboratory test means a clinical diagnostic laboratory test that is included on the list of shoppable services specified by the Centers for Medicare & Medicaid Services (as described in subsection (a)(2)(A)(i)(II)), other than an advanced diagnostic laboratory test (as defined in section 1834A(d)(5)). (c) Imaging services (1) In general Beginning January 1, 2028, each provider of services and supplier that receives payment under this title for furnishing a specified imaging service, other than such a provider or supplier with respect to which standard charges and prices for such services furnished by such provider or supplier are made available by a specified hospital pursuant to subsection (a) or an ambulatory surgical center pursuant to subsection (d), shall— (A) make publicly available, in accordance with a method and format established by the Secretary under paragraph (3), the information described in paragraph (2) with respect to each such service that such provider of services or supplier furnishes; (B) updated such information not less frequently than annually (or at such greater frequency as the Secretary may specify); (C) submit to the Secretary on an annual basis an attestation, signed by the chief executive officer, chief financial officer, or other comparable official (as specified by the Secretary) of such provider or supplier, that all such information is complete and accurate; and (D) post in a publicly accessible location of such provider or supplier (in a form and manner specified by the Secretary) the discounted cash price, as applicable, expressed as a dollar amount, for each Centers for Medicare & Medicaid Services-specified shoppable service that is furnished by the provider or supplier (or, in the case no discounted cash price is available for such service, the median cash price charged by the provider or supplier to self-pay individuals for such service for the previous three years, expressed as a dollar amount). (2) Information described For purposes of paragraph (1), the information described in this paragraph is, with respect to a provider of services or supplier and a specified imaging service, the discounted cash price for such service (or, if no such price exists, the gross charge for such service). (3) Uniform method and format Not later than January 1, 2028, the Secretary shall establish a standard, uniform method and format for providers of services and suppliers to use in making public information described in paragraph (2). Any such method and format— (A) may be similar to any template made available by the Centers for Medicare & Medicaid Services (as described in subsection (a)(2)(C)(ii)); (B) shall meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such information; and (C) shall be updated as determined appropriate by the Secretary, in consultation with stakeholders. (4) Monitoring compliance The Secretary shall, through notice and comment rulemaking, establish a process to monitor compliance with this subsection. (5) Enforcement (A) In general In the case that the Secretary determines that a provider of services or supplier is not in compliance with the requirements of paragraph (1)— (i) not later than 30 days after such determination, the Secretary shall notify such provider or supplier 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)); and (ii) in the case of a provider of services or supplier that does not receive a request for a corrective action plan as part of a notification under clause (i)— (I) the Secretary shall, not later than 90 days after such notification is sent, determine whether such provider or supplier is in compliance with such requirements; and (II) if the Secretary determines under subclause (I) that such provider or supplier is not in compliance with such requirements, the Secretary shall either— (aa) submit to such provider or supplier 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 provider or supplier 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 A provider of services or supplier 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 paragraph (1) by the date that is 90 days after such request is made, and a provider of services or supplier 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 in an amount not to exceed $300 for each day (beginning with the day on which the Secretary first determined that such provider or supplier was not complying with such requirements) during which such failure was ongoing. (C) Increase authority In applying this paragraph with respect to failures to comply occurring in 2029 or a subsequent year, the Secretary may through notice and comment rulemaking increase the amount of the civil monetary penalty under subparagraph (B). (D) 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 paragraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section. (E) Authority to waive or reduce penalty (i) In general Subject to clause (ii), the Secretary may waive or reduce any penalty otherwise applicable with respect to a provider of services or supplier under this paragraph if the Secretary determines that imposition of such penalty would result in an immediate threat to access to care for individuals in the service area of such provider or supplier. (ii) Limitation The Secretary may not elect to waive or reduce a penalty under clause (i) with respect to a specific provider of services or supplier more than 3 times in a 10 year period. (F) Hardship exemption Notwithstanding any limit on the waiver or reduction of a penalty under subpargraph (E), the Secretary may waive any penalty with respect to a provider of services or supplier on a case-by-case basis if the Secretary determines that a circumstance exists interfering with such provider’s or supplier’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 unique or unexpected event). (G) Provision of technical assistance The Secretary shall, to the extent practicable, provide technical assistance relating to compliance with the provisions of this subsection to providers