S 2355 — Patients Deserve Price Tags Act

Such amount shall not exceed-- </DELETED> <DELETED> ``(I) in the case of a hospital with 30 or fewer beds, $300 per day;</DELETED> <DELETED> ``(II) 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);</DELETED> <DELETED> ``(III) 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);</DELETED> <DELETED> ``(IV) 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</DELETED> <DELETED> ``(V) 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).</DELETED> <DELETED> ``(ii) Increase authority.--In applying this subparagraph with respect to violations occurring in 2027 or a subsequent year, the Secretary may through notice and comment rulemaking increase--</DELETED> <DELETED> ``(I) the limitation on the per day amount of any penalty applicable to a hospital under clause (i)(I);</DELETED> <DELETED> ``(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</DELETED> <DELETED> ``(III) the limitation on the increase of any penalty applied under clause (iii) pursuant to the amounts specified in subclause (II) of such clause.</DELETED> <DELETED> ``(iii) Persistent noncompliance.--</DELETED> <DELETED> ``(I) In general.--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.</DELETED> <DELETED> ``(II) Specified amount.-- For purposes of subclause (I), the amount specified in this subclause is, with respect to a hospital--</DELETED> <DELETED> ``(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;</DELETED> <DELETED> ``(bb) with more than 100 beds but fewer than beds, an amount that is greater than $1,000,000 and not more than $2,000,000;</DELETED> <DELETED> ``(cc) with more than 300 beds but fewer than beds, an amount that is greater than $2,000,000 and not more than $4,000,000;

and</DELETED> <DELETED> ``(dd) with more than 500 beds, and amount that is not less than $5,000,000 and not more than $10,000,000.</DELETED> <DELETED> ``(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.</DELETED> <DELETED> ``(v) 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.</DELETED> <DELETED> ``(C) No waiver.--The Secretary shall not grant or extend any waiver, delay, tolling, or other mitigation of a civil monetary penalty for violation of this subsection.</DELETED> <DELETED> ``(6) Definitions.--For purposes of this subsection:</DELETED> <DELETED> ``(A) Discounted cash price.--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.</DELETED> <DELETED> ``(B) Gross charge.--The term `gross charge' means the charge for an individual item or service that is reflected on a hospital's chargemaster, absent any discounts.</DELETED> <DELETED> ``(C) Hospital.--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.</DELETED> <DELETED> ``(D) 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.</DELETED> <DELETED> ``(E) 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.</DELETED> <DELETED> ``(F) 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.</DELETED> <DELETED> ``(7) Rulemaking.--The Secretary shall implement this subsection through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.</DELETED> <DELETED> (b) Effective Date.--</DELETED> <DELETED> (1) In general.--The amendment made by subsection (a) shall apply beginning January 1, 2026.</DELETED> <DELETED> (2) Continued applicability of rules for previous years.--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, 2025.</DELETED> <DELETED> (c) Continued Applicability of State Law.--The provisions of this Act 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 Act.</DELETED> <DELETED>SEC.

3.

INCREASING PRICE TRANSPARENCY OF CLINICAL DIAGNOSTIC LABORATORY TESTS.</DELETED> <DELETED> Section 2718 of the Public Health Service Act (42 U.S.C.

300gg-18) is amended by adding at the end the following:</DELETED> <DELETED> ``(f) Clinical Diagnostic Laboratory Price Transparency.-- </DELETED> <DELETED> ``(1) In general.--Beginning July 1, 2027, an applicable laboratory shall--</DELETED> <DELETED> ``(A) make publicly available on an internet website the information described in paragraph (2) with respect to each such specified clinical diagnostic laboratory test that such laboratory so furnishes;

and</DELETED> <DELETED> ``(B) ensure that such information is updated not less frequently than monthly, if there have been any changes to such information.</DELETED> <DELETED> ``(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 following:</DELETED> <DELETED> ``(A) 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.</DELETED> <DELETED> ``(B) The gross charge expressed as a dollar amount, for each such item or service.</DELETED> <DELETED> ``(C) The discounted cash price expressed as a dollar amount, for each such item or service (or, in the case no discounted cash price is available for an item or service, the minimum cash price accepted by the laboratory from self-pay individuals for such item or service when provided in such settings for the previous three years, 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 laboratory's charity care policy).

The laboratory shall accept the discounted or minimum cash price as payment in full from any patient that chooses to pay in cash without regard to the patient's coverage.</DELETED> <DELETED> ``(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 clinical diagnostic laboratory 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.</DELETED> <DELETED> ``(E) The de-identified maximum and minimum negotiated charges for each such item or service, expressed as a non-zero dollar amount.</DELETED> <DELETED> ``(F) 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.</DELETED> <DELETED> ``(3) Uniform method and format.--Not later than January 1, 2027, 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 shall--</DELETED> <DELETED> ``(A) include a machine-readable spreadsheet format containing the information described in paragraph (2) for all items and services furnished by each laboratory;</DELETED> <DELETED> ``(B) meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such information;

and</DELETED> <DELETED> ``(C) be updated as determined appropriate by the Secretary, in consultation with stakeholders.</DELETED> <DELETED> ``(4) Inclusion of ancillary services.--Any price or rate for a specified clinical diagnostic laboratory test available to be furnished by an applicable laboratory made publicly available in accordance with paragraph (1) shall include the price or rate for any ancillary item or service (including specimen collection services, specimen transport, centrifugation, aliquoting, labeling, requisition processing, and standard result reporting services) that would customarily and routinely be furnished by such laboratory as part of such test, as specified by the Secretary.</DELETED> <DELETED> ``(5) Enforcement.--</DELETED> <DELETED> ``(A) In general.--In the case that the Secretary determines that an applicable laboratory is not in compliance with paragraph (1)--</DELETED> <DELETED> ``(i) not later than 30 days after such determination, the Secretary shall notify such laboratory of such determination;

and</DELETED> <DELETED> ``(ii) if such laboratory continues to fail to comply with such paragraph after the date that is 90 days after such notification is sent, the Secretary may impose 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 laboratory was failing to comply with such paragraph) during which such failure is ongoing.</DELETED> <DELETED> ``(B) Increase authority.--In applying this paragraph with respect to violations occurring in or a subsequent year, the Secretary may through notice and comment rulemaking increase the per day limitation on civil monetary penalties under subparagraph (A)(ii).</DELETED> <DELETED> ``(C) 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 paragraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section.</DELETED> <DELETED> ``(6) 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.</DELETED> <DELETED> ``(7) Definitions.--In this subsection:</DELETED> <DELETED> ``(A) 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 and prices for specified clinical diagnostic laboratory tests furnished by such laboratory are made available by a hospital pursuant to subsection (e) of this section.</DELETED> <DELETED> ``(B) 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.</DELETED> <DELETED> ``(C) Gross charge.--The term `gross charge' means the charge for an individual item or service that is reflected on an applicable laboratory's chargemaster, absent any discounts.</DELETED> <DELETED> ``(D) 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.</DELETED> <DELETED> ``(E) 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 (e) of this section), other than such a test that is only available to be furnished by a single provider of services or supplier.</DELETED> <DELETED> ``(F) 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.</DELETED> <DELETED> ``(8) Rulemaking.--The Secretary shall implement this subsection through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.</DELETED> <DELETED>SEC.

4.

IMAGING TRANSPARENCY.</DELETED> <DELETED> Section 2718 of the Public Health Service Act (42 U.S.C.

300gg-18), as amended by section 3, is further amended by adding at the end the following:</DELETED> <DELETED> ``(g) Imaging Services Price Transparency.--</DELETED> <DELETED> ``(1) In general.--Beginning July 1, 2027, each provider of services or supplier that furnishes 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 hospital pursuant to subsection (e), shall--</DELETED> <DELETED> ``(A) make publicly available (in accordance with paragraph (3)) on an internet website the information described in paragraph (2) with respect to each such service that such provider of services or supplier furnishes;

and</DELETED> <DELETED> ``(B) ensure that such information is updated not less frequently than annually.</DELETED> <DELETED> ``(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 following:</DELETED> <DELETED> ``(A) 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.</DELETED> <DELETED> ``(B) The gross charge expressed as a dollar amount, for each such item or service.</DELETED> <DELETED> ``(C) The discounted cash price expressed as a dollar amount, for each such item or service (or, in the case no discounted cash price is available for an item or service, the minimum cash price accepted by the provider of services or supplier from self-pay individuals for such item or service when provided in such settings for the previous three years, 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 provider of services or supplier's charity care policy).

The provider of services or supplier shall accept the discounted or minimum cash price as payment in full from any patient that chooses to pay in cash without regard to the patient's coverage.</DELETED> <DELETED> ``(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 provider or supplier 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.</DELETED> <DELETED> ``(E) The de-identified maximum and minimum negotiated charges for each such item or service, expressed as a non-zero dollar amount.</DELETED> <DELETED> ``(F) 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.</DELETED> <DELETED> ``(3) Uniform method and format.--Not later than January 1, 2027, 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 shall--</DELETED> <DELETED> ``(A) include a machine-readable spreadsheet format containing the information described in paragraph (2) for all items and services furnished by each provider of services and supplier described in paragraph (1);</DELETED> <DELETED> ``(B) meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such information;

and</DELETED> <DELETED> ``(C) be updated as determined appropriate by the Secretary, in consultation with stakeholders.</DELETED> <DELETED> ``(4) Monitoring compliance.--The Secretary shall, through notice and comment rulemaking and in consultation with the Inspector General of the Department of Health and Human Services, establish a process to monitor compliance with this subsection.</DELETED> <DELETED> ``(5) Enforcement.--</DELETED> <DELETED> ``(A) In general.--In the case that the Secretary determines that a provider of services or supplier is not in compliance with paragraph (1)-- </DELETED> <DELETED> ``(i) not later than 30 days after such determination, the Secretary shall notify such provider or supplier of such determination;</DELETED> <DELETED> ``(ii) upon request of the Secretary, such provider or supplier shall submit to the Secretary, not later than 45 days after the date of such request, a corrective action plan to comply with such paragraph;

and</DELETED> <DELETED> ``(iii) if such provider or supplier continues to fail to comply with such paragraph after the date that is 90 days after such notification is sent (or, in the case of such a provider or supplier that has submitted a corrective action plan described in clause (ii) in response to a request so described, after the date that is 90 days after such submission), the Secretary may impose 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 failing to comply with such paragraph) during which such failure to comply or failure to submit is ongoing.</DELETED> <DELETED> ``(B) Increase authority.--In applying this paragraph with respect to violations occurring in or a subsequent year, the Secretary may through notice and comment rulemaking increase the amount of the civil monetary penalty under subparagraph (A)(iii).</DELETED> <DELETED> ``(C) 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 paragraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section.</DELETED> <DELETED> ``(D) 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 violation of this subsection.</DELETED> <DELETED> ``(E) 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.</DELETED> <DELETED> ``(F) Clarification of nonapplicability of other enforcement provisions.--Notwithstanding any other provision of this title, this paragraph shall be the sole means of enforcing the provisions of this subsection.</DELETED> <DELETED> ``(6) Specified imaging service defined.--the term `specified imaging service' means an imaging service that is a Centers for Medicare & Medicaid Services-specified shoppable service (as described in subsection (e)).</DELETED> <DELETED> ``(7) Rulemaking.--The Secretary shall implement this subsection through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.</DELETED> <DELETED>SEC.

5.

AMBULATORY SURGICAL CENTER PRICE TRANSPARENCY REQUIREMENTS.</DELETED> <DELETED> Section 2718 of the Public Health Service Act (42 U.S.C.

300gg-18), as amended by section 4, is further amended by adding at the end the following:</DELETED> <DELETED> ``(h) Ambulatory Surgery Center Transparency.--</DELETED> <DELETED> ``(1) In general.--Beginning July 1, 2027, each specified ambulatory surgical center shall comply with the price transparency requirement described in paragraph (2).</DELETED> <DELETED> ``(2) Requirement described.--</DELETED> <DELETED> ``(A) In general.--A specified ambulatory surgical center, in accordance with a method and format established by the Secretary under subparagraph (C), shall compile and make public (without subscription and free of charge), for each year--</DELETED> <DELETED> ``(i) one or more lists, in a machine-readable format specified by the Secretary, 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;</DELETED> <DELETED> ``(ii) information in a consumer- friendly format (as specified by the Secretary) 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 included on the list described in subsection (e) 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</DELETED> <DELETED> ``(iii) with respect to each Centers for Medicare & Medicaid Services- specified shoppable service (as described in clause (ii)) that is not furnished by the ambulatory surgical center, an indication that such service is not so furnished.</DELETED> <DELETED> ``(B) Information described.--For purposes of subparagraph (A), the information described in this subparagraph is, with respect to standard charges and prices made public by a specified ambulatory surgical center, the following:</DELETED> <DELETED> ``(i) A description of each item or service, accompanied by the Healthcare Common Procedure Coding System code, the national drug code, or other identifier used or approved by the Centers for Medicare & Medicaid Services.</DELETED> <DELETED> ``(ii) The gross charge, expressed as a dollar amount, for each such item or service.</DELETED> <DELETED> ``(iii) The discounted cash price, expressed as a dollar amount, for each such item or service (or, in the case no discounted cash price is available for an item or service, the minimum cash price accepted by the specified ambulatory surgical center from self- pay individuals for such item or service when provided in such settings for the previous three years, 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 provider of services or supplier's charity care policy).

The specified ambulatory surgical center 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.</DELETED> <DELETED> ``(iv) 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 ambulatory surgical center 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.</DELETED> <DELETED> ``(v) The de-identified maximum and minimum negotiated charges for each such item or service, expressed as a non-zero dollar amount.</DELETED> <DELETED> ``(vi) 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.</DELETED> <DELETED> ``(C) Uniform method and format.--Not later than January 1, 2027, the Secretary shall establish a standard, uniform method and format for specified 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 shall--</DELETED> <DELETED> ``(i) in the case of such charges made public by an ambulatory surgical center, ensure that such charges are made available in a machine-readable format;</DELETED> <DELETED> ``(ii) meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such charges and prices;

and</DELETED> <DELETED> ``(iii) be updated as determined appropriate by the Secretary, in consultation with stakeholders.</DELETED> <DELETED> ``(3) No deemed compliance.--The availability of a price estimator tool shall not be considered to deem compliance with or otherwise vitiate the requirements of this subsection (aa).

Furthermore, the use of an estimator tool shall not be used for purposes of compliance with any provisions in this subsection.</DELETED> <DELETED> ``(4) 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 specified ambulatory surgical center's compliance with this subsection is reviewed not less frequently than once every year.</DELETED> <DELETED> ``(5) Enforcement.--</DELETED> <DELETED> ``(A) In general.--In the case of a specified ambulatory surgical center that fails to comply with the requirements of this subsection-- </DELETED> <DELETED> ``(i) the Secretary shall notify such ambulatory surgical center of such failure not later than 30 days after the date on which the Secretary determines such failure exists;

and</DELETED> <DELETED> ``(ii) upon request of the Secretary, the ambulatory surgical center shall submit to the Secretary, not later than 45 days after the date of such request, a corrective action plan to comply with such requirements.</DELETED> <DELETED> ``(B) Civil monetary penalty.--</DELETED> <DELETED> ``(i) In general.--A specified ambulatory surgical center that has received a notification under subparagraph (A)(i) and fails to comply with the requirements of this subsection by the date that is 90 days after such notification (or, in the case of an ambulatory surgical center that has submitted a corrective action plan described in subparagraph (A)(ii) in response to a request so described, by the date that is 90 days after such submission) 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 is ongoing (not to exceed $300 per day).</DELETED> <DELETED> ``(ii) Increase authority.--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 specified ambulatory surgical center under clause (i).</DELETED> <DELETED> ``(iii) 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.</DELETED> <DELETED> ``(iv) 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 violation of this subsection.</DELETED> <DELETED> ``(6) 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 ambulatory surgical centers requesting such assistance.</DELETED> <DELETED> ``(7) Definitions.--For purposes of this section:</DELETED> <DELETED> ``(A) Discounted cash price.--The term `discounted cash price' means the charge that applies to an individual who pays cash, or cash equivalent, for a item or service furnished by an ambulatory surgical center.</DELETED> <DELETED> ``(B) Gross charge.--The term `gross charge' means the charge for an individual item or service that is reflected on a specified surgical center's chargemaster, absent any discounts.</DELETED> <DELETED> ``(C) Group health plan;

group health insurance coverage;

individual health insurance coverage.--The terms `group health plan', `group health insurance coverage', and `individual health insurance coverage' have the meaning given such terms in section of the Public Health Service Act.</DELETED> <DELETED> ``(D) Payer-specific negotiated charge.-- The term `payer-specific negotiated charge' means the charge that a specified surgical center has negotiated with a third party payer for an item or service.</DELETED> <DELETED> ``(E) 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.</DELETED> <DELETED> ``(F) Specified ambulatory surgical center.--The term `specified ambulatory surgical center' means an ambulatory surgical center with respect to which a hospital (or any person with an ownership or control interest (as defined in section 1124(a)(3) of the Social Security Act) in a hospital) is a person with an ownership or control interest (as so defined).</DELETED> <DELETED> ``(G) 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.</DELETED> <DELETED> ``(8) Rulemaking.--The Secretary shall implement this subsection through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.</DELETED> <DELETED>SEC.

