Strengthening hospital price transparency

Title XXVII of the Public Health Service Act is amended by inserting after section 2718 (42 U.S.C. 300gg–18) the following: 2718A. Provider price transparency (a) Definitions In this section: (1) Applicable imaging service provider The term applicable imaging provider means a provider of services or supplier who furnishes any imaging services to patients, including an independent diagnostic testing facility, an outpatient diagnostic facility, and any other imaging center designated by the Secretary, except that such term does not include an imaging service provider with respect to which standard charges for specified imaging service provider services furnished by such service provider are made available by a hospital pursuant to subsection (b) or specified ambulatory surgical center pursuant to subsection (e). (2) Applicable laboratory The term applicable laboratory means a laboratory as such term is defined in section 493.2, 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 for specified clinical diagnostic laboratory tests furnished by such laboratory are made available by a hospital pursuant to subsection (b) or specified ambulatory surgical center pursuant to subsection (e). (3) Discounted cash price (A) In general The term discounted cash price means the minimum charge expressed as a dollar amount, subject to subparagraph (B), that the applicable service provider subject to this section accepts from an individual who pays cash, or cash equivalent, for a furnished item or service, without regard to health insurance coverage, as payment in full. (B) Exclusions For purposes of subparagraph (A), the minimum charge described in such subparagraph, with respect to a furnished item or service, as applicable, shall be calculated without taking into account any financial assistance, including assistance attributable to charity care (in the case of a hospital, as such term is used for purposes of hospital cost reporting under title XVIII of the Social Security Act), or third-party assistance for such item or service. (4) Extraordinary collection actions The term extraordinary collection action has the meaning given such term for purposes of section 501(r) of the Internal Revenue Code of 1986. (5) Gross charge The term gross charge means the charge for an individual item or service that is reflected on a hospital’s chargemaster or similar list of prices facilitated by any other provider, as defined by the Secretary, absent any discounts. (6) Hospital The term hospital means an institution in any State in which State or applicable local law provides for the licensing of hospitals, that is licensed as a hospital pursuant to such law or is approved, by the agency of such State or locality responsible for licensing hospitals, as meeting the standards established for such licensing. For purposes of this paragraph, the term State includes each of the several States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. (7) 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. (8) Shoppable service The term shoppable service means a service that can be scheduled by a healthcare consumer in advance. Such services are routinely provided in non-urgent situations that do not require immediate action or attention to the patient, thus allowing patients to price shop and schedule a service at a time that is convenient for them. (9) Specified ambulatory surgical center The term specified ambulatory surgical center means any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission, except that such term does not include a surgical center with respect to which standard charges for specified ambulatory surgical center services furnished by such surgical center are made available by a hospital pursuant to subsection (b). (10) Specified clinical diagnostic laboratory test The term specified clinical diagnostic laboratory test means any clinical diagnostic laboratory test or service that is provided by the applicable laboratory, excluding advanced diagnostic laboratory tests (as defined in section 1834A(d)(5) of the Social Security Act). (11) Specified imaging service The term specified imaging service has the meaning given to the term radiology and certain other imaging services for purposes of section 411.351 of title 42, Code of Federal Regulations (or successor regulations). (12) 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. (b) Hospital price transparency (1) In general Beginning January 1 of the year that begins on or after the date that is 1 year after the date of enactment of the Health CARE Act of 2026, each hospital shall, in accordance with a method and format established by the Secretary under paragraph (3), on a quarterly basis (if there have been any changes to the standard charges described in subparagraph (2)) compile and make publicly available on an internet website (without subscription and free of charge)— (A) all of the hospital’s standard charges for each item and service furnished by such hospital in a machine-readable format (or a successor technology specified by the Secretary); (B) all of the hospital’s standard charges in a consumer-friendly format (as specified by the Secretary), that includes— (i) 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 through the January 1 described in this subparagraph, after which the hospital shall include all shoppable services that the hospital furnishes; and (ii) 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; and (C) the name and business address for each person or entity that, with respect to the hospital— (i) has an ownership or investment interest; (ii) has a controlling interest; (iii) is a management services organization; or (iv) is a significant equity investor. (2) Standard charges defined For purposes of paragraph (1), the term standard charges means the following: (A) A plain language description of each item and service, accompanied by any applicable billing codes, including modifiers, using commonly recognized billing code sets, including— (i) the Diagnosis Related Group; (ii) the Healthcare Common Procedure Coding System code; (iii) the National Drug Code; and (iv) other applicable identifiers as determined by the Secretary (or successor code sets). (B) The gross charge, expressed as a dollar amount, for each such item or service, when provided in, as applicable, the inpatient setting and outpatient department setting. (C) The discounted cash price. (D) The payer-specific negotiated charges, expressed as a dollar amount and clearly associated with the name of the applicable third-party payer and name of each plan, that apply to each such item or service when provided in, as applicable, the inpatient setting and outpatient department setting. If the charges are based on an algorithm, percentage of another amount, or other formula or criteria, the hospital shall also disclose such algorithm, percentage, formula, or