Summary#
This bill would add new federal rules that require many health care providers and health plans to publish clear price and payment information. Hospitals must post detailed, machine-readable lists of their standard charges, discounted cash prices, and payer-specific negotiated charges. Clinical laboratories, imaging providers, and certain ambulatory surgery centers must also publish similar price lists. Health plans must submit monthly machine-readable rate and payment files and offer a real-time self-service tool to show in-network rates and estimated cost sharing. Group health plans would get stronger access to claims, encounter, and payment data from vendors and service providers. The bill sets deadlines for formats, requires senior attestation of accuracy, requires periodic monitoring, creates enforcement procedures, and specifies civil monetary penalties for noncompliance.
What it means for you#
- Hospitals, labs, imaging centers, and some outpatient surgery centers must post prices and payment data online in a format computers can read. That includes gross charges, discounted cash prices, and negotiated rates tied to specific payers or plans. The bill says hospitals must accept the posted discounted cash price as payment in full from patients who pay cash.
- Health plans must give monthly machine-readable files with in-network rates, amounts billed, and amounts allowed, and must provide a real-time self-service tool for members to get estimated cost sharing. Plans must also provide a written explanation of benefits within 45 days after a payment request, showing item descriptions, billing codes, plan payment amounts, and patient cost-sharing.
- Group health plans would have direct rights to receive full claims and encounter data from contractors, vendors, and network managers on a regular basis. Vendors would have to give detailed contract terms, rebate and fee amounts, and payment reconciliation data.
- Providers and facilities must give patients an itemized bill listing each distinct item or service, billing codes, prices, payments made, charity care information, and contact information. Collections actions are limited until the itemized bill is provided.
Expenses#
No publicly available information on estimated federal costs, budget effects, or fiscal notes appears in the bill text or metadata provided.
Proponents' View#
No publicly available information on proponents' public statements, floor remarks, or formal legislative findings is included in the bill text or metadata provided.
Opponents' View#
No publicly available information on opponents' public statements, floor remarks, or formal objections is included in the bill text or metadata provided.