6.

STRENGTHENING HEALTH COVERAGE TRANSPARENCY REQUIREMENTS.</DELETED> <DELETED> (a) Transparency in Coverage.--Section 1311(e)(3)(C) of the Patient Protection and Affordable Care Act (42 U.S.C.

18031(e)(3)(C)) is amended--</DELETED> <DELETED> (1) by striking ``The Exchange'' and inserting the following:</DELETED> <DELETED> ``(i) In general.--The Exchange'';</DELETED> <DELETED> (2) in clause (i), as inserted by paragraph (1)-- </DELETED> <DELETED> (A) by striking ``participating provider'' and inserting ``provider'';</DELETED> <DELETED> (B) by inserting ``shall include the information specified in clause (ii) and'' after ``such information'';</DELETED> <DELETED> (C) by striking ``an Internet website'' and inserting ``a self-service tool that meets the requirements of clause (iii)'';

and</DELETED> <DELETED> (D) by striking ``and such other'' and all that follows through the period and inserting ``or, at the option such individual, through a paper or phone disclosure (as selected by such individual and provided at no cost to such individual) that meets such requirements as the Secretary may specify.'';

and</DELETED> <DELETED> (3) by adding at the end the following new clauses:</DELETED> <DELETED> ``(ii) Specified information.--For purposes of clause (i), the information specified in this clause is, with respect to benefits available under a health plan for an item or service furnished by a health care provider, the following:</DELETED> <DELETED> ``(I) If such provider is a participating provider with respect to such item or service, the in-network rate (as defined in subparagraph (F)) for such item or service.</DELETED> <DELETED> ``(II) If such provider is not described in subclause (I), the maximum allowed dollar amount for such item or service.</DELETED> <DELETED> ``(III) The amount of cost sharing (including deductibles, copayments, and coinsurance) that the individual will incur for such item or service (which, in the case such item or service is to be furnished by a provider described in subclause (II), shall be calculated using the maximum amount described in such subclause).</DELETED> <DELETED> ``(IV) The amount the individual has already accumulated with respect to any deductible or out of pocket maximum under the plan (broken down, in the case separate deductibles or maximums apply to separate individuals enrolled in the plan, by such separate deductibles or maximums, in addition to any cumulative deductible or maximum).</DELETED> <DELETED> ``(V) In the case such plan imposes any frequency or volume limitations with respect to such item or service (excluding medical necessity determinations), the amount that such individual has accrued towards such limitation with respect to such item or service.</DELETED> <DELETED> ``(VI) Any prior authorization, concurrent review, step therapy, fail first, or similar requirements applicable to coverage of such item or service under such plan.</DELETED> <DELETED> ``(iii) Self-service tool.--For purposes of clause (i), a self-service tool established by a health plan meets the requirements of this clause if such tool-- </DELETED> <DELETED> ``(I) is based on an internet website;</DELETED> <DELETED> ``(II) provides for real- time responses to requests described in such clause;</DELETED> <DELETED> ``(III) is updated in a manner such that information provided through such tool is timely and accurate;</DELETED> <DELETED> ``(IV) allows such a request to be made with respect to an item or service furnished by-- </DELETED> <DELETED> ``(aa) a specific provider that is a participating provider with respect to such item or service;</DELETED> <DELETED> ``(bb) all providers that are participating providers with respect to such plan and such item or service;

or</DELETED> <DELETED> ``(cc) a provider that is not described in item (bb);</DELETED> <DELETED> ``(V) provides that such a request may be made with respect to an item or service through use of-- </DELETED> <DELETED> ``(aa) the billing code for such item or service;

or</DELETED> <DELETED> ``(bb) through use of a descriptive term for such item or service to produce a list of billing code options from which the individual selects to indicate the subject matter items or services;

and</DELETED> <DELETED> ``(VI) holds a member harmless for the amount of any difference in excess of the amount of the individual's responsibility generated by the self-service tool and the amount ultimately billed or charged to the individual.''.</DELETED> <DELETED> (b) Disclosure of Additional Information.--Section 1311(e)(3) of the Patient Protection and Affordable Care Act (42 U.S.C.

18031(e)(3)) is amended by adding at the end the following new subparagraphs:</DELETED> <DELETED> ``(E) Rate and payment information.-- </DELETED> <DELETED> ``(i) In general.--Not later than January 1, 2027, and every month thereafter, each health plan shall submit to the Exchange, the Secretary, the State insurance commissioner, and make available to the public, the rate and payment information described in clause (ii) in accordance with clause (iii).</DELETED> <DELETED> ``(ii) Rate and payment information described.--For purposes of clause (i), the rate and payment information described in this clause is, with respect to a health plan, the following:</DELETED> <DELETED> ``(I) With respect to each item or service for which benefits are available under such plan (expressed as a dollar amount), including prescription drugs, identified by CPT, HCPCS, DRG, NDC, or other applicable nationally recognized identifier, including any applicable code modifiers, and accompanied by a brief description of the item or service, the in-network rate in effect as of the date of the submission of such information with each provider (identified by national provider identifier) that is a participating provider with respect to such item or service, other than such a rate in effect with a provider--</DELETED> <DELETED> ``(aa) that has submitted no claims;

and</DELETED> <DELETED> ``(bb) expects to receive no claims in the then applicable calendar year for such item or service to such plan.</DELETED> <DELETED> ``(II) With respect to each drug (identified by National Drug Code, J-code, or other commonly recognized billing code used for drugs) for which benefits are available under such plan:</DELETED> <DELETED> ``(aa) The in- network rate (expressed as a dollar amount), including the individual and total amounts for any bundled rates, in effect as of the first day of the month in which such information is made public with each provider that is a participating provider with respect to such drug.</DELETED> <DELETED> ``(bb) The historical net price paid by such plan (net of rebates, discounts, and price concessions) (expressed as a dollar amount) for such drug dispensed or administered during the 90-day period beginning 180 days before such date of submission to each provider that was a participating provider with respect to such drug, broken down by each such provider (identified by national provider identifier), other than such an amount paid to a provider that has submitted no claims for such drug to such plan.</DELETED> <DELETED> ``(III) With respect to each item or service for which benefits are available under such plan (expressed as a dollar amount), identified by CPT, DRG, HCPCS, NDC, or other applicable nationally recognized identifier, including any applicable code modifiers, and accompanied by a brief description of the item or service, the amount billed or charged by the provider, and the amount allowed by the plan, for each such item or service furnished during the 90-day period beginning 180 days before such date of submission by each provider that was not a participating provider with respect to such item or service, broken down by each such provider (identified by national provider identifier), other than items and services with respect to which no claims for such item or service were submitted to such plan during such period.</DELETED> <DELETED> ``(iii) Manner of submission.-- Rate and payment information required to be submitted and made available under this subparagraph shall be so submitted and so made available as follows:</DELETED> <DELETED> ``(I) Information shall be contained in 3 separate machine- readable files corresponding to the information described in each of subclauses (I) through (III) of clause (ii) that meet such requirements as specified by the Secretary through rulemaking, in consultation with the Secretaries of Labor and the Treasury to apply comparable requirements to group health plans and to entities providing benefit management or other third-party administration services on a contractual basis with a group health plan.</DELETED> <DELETED> ``(II) Requirements specified by the Secretary through rulemaking shall ensure that:</DELETED> <DELETED> ``(aa) Such files are limited to an appropriate size, are made available in a widely available format that allows for information contained in such files to be compared across health plans, and are accessible to individuals at no cost and without the need to establish a user account or provider other credentials.</DELETED> <DELETED> ``(bb) The rates, amounts, and prices to be disclosed include contractual terms containing calculation formulae, pricing methodologies, and other information necessary to determine the dollar value of reimbursement.</DELETED> <DELETED> ``(cc) Each such file includes each of the following data elements:</DELETED> <DELETED> ``(AA) A numerical identifier for the group health plan and/or health insurance issuer (such as a Health Insurance Oversight System identifier).</DELETED> <DELETED> ``(BB) A plain-language description of the item or service (including, for drugs, the proprietary and nonproprietary name assigned).</DELETED> <DELETED> ``(CC) The billing code, including any applicable modifiers, associated with such item or service, including the Healthcare Common Procedure Coding System code, diagnosis-related group, national drug code, or other commonly recognized code set.</DELETED> <DELETED> ``(DD) The place of service code.</DELETED> <DELETED> ``(EE) The National Provider Identifier or provider Tax Identification Number.</DELETED> <DELETED> ``(III) The rate and payment information disclosed under subclauses (I) through (III) of clause (ii) shall be separately delineated for each item or service, regardless of whether such item or service is reimbursed as a part of a bundle, episode, or other grouping of items and services.</DELETED> <DELETED> ``(IV) An officer or executive of competent authority shall attest to the accuracy and completeness of information submitted and made available under this subparagraph.

Such attestation shall be subject to enforcement under subparagraph (H) and, where applicable, shall be deemed material to payments from the Federal Government received by the group health plan or health insurance issuer.</DELETED> <DELETED> ``(V) Regulations promulgated pursuant to this section shall provide that:</DELETED> <DELETED> ``(aa) The Secretary shall audit the three machine-readable files required by subparagraph (E)(ii) posted by no fewer than 20 group health plans or health insurance issuers.</DELETED> <DELETED> ``(bb) The Secretary of Labor shall audit the three machine-readable files required by subparagraph (E)(ii) posted by no fewer than group health plans or service providers furnishing third-party administrator services to a group health plan.</DELETED> <DELETED> ``(cc) Findings, conclusions, and enforcement actions taken based on audits of the machine-readable files shall be reported annually to Congress no later than July 1 of the calendar year during which the files were audited.

Such report to Congress shall be accessible to the public.</DELETED> <DELETED> ``(iv) User guide.--Each health plan shall make available to the public instructions written in plain language explaining how individuals may search for information described in clause (ii) in files submitted in accordance with clause (iii).</DELETED> <DELETED> ``(F) Definitions.--In this paragraph:</DELETED> <DELETED> ``(i) Participating provider.--The term `participating provider' has the meaning given such term in section 2799A-1 of the Public Health Service Act.</DELETED> <DELETED> ``(ii) In-network rate.--The term `in-network rate' means, with respect to a health plan and an item or service furnished by a provider that is a participating provider with respect to such plan and item or service, the contracted rate in effect between such plan and such provider for such item or service.

If the rate is based on an algorithm, percentage of another amount, or other formula or criteria, the health plan 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 rate.</DELETED> <DELETED> ``(G) Applicability to accountable care organizations.--An applicable ACO participating in the Medicare Shared Savings Program, as defined in Section of the Social Security Act (42 U.S.C.

1395jjj), shall be subject to the requirements of this paragraph as if such applicable ACO is a group health plan or health insurance issuer.</DELETED> <DELETED> ``(H) Enforcement.--</DELETED> <DELETED> ``(i) In general.--Each year, the Secretary shall audit the three machine- readable files required by subparagraph (E)(ii) posted by no fewer than 20 group health plans or health insurance issuers.</DELETED> <DELETED> ``(ii) Notification and request for corrective action.--In the case of a health plan 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 health plan a notification of such determination, which shall include a request for a corrective action plan to comply with such requirements.</DELETED> <DELETED> ``(iii) Civil monetary penalty.--A health plan that has received a request for a corrective action plan under clause (ii) 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 with the day on which the Secretary first determined that such laboratory was failing to comply with such paragraph) during which such failure was ongoing.

Such amount shall not exceed $300 per member per day or $10,000,000, whichever is lesser.</DELETED> <DELETED> ``(I) Rulemaking.--The Secretary shall implement subparagraphs (E) through (H) through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.</DELETED> <DELETED> (c) Effective Date.--</DELETED> <DELETED> (1) In general.--The amendments made by subsections (a) and (b) shall apply beginning January 1, 2026.</DELETED> <DELETED> (2) Continued applicability of rules for previous years.--Nothing in the amendments made by this section may be construed as affecting the applicability of the rule entitled ``Transparency in Coverage'' published by the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services on November 12, 2020 (85 Fed.

Reg.

72158) before January 1, 2026.</DELETED> <DELETED>SEC.

7.

INCREASING GROUP HEALTH PLAN ACCESS TO HEALTH DATA.</DELETED> <DELETED> (a) Group Health Plan Access to Information.--</DELETED> <DELETED> (1) In general.--Paragraph (2) of section 408(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C.

1108(b)) is amended by adding at the end the following new subparagraphs:</DELETED> <DELETED> ``(C) No contract or arrangement for services, and no extension or renewal of such contract or arrangement, between a group health plan (as that term is defined in section 733(a) of this title) and party in interest, including a health care provider (which for purposes of this subparagraph, includes a health care facility), network or association of providers, service provider offering access to a network of providers, third-party administrator, or pharmacy benefit manager (collectively referred to as `Covered Service Providers'), is reasonable within the meaning of this paragraph unless such contract or arrangement--</DELETED> <DELETED> ``(i) allows the responsible plan fiduciary (as that term is defined in subparagraph (B)(ii)(I)(ee)) access to all claims and encounter information or data, and any documentation supporting claim payments, including, but not limited to, medical records and policy documents, or information or data described in section 724(a)(1)(B) to-- </DELETED> <DELETED> ``(I) enable such entity to comply with the terms of the plan and any applicable law;

and</DELETED> <DELETED> ``(II) determine the accuracy or reasonableness of payment;

and</DELETED> <DELETED> ``(ii) does not--</DELETED> <DELETED> ``(I) unreasonably limit or delay access, as determined by the Secretary but in any event not longer than 15 days, to such information or data;</DELETED> <DELETED> ``(II) limit the volume of claims and encounter information or data that the group health plan, the plan sponsor, the plan administrator, or a business associate of such plan may access during an audit or pursuant to any request for such information or data;</DELETED> <DELETED> ``(III) limit the disclosure of pricing terms for value- based payment arrangements or capitated payment arrangements, including-- </DELETED> <DELETED> ``(aa) payment calculations and formulas;</DELETED> <DELETED> ``(bb) quality measures;</DELETED> <DELETED> ``(cc) contract terms;</DELETED> <DELETED> ``(dd) payment amounts;</DELETED> <DELETED> ``(ee) measurement periods for all incentives;

and</DELETED> <DELETED> ``(ff) other payment methodologies used by an entity, including a health care provider (including a health care facility), network or association of providers, service provider offering access to a network of providers, third-party administrator, or pharmacy benefit manager;</DELETED> <DELETED> ``(IV) limit the disclosure of overpayments and overpayment recovery terms;</DELETED> <DELETED> ``(V) limit the right of the group health plan, the plan sponsor, or the plan administrator of such plan to select an auditor or define audit scope or frequency;</DELETED> <DELETED> ``(VI) otherwise limit or unduly delay the group health plan, the plan sponsor, the plan administrator, or a business associate of such plan from accessing claims and encounter information or data in a daily batch;</DELETED> <DELETED> ``(VII) limit the disclosure of fees charged to the group health plan related to plan administration and claims processing, including renegotiation fees, access fees, repricing fees, or enhanced review fees;</DELETED> <DELETED> ``(VIII) limit the right of the group health plan, the plan sponsor, or the plan administrator to request action on any suspect claim payments;

or</DELETED> <DELETED> ``(IX) limit public disclosure of de-identified or aggregate information.</DELETED> <DELETED> ``(D)(i) Covered Service Providers shall provide information or data under this paragraph in a manner consistent with the privacy and security regulations promulgated under the Health Insurance Portability and Accountability Act (referred to in this subparagraph as `HIPAA').</DELETED> <DELETED> ``(ii) A group health plan that receives a disclosure from a party in interest pursuant to subparagraph (B) or (C) shall comply with the privacy and security regulations promulgated under HIPAA.</DELETED> <DELETED> ``(iii) Nothing in this subparagraph shall be construed to modify the requirements for the creation, receipt, maintenance, or transmission of protected health information under the HIPAA privacy regulation (as defined in section 1180(b)(3) of the Social Security Act) as they apply directly or indirectly to an entity pursuant to this paragraph.</DELETED> <DELETED> ``(iv) This subparagraph shall not be read to abridge or limit the disclosure requirements under this paragraph or to impose additional privacy or security requirements on Covered Service Providers or plan sponsors.</DELETED> <DELETED> ``(E) A group health plan receiving information or data under this paragraph may disclose such information only in a manner that is consistent with the Health Insurance Portability and Accountability Act (HIPAA) and the privacy and security regulations promulgated thereunder, regardless of their direct or indirect applicability to the plan or any entities that could be or are business associates.</DELETED> <DELETED> ``(F) Information made available under this section shall conform to the following standards:</DELETED> <DELETED> ``(i) All claims from a healthcare provider shall be made to the group health plan in accordance with transaction standards adopted by regulation under HIPAA, as follows:</DELETED> <DELETED> ``(I) Institutional, professional, and dental claims shall be in ASC X12N 837 format or any subsequent standard.</DELETED> <DELETED> ``(II) Pharmacy claims shall be in the National Council for Prescription Drug Programs (NCPDP) format or any subsequent standard.</DELETED> <DELETED> ``(III) The files shall be unmodified copies of the files sent from the provider.

