Sec. 201. Strengthening hospital price transparency requirements

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Section 2718(e) of the Public Health Service Act ( 42 U.S.C. 300gg–18(e) ) is amended to read as follows: Each hospital shall, in accordance with a method and format established by the Secretary under subparagraph (C), on a monthly basis compile and make public (without subscription and free of charge)— all of the hospital’s standard charges (including the information described in subparagraph (B)) for each item and service furnished by such hospital; and hospital standard charge information, including the information described in subparagraph (B), in a consumer-friendly format (as specified by the Secretary), that includes— 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 December 31, 2026, after which the hospital’s prices shall include all shoppable services; and 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.

For purposes of subparagraph (A), standard charges means: A plain language description of each item or service, accompanied by any applicable billing codes, including modifiers, using commonly recognized billing code sets, including the Current Procedural Terminology code, the Healthcare Common Procedure Coding System code, the diagnosis-related group, the National Drug Code, and other nationally recognized identifier. 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.

The discounted cash price expressed as a dollar amount, for each such item or service when provided in, as applicable, the inpatient setting and outpatient department setting (or, in the case no discounted cash price is available for an item or service, the minimum cash price accepted by the hospital from self-pay individuals for such item or service, expressed as a dollar amount, as well as, 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).

The hospital shall accept the discounted cash price as payment in full from any patient that chooses to pay in cash without regard to the patient’s coverage. 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 also shall disclose such algorithm, percentage, formula, or criteria as set forth in its contract and any other terms, schedules, exhibits, data, or other information referenced in any such contract as shall be required to determine and disclose the negotiated charge.

The de-identified maximum and minimum negotiated charges for each such item or service, expressed as a non-zero dollar amount. 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 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.

Not later than January 1, 2026, 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 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 spreadsheet format; meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such charges and prices; and be updated as determined appropriate by the Secretary, in consultation with stakeholders.

The availability of a price estimator tool shall not be considered to deem compliance with or otherwise vitiate the requirements of paragraph (1)(A)(ii) or any other requirements of this section. Furthermore, the use of an estimator tool shall not be used for purposes of compliance with any provisions in this Section. 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. 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 made in accordance with the hospital price transparency requirements set forth in this regulation. Such attestation shall be deemed to be material to payment from the Federal Government to the hospital.

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 submit to such hospital a notification of such determination, which shall include a request for a corrective action plan to comply with such requirements. 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 45 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 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— in the case of a hospital with 30 or fewer beds, $300 per day; 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); in the case of a hospital with more than 100 beds but fewer than 301 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); in the case of a hospital with more than 300 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 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). In applying this subparagraph with respect to violations occurring in 2027 or a subsequent year, the Secretary may through notice and comment rulemaking increase— the limitation on the per day amount of any penalty applicable to a hospital under clause (i)(I); the limitations on the per bed per day amount of any penalty applicable under any of subclauses

(II)through

(V)of clause (i); and the limitation on the increase of any penalty applied under clause

(iii)pursuant to the amounts specified in subclause

(II)of such clause. In the case of a hospital that the Secretary has determined to be knowingly and willfully noncompliant with the provisions of this subsection two or more times during a 1-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. For purposes of subclause (I), the amount specified in this subclause is, with respect to a hospital— 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; 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; 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 with more than 500 beds, and amount that is not less than $5,000,000 and not more than $10,000,000. The Secretary may, to the extent practicable, provide technical assistance relating to compliance with the provisions of this section to hospitals requesting such assistance. 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. The Secretary shall not grant or extend any waiver, delay, tolling, or other mitigation of a civil monetary penalty for violation of this subsection. For purposes of this subsection: The term discounted cash price means the minimum charge, exclusive of any hospital or third-party payer assistance, that the hospital accepts from an individual who pays cash, or cash equivalent, for a hospital-furnished item or service, without regard to patient coverage, as payment in full. The term gross charge means the charge for an individual item or service that is reflected on a hospital’s chargemaster, absent any discounts. The term hospital means a hospital (as defined in section 1861(e) of the Social Security Act), a critical access hospital (as defined in section 1861(mmm)(1) of the Social Security Act), or a rural emergency hospital (as defined in section 1861(kkk) of the Social Security Act), together with any parent, subsidiary, or other affiliated provider or supplier of health care items and services without regard to whether such parent, subsidiary, or other affiliated provider or supplier operates under separate licensure, certification, or designation. The term payer-specific negotiated charge means the charge that a hospital has negotiated with a third party payer for an item or 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. 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. The Secretary shall implement this subsection through notice and comment rulemaking in accordance with section 553 of title 5, United States Code. . The amendment made by subsection

(a)shall apply beginning January 1, 2026. Nothing in the amendment made by this section may be construed as affecting the applicability of the regulations codified at part 180 of title 45, Code of Federal Regulations, before January 1, 2026. The provisions of this title shall not supersede any provision of State law that establishes, implements, or continues in effect any requirement or prohibition related to health care price transparency, except to the extent that such requirement or prohibition prevents the application of a requirement or prohibition of this title.

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42 USC 300gg–18(e)

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Sec. 201

Strengthening hospital price transparency requirements

Cite42 USC 300gg–18(e)

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