of services and suppliers requesting such assistance. (6) Definition In this subsection, the term specified imaging service means an imaging service that is included on the list of Centers for Medicare & Medicaid Services-specified shoppable services (as described in subsection (a)(i)(II)). (d) Ambulatory surgical centers (1) In general Beginning January 1, 2028, each ambulatory surgical center 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 subsection is, with respect to an ambulatory surgical center, that such center— (i) in accordance with a method and format established by the Secretary under subparagraph (C), compile and make public (without subscription and free of charge), and update not less frequently than annually (or at such greater frequency as may be specified by the Secretary)— (I) all of the ambulatory surgical center’s standard charges (including the information described in subparagraph (B)) for each item and service furnished by such surgical center; (II) information on the ambulatory surgical center’s prices (including the information described in subparagraph (B)) for as many of the Centers for Medicare & Medicaid Services-specified shoppable services (as specified by the Secretary) that are furnished by such surgical center, and as many additional ambulatory surgical center-selected shoppable services (or all such additional services, if such surgical center furnishes fewer than 300 shoppable services) as may be necessary for a combined total of at least 300 shoppable services; and (III) with respect to each Centers for Medicare & Medicaid Services-specified shoppable service that is not furnished by the ambulatory surgical center, an indication that such service is not so furnished; (ii) submit to the Secretary on an annual basis an attestation, signed by the chief executive officer, chief financial officer, or other comparable official (as specified by the Secretary) of such center, that all information made public pursuant to this subparagraph is complete and accurate; and (iii) post in a publicly accessible location of such center (in a form and manner specified by the Secretary) the discounted cash price, as applicable, expressed as a dollar amount, for each Centers for Medicare & Medicaid Services-specified shoppable service that is furnished by the center (or, in the case no discounted cash price is available for such service, the median cash price charged by the center to self-pay individuals for such service for the previous three years, expressed as a dollar amount). (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 an ambulatory surgical center, the following: (i) A plain language description (as specified by the Secretary) of each item or service, accompanied by, as applicable, commonly recognized billing code sets, including the Healthcare Common Procedure Coding System code, the national drug code, or other applicable identifier determined appropriate by the Secretary. (ii) For each such item or service— (I) the gross charge, as applicable, expressed as a dollar amount; (II) each payer-specific negotiated charge in effect between such center and a third party payer, expressed as a dollar amount; (III) the deidentified maximum and minimum payer-specific negotiated charges in effect between such center and any third party payer; and (IV) the discounted cash price, as applicable, expressed as a dollar amount (or, in the case no discounted cash price is available for an item or service, the median cash price charged to self-pay individuals (not including charity care) for such item or service for the previous three years, expressed as a dollar amount). (iii) 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. In the case of standard charges and prices for an item or service included as part of a bundled, per diem, episodic, or other similar arrangement, the information described in this subparagraph shall be made available as determined appropriate by the Secretary. (C) Uniform method and format Not later than January 1, 2028, the Secretary shall establish a standard, uniform method and format for ambulatory surgical centers to use in making public standard charges pursuant to subparagraph (A)(i) and a standard, uniform method and format for such centers to use in making public prices pursuant to subparagraph (A)(ii). Any such method and format— (i) shall, in the case of— (I) standard charges made public by an ambulatory surgical center under subparagraph (A)(i), ensure that such charges are made available in a machine-readable format (or successor technology); and (II) prices made public by an ambulatory surgical center under subparagraph (A)(ii), ensure that such prices are made available in a consumer-friendly format (as specified by the Secretary); (ii) may be similar to any template made available by the Centers for Medicare & Medicaid Services (as described in subsection (a)(2)(C)(ii)); (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. (D) Deemed compliance with shoppable services requirement for centers with a price estimator tool (i) In general Before the effective date of regulations implementing the provisions of sections 2799A–1(f) and 2799B–6 of the Public Health Service Act (relating to advanced explanations of benefits), including regulations on establishing data transfer standards to effectuate such provisions, a specified hospital shall be deemed to have compiled and made public information described in subparagraph (A)(i)(II) (relating to shoppable services) in accordance with a method and format specified by the Secretary under subparagraph (C) if such hospital maintains a price estimator tool described in clause (ii). (ii) Price estimator tool described For purposes of clause (i), a price estimator tool described in this subparagraph is, with respect to an ambulatory surgical center, a tool that meets the following requirements: (I) Such tool allows an individual to immediately obtain a price estimate (taking into account whether such individual is covered under