In the event that paper claims are sent by the provider, they shall be converted to the appropriate standard electronic format.

Files shall be accessible to the plan at no cost to the group health plan.</DELETED> <DELETED> ``(ii) All claim payment (or EFT, electronic funds transfer) and electronic remittance advice (ERA) notices sent by a Covered Service Provider shall be made available to the group health plan as ASC X12N files in accordance with standards adopted by regulation under HIPAA.

The files shall be unmodified copies of the files sent by the Covered Service Provider to the healthcare provider.

Files shall be accessible at no cost to the group health plan.</DELETED> <DELETED> ``(iii) The contractual terms containing calculation formulae, pricing methodologies, and other information used to determine the dollar value of reimbursement.</DELETED> <DELETED> ``(iv) All non-claim costs shall be itemized and made available to the group health plan in real time through a web-based portal, through an API, and through a downloadable CSV file.</DELETED> <DELETED> ``(G) The Secretary shall implement subparagraphs (C) through (F) through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.</DELETED> <DELETED> (2) Civil enforcement.--Subsection (c) of section of such Act (29 U.S.C.

1132) is amended by adding at the end the following new paragraph:</DELETED> <DELETED> ``(13) In the case of an agreement between a group health plan (as defined in section 733(a)), the plan sponsor of such plan (as defined in section 3(16)(B)), or the plan administrator of such plan (as defined in section 3(16)(A)) and a health care provider (which, for purposes of this paragraph, includes a health care facility), network or association of providers, service provider offering access to a network or association of providers, third-party administrator, or pharmacy benefit manager, that violates the provisions of section 724, the Secretary may assess a civil penalty against such provider, network or association, service provider offering access to a network or association of providers, third-party administrator, pharmacy benefit manager, or other service provider in the amount of $10,000 for each day during which such violation continues.

Such penalty shall be in addition to other penalties as may be prescribed by law.''.</DELETED> <DELETED> (3) Existing provisions void.--Section 410 of such Act (29 U.S.C.

1110) is amended by adding at the end the following:</DELETED> <DELETED> ``(c) Any provision in an agreement or instrument shall be void as against public policy if such provision--</DELETED> <DELETED> ``(1) unduly delays or limits a group health plan (as defined in section 733(a)), the plan sponsor of such plan (as defined in section 3(16)(B)), or the plan administrator of such plan (as defined in section 3(16)(A)) from accessing the claims and encounter information or data described in section 724(a)(1)(B);

or</DELETED> <DELETED> ``(2) violates the requirements of section 408(b)(2)(C).''.</DELETED> <DELETED> (4) Technical amendment.--Clause (i) of section 408(b)(2)(B) of such Act is amended by striking ``this clause'' and inserting ``this paragraph''.</DELETED> <DELETED> (b) Updated Attestation for Price and Quality Information.--Section 724(a)(3) of the Employee Retirement Income Security Act of 1974 (29 U.S.C.

1185m(a)(3)) is amended to read as follows:</DELETED> <DELETED> ``(3) Attestation.--</DELETED> <DELETED> ``(A) In general.--Subject to subparagraph (C), a group health plan or health insurance issuer offering group health insurance coverage shall annually submit to the Secretary an attestation that such plan or issuer of such coverage is in compliance with the requirements of this subsection.

Such attestation shall also include a statement verifying that--</DELETED> <DELETED> ``(i) the information or data described under subparagraphs (A) and (B) of paragraph (1) is available upon request and provided to the group health plan, the plan sponsor, the plan administrator, or the business associate of such plan, or the issuer in a timely manner;

and</DELETED> <DELETED> ``(ii) there are no terms in the agreement under such paragraph (1) that directly or indirectly restrict or unduly delay a group health plan, the plan sponsor, the plan administrator, a business associate of such plan, or the issuer from auditing, reviewing, or otherwise accessing such information.</DELETED> <DELETED> ``(B) Limitation on submission.--Subject to clause (ii), a group health plan or issuer offering group health insurance coverage may not enter into an agreement with a third-party administrator or other service provider to submit the attestation required under subparagraph (A).</DELETED> <DELETED> ``(C) Exception.--In the case of a group health plan or issuer offering group health insurance coverage that is unable to obtain the information or data needed to submit the attestation required under subparagraph (A), such plan or issuer may submit a written statement in lieu of such attestation that includes--</DELETED> <DELETED> ``(i) an explanation of why such plan or issuer was unsuccessful in obtaining such information or data, including whether such plan, the plan sponsor, or the plan administrator or issuer was limited or prevented from auditing, reviewing, or otherwise accessing such information or data;</DELETED> <DELETED> ``(ii) a description of the efforts made by the group health plan, the plan sponsor, or the plan administrator to remove any gag clause provisions from the agreement under paragraph (1);

and</DELETED> <DELETED> ``(iii) a description of any response by the third-party administrator or other service provider with respect to efforts to comply with the attestation requirement under subparagraph (A), including the name of the third-party administrator or other service provider.''.</DELETED> <DELETED> (c) Effective Date.--The amendments made by subsections (a) and (b) shall apply with respect to a plan beginning with the first plan year that begins on or after the date that is 1 year after the date of enactment of this Act.</DELETED> <DELETED>SEC.

8.

OVERSIGHT OF ADMINISTRATIVE SERVICE PROVIDERS.</DELETED> <DELETED> (a) ERISA Amendments.--</DELETED> <DELETED> (1) In general.--Subpart B of part 7 of subtitle B of the Employee Retirement Income Security Act of 1974 (29 U.S.C.

1021 et seq.) is amended by adding at the end the following:</DELETED> <DELETED>``SEC.

726.

OVERSIGHT OF ADMINISTRATIVE SERVICE PROVIDERS.</DELETED> <DELETED> ``(a) In General.--For plan years beginning on or after the date that is 2 years after the date of enactment of this section, no agreement between a group health plan (as defined in section 733(a)), the plan sponsor of such plan (as defined in section 3(16)(B)), the plan administrator of such plan (as defined in section 3(16)(A)), or a business associate of such plan (as defined in section 160.103 of title 45, Code of Federal Regulations), (or health insurance issuer offering group health insurance coverage in connection with such a plan), and a health care provider, network or association of providers, third-party administrator, service provider offering access to a network of providers, pharmacy benefit managers, or any other third party (each referred to as a `health plan service provider') is permissible if such agreement limits (or delays beyond the applicable reporting period described in subsection (b)(1)) the disclosure of information to group health plans in such a manner that prevents such plan, issuer, or entity from providing the information described in subsection (b).</DELETED> <DELETED> ``(b) Required Disclosures.--</DELETED> <DELETED> ``(1) Contents and frequency.--With respect to plan years beginning on or after the date that is 2 years after the date of enactment of this section, not less frequently than quarterly, a health plan service provider shall provide to the group health plan or health insurance issuer the following information at no cost to the group health plan or health insurance issuer:</DELETED> <DELETED> ``(A) The information described in section 724(a)(1)(B).</DELETED> <DELETED> ``(B) Any contractual and subcontractual calculation methodologies, pricing or fee schedules, or other formulae used to determine reimbursement amounts to providers and subcontractors, including methodologies, schedules, fee structures, and any applied adjustments or modifiers, with such information provided in a manner sufficiently detailed to enable the group health plan or health insurance issuer to accurately assess, verify, and ensure compliance with the terms of any contractual and subcontractual agreement governing the reimbursement amounts.</DELETED> <DELETED> ``(C) The total amount received or expected to be received by the health plan service provider or its subcontractors in provider or supplier rebates, fees, alternative discounts, and all other remuneration including amounts held in escrow or variance accounts that has been paid or is to be paid for claims incurred and administrative services including data sales or network payments.</DELETED> <DELETED> ``(D) The total amount paid or expected to be paid by the health plan service provider or to subcontractors in rebates, fees, contractual arrangements, and all other remuneration that has been paid or is expected to be paid for administrative and other services.</DELETED> <DELETED> ``(E) All payment data and reconciliation information related to alternative compensation arrangements including accountable care organizations, value-based programs, shared savings programs, incentive compensation, bundled payments, capitation arrangements, performance payments, and any other reimbursement or payment models, where the group health plan or health insurance issuer paid fees, incurred obligations, or made payments in connection with the group health plan related to such arrangements.</DELETED> <DELETED> ``(2) Privacy requirements.--</DELETED> <DELETED> ``(A) In general.--Health plan service providers shall provide the information or data under paragraph (1) consistent with the privacy, security, and breach notification regulations at parts 160 and of title 45, Code of Federal Regulations, promulgated under subtitle F of the Health Insurance Portability and Accountability Act of 1996, subtitle D of the Health Information Technology for Clinical Health Act of 2009, and section 1180 of the Social Security Act, and shall restrict the use and disclosure of such information according to such privacy, security, and breach notification regulations.

An entity that receives a disclosure from a party in interest pursuant to subparagraph (B) or (C) shall comply with the privacy and security regulations promulgated under HIPAA.</DELETED> <DELETED> ``(B) Restrictions.--A group health plan shall comply with section 164.504(f) of title 45, Code of Federal Regulations (or a successor regulation), and a plan sponsor shall act in accordance with the terms of the agreement described in such section.</DELETED> <DELETED> ``(C) Rule of construction.--Nothing in this section shall be construed to modify the requirements for the creation, receipt, maintenance, or transmission of protected health information under the HIPAA privacy regulations (45 C.F.R.

parts 160 and 164, subparts A and E).</DELETED> <DELETED> ``(3) Disclosure and redisclosure.--</DELETED> <DELETED> ``(A) In general.--A group health plan receiving information under paragraph (1) may disclose such information only--</DELETED> <DELETED> ``(i) to the entity from which the information was received or to that entity's business associates or to the group health plan's business associates as defined in section 160.103 of title 45, Code of Federal Regulations (or successor regulations);

or</DELETED> <DELETED> ``(ii) as permitted by the HIPAA Privacy Rule (45 C.F.R.

parts 160 and 164, subparts A and E).</DELETED> <DELETED> ``(B) Availability of information.--To the extent the information required by this subsection is made available to the health insurance issuer offering group health insurance in connection with a group health plan, the health insurance issuer shall make such information available, at the same time, in the same format, and at no cost, to the group health plan.</DELETED> <DELETED> ``(C) Failure to provide.--The obligation to provide information pursuant to this subsection shall exist notwithstanding the presence of any formal data-sharing agreement between the parties.

Failure to provide the required information as specified shall constitute a violation of this Act and the Secretary shall initiate enforcement action under section 502 within 90 days of becoming aware of a violation of this section, except that nothing in this section shall be construed to limit the Secretary's existing authority under the Act.</DELETED> <DELETED> ``(4) Data format standards.--All data and information provided pursuant to this subsection shall comply with the following standards:</DELETED> <DELETED> ``(A) All claims from a healthcare provider shall be made to the group health plan in accordance with transactions standards adopted under HIPAA, as follows:</DELETED> <DELETED> ``(i) Institutional, professional, and dental claims and adjustments to these claims shall be in ASC X12N 837 format, as transmitted by the provider, or, in the case of paper claims, converted to the ASC X12N 837 electronic format.</DELETED> <DELETED> ``(ii) Prescription drug claims shall be in the National Council for Prescription Drug Programs (NCPDP) format, as transmitted by the provider, or in the case of paper claims, converted to the NCPDP electronic format.</DELETED> <DELETED> ``(iii) Such data shall be provided at no cost to the group health plan.</DELETED> <DELETED> ``(B) All claim payment (or EFT, electronic funds transfer) and electronic remittance advice (ERA) information sent by a health plan service provider shall be provided to the group health plan or health insurance issuer in the ASC X12N 835 format in accordance with transaction standards adopted under HIPAA, unmodified from the form in which it was transmitted to the healthcare provider.

Such information shall be provided at no cost to the group health plan or health insurance issuer.</DELETED> <DELETED> ``(C) The Secretary may modify the standards set forth in this paragraph as necessary to align with any changes adopted by the Secretary of Health and Human Services pursuant to the authority provided under section 1173 of the Social Security Act (42 U.S.C.

1320d-2).</DELETED> <DELETED> ``(c) Prohibited Contractual Provisions.--Any provision in an agreement between a group health plan, the plan sponsor, the plan administrator, or a business associate of such plan or a health insurance issuer and a health plan service provider that unduly delays or limits a group health plan's or health insurance issuer's access to information described in this section or that restricts the format or timing of the provision of such information in a manner that is inconsistent with the requirements of this section shall be prohibited and, if a group health plan or health insurance issuer enters into such agreement, shall be deemed void as against public policy.</DELETED> <DELETED> ``(d) Penalties for Non-Compliance.--Any failure by a health plan service provider to comply with the requirements of this section shall result in the imposition of a civil penalty of $100,000 for each day the violation continues, in addition to any other penalties prescribed by law.</DELETED> <DELETED> ``(e) Regulations.--The Secretary shall implement this section through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.</DELETED> <DELETED> (2) Penalty.--</DELETED> <DELETED> (A) In general.--Section 502(a) of the Employee Retirement Income Security Act of 1974 (29 U.S.C.

1132(a)) is amended by adding at the end the following new paragraph:</DELETED> <DELETED> ``(14) The Secretary may assess a civil penalty against any person of $100,000 per day for each violation by any person of section 726.''.</DELETED> <DELETED> (B) Technical amendment.--Paragraph (6) of section 502(a) of the Employee Retirement Income Security Act of 1974 (29 U.S.C.

1132(a)) is amended by striking ``or (9)'' and inserting it with the phrase ``(9), (13), or (14)''.</DELETED> <DELETED> (b) PHSA Amendments.--</DELETED> <DELETED> (1) In general.--Part D of title XXVII of the Public Health Service Act (42 U.S.C.

300gg-111 et seq.) is amended by adding at the end the following:</DELETED> <DELETED>``SEC.

2799A-11.

