Transparency in billing

(a) In general Part E of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–131 et seq.) is amended by adding at the end the following: 2799B–10. Patient access to complete billing information (a) Requirements (1) Notice of right of access to itemized bills; In general A health care provider or health care facility that requests payment from an individual for providing a health care item or service to the patient shall include with such request a written notice of the individual’s right to request an itemized bill as part of the individual’s designated record set under section 164.524 of title 45, Code of Federal Regulations (or a successor regulation). (2) Required information A notice under paragraph (1) shall provide— (A) a phone number and internet website where an individual can make a request for access to their itemized bill; (B) information about the availability of language-assistance services for individuals with limited English proficiency (LEP); and (C) information about the health care provider’s or health care facility’s charity care policies and instructions on how to apply for charity care. (3) Collections actions (A) In general A health care provider or health care facility shall not bill or take any collections actions against an individual— (i) for any provided health care item or service unless the health care provider or health care facility has complied with paragraph (1) or section 13405(e)(4) of the HITECH Act; or (ii) with respect to any items or services for which the amount appearing on an itemized bill described above in paragraph (1) exceeds the amount disclosed pursuant to Federal health care price transparency regulations, including part 180 of title 45, Code of Federal Regulations, or provided in a good faith estimate that complies with section 2799B–6 of this Act and section 149.610 of title 45, Code of Federal Regulations, or another good faith estimate provided by a health care entity covered under this section but not otherwise covered under such section 2799B–6, unless the provider or facility documents that the additional items or services were medically necessary due to unforeseen complications or a patient-initiated change, and could not reasonably have been anticipated. (B) Provider requirement If a provider fails to provide a documentation as required under subparagraph (A)(ii) in the case of items or services, the good faith estimate described in such subparagraph with respect to such items or services shall be binding. (b) Failure To comply (1) Penalties The Secretary shall impose penalties on any health care provider or health care facility that fails to comply with the requirements of this section in an amount not to exceed $10,000 for each instance of failure to comply. (2) Presumption in favor of individual If a health care provider or health care facility fails to comply with the requirements of this section, the presumption shall be that charges were substantially in excess of the good faith estimate, as set forth in section 2799B–6, for the purpose of any patient-provider dispute, including in accordance with section 2799B–7 and regulations promulgated thereunder. (c) Regulations The Secretary shall implement this section through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.. (b) Standards for accessing itemized bills Section 13405(e) of the HITECH Act (42 U.S.C. 17935(e)) is amended— (1) in paragraph (2), by striking and at the end; (2) in paragraph (3), by striking the period and inserting; and; and (3) by adding at the end, the following: (4) if the individual makes a request only for an itemized copy of a bill for services provided, the covered entity or business associate shall— (A) make such protected health information available within 30 days of such request; (B) not impose any fee for providing such individual a copy of their information; and (C) include in such itemized bill, a plain language description of each distinct health care item or service, all applicable billing codes for each distinct item or service, including modifiers, using standard and commonly recognized billing code sets, the price and billed amount, if different, of each distinct item or service..