any plan, coverage, or program described in subclause (IV)(cc)) and the discounted cash price charged by an ambulatory surgical center for each Centers for Medicare & Medicaid Services-specified shoppable service that is furnished by such center, and for each additional shoppable service as such center may select, such that price estimates are available through such tool for at least 300 shoppable services (or for all such services, if such hospital furnishes fewer than 300 shoppable services). (II) Such tool allows an individual to obtain such an estimate by billing code and by service description. (III) Such tool is prominently displayed on the public internet website of such center. (IV) Such tool does not require an individual seeking such an estimate to create an account or otherwise input personal information, except that such tool may require that such individual provide information specified by the Secretary, which may include the following: (aa) The name of such individual. (bb) The date of birth of such individual. (cc) In the case such individual is covered under a group health plan, group or individual health insurance coverage, a Federal health care program, or the program established under chapter 89 of title 5, United States Code, an identifying number assigned by such plan, coverage, or program to such individual. (dd) In the case of an individual described in item (cc), an indication as to whether such individual is the primary insured individual under such plan, coverage, or program (and, if such individual is not the primary insured individual, a description of the individual’s relationship to such primary insured individual). (ee) Any other information specified by the Secretary. (V) Such tool contains a statement confirming the accuracy and completeness of information presented through such tool as of the date such request is made. (VI) Such tool meets any other requirement specified by the Secretary. (3) Monitoring compliance The Secretary shall establish processes to monitor and assess ambulatory surgical centers’ 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 centers’ compliance with this subsection. (B) The use of audits to ensure such centers’ compliance with this subsection. (C) The obtaining of additional information from such centers to determine such centers’ compliance with this subsection (as determined appropriate by the Secretary). (4) Enforcement (A) In general In the case that the Secretary determines that an ambulatory surgical center is not in compliance with the requirements of paragraph (1)— (i) not later than 30 days after such determination, the Secretary shall notify such center 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)); and (ii) in the case of an ambulatory surgical center that does not receive a request for a corrective action plan as part of a notification under clause (i)— (I) the Secretary shall, not later than 90 days after such notification is sent, determine whether such center is in compliance with such requirements; and (II) if the Secretary determines under subclause (I) that such center is not in compliance with such requirements, the Secretary shall either— (aa) submit to such center 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 center 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 An ambulatory surgical center 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 paragraph (1) by the date that is 90 days after such request is made, and an ambulatory surgical center 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 in an amount not to exceed $300 for each day (beginning with the day on which the Secretary first determined that such center was not complying with such requirements) during which such failure was ongoing. (ii) Increase authority In applying this subparagraph with respect to failures to comply occurring in 2029 or a subsequent year, the Secretary may through notice and comment rulemaking increase the limitation on the per day amount of any penalty under clause (i). (iii) 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. (iv) Authority to waive or reduce penalty (I) In general Subject to subclause (II), the Secretary may waive any penalty, or reduce any penalty by not more than 75 percent, otherwise applicable under this subparagraph with respect to an ambulatory surgical center 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 surgical center. (II) Limitation on application The Secretary may not elect to waive a penalty under subclause (I) with respect to an ambulatory surgical center more than once in a 6-year period and may not elect to reduce such a penalty with respect to such a surgical center 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 an ambulatory surgical center during a 6-year period. (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 an ambulatory surgical center on a case-by-case basis if the Secretary determines that a circumstance exists interfering with such center’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 unique or unexpected event). (5) Provision of technical assistance The Secretary shall, to the extent practicable, provide technical assistance relating to compliance with the provisions of this subsection to ambulatory surgical centers requesting such assistance. (e) Ensuring accessibility through implementation In implementing this section, the Secretary shall through rulemaking ensure that a provider of services or supplier 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 provision of interpretation services or the provision of translations of charges and information. (f) 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 an applicable laboratory 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 an item or service.. (b) Conforming amendment Section 2718(e) of the Public Health Service Act (42 U.S.C. 300gg–18(e)) is amended by adding at the end the following new sentence: The preceding provisions of this subsection shall not apply beginning on January 1, 2028..