OVERSIGHT OF ADMINISTRATIVE SERVICE PROVIDERS.</DELETED> <DELETED> ``(a) In General.--For plan years beginning on or after the date that is 1 year after the date of enactment of this section, no agreement between a group health plan that is a self-funded, non- Federal governmental plan, as defined in section 2791(d)(8)(C) (42 U.S.C.

300gg-91(d)(8)(C)), and a health care provider, network or association of providers, third-party administrator, service provider offering access to a network of providers, pharmacy benefit managers, or any other third party (each referred to in this section as a `health plan service provider') is permissible if such agreement limits (or delays beyond the applicable reporting period described in subsection (b)(1)) the disclosure of information to group health plans in such a manner that prevents such plan, issuer, or entity from providing the information described in subsection (b).</DELETED> <DELETED> ``(b) Required Disclosures.--</DELETED> <DELETED> ``(1) Contents and frequency.--With respect to plan years beginning on or after the date that is 1 year after the date of enactment of this section, not less frequently than quarterly, a health plan service provider shall provide to the group health plan that is a self-funded, non-Federal governmental plan the following information at no cost to the plan:</DELETED> <DELETED> ``(A) The information described in section 2799A-9(a)(1)(B) (42 U.S.C.

300gg- 119(a)(1)(B)).</DELETED> <DELETED> ``(B) Any contractual and subcontractual calculation methodologies, pricing or fee schedules, or other formulae used to determine reimbursement amounts to providers and subcontractors, including methodologies, schedules, fee structures, and any applied adjustments or modifiers, with such information provided in a manner sufficiently detailed to enable the group health plan to accurately assess, verify, and ensure compliance with the terms of any contractual and subcontractual agreement governing the reimbursement amounts.</DELETED> <DELETED> ``(C) The total amount received or expected to be received by the health plan service provider or its subcontractors in provider or supplier rebates, fees, alternative discounts, and all other remuneration including amounts held in escrow or variance accounts that has been paid or is to be paid for claims incurred and administrative services including data sales or network payments.</DELETED> <DELETED> ``(D) The total amount paid or expected to be paid by the health plan service provider or to subcontractors in rebates, fees, contractual arrangements, and all other remuneration that has been paid or is expected to be paid for administrative and other services.</DELETED> <DELETED> ``(E) All payment data and reconciliation information related to alternative compensation arrangements including accountable care organizations, value-based programs, shared savings programs, incentive compensation, bundled payments, capitation arrangements, performance payments, and any other reimbursement or payment models, where the group health plan paid fees, incurred obligations, or made payments in connection with the group health plan related to such arrangements.</DELETED> <DELETED> ``(2) Privacy requirements.--</DELETED> <DELETED> ``(A) In general.--Health plan service providers shall provide the information or data under paragraph (1) consistent with the privacy, security, and breach notification regulations at parts 160 and of title 45, Code of Federal Regulations, promulgated under subtitle F of the Health Insurance Portability and Accountability Act of 1996, subtitle D of the Health Information Technology for Clinical Health Act of 2009, and section 1180 of the Social Security Act, and shall restrict the use and disclosure of such information according to such privacy, security, and breach notification regulations.

An entity that receives a disclosure from a party in interest pursuant to subparagraph (B) or (C) shall comply with the privacy and security regulations promulgated under HIPAA.</DELETED> <DELETED> ``(B) Restrictions.--A group health plan that is a self-funded, non-Federal governmental plan shall comply with section 164.504(f) of title 45, Code of Federal Regulations (or a successor regulation), and a plan sponsor shall act in accordance with the terms of the agreement described in such section.</DELETED> <DELETED> ``(C) Rule of construction.--Nothing in this section shall be construed to modify the requirements for the creation, receipt, maintenance, or transmission of protected health information under the HIPAA privacy regulations (45 C.F.R.

parts 160 and 164, subparts A and E).</DELETED> <DELETED> ``(3) Disclosure and redisclosure.--</DELETED> <DELETED> ``(A) In general.--A group health plan that is a self-funded, non-Federal governmental plan receiving information under paragraph (1) may disclose such information only--</DELETED> <DELETED> ``(i) to the entity from which the information was received or to that entity's business associates as defined in section 160.103 of title 45, Code of Federal Regulations (or successor regulations);

or</DELETED> <DELETED> ``(ii) as permitted by the HIPAA Privacy Rule (45 C.F.R.

parts 160 and 164, subparts A and E).</DELETED> <DELETED> ``(B) Rule of construction.--Nothing in this section shall be construed to prevent a group health plan that is a self-funded, non-Federal governmental plan, or a health plan service provider providing services with respect to such a plan, from placing reasonable restrictions on the public disclosure of the information described in paragraph (1), except that such plan or entity may not restrict disclosure of such information to the Department of Health and Human Services, the Department of Labor, the Department of the Treasury, or the Comptroller General of the United States.</DELETED> <DELETED> ``(C) Failure to provide.--The obligation to provide information pursuant to this subsection shall exist notwithstanding the presence of any formal data-sharing agreement between the parties.

Failure to provide the required information as specified shall constitute a violation of this Act and the Secretary shall initiate enforcement action under section 2723(b) (42 U.S.C.

300gg-22(b)) within 90 days of becoming aware of a violation of this section, except that nothing in this section shall be construed to limit the Secretary's existing authority under this Act.</DELETED> <DELETED> ``(4) Data format standards.--All data and information provided pursuant to this subsection shall comply with the following standards:</DELETED> <DELETED> ``(A) All claims from a healthcare provider shall be made to the group health plan in accordance with standards adopted under HIPAA at section 162.1101 of title 45, Code of Federal Regulations, as follows:</DELETED> <DELETED> ``(i) Institutional, professional, and dental claims and adjustments to these claims shall be provided to the group health plan that is a self-funded, non-Federal governmental plan in the ASC X12N 837 format.</DELETED> <DELETED> ``(ii) Prescription drug claims shall be in the National Council for Prescription Drug Programs (NCPDP) format.</DELETED> <DELETED> ``(iii) The files shall be unmodified copies of the files sent from the provider.

In the event that paper claims are sent by the provider, they shall be converted to the appropriate standard electronic format.

Such data shall be provided at no cost to the group health plan.</DELETED> <DELETED> ``(B) All claim payment (or EFT, electronic funds transfer) and electronic remittance advice (ERA) information sent by a health plan service provider shall be provided to the group health plan or health insurance issuer in the ASC X12N 835 format, in accordance with standards adopted under HIPAA at section 162.1602 of title 45, Code of Federal Regulations, unmodified from the form in which it was transmitted to the healthcare provider.

Such information shall be provided at no cost to the group health plan.</DELETED> <DELETED> ``(C) The Secretary may modify the standards set forth in this paragraph as necessary to align with any changes adopted by the Secretary pursuant to the authority provided under section 1173 of the Social Security Act (42 U.S.C.

1320d- 2).</DELETED> <DELETED> ``(c) Prohibited Contractual Provisions.--Any provision in an agreement that unduly delays or limits a group health plan that is a self-funded, non-Federal governmental plan's access to information described in this section or that restricts the format or timing of the provision of such information in a manner that is inconsistent with the requirements of this section shall be prohibited and, if a self-funded, non-Federal governmental plan enters into such agreement, shall be deemed void as against public policy.</DELETED> <DELETED> ``(d) Regulations.--The Secretary shall implement this section through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.</DELETED> <DELETED> (2) Penalty.--Section 2723(b) of the Public Health Service Act (42 U.S.C.

300gg-22(b)) is amended by adding at the end the following:</DELETED> <DELETED> ``(4) Enforcement authority relating to health plan service providers.--Notwithstanding any provisions to the contrary, the Secretary may assess a penalty against a health plan service provider, as defined in section 2799A-11(a) (42 U.S.C.

300gg-121(a)), of $100,000 per day for each violation of such section, pursuant to substantially similar processes and procedures as those set forth in section 2723(b)(2)(D) through (G) (42 U.S.C.

300gg-121(b)(2)(D) through (G)).''.</DELETED> <DELETED>SEC.

9.

STATE PREEMPTION ONLY IN EVENT OF CONFLICT.</DELETED> <DELETED> The provisions of sections 2 through 5 (including the amendments made by such sections) shall not supersede any provision of State law which establishes, implements, or continues in effect any requirement or prohibition related to health care price transparency, including hospital, clinical diagnostic laboratory tests, imaging services, and ambulatory surgical center, except to the extent that such requirement or prohibition prevents the application of a requirement or prohibition of such sections (or amendment).

Nothing in this section shall be construed to affect group health plans established under the Employee Retirement Income Security Act of 1974, or alter the application of section 514 of such Act (29 U.S.C.

1144).</DELETED> <DELETED>SEC.

10.

REQUIREMENT FOR EXPLANATION OF BENEFITS.</DELETED> <DELETED> (a) PHSA Amendments.--</DELETED> <DELETED> (1) Emergency services.--Section 2799A-1(f)(1)(C) of the Public Health Service Act (42 U.S.C.

300gg-111(f)(1)(C)) is amended to read as follows:</DELETED> <DELETED> ``(C) A good faith estimate of the amount the plan or coverage is responsible for paying for items and services included in the estimate described in subparagraph (B), including a plain language description of each item or service and all applicable billing codes for each item or service, including modifiers, using standard and commonly recognized billing code sets that are clearly identified.''.</DELETED> <DELETED> (2) Explanation of benefits.--Section 2799A-1 of the Public Health Service Act (42 U.S.C.

300gg-111) is amended by adding at the end the following:</DELETED> <DELETED> ``(g) Explanation of Benefits.--</DELETED> <DELETED> ``(1) In general.--For plan years beginning on or after January 1, 2026, each group health plan, or a health insurance issuer offering group or individual health insurance coverage shall, within 45 days of receiving any request for payment for an item or service under the plan, provide to the participant, beneficiary, or enrollee (through mail or electronic means, as requested by the participant, beneficiary, or enrollee) a notification (in clear and understandable language and utilizing substantially the same format as the advanced explanation of benefits required by subsection (f) to enable comparison) including the following:</DELETED> <DELETED> ``(A) Whether or not the provider or facility is a participating provider or a participating facility with respect to the plan or coverage with respect to the furnishing of such item or service.</DELETED> <DELETED> ``(B) An itemized explanation of benefits that includes the following:</DELETED> <DELETED> ``(i) A plain language description of each item or service.</DELETED> <DELETED> ``(ii) All applicable billing codes for each item or service, including modifiers, using standard and commonly recognized billing code sets that are clearly identified.</DELETED> <DELETED> ``(iii) The amount the plan or coverage is responsible for paying for each item or service.</DELETED> <DELETED> ``(iv) The amount of any cost- sharing for which the participant, beneficiary, or enrollee is responsible for each item or service (as of the date of such notification).</DELETED> <DELETED> ``(v) The amount that the participant, beneficiary, or enrollee has incurred toward meeting the limit of the financial responsibility (including with respect to deductibles and out-of-pocket maximums) under the plan or coverage (as of the date of such notification).</DELETED> <DELETED> ``(vi) The site of each item or service.</DELETED> <DELETED> ``(2) Format.--If applicable, the notification described in paragraph (1) may be provided in conjunction with, or as part of, a notice of a claim determination or other communication required by section 2719(a) (42 U.S.C.

300gg- 19(a)), or regulations thereunder.</DELETED> <DELETED> ``(h) Regulations.--The Secretary shall implement this section through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.</DELETED> <DELETED> (b) IRC Amendments.--</DELETED> <DELETED> (1) Emergency services.--Section 9816(f)(1)(C) of the Internal Revenue Code of 1986 is amended to read as follows:</DELETED> <DELETED> ``(C) A good faith estimate of the amount the plan is responsible for paying for items and services included in the estimate described in subparagraph (B), including a plain language description of each item or service and all applicable billing codes for each item or service, including modifiers, using standard and commonly recognized billing code sets that are clearly identified.''.</DELETED> <DELETED> (2) Explanation of benefits.--Section 9816 of the Internal Revenue Code of 1986 is amended by adding at the end the following:</DELETED> <DELETED> ``(g) Explanation of Benefits.--</DELETED> <DELETED> ``(1) In general.--For plan years beginning on or after January 1, 2026, each group health plan shall, within 45 days of receiving any request for payment for an item or service under the plan, provide to the participant or beneficiary (through mail or electronic means, as requested by the participant or beneficiary) a notification (in clear and understandable language and utilizing substantially the same format as the advanced explanation of benefits required by subsection (f) to enable comparison) including the following:</DELETED> <DELETED> ``(A) Whether or not the provider or facility is a participating provider or a participating facility with respect to the plan with respect to the furnishing of such item or service.</DELETED> <DELETED> ``(B) An itemized explanation of benefits that includes the following:</DELETED> <DELETED> ``(i) A plain language description of each item or service.</DELETED> <DELETED> ``(ii) All applicable billing codes for each item or service, including modifiers, using standard and commonly recognized billing code sets that are clearly identified.</DELETED> <DELETED> ``(iii) The amount the plan is responsible for paying for each item or service.</DELETED> <DELETED> ``(iv) The amount of any cost- sharing for which the participant or beneficiary is responsible for each item or service (as of the date of such notification).</DELETED> <DELETED> ``(v) The amount that the participant or beneficiary has incurred toward meeting the limit of the financial responsibility (including with respect to deductibles and out-of-pocket maximums) under the plan (as of the date of such notification).</DELETED> <DELETED> ``(vi) The site of each item or service.</DELETED> <DELETED> ``(2) Format.--If applicable, the notification described in paragraph (1) may be provided in conjunction with, or as part of, a notice of a claim determination or other communication required by section 503 of the Employee Retirement Income Security Act of 1974 or regulations thereunder.</DELETED> <DELETED> ``(h) Regulations.--The Secretary shall implement this section through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.</DELETED> <DELETED> (c) ERISA Amendments.--</DELETED> <DELETED> (1) Emergency services.--Section 716(f)(1)(C) of the Employee Retirement Income Security Act of 1974 (29 U.S.C.

1185e(f)(1)(C)) is amended to read as follows:</DELETED> <DELETED> ``(C) A good faith estimate of the amount the health plan is responsible for paying for items and services included in the estimate described in subparagraph (B), including a plain language description of each item or service and all applicable billing codes for each item or service, including modifiers, using standard and commonly recognized billing code sets that are clearly identified.''.</DELETED> <DELETED> (2) Explanation of benefits.--Section 716 of the Employee Retirement Income Security Act of 1974 (29 U.S.C.

1185e) is amended by adding at the end the following:</DELETED> <DELETED> ``(g) Explanation of Benefits.--</DELETED> <DELETED> ``(1) In general.--For plan years beginning on or after January 1, 2026, each group health plan or health insurance issuer offering group health insurance coverage shall, within 45 days of receiving any request for payment for an item or service under the plan, provide to the participant or beneficiary (through mail or electronic means, as requested by the participant or beneficiary) a notification (in clear and understandable language and utilizing substantially the same format as the advanced explanation of benefits required by subsection (f) to enable comparison) including the following:</DELETED> <DELETED> ``(A) Whether or not the provider or facility is a participating provider or a participating facility with respect to the plan or coverage with respect to the furnishing of such item or service.</DELETED> <DELETED> ``(B) An itemized explanation of benefits that includes the following:</DELETED> <DELETED> ``(i) A plain language description of each item or service.</DELETED> <DELETED> ``(ii) All applicable billing codes for each item or service, including modifiers, using standard and commonly recognized billing code sets that are clearly identified.</DELETED> <DELETED> ``(iii) The amount the plan or coverage is responsible for paying for each item or service.</DELETED> <DELETED> ``(iv) The amount of any cost- sharing for which the participant or beneficiary is responsible for each item or service (as of the date of such notification).</DELETED> <DELETED> ``(v) The amount that the participant or beneficiary has incurred toward meeting the limit of the financial responsibility (including with respect to deductibles and out-of-pocket maximums) under the plan or coverage (as of the date of such notification).</DELETED> <DELETED> ``(vi) The site of each item or service.</DELETED> <DELETED> ``(2) Format.--If applicable, the notification described in paragraph (1) may be provided in conjunction with, or as part of, a notice of a claim determination or other communication required by section 503 or regulations thereunder.</DELETED> <DELETED> ``(h) Regulations.--The Secretary shall implement this section through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.</DELETED> <DELETED>SEC.