criteria as set forth in its contract and any other information necessary to determine the negotiated charge as a dollar amount. (E) The de-identified maximum and minimum negotiated charges for each such item or service, expressed as a non-zero dollar amount. (F) The amount of any facility fee, as defined by the Secretary, or add-on charges that will be part of the final payment amount, in addition to any information that might help the patient understand when a facility fee or add-on charge may apply and how to avoid such charges. (G) Any other additional information the Secretary may require for the purpose of improving the accuracy of, or enabling consumers to easily understand and compare, standard charges for an item or service, except information that is duplicative of any other reporting requirement under this subsection. In the case of standard charges 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. (3) Uniform method and format The Secretary shall establish a standard, uniform method and format for hospitals to use in compiling and making public information described in paragraph (1). Such method and format shall— (A) include a machine-readable format (or successor technology specified by the Secretary) containing the information described in paragraph (2) for all items and services furnished by each hospital; (B) meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such charges; and (C) be updated as determined appropriate by the Secretary, in consultation with stakeholders. (4) No deemed compliance Hospitals may offer a price estimator tool, but the availability of such a price estimator tool shall not be considered to deem compliance with or otherwise vitiate the requirements of paragraph (1)(B) or any other requirements of this subsection. (5) Monitoring compliance The Secretary shall, in consultation with the Inspector General of the Department of Health and Human Services, establish a process to monitor compliance with this subsection. Such process shall ensure that each hospital’s compliance with this subsection is reviewed not less frequently than once every year. (6) Attestation A senior official from each hospital (the Chief Executive Officer, Chief Financial Officer, or an official of equivalent seniority) shall attest to the accuracy and completeness of the disclosures, and any other attestations as required by the Secretary, made in accordance with the hospital price transparency requirements based on criteria established by the Secretary. (7) Enforcement (A) In general In the case of a hospital that fails to comply with the requirements of this subsection, not later than 30 days after the date on which the Secretary determines such failure exists, the Secretary shall notify such hospital of such determination, which shall include a request for a corrective action plan if applicable to comply with such requirements. (B) Civil monetary penalty (i) In general In addition to any other enforcement actions or penalties that may apply under another provision of law, a hospital that has received a request for a corrective action plan under subparagraph (A) and fails to comply with the requirements of this subsection by the date that is 90 days after such request is made shall be subject to a civil monetary penalty of an amount specified by the Secretary for each day (beginning on the day the hospital was first out of compliance, as determined by the Secretary) 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 hospitals that fail to comply in 2028 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 limitation on the increase of any penalty applied under clause (iii) pursuant to the amounts specified in subclause (II) of such clause. (iii) Persistent noncompliance (I) In general In the case of a hospital that the Secretary has determined to be noncompliant with the provisions of this subsection two or more times during a 1-year period (as determined by the Secretary), 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, an amount that is not less than $5,000,000 and not more than $10,000,000. (iv) Provision of technical assistance The Secretary may, to the extent practicable, provide technical assistance relating to compliance with the provisions of this section to hospitals requesting such assistance. (v) 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. (C) No authority to waive or reduce penalty The Secretary shall not grant or extend any waiver, delay, tolling, or other mitigation of a civil monetary penalty for failing to comply with the requirements of this subsection except where the Secretary determines that imposing the maximum civil monetary penalty, including penalties for persistent noncompliance, will disrupt hospital operations in a manner that impacts patient care. The Secretary may request documentation in such form and manner as the Secretary may require in order to evaluate impact on hospital operations. (D) Prohibition on extraordinary collection In addition to civil monetary penalties applicable under subparagraph (B) and any other enforcement actions or penalties that may apply under any other provision of law, for a hospital that has received a request for a corrective action plan under subparagraph (A) and fails to comply with the requirements of this subsection by the date that is 90 days after such request, that hospital or any other person or entity collecting on behalf of the hospital shall— (i) not take any extraordinary collection actions against any patient or patient guarantor for debt incurred by any patient on the date or dates of service when the hospital was not in compliance with the requirements of this subsection; (ii) cease any extraordinary collection actions that have begun against any patient or patient guarantor for debt incurred by any patient on the date or dates of service when the hospital was not in compliance with the requirements of this subsection; and (iii) not take any extraordinary collection actions against any patient or patient guarantor for debt incurred by any patient on the date or dates of service when the hospital was not in compliance with the requirements of this subsection after the hospital comes back into compliance with the requirements of this subsection. (8) Rulemaking (A) In general The Secretary shall implement this subsection through notice and comment rulemaking in accordance with section 553 of title 5, United States Code. (B) Ownership information In promulgating regulations under this paragraph, the Secretary shall define the individuals and organizations that must be disclosed under paragraph (1)(C) in a manner that harmonizes disclosure requirements with requirements established under section 1124 of the Social Security Act and prioritizes the disclosure of individuals and organizations whose ownership or management relationship with a hospital impacts operational, financial, or clinical decision making for such hospital..