11.

PROVISION OF ITEMIZED BILLS.</DELETED> <DELETED> 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:</DELETED> <DELETED>``SEC.

2799B-10.

PROVIDER REQUIREMENTS FOR ITEMIZED BILLS.</DELETED> <DELETED> ``(a) Requirements.--</DELETED> <DELETED> ``(1) Itemized bill and other information required.--</DELETED> <DELETED> ``(A) In general.--A health care provider or health care facility that requests payment from an individual after providing a health care item or service to the patient shall include with such request a written, itemized bill of the cost of each reasonably expected item or service the health care provider or health care facility provided to the individual, including telehealth visits or visits by other electronic means.

The health care provider or health care facility shall provide the itemized bill not later than 30 days after the health care provider or health care facility received a final payment on the provided service or supply from a third party.</DELETED> <DELETED> ``(B) Required information.--For each item or service provided by the health care provider or facility or for which the health care provider or facility is billing the individual, the itemized bill must include--</DELETED> <DELETED> ``(i) a plain language description of each distinct health care item or service;</DELETED> <DELETED> ``(ii) all applicable billing codes for each distinct health care item or service, including modifiers, using standard and commonly recognized billing code sets that are clearly identified;</DELETED> <DELETED> ``(iii) the price and billed amount, if different, of each distinct health care item or service or if the provider or facility is offering binding, all-in prices for bundled items and services, the total binding price for bundled items and services and billed amount;</DELETED> <DELETED> ``(iv) any payments made to the health care provider or health care facility by or on behalf of the individual (including payments by any health plan or insurance) for any health care item or service covered in the itemized bill;</DELETED> <DELETED> ``(v) information about the availability of language-assistance services for individuals with limited English proficiency (LEP);</DELETED> <DELETED> ``(vi) the identification of an office or individual at the health care provider or health care facility, including phone number and email address, that shall be able to discuss the specific details of the itemized statement and be authorized to make appropriate changes thereto;

and</DELETED> <DELETED> ``(vii) information about the health care provider's or health care facility's charity care policies and instructions on how to apply for charity care.</DELETED> <DELETED> ``(2) Collections actions.--</DELETED> <DELETED> ``(A) In general.--A health care provider or health care facility shall not take any collections actions against an individual--</DELETED> <DELETED> ``(i) for any provided health care item or service unless the health care provider or health care facility has complied with paragraph (1);

or</DELETED> <DELETED> ``(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.</DELETED> <DELETED> ``(B) Burden of proof.--The burden of proof under subparagraph (A)(ii) shall rest with the provider, and absent the documentation described in such subparagraph, the good faith estimate shall be binding.</DELETED> <DELETED> ``(b) Failure To Comply.--</DELETED> <DELETED> ``(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.</DELETED> <DELETED> ``(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.</DELETED> <DELETED> ``(c) Regulations.--The Secretary shall implement this section through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.</DELETED> SECTION 1.

STRENGTHENING HOSPITAL PRICE TRANSPARENCYTRANSPARENCY. REQUIREMENTS.

(a)Title InXXVII General.--Section 2718(e) of the Public Health Service Act is amended by inserting after section 2718 (42 U.S.C.

300gg-18(e))300gg-18) isthe amendedfollowing: to read as follows:

``(e)``SEC. Standard Hospital Charges.-- ``(1) In general.-- ``(A) Disclosure of standard charges.--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)-- ``(i) all of the hospital's standard charges (including the information described in subparagraph (B)) for each item and service furnished by such hospital;

and2718A. ``(ii) hospital standard charge information, including the information described in subparagraph (B), 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 December 31, 2026, after which the hospital's prices shall include all shoppable services;

andPROVIDER ``(II)PRICE withTRANSPARENCY. 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.

``(B)``(a) StandardDefinitions.--In chargesthis described.--Forsection: purposes of subparagraph (A), standard charges means:

``(i)``(1) AApplicable plainimaging languageservice descriptionprovider.--The ofterm each`applicable itemimaging provider' means a provider of services or service,supplier accompaniedwho byfurnishes any applicableimaging billingservices codes,to patients, including modifiers,an usingindependent commonlydiagnostic recognizedtesting billingfacility, codean sets,outpatient includingdiagnostic thefacility, Currentand Proceduralany Terminologyother code,imaging center designated by the HealthcareSecretary, Commonexcept Procedurethat Codingsuch Systemterm code,does thenot diagnosis-relatedinclude group,an theimaging Nationalservice Drugprovider Code,with andrespect otherto nationallywhich recognizedstandard identifier.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).

``(ii)``(2) TheApplicable grosslaboratory.--The charge,term expressed`applicable laboratory' means a `laboratory' as such term is defined in section 493.2, of title 42, Code of Federal Regulations (or a dollarsuccessor amount,regulation), except that such term does not include a laboratory with respect to which standard charges for eachspecified clinical diagnostic laboratory tests furnished by such itemlaboratory orare service,made whenavailable providedby in,a ashospital applicable,pursuant theto inpatientsubsection setting(b) andor outpatientspecified departmentambulatory setting.surgical center pursuant to subsection (e).

``(iii)``(3) TheDiscounted discounted cash priceprice.-- expressed``(A) asIn ageneral.--The dollarterm amount,`discounted forcash eachprice' suchmeans itemthe orminimum servicecharge whenexpressed provided in, as applicable,a thedollar inpatientamount, settingsubject andto outpatientsubparagraph department(B), settingthat (or, in the caseapplicable noservice discountedprovider cashsubject priceto isthis availablesection foraccepts from an itemindividual orwho service,pays thecash, minimumor cash priceequivalent, accepted by the hospital from self-pay individuals for sucha furnished item or service, expressedwithout asregard a dollar amount, as well as, with respect to priceshealth madeinsurance publiccoverage, pursuantas topayment subparagraphin (A)(ii),full. a link to a consumer- friendly document that clearly explains the hospital's charity care policy).

The``(B) hospitalExclusions.--For shallpurposes acceptof subparagraph (A), the discountedminimum cashcharge pricedescribed in such subparagraph, with respect to a furnished item or service, as paymentapplicable, inshall fullbe fromcalculated without taking into account any patientfinancial thatassistance, choosesincluding assistance attributable to paycharity incare cash(in withoutthe regardcase toof a hospital, as such term is used for purposes of hospital cost reporting under title XVIII of the patient'sSocial coverage.Security Act), or third-party assistance for such item or service.

``(iv)``(4) TheExtraordinary payer-specificcollection negotiatedactions.--The charges,term expressed`extraordinary ascollection aaction' dollarhas amountthe andmeaning clearlygiven associatedsuch withterm thefor namepurposes of thesection applicable501(r) third party payer and name of each plan, that apply to each such item or service when provided in, as applicable, the inpatientInternal settingRevenue andCode outpatientof department1986. setting.

If``(5) theGross chargescharge.--The areterm based`gross oncharge' anmeans algorithm,the percentagecharge offor anotheran amount,individual oritem other formula or criteria,service thethat hospitalis alsoreflected shallon disclosea suchhospital's algorithm,chargemaster percentage, formula, or criteriasimilar aslist setof forthprices infacilitated itsby contract and any other terms,provider, schedules,as exhibits,defined data,by orthe otherSecretary, informationabsent referenced in any suchdiscounts. contract as shall be required to determine and disclose the negotiated charge.

``(v)``(6) TheHospital.--The de-identifiedterm maximum`hospital' andmeans minimuman negotiatedinstitution chargesin any State in which State or applicable local law provides for eachthe licensing of hospitals, that is licensed as a hospital pursuant to such itemlaw or service,is expressedapproved, by the agency of such State or locality responsible for licensing hospitals, as ameeting non-zerothe dollarstandards amount.established for such licensing.

``(vi)For Anypurposes otherof additionalthis informationparagraph, the Secretaryterm may`State' requireincludes foreach of the purposeseveral ofStates, improving the accuracyDistrict of,of orColumbia, enablingPuerto consumersRico, tothe easilyVirgin understandIslands, andGuam, compare,American standardSamoa, charges and pricesthe forNorthern anMariana itemIslands. or service, except information that is duplicative of any other reporting requirement under this subsection.

In``(7) thePayer-specific casenegotiated ofcharge.--The standardterm charges`payer- andspecific pricesnegotiated forcharge' anmeans itemthe orcharge servicethat included as part of a bundled,hospital perhas diem,negotiated episodic,with ora otherthird-party similarpayer arrangement,for thean informationitem describedor inservice. this subparagraph shall be made available as determined appropriate by the Secretary.

``(C)``(8) UniformShoppable methodservice.--The andterm format.--Not`shoppable laterservice' thanmeans January 1, 2026, the Secretary shall establish a standard,service uniformthat methodcan andbe formatscheduled forby hospitals to use in compiling and making public standard charges pursuant to subparagraph (A)(i) and a standard,healthcare uniformconsumer method and format for such hospitals to use in compilingadvance. and making public prices pursuant to subparagraph (A)(ii).

Such methodsservices andare formatsroutinely shall--provided ``(i) in thenon-urgent casesituations ofthat suchdo methodnot andrequire formatimmediate foraction makingor publicattention standardto chargesthe pursuantpatient, tothus subparagraphallowing (A)(i),patients ensureto thatprice suchshop chargesand areschedule madea availableservice inat a machine-readabletime spreadsheetthat format;is convenient for them.

``(ii)``(9) meetSpecified suchambulatory standardssurgical ascenter.--The determinedterm appropriate`specified byambulatory surgical center' means any distinct entity that operates exclusively for the Secretarypurpose inof orderproviding surgical services to ensurepatients thenot accessibilityrequiring hospitalization and usabilityin 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 andfor prices;specified ambulatory surgical center services furnished by such surgical center are made available by a hospital pursuant to subsection (b).

and``(10) ``(iii)Specified beclinical updateddiagnostic aslaboratory determinedtest.--The appropriateterm `specified clinical diagnostic laboratory test' means any clinical diagnostic laboratory test or service that is provided by the Secretary,applicable laboratory, excluding advanced diagnostic laboratory tests (as defined in consultationsection with1834A(d)(5) stakeholders.of the Social Security Act).

``(2)``(11) NoSpecified deemedimaging compliance.--Theservice.--The availabilityterm of`specified aimaging priceservice' estimatorhas toolthe shallmeaning notgiven beto consideredthe toterm deem`radiology complianceand withcertain orother otherwiseimaging vitiateservices' thefor requirementspurposes of paragraphsection (1)(A)(ii)411.351 orof anytitle other42, requirementsCode of thisFederal section.Regulations (or successor regulations).

Furthermore,``(12) theThird useparty ofpayer.--The term `third party payer' means an estimatorentity toolthat shallis, notby bestatute, usedcontract, or agreement, legally responsible for purposespayment of compliancea withclaim anyfor provisionsa inhealth thiscare Section.item or service.

``(3)``(b) MonitoringHospital compliance.--ThePrice SecretaryTransparency.-- ``(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 Patients Deserve Price Tags Act, each hospital shall, in consultationaccordance with a method and format established by the InspectorSecretary Generalunder ofparagraph (3), on a quarterly basis (if there have been any changes to the Departmentstandard charges described in subparagraph (2) compile and make publicly available on an internet website (without subscription and free of Healthcharge)-- ``(A) all of the hospital's standard charges for each item and Humanservice Services,furnished establishby such hospital in a processmachine-readable toformat monitor(or compliancea withsuccessor thistechnology subsection.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.

``(4)``(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 disclosuresdisclosures, and any other attestations as required by the Secretary, made in accordance with the hospital price transparency requirements setbased forthon incriteria thisestablished regulation.by the Secretary.

Such``(7) attestationEnforcement.-- shall``(A) beIn deemedgeneral.--In tothe becase materialof a hospital that fails to paymentcomply fromwith the Federalrequirements Governmentof tothis subsection, not later than 30 days after the hospital.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.

``(5)``(B) Enforcement.--Civil ``(A)monetary penalty.-- ``(i) In general.--In theaddition caseto 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,subsection notby laterthe thandate 30that is 90 days after thesuch daterequest onis whichmade theshall Secretarybe determinessubject suchto failurea exists,civil monetary penalty of an amount specified by the Secretary shallfor submiteach today such(beginning hospitalon athe notificationday ofthe suchhospital determination,was whichfirst shallout includeof acompliance, requestas fordetermined aby correctivethe actionSecretary) planduring towhich complysuch withfailure suchwas requirements.ongoing.

``(B)Such Civilamount monetaryshall penalty.--not ``(i)exceed-- In``(I) general.--Inin additionthe tocase any other enforcement actions or penalties that may apply under another provision of law, a specified hospital thatwith has30 receivedor afewer requestbeds, for$300 aper correctiveday action(or, planin under subparagraph (A) and fails to comply with the requirementscase of thissuch subsectiona byhospital the date that ishas 45been daysnoncompliant afterwith such requestrequirements isfor made shall be subject to a civil1-year monetaryperiod penaltyor oflonger, anbeginning amount specified by the Secretary for each day (beginning with the day on which the Secretary first determinedday thatfollowing such hospital1-year wasperiod, not$400 complyingper withday); such requirements) during which such failure was ongoing.

Such``(II) amountin shallthe notcase exceed--of ``(I)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 30such requirements for a 1-year period or fewerlonger, beds,beginning $300with the first day following such 1-year period, $15 per day;bed per day);

``(II)``(III) in the case of a specified hospital with more than 30100 beds but fewer than 201 beds, $12.50$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, $15$20 per bed per day);

``(III)``(IV) in the case of a specified hospital with more than 100200 beds but fewer than 501 beds, $17.50$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, $20$25 per bed per day);

``(IV)and ``(V) in the case of a specified hospital with more than 300500 beds but fewer than beds, $20$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-year1- year period, $25$35 per bed per day);day).

and``(ii) ``(V)Increase inauthority.--In theapplying casethis ofsubparagraph a hospital with morerespect thanto 500hospitals beds,that $25fail perto bedcomply per day (or, in the2028 caseor of such a hospitalsubsequent thatyear, hasthe beenSecretary noncompliantmay withthrough suchnotice requirementsand forcomment arulemaking 1-yearincrease-- period``(I) orthe longer,limitation beginningon with the firstper day followingamount suchof 1-yearany period,penalty $35applicable perto beda perhospital day).under clause (i)(I);

``(ii) Increase authority.--In applying this subparagraph with respect to violations occurring in 2027 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);

``(iii) Persistent noncompliance.-- ``(I) In general.--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,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.

``(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 waiver.--Theauthority 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 violationfailing to comply with the requirements of this subsection.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.

``(6)The Definitions.--ForSecretary purposesmay ofrequest thisdocumentation subsection:in such form and manner as the Secretary may require in order to evaluate impact on hospital operations.

``(A)``(D) DiscountedProhibition cashon price.--Theextraordinary termcollection.--In `discountedaddition cashto price'civil meansmonetary thepenalties minimumapplicable charge,under exclusivesubparagraph of(B) and any hospitalother enforcement actions or third-partypenalties payerthat assistance,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 acceptsor fromany another individualperson whoor paysentity cash,collecting on behalf of the hospital shall-- ``(i) not take any extraordinary collection actions against any patient or cashpatient equivalent,guarantor for adebt hospital-furnishedincurred itemby any patient on the date or service,dates withoutof regardservice towhen patientthe coverage,hospital aswas paymentnot in full.compliance with the requirements of this subsection;

``(B)``(ii) Grosscease charge.--Theany termextraordinary `grosscollection charge'actions meansthat thehave chargebegun against any patient or patient guarantor for andebt individualincurred itemby any patient on the date or dates of service thatwhen isthe reflectedhospital onwas anot hospital'sin chargemaster,compliance absentwith anythe discounts.requirements of this subsection;

``(C)and Hospital.--The``(iii) termnot `hospital'take meansany aextraordinary hospitalcollection (asactions definedagainst inany sectionpatient 1861(e)or ofpatient theguarantor Socialfor Securitydebt Act),incurred aby criticalany accesspatient hospitalon (asthe defineddate inor sectiondates 1861(mmm)(1) of theservice Socialwhen Securitythe Act), or a rural emergency hospital (aswas definednot in sectioncompliance 1861(kkk)with of the Socialrequirements Securityof Act),this togethersubsection withafter anythe parent,hospital subsidiary,comes orback otherinto affiliatedcompliance providerwith orthe supplierrequirements of healththis caresubsection. items and services without regard to whether such parent, subsidiary, or other affiliated provider or supplier operates under separate licensure, certification, or designation.

``(D)``(8) Payer-specificRulemaking.-- negotiated``(A) charge.--TheIn termgeneral.--The `payer-specificSecretary negotiatedshall charge'implement meansthis thesubsection chargethrough thatnotice aand hospitalcomment hasrulemaking negotiatedin accordance with asection third553 partyof payertitle for5, anUnited itemStates orCode. service.

``(E)``(B) ShoppableOwnership service.--Theinformation.--In termpromulgating `shoppableregulations service'under meansthis aparagraph, servicethe Secretary shall define the individuals and organizations that canmust be scheduleddisclosed byunder paragraph (1)(C) in a healthmanner carethat consumerharmonizes indisclosure advancerequirements with requirements established under section 1124 of the Social Security Act and includesprioritizes allthe ancillarydisclosure itemsof individuals and servicesorganizations customarilywho's furnishedownership asor partmanagement ofrelationship with a hospital impacts operational, financial, or clinical decision making for such service.hospital.''.

``(F) 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.

``(7) Rulemaking.--The Secretary shall implement this subsection through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.

(b) Effective Date.-- (1) In general.--The amendment made by subsection (a) shall apply beginning January 1, 2026.

(2) Continued applicability of rules for previous years.-- 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, 2025.

(c) Continued Applicability of State Law.--The provisions of this Act 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 Act.

INCREASING PRICE TRANSPARENCY OF CLINICAL DIAGNOSTIC LABORATORY TESTS.PRICE TRANSPARENCY.

Section 27182718A of the Public Health Service ActAct, (42as U.S.C.added by section 2, is amended by adding at the end the following:

300gg-18)``(c) Clinical Diagnostic Laboratory Price Transparency.-- ``(1) In general.--Beginning January 1 of the year that begins on or after the date that is amended1 byyear addingafter atthe date of enactment of the endPatients Deserve Price Tags Act, an applicable laboratory shall, on a quarterly basis (if there have been any changes to the following:standard charges described in paragraph (2)) compile and make publicly available on an internet website (without subscription and free of charge)-- ``(A) the standard charges described in paragraph (2) with respect to each specified clinical diagnostic laboratory test that such laboratory so furnishes;

``(f)and Clinical``(B) Diagnosticthe Laboratoryname Priceand Transparency.--business ``(1)address Infor general.--Beginningeach Julyperson 1,or 2027,entity anthat, applicable laboratory shall-- ``(A) make publicly available on an internet website the information described in paragraph (2) with respect to eachthe suchlaboratory-- specified``(i) clinicalhas diagnostican laboratoryownership testor thatinvestment suchinterest; laboratory so furnishes;

and``(ii) ``(B)has ensurea thatcontrolling suchinterest; information is updated not less frequently than monthly, if there have been any changes to such information.

``(2)``(iii) Informationis described.--For purposes of paragraph (1), the information described in this paragraph is, with respect to an applicable laboratory and a specifiedmanagement clinicalservices diagnosticorganization; laboratory test, the following:

``(A) A plain language description of each item or service,``(iv) accompaniedis bya anysignificant applicableequity billinginvestor. 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.

``(B)``(2) TheStandard grosscharges chargedefined.--For expressedpurposes asof aparagraph dollar(1), amount,the forterm each`standard suchcharges' itemmeans, orwith service.respect to an applicable laboratory and a specified clinical diagnostic laboratory test, the following:

``(C)``(A) TheA discountedplain cashlanguage pricedescription expressedof as a dollar amount, for each such item or serviceservice, (or,accompanied inby theany caseapplicable nobilling discountedcodes cash(including pricemodifiers isthat availablematerially forchange an item or service, the minimum cash price accepted by the laboratory from self-pay individuals for suchinsurers item or serviceproviders, whenand providedthat inmaterially suchchange settingsout-of-pocket costs for theconsumers) previoususing threecommonly years,recognized expressedbilling ascode asets, dollarincluding-- amount,``(i) asthe wellHealthcare as,Common withProcedure respectCoding toSystem pricescode; made public pursuant to subparagraph (A)(ii), a link to a consumer-friendly document that clearly explains the laboratory's charity care policy).

The``(ii) laboratory shall accept the discountedNational orDrug minimumCode; cash price as payment in full from any patient that chooses to pay in cash without regard to the patient's coverage.

``(D)or The``(iii) payer-specificother negotiatedapplicable charges,identifier expressed as adetermined dollarby amount and clearly associated with the nameSecretary of(or thesuccessor applicablecode thirdsets). 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``(B) theThe chargesgross arecharge basedexpressed onas ana algorithm,dollar percentage of another amount, orfor othereach formula or criteria, the clinical diagnostic laboratory also shall disclose such algorithm,test. 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.

``(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 test.

If the charges are based on an algorithm, percentage of another amount, or other formula or criteria, the applicable laboratory also shall 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.

``(F) 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.section.

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.

``(3) Uniform method and format.--Notformat.--The later than January 1, 2027, 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 shall-- ``(A) include a machine-readable spreadsheet format (or a successor technology specified by the Secretary) containing the information described in paragraph (2) for all itemsspecified andclinical servicesdiagnostic laboratory tests furnished by each laboratory;laboratory and the ownership information described in paragraph (1)(B);

``(4) InclusionMonitoring ofcompliance.--The ancillarySecretary services.--Anyshall, price or rate for a specified clinical diagnostic laboratory test available to be furnished by an applicable laboratory made publicly available in accordanceconsultation with paragraphthe (1)Inspector shallGeneral includeof the priceDepartment orof rateHealth for any ancillary item or service (including specimen collection services, specimen transport, centrifugation, aliquoting, labeling, requisition processing, and standardHuman resultServices, reportingestablish services)a thatprocess wouldto customarilymonitor andcompliance routinelywith bethis furnishedsubsection. by such laboratory as part of such test, as specified by the Secretary.

``(5)Such Enforcement.--process ``(A)shall Inensure general.--In the case that theeach Secretary determines that an applicable laboratorylaboratory's is not in compliance with paragraphthis (1)--subsection ``(i)is reviewed not laterless frequently than 30once daysevery afteryear. such determination, the Secretary shall notify such laboratory of such determination;

and``(5) ``(ii)Inclusion ifof suchancillary laboratoryservices.--Any continuescharge tofor faila tospecified complyclinical withdiagnostic suchlaboratory paragraphtest afterfurnished theby datean thatapplicable islaboratory 90made dayspublicly afteravailable suchin notificationaccordance iswith sent,paragraph the(1) Secretaryshall mayinclude imposethe acharge civilfor monetaryany penaltyancillary initem anor amountservice not(such toas exceedspecimen $300collection forservices, eachspecimen daytransport, (beginningcentrifugation, withaliquoting, thelabeling, dayrequisition onprocessing, whichand thestandard Secretaryresult firstreporting determinedservices) that suchwould laboratorycustomarily wasand failingroutinely tobe complyfurnished withby such paragraph)laboratory duringas whichpart of such failuretest, isas ongoing.specified by the Secretary.

``(B)``(6) IncreaseAttestation.--A authority.--Insenior applyingofficial thisfrom paragrapheach withclinical respectdiagnostic tolaboratory violations(the occurringChief inExecutive 2028Officer, Chief Financial Officer, or aan subsequentofficial year,of equivalent seniority) shall attest to the Secretaryaccuracy mayand throughcompleteness noticeof the disclosures, and commentany rulemakingother increaseattestations as required by the perSecretary, daymade limitationin onaccordance civilwith monetarythe penaltiesclinical underlaboratory subparagraphprice (A)(ii).transparency requirements based on criteria established by the Secretary.

``(C)``(7) ApplicationEnforcement.-- of``(A) certainIn provisions.--Thegeneral.--In provisionsthe ofcase section 1128A of thean Socialapplicable Securitylaboratory Actthat (otherfails thanto subsectionscomply (a)with andthe (b)requirements of suchthis section)subsection-- shall``(i) applythe toSecretary ashall civilnotify monetarysuch penaltylaboratory imposedof undersuch thisfailure paragraphnot inlater thethan same30 mannerdays asafter suchthe provisionsdate applyon towhich athe civilSecretary monetarydetermines penalty imposed under subsection (a) of such section.failure exists;

``(6)and Provision``(ii) upon request of technicalthe assistance.--TheSecretary, Secretarysuch shall,laboratory shall submit to the extentSecretary, practicable,not providelater technicalthan assistance45 relatingdays toafter compliance with the provisionsdate of thissuch subsectionrequest, toa applicablecorrective laboratoriesaction requestingplan to comply with such assistance.requirements.

``(7)``(B) Definitions.--InCivil monetary penalty.-- ``(i) In general.--An applicable laboratory that has received a notification under subparagraph (A)(i) and fails to comply with the requirements of this subsection:subsection by the date that is 90 days after such notification (or, in the case of an applicable laboratory that has submitted a corrective action plan described in subparagraph (A)(ii) in response to a request so described, by the date that is 90 days after such submission) 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 laboratory was not complying with such requirements) during which such failure is ongoing (not to exceed $300 per day).

``(A)``(ii) ApplicableIncrease laboratory.--Theauthority.--In termapplying `applicablethis laboratory'subparagraph meanswith arespect `laboratory'to asan suchapplicable termlaboratory isthat definedfails into sectioncomply 493.2,with ofthe titlerequirements 42, Code of Federalthis Regulationssubsection (orin a2028 successoror regulation), except that such term does not include a laboratorysubsequent withyear, respectthe toSecretary whichmay standardthrough chargesnotice and pricescomment forrulemaking specifiedincrease clinicalthe diagnosticlimitation laboratoryon teststhe furnishedper byday suchamount laboratoryof areany madepenalty availableapplicable by a hospital pursuant to subsectionan (e)applicable oflaboratory thisunder section.clause (i).

``(B)``(iii) DiscountedApplication cashof price.--Thecertain termprovisions.--The `discountedprovisions cashof price'section means1128A of the chargeSocial thatSecurity appliesAct (other than subsections (a) and (b) of such section) shall apply to ana individualcivil whomonetary payspenalty cash,imposed orunder cashthis equivalent,subparagraph forin anthe itemsame ormanner service.as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section.

``(C)``(iv) GrossNo charge.--Theauthority termto `grosswaive charge'or meansreduce thepenalty.--The chargeSecretary forshall annot individualgrant itemor extend any waiver, delay, tolling, or serviceother mitigation of a civil monetary penalty for failing to comply with the requirements of this subsection except where the Secretary determines that isimposing reflectedthe onmaximum ancivil monetary penalty will disrupt applicable laboratory'slaboratory chargemaster,operations absentin anya discounts.manner that impacts patient care.

``(D)The Payer-specificSecretary negotiatedmay charge.--Therequest termdocumentation `payer-specificin negotiatedsuch charge'form meansand themanner chargeas thatthe anSecretary applicablemay laboratoryrequire hasin negotiatedorder withto aevaluate thirdimpact partyon payerapplicable forlaboratory anoperations. item or service.

``(E)``(8) SpecifiedProvision clinicalof diagnostictechnical laboratoryassistance.--The test.--TheSecretary termshall, `specifiedto clinicalthe diagnosticextent laboratorypracticable, test'provide meanstechnical aassistance clinicalrelating diagnosticto laboratorycompliance testwith that is included on the listprovisions of shoppablethis services specified by the Centers for Medicare & Medicaid Services (as described in subsection (e)to ofapplicable thislaboratories section),requesting other than such aassistance. test that is only available to be furnished by a single provider of services or supplier.

``(F)``(9) ThirdRulemaking.-- party``(A) payer.--TheIn termgeneral.--The `thirdSecretary partyshall payer'implement meansthis ansubsection entitythrough thatnotice is,and bycomment statute,rulemaking contract,in oraccordance agreement,with legallysection responsible553 for payment of atitle claim5, forUnited aStates healthCode. care item or service.

``(8)``(B) Rulemaking.--TheOwnership Secretaryinformation.--In shallpromulgating implementregulations under this subsectionparagraph, throughthe noticeSecretary shall define the individuals and commentorganizations rulemakingthat must be disclosed under paragraph (1)(C) in accordancea manner that harmonizes disclosure requirements with requirements established under section 5531124 of titlethe 5,Social UnitedSecurity StatesAct Code.''.and prioritizes the disclosure of individuals and organizations who's ownership or management relationship with a hospital impacts operational, financial, or clinical decision making for such hospital.''.

IMAGING SERVICES PRICE TRANSPARENCY.

Section 27182718A of the Public Health Service ActAct, (42as U.S.C.amended by section 3, is further amended by adding at the end the following:

300gg-18),``(d) asImaging amendedServices byPrice sectionTransparency.-- 3,``(1) In general.--Beginning January 1 of the year that begins on or after the date that is further1 amendedyear byafter addingthe atdate of enactment of the endPatients Deserve Price Tags Act, each applicable imaging service provider shall, on a quarterly basis (if there have been any changes to the following:standard charges described in paragraph (2)) compile and make publicly available on an internet website (without subscription and free of charge)-- ``(A) the standard charges described in paragraph (2) with respect to each such specified imaging service provided by such provider;

``(g)and Imaging``(B) Servicesthe Pricename Transparency.--and ``(1)business Inaddress general.--Beginningfor July 1, 2027, each providerperson of services or supplierentity thatthat, furnishes a specified imaging service, other than such a provider or supplier with respect to whichthe standardimaging charges and prices for such services furnishedprovider-- by``(i) suchhas provider or supplier are made available by a hospital pursuant to subsection (e), shall-- ``(A) make publicly available (in accordance with paragraph (3)) on an internetownership website the information described in paragraph (2) with respect to each such service that such provider of services or supplierinvestment furnishes;interest;

and``(ii) ``(B)has ensurea thatcontrolling suchinterest; information is updated not less frequently than annually.

``(2)``(iii) Informationis described.--For purposes of paragraph (1), the information described in this paragraph is, with respect to a providermanagement of services ororganization; supplier and a specified imaging service, the following:

``(A) A plain language description of each item or service,``(iv) accompaniedis bya anysignificant applicableequity billinginvestor. 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.

``(2) Standard charges defined.--For purposes of paragraph (1), the term `standard charges', with respect to an applicable imaging service provider and a specified imaging service, means the following:

``(A) A plain language description of each item or service, accompanied by any applicable billing codes (including modifiers that materially change the price for insurers or providers, and that materially change out-of-pocket costs for consumers) using commonly recognized billing code sets, including-- ``(i) the Healthcare Common Procedure Coding System code;

``(ii) the National Drug Code;

or ``(iii) other applicable identifier as determined by the Secretary (or successor code sets).

``(C) The discounted cash priceprice. expressed as a dollar amount, for each such item or service (or, in the case no discounted cash price is available for an item or service, the minimum cash price accepted by the provider of services or supplier from self-pay individuals for such item or service when provided in such settings for the previous three years, 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 provider of services or supplier's charity care policy).

``(D) The providerpayer-specific ofnegotiated servicescharges, orexpressed supplieras shalla acceptdollar theamount discountedand orclearly minimumassociated cashwith pricethe asname paymentof inthe fullapplicable fromthird-party anypayer patientand thatname choosesof toeach payplan, inthat cashapply without regard to theeach patient'ssuch coverage.service.

``(D)If Thethe payer-specificcharges negotiatedare charges,based expressedon asan aalgorithm, dollarpercentage amountof andanother clearlyamount, associatedor withother theformula nameor ofcriteria, the applicableprovider thirdor partysupplier payeralso andshall namedisclose ofsuch eachalgorithm, plan,percentage, thatformula, applyor tocriteria eachas suchset itemforth orin serviceits whencontract providedand in,any asother applicable,information necessary to determine the inpatientnegotiated settingcharge andas outpatienta departmentdollar setting.amount.

If the charges are based on an algorithm, percentage of another amount, or other formula or criteria, the provider or supplier 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.

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.

``(3) Uniform method and format.--Notformat.--The later than January 1, 2027, the Secretary shall establish a standard, uniform method and format for providersapplicable ofimaging servicesservice andproviders suppliers to use in making public information described in paragraph (2).(1).

Any such method and format shall-- ``(A) include a machine-readable spreadsheet format (as specified by the Secretary) containing the information described in paragraph (2) for all itemsspecified andimaging services furnished by each providerapplicable ofimaging servicesservice provider and supplierownership information described in paragraph (1);(1)(B);

``(4) Monitoring compliance.--The Secretary shall, through notice and comment rulemaking and in consultation with the Inspector General of the Department of Health and Human Services, establish a process to monitor compliance with this subsection.

``(5) Enforcement.--Attestation.--A ``(A)senior Inofficial general.--Infrom theeach casespecified thatimaging theservice Secretaryprovider determines(the thatChief aExecutive providerOfficer, ofChief servicesFinancial Officer, or supplieran isofficial notof inequivalent complianceseniority) withshall paragraphattest (1)--to ``(i)the notaccuracy laterand thancompleteness 30of daysthe afterdisclosures, suchand determination,any other attestations as required by the SecretarySecretary, shallmade notifyin suchaccordance with the imaging service provider orprice suppliertransparency ofrequirements suchbased determination;on criteria established by the Secretary.

``(ii)``(6) uponEnforcement.-- request``(A) ofIn general.--In the Secretary,case suchof providera orspecified supplierimaging shallservice submitprovider that fails to thecomply Secretary,with notthe laterrequirements thanof 45this dayssubsection-- after``(i) the dateSecretary shall notify such imaging service provider of such request,failure anot correctivelater actionthan plan30 todays complyafter withthe date on which the Secretary determines such paragraph;failure exists;

and ``(iii)``(ii) ifupon suchrequest providerof orthe supplierSecretary, continuessuch toimaging failservice toprovider complyshall withsubmit suchto paragraph after the dateSecretary, thatnot islater 90than 45 days after such notification is sent (or, in the casedate of such arequest, provider or supplier that has submitted a corrective action plan described in clause (ii) in response to a request so described, after the date that is 90 days after such submission), the Secretary may impose 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 failing to comply with such paragraph)requirements. during which such failure to comply or failure to submit is ongoing.

``(B) IncreaseCivil authority.--Inmonetary applyingpenalty.-- this``(i) paragraphIn withgeneral.--A respectspecified toimaging violationsservice occurringprovider inthat 2027has orreceived a subsequentnotification year,under subparagraph (A)(i) and fails to comply with the Secretaryrequirements mayof throughthis noticesubsection andby commentthe rulemakingdate increasethat is 90 days after such notification (or, in the amountcase of a specified imaging service provider that has submitted a corrective action plan described in subparagraph (A)(ii) in response to a request so described, by the date that is 90 days after such submission) shall be subject to a civil monetary penalty underof subparagraphan (A)(iii).amount specified by the Secretary for each day (beginning with the day on which the Secretary first determined that such imaging service provider was not complying with such requirements) during which such failure is ongoing (not to exceed $300 per day).

``(C)``(ii) ApplicationIncrease ofauthority.--In certainapplying provisions.--Thethis provisionssubparagraph ofwith sectionrespect 1128Ato ofa thespecified Socialimaging Securityservice Actprovider (otherthat thanfails subsectionsto (a)comply andwith (b)the requirements of suchthis section)subsection shallin applyor to a civilsubsequent monetaryyear, penaltythe imposedSecretary undermay thisthrough paragraphnotice inand thecomment samerulemaking mannerincrease asthe suchlimitation provisionson applythe toper aday civilamount monetaryof any penalty imposedapplicable underto subsectiona (a)specified ofimaging suchservice section.provider under clause (i).

``(D)``(iii) NoApplication authorityof tocertain waiveprovisions.--The orprovisions reduceof penalty.--Thesection Secretary1128A of the Social Security Act (other than subsections (a) and (b) of such section) shall notapply grantto ora extendcivil anymonetary waiver,penalty delay,imposed tolling,under orthis othersubparagraph mitigationin ofthe same manner as such provisions apply to a civil monetary penalty forimposed violationunder subsection (a) of thissuch subsection.section.

``(E)``(iv) ProvisionNo ofauthority technicalto assistance.--Thewaive or reduce penalty.--The Secretary shall,shall tonot thegrant extentor practicable,extend provideany technicalwaiver, assistancedelay, relatingtolling, or other mitigation of a civil monetary penalty for failing to compliancecomply with the provisionsrequirements of this subsection toexcept providerswhere ofthe servicesSecretary anddetermines suppliersthat requestingimposing suchthe assistance.maximum civil monetary penalty will disrupt specified imaging service provider operations in a manner that impacts patient care.

``(F)The ClarificationSecretary ofmay nonapplicabilityrequest ofdocumentation otherin enforcementsuch provisions.--Notwithstandingform anyand othermanner provisionas ofthe thisSecretary title,may thisrequire paragraphin shallorder beto theevaluate soleimpact meanson ofspecified enforcingimaging theservice provisionsprovider ofoperations. this subsection.

``(6)``(7) SpecifiedProvision imagingof servicetechnical defined.--theassistance.--The termSecretary `specifiedshall, imagingto service'the meansextent anpracticable, imagingprovide servicetechnical thatassistance isrelating ato Centerscompliance forwith Medicarethe &provisions Medicaidof Services-specifiedthis shoppablesubsection serviceto (asproviders describedof inservices subsectionand (e)).suppliers requesting such assistance.

``(7)``(8) Rulemaking.--TheRulemaking.-- ``(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.''.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 who's ownership or management relationship with a hospital impacts operational, financial, or clinical decision making for such hospital.''.

AMBULATORY SURGICAL CENTER PRICE TRANSPARENCYTRANSPARENCY. REQUIREMENTS.

Section 27182718A of the Public Health Service ActAct, (42as U.S.C.amended by section 4, is further amended by adding at the end the following:

300gg-18),``(e) asAmbulatory amendedSurgical byCenter sectionPrice 4,Transparency.-- ``(1) In general.--Beginning January 1 of the year that begins on or after the date that is further1 amendedyear byafter addingthe atdate of enactment of the endPatients Deserve Price Tags Act, each specified ambulatory surgical center shall, on a quarterly basis (if there have been any changes to the following:standard charges described in paragraph (2)), compile and make publicly available on an internet website (without subscription and free of charge)-- ``(A) the standard charges described in paragraph (2) with respect to each specified service furnished by such surgical center;

``(h)and Ambulatory``(B) Surgerythe Centername Transparency.--and ``(1)business Inaddress general.--Beginningfor Julyeach 1,person 2027,or eachentity specifiedthat, ambulatorywith surgicalrespect centerto shallthe complyambulatory withsurgical thecenter-- price``(i) transparencyhas requirementan describedownership inor paragraphinvestment (2).interest;

``(2)``(ii) Requirementhas described.-- ``(A) In general.--A specified ambulatory surgical center, in accordance with a methodcontrolling andinterest; format established by the Secretary under subparagraph (C), shall compile and make public (without subscription and free of charge), for each year-- ``(i) one or more lists, in a machine- readable format specified by the Secretary, 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)``(iii) informationis in a consumer-friendlymanagement format (as specified by the Secretary) 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 includedorganization; on the list described in subsection (e) 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;

andor ``(iii)``(iv) with respect to each Centers for Medicare & Medicaid Services-specified shoppable service (as described in clause (ii)) that is nota furnishedsignificant byequity theinvestor. ambulatory surgical center, an indication that such service is not so furnished.

``(B)``(2) InformationStandard described.--Forcharges defined.--For purposes of subparagraphparagraph (A),(1), the informationterm described`standard incharges' this subparagraph is, with respect to standard charges and prices made public by a specified ambulatory surgical center,center means the following:

``(i)``(A) A plain language description of each item or service, accompanied by theany Healthcareapplicable Commonbilling Procedurecodes Coding(including Systemmodifiers code,that materially change the nationalprice drugfor code,insurers or otherproviders, identifierand usedthat ormaterially approvedchange byout-of-pocket costs for consumers) using commonly recognized billing code sets, including-- ``(i) the CentersHealthcare forCommon MedicareProcedure &Coding MedicaidSystem Services.code;

``(ii) Thethe grossNational charge,Drug expressedCode; as a dollar amount, for each such item or service.

or ``(iii) Theother discountedapplicable cashidentifier price, expressed as adetermined dollar amount, for each such item or service (or, in the case no discounted cash price is available for an item or service, the minimum cash price accepted by the specifiedSecretary ambulatory(or surgicalsuccessor centercode fromsets). self- pay individuals for such item or service when provided in such settings for the previous three years, 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 provider of services or supplier's charity care policy).

``(B) The specifiedgross ambulatorycharge, surgicalexpressed center shall accept the discounted cash price as paymenta indollar fullamount, fromfor anyeach patientsuch thatitem choosesor toservice. pay in cash without regard to the patient's coverage.

``(iv)``(C) The payer-specificdiscounted negotiatedcash charges,price. 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``(D) theThe chargespayer-specific arenegotiated basedcharges, onexpressed anas algorithm,a percentagedollar ofamount anotherand amount,clearly orassociated otherwith formulathe orname criteria,of the ambulatoryapplicable surgicalthird centerparty alsopayer shall disclose such algorithm, percentage, formula, or criteria as set forth in its contract and anyname otherof terms,each schedules,plan, exhibits,that data,apply orto othereach information referenced in any such contractitem asor shallservice. be required to determine and disclose the negotiated charge.

``(v)If Thethe de-identifiedcharges maximumare andbased minimumon negotiatedan chargesalgorithm, forpercentage eachof another amount, or other formula or criteria, the ambulatory surgical center also shall disclose such itemalgorithm, percentage, formula, or service,criteria expressedas set forth in its contract and any other information necessary to determine the negotiated charge as a non-zero dollar amount.

``(vi)``(E) AnyThe otherde-identified additionalmaximum information the Secretary may require for the purpose of improving the accuracy of, or enabling consumers to easily understand and compare,minimum standardnegotiated charges and prices for aneach such item or service, exceptexpressed informationas thata isnon-zero duplicativedollar ofamount. any other reporting requirement under this subsection.

``(C)``(F) UniformAny methodother andadditional format.--Notinformation later than January 1, 2027, the Secretary shallmay establishrequire afor standard,the uniformpurpose methodof andimproving formatthe foraccuracy specifiedof, ambulatoryor surgicalenabling centersconsumers to useeasily inunderstand makingand publiccompare, standard charges pursuant to subparagraph (A)(i) and aprices standard, uniform method and format for suchan centersitem toor useservice. in making public prices pursuant to subparagraph (A)(ii).

AnyIn suchthe methodcase andof formatstandard shall--charges ``(i)for inan theitem caseor service included as part of sucha chargesbundled, madeper publicdiem, byepisodic, anor ambulatoryother surgicalsimilar center,arrangement, ensurethe thatinformation suchdescribed chargesin arethis subparagraph shall be made available inas adetermined machine-readableappropriate format;by the Secretary.

``(ii)``(3) meetUniform suchmethod standardsand asformat.--The determinedSecretary appropriateshall byestablish thea Secretarystandard, inuniform ordermethod and format for specified ambulatory surgical centers to ensureuse thein accessibilitycompiling and usabilitymaking ofpublic suchinformation chargespursuant andto prices;paragraph (1).

Such method and ``(iii)format beshall-- updated``(A) asinclude determineda appropriatemachine-readable format (or a successor technology specified by the Secretary,Secretary) containing the information described in consultationparagraph with(2) stakeholders.for all specified services furnished by each ambulatory surgical center and for the ownership information described in paragraph (1)(B);

``(3)``(B) Nomeet deemedsuch compliance.--Thestandards availabilityas ofdetermined aappropriate priceby estimatorthe toolSecretary shallin notorder be considered to deemensure compliancethe withaccessibility orand otherwiseusability vitiate the requirements of thissuch subsectioncharges; (aa).

Furthermore,and the``(C) use of an estimator tool shall not be usedupdated foras purposesdetermined ofappropriate complianceby withthe anySecretary, provisions in thisconsultation subsection.with stakeholders.

``(5) Enforcement.--Attestation.--A ``(A)senior Inofficial general.--Infrom theeach case of a specified ambulatory surgical center that(the failsChief toExecutive complyOfficer, withChief theFinancial requirementsOfficer, ofor thisan subsection--official ``(i)of theequivalent Secretaryseniority) shall notifyattest suchto ambulatorythe surgicalaccuracy centerand completeness of suchthe failuredisclosures, notand laterany thanother 30attestations daysas afterrequired by the dateSecretary, onmade whichin accordance with the Secretaryambulatory determinescenter suchprice failuretransparency exists;requirements based on criteria established by the Secretary.

and``(6) ``(ii)Enforcement.-- upon``(A) requestIn ofgeneral.--In the Secretary,case theof a specified ambulatory surgical center shallthat submitfails to thecomply Secretary,with notthe laterrequirements thanof 45this dayssubsection-- after``(i) the dateSecretary shall notify such ambulatory surgical center of such request,failure anot correctivelater actionthan plan30 todays complyafter withthe date on which the Secretary determines such requirements.failure exists;

``(B)and Civil``(ii) monetaryupon penalty.--request ``(i)of Inthe general.--ASecretary, specifiedsuch ambulatory surgical center thatshall hassubmit received a notification under subparagraph (A)(i) and fails to comply with the requirementsSecretary, ofnot thislater subsectionthan by45 the date that is 90 days after such notification (or, in the casedate of ansuch ambulatoryrequest, surgical center that has submitted a corrective action plan described in subparagraph (A)(ii) in response to acomply request so described, by the date that is 90 days after such submission) 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 hospitalrequirements. was not complying with such requirements) during which such failure is ongoing (not to exceed $300 per day).

``(ii)``(B) IncreaseCivil authority.--Inmonetary applyingpenalty.-- this``(i) In general.--A specified ambulatory surgical center that has received a notification under subparagraph with(A)(i) respectand fails to violationscomply occurringwith inthe 2027requirements orof athis subsequentsubsection year,by the Secretarydate maythat throughis notice90 anddays commentafter rulemakingsuch increasenotification (or, in the limitationcase onof a specified ambulatory surgical center that has submitted a corrective action plan described in subparagraph (A)(ii) in response to a request so described, by the perdate daythat amountis of90 anydays penaltyafter applicablesuch submission) 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 ambulatory surgical center underwas clausenot (i).complying with such requirements) during which such failure is ongoing (not to exceed $300 per day).

``(ii) Increase authority.--In applying this subparagraph with respect to a specified ambulatory surgical center that fails to comply with the requirements of this subsection in 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 specified ambulatory surgical center under clause (i).

``(iv) 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 violationfailing to comply with the requirements of this subsection.subsection except where the Secretary determines that imposing the maximum civil monetary penalty will disrupt specified ambulatory surgical center operations in a manner that impacts patient care.

``(6)The Provision of technical assistance.--The Secretary shall,may torequest thedocumentation extentin practicable,such provideform technicaland assistancemanner relatingas tothe complianceSecretary withmay therequire provisionsin oforder thisto subsectionevaluate toimpact on specified ambulatory surgical centerscenter requestingoperations. such assistance.

``(7) Definitions.--ForProvision purposesof technical assistance.--The Secretary shall, to the extent practicable, provide technical assistance relating to compliance with the provisions of this section:subsection to specified ambulatory surgical centers requesting such assistance.

``(A)``(8) DiscountedRulemaking.-- cash``(A) price.--TheIn termgeneral.--The `discountedSecretary cashshall price'implement meansthis thesubsection chargethrough thatnotice appliesand tocomment anrulemaking individualin whoaccordance payswith cash,section or553 cashof equivalent,title for5, aUnited itemStates orCode. service furnished by an ambulatory surgical center.

``(B) GrossOwnership charge.--Theinformation.--In termpromulgating `grossregulations charge'under meansthis paragraph, the chargeSecretary forshall andefine individualthe itemindividuals orand serviceorganizations that ismust reflectedbe ondisclosed under paragraph (1)(C) in a specifiedmanner surgicalthat center'sharmonizes chargemaster,disclosure absentrequirements anywith discounts.requirements established under section 1124 of the Social Security Act and prioritizes the disclosure of individuals and organizations who's ownership or management relationship with a hospital impacts operational, financial, or clinical decision making for such hospital.

``(C)``(f) GroupContinued Applicability of State Law.--The provisions of this section shall not supersede any provision of State law that establishes, implements, or continues in effect any requirement or prohibition related to health plan;care price transparency, except to the extent that such requirement or prohibition prevents the application of a requirement or prohibition of this section.''.

group health insurance coverage;

individual health insurance coverage.--The terms `group health plan', `group health insurance coverage', and `individual health insurance coverage' have the meaning given such terms in section 2791 of the Public Health Service Act.

``(D) Payer-specific negotiated charge.--The term `payer-specific negotiated charge' means the charge that a specified surgical center has negotiated with a third party payer for an item or service.

``(E) 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.

``(F) Specified ambulatory surgical center.--The term `specified ambulatory surgical center' means an ambulatory surgical center with respect to which a hospital (or any person with an ownership or control interest (as defined in section 1124(a)(3) of the Social Security Act) in a hospital) is a person with an ownership or control interest (as so defined).

``(G) 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.

``(8) Rulemaking.--The Secretary shall implement this subsection through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.

(a) Transparency in Coverage.--Section 1311(e)(3)(C)2715A of the PatientPublic ProtectionHealth andService Affordable Care Act (42 U.S.C.

18031(e)(3)(C))300gg-15a) is amended-- (1) by striking ``The``A Exchange''Group health'' and inserting the following:

``(i)``(a) In general.--TheGeneral.--A Exchange'';group health'';

and (2) in clause (i), as inserted by paragraphending (1)--at (A)the byend strikingthe ``participatingfollowing: provider'' and inserting ``provider'';

(B)``(b) byAdditional insertingTransparency ``shallRequirements.-- include``(1) theSpecified information specifiedrequired.-- ``(A) In general.--A group health plan or health insurance issuer offering coverage in clausethe (ii)individual and''or aftergroup ``suchmarket information'';shall provide to each participant, beneficiary, or enrollee, at the time of enrollment in the plan or coverage, the information described in subparagraph (B).

(C)``(B) byInformation strikingrequired.--For ``anpurposes Internetof website''subparagraph and(A), insertingthe ``ainformation self-servicespecified toolin thatthis meetssubparagraph is, with respect to benefits available under the requirementsplan ofor clausecoverage (iii)'';for an item or service furnished by a health care provider, the following (or other information as determined appropriate by the Secretary):

and``(i) (D)If by striking ``and such other''provider andis allan thatin-network followsprovider throughwith therespect periodto andsuch insertingitem ``or,or atservice, the optionin-network suchrate individual, through a paper or phone disclosure (as selecteddefined byin suchparagraph individual(5)) andfor provided at no cost to such individual)item thator meetsservice. such requirements as the Secretary may specify.'';

and``(ii) (3)If bysuch addingprovider atis not described in clause (i), the endout-of-network allowed amount (as such term is defined for purposes of section 147.210(a)(2)(xvii) of title 45, Code of Federal Regulation) for such item or service that the followingplan newor clauses:coverage will pay without regard to the amount in clause (iii).

``(ii)``(iii) SpecifiedThe information.--Foramount purposes of clausecost-sharing (i),liability (including deductibles, copayments, and coinsurance) that the informationindividual specifiedwill inincur thisfor clausesuch is,item withor respectservice tobased benefitson availablethe underinformation aavailable healthto the plan foror ancoverage at the time the request is made (which, in the case such item or service is to be furnished by a healthprovider caredescribed provider,in clause (ii), shall be calculated using the following:maximum amount described in such clause).

``(I)``(iv) IfThe suchaccumulated provideramounts iswith arespect participatingto providerany withdeductible respector toout-of-pocket suchmaximum itemunder the plan or service,coverage reflected in the in-networkplan's rateor (ascoverage's definedrecords at the time the request is made (broken down, in subparagraphthe (F))case forseparate deductibles or maximums apply to separate individuals enrolled in the plan or coverage, by such itemseparate deductibles or service.maximums, in addition to any cumulative deductible or maximum).

``(II)``(v) IfIn the case such providerplan isor notcoverage describedimposes inany subclausefrequency (I),or thevolume maximumlimitations allowedwith dollarrespect to such item or service (excluding medical necessity determinations), the amount forthat such individual has accrued towards such limitation with respect to such item or service.service reflected in the plan's or coverage's records at the time the request is made.

``(III)``(vi) TheInformation amountabout ofany costutilization sharingmanagement (includingrequirements, deductibles,such copayments,as andprior coinsurance)authorization, thatconcurrent thereview, individualstep willtherapy, incurfail forfirst, or similar requirements applicable to coverage of such item or service (which,under insuch theplan caseor suchcoverage, itemincluding orinformation serviceregarding isutilization tomanagement bepractices furnishedand bydeterminations, aincluding provideraggregate describedinformation inrelated subclauseto (II),approval shalland bedenial calculatedrates, usingassociated thetimelines, maximumand amountappeals, describedas indetermined suchappropriate subclause).by the Secretary.

``(IV)``(C) TheSelf-service amounttool the.--For individualpurposes hasof alreadysubparagraph accumulated(A), witha respectself-service totool anyestablished deductibleby ora outhealth of pocket maximum under the plan (brokenmeets down, in the caserequirements separateof deductiblesthis orsubparagraph maximumsif apply to separate individuals enrolled in the plan, by such separatetool-- deductibles``(i) oris maximums,based inon additionan tointernet anywebsite; cumulative deductible or maximum).

``(V)``(ii) Inprovides thefor casereal-time suchresponses plan imposes any frequency or volume limitations with respect to suchrequests itemdescribed orin service (excluding medical necessity determinations), the amount that such individualsubparagraph; has accrued towards such limitation with respect to such item or service.

``(VI)``(iii) Anyis priorupdated authorization,in concurrenta review,manner stepsuch therapy,that failthe first,information oris similaraccurate requirementsbased applicableon tothe coverageinformation ofavailable suchto itemthe plan or servicecoverage underat suchthe plan.time the request is made;

``(iii)``(iv) Self-serviceallows tool.--Forsuch purposesa ofrequest clauseto (i),be amade self-servicefor toolinformation establishedwith byrespect ato healthan planitem meetsor theservice requirementsfurnished ofby-- this``(I) clausea ifspecific suchprovider tool--that ``(I) is basedan onin-network anprovider internetwith website;respect to such item or service;

or ``(II) providesall forproviders real-timethat responsesare in- network providers with respect to requestssuch describedplan inor coverage and such clause;item or service;

``(III)``(v) isprovides updatedthat insuch a mannerrequest suchmay thatbe made for information providedwith respect to an item or service through suchuse toolof-- is``(I) timelythe andbilling accurate;code for such item or service;

``(IV) allows such a request to be made with respect to an item or service``(II) furnishedthrough by--use ``(aa)of a specificdescriptive providerterm thatfor is a participating provider with respect to such item or service;

``(bb)and all``(vi) providersis thatmade areavailable participatingin providersplain withlanguage, respectwithout tosubscription such plan and such item or service;other fee.

``(D) Nonduplication.--A group health plan or ``(cc)health ainsurance providerissuers thatshall isbe notdeemed describedto be in itemcompliance (bb);with this paragraph if such plan or issuer has a tool in place under section 2799A-4.

``(V)``(2) providesRate and payment information.-- ``(A) In general.--Beginning January 1 of the year that suchbegins aon requestor mayafter bethe madedate withthat respectis 1 year after the date of enactment of the Patients Deserve Price Tags Act, and every quarter thereafter (if there have been any changes to anthe itemrate and payment information described in subparagraphs (B) and (C), each group health plan or servicehealth throughinsurance useissuer of--offering ``(aa)coverage in the billinggroup codeor forindividual suchmarket itemshall ormake service;available to the public, the rate and payment information described in subparagraph (B) in accordance with subparagraph (C).

or``(B) ``(bb)Rate throughand usepayment ofinformation adescribed.--For descriptivepurposes termof forsubparagraph such(A), itemthe orrate serviceand topayment produceinformation adescribed listin ofthis billingsubparagraph codeis, optionswith fromrespect whichto thea individualplan selectsor tocoverage, indicate the subjectfollowing: matter items or services;

``(i) With respect to each item or service for which benefits are available under such plan or coverage, excluding those included in clause (ii), identified by CPT, HCPCS, DRG, or other applicable nationally recognized identifier, including any applicable code modifiers, and ``(VI)accompanied holdsby a memberplain harmlesslanguage fordescription of the item or service, the in- network rate (expressed as a dollar amount or percentage of charges, unless otherwise specified by the Secretary), including the individual and total amounts for any differencebundled rates, in excesseffect as of the amountdate of the individual'ssubmission responsibilityof generatedsuch information with each provider (identified by thenational self-provider serviceidentifier) toolthat andis thean amountin-network ultimatelyprovider billedwith respect to such item or chargedservice, toother than such a rate in effect with a provider that an issuer has determined based on factors determined by the individual.''.Secretary (such as medical specialty) that it is unlikely that the provider would be reimbursed for the item or service.

(b)``(ii) DisclosureWith respect to each drug and biologic (identified by National Drug Code, J- code, or other commonly recognized billing code used for drugs) for which benefits are available under such plan or coverage, the in- network rate (expressed as a dollar amount or percentage of Additionalcharges, Information.--Sectionunless 1311(e)(3)otherwise specified by the Secretary) in effect as of the Patientfirst Protectionday andof Affordablethe Carequarter Actin (42which U.S.C.such information is made public with each pharmacy or other prescription drug dispenser that is an in-network pharmacy or other prescription drug dispenser with respect to such drug.

18031(e)(3))``(iii) isWith amendedrespect to each item or service for which benefits are available under such plan or coverage (expressed as a dollar amount), identified by addingCPT, atDRG, HCPCS, or other applicable nationally recognized identifier, including any applicable code modifiers, and accompanied by a brief description of the enditem or service, the followingamount newbilled subparagraphs:or charged by the provider, and the amount allowed by the plan or coverage, for each such item or service furnished during a representative lookback window established by the Secretary by each provider that was an out- of-network provider with respect to such item or service, broken down by each such provider (identified by national provider identifier), other than items and services with respect to which not fewer than 11 claims for such item or service were submitted to such plan during such period.

``(E)``(C) RateManner andof paymentsubmission.--Rate information.-- ``(i) In general.--Not later than January 1, 2027, and everypayment monthinformation thereafter,required each health plan shall submit to thebe Exchange,submitted the Secretary, the State insurance commissioner, and makemade available tounder thethis public,paragraph theshall ratebe andso paymentsubmitted informationand describedso inmade clauseavailable (ii)as infollows: accordance with clause (iii).

``(ii)``(i) RateInformation andshall paymentbe informationcontained described.--Forin purposesat ofleast clause3 (i),separate themachine-readable ratefiles andcorresponding paymentto the information described in thiseach clauseof is,clauses (i) through (iii) of subparagraph (B) that meet such requirements as specified by the Secretary through rulemaking, in consultation with respectthe Secretaries of Labor and the Treasury, to apply comparable requirements to group health plans and health insurance coverage and to entities providing benefit management or other third-party administration services on a contractual basis with a group health plan,plan theor following:coverage.

``(I)``(ii) WithRequirements respectspecified to each item or service for which benefits are available under such plan (expressed as a dollar amount), including prescription drugs, identified by CPT, HCPCS, DRG, NDC, or other applicable nationally recognized identifier, including any applicable code modifiers, and accompanied by a brief description of the itemSecretary orthrough service,rulemaking the(or in-networksubregulatory rateguidance) inshall effectensure as of the datefollowing: of the submission of such information with each provider (identified by national provider identifier) that is a participating provider with respect to such item or service, other than such a rate in effect with a provider-- ``(aa) that has submitted no claims;

and``(I) ``(bb)Such expectsfiles toare receivemade noavailable claims in thea thenwidely applicableavailable calendarformat yearthat allows for information contained in such itemfiles orto servicebe compared across plans and coverage and are freely accessible to suchindividuals plan.at no cost and without the need to establish a user account or provide other credentials.

``(II) WithEach respectsuch tofile includes each drugof (identifiedthe byfollowing Nationaldata Drugelements: Code, J- code, or other commonly recognized billing code used for drugs) for which benefits are available under such plan:

``(aa) TheA in-networknumerical rateidentifier (expressedfor as a dollar amount), including the individualgroup andhealth totalplan amountsor forhealth anyinsurance bundledissuer rates,(such in effect as of the first day of the month in which such information is made public with each provider that is a participatingHealth providerInsurance withOversight respectSystem toidentifier). such drug.

``(bb) TheA historicalplain-language netdescription price paid by such plan (net of rebates,the discounts,item andor priceservice concessions)(including, (expressed as a dollar amount) for suchdrugs, drug dispensed or administered during the 90-dayproprietary periodand beginningnonproprietary 180name daysassigned). before such date of submission to each provider that was a participating provider with respect to such drug, broken down by each such provider (identified by national provider identifier), other than such an amount paid to a provider that has submitted no claims for such drug to such plan.

``(III)``(cc) WithThe respectbilling tocode, each item or service for which benefits are available under such plan (expressed as a dollar amount), identified by CPT, DRG, HCPCS, NDC, or other applicable nationally recognized identifier, including any applicable code modifiers, andassociated accompaniedwith bysuch a brief description of the item or service, theincluding amount billed or charged by the provider,Healthcare andCommon theProcedure amountCoding allowedSystem bycode, thediagnosis- plan,related forgroup, eachnational suchdrug itemcode, or service furnished during the 90-day period beginning 180 days before such date of submission by each provider that was not a participating provider with respect to such item or service, broken down by each such provider (identified by national provider identifier), other thancommonly itemsrecognized andcode servicesset. with respect to which no claims for such item or service were submitted to such plan during such period.

``(iii)``(dd) MannerThe place of submission.--Rateservice andcode. payment information required to be submitted and made available under this subparagraph shall be so submitted and so made available as follows:

``(I)``(ee) InformationThe shallNational beProvider containedIdentifier in 3 separate machine- readable files corresponding to the information described in each of subclauses (I) through (III) of clause (ii) that meet such requirements as specified by the Secretary through rulemaking, in consultation with the Secretaries of Labor and theprovider TreasuryTax toIdentification applyNumber. comparable requirements to group health plans and to entities providing benefit management or other third-party administration services on a contractual basis with a group health plan.

``(II)``(iii) RequirementsThe specifiedrate byand thepayment Secretaryinformation disclosed under clauses (i) through rulemaking(iii) of subparagraph (B) shall ensurebe that:separately delineated for each item or service, regardless of whether such item or service is reimbursed as a part of a bundle, episode, or other grouping of items and services.

``(aa)``(iv) SuchAn filesofficer areor limitedexecutive toof ancompetent appropriateauthority size,shall areattest made available in a widely available format that allows for information contained in such files to bethe comparedaccuracy across health plans, and arecompleteness accessibleof toinformation individualssubmitted at no cost and withoutmade theavailable needunder tothis establishsubparagraph. a user account or provider other credentials.

``(bb)In Thethe rates,case amounts,of anda pricesplan toor becoverage disclosedthat includerelies contractualon termsa containingthird- calculationparty formulae,administrator pricingor methodologies,other andservice otherprovider to compile the information necessarysubmitted toand determinemade available under this subparagraph, such plan or coverage may satisfy the dollarrequirement valueunder ofthis reimbursement.clause by obtaining such an attestation from the third-party administrator or other service provider.

``(cc)Such Eachattestation suchshall filebe includessubject eachto ofenforcement theunder followingparagraph data(6). elements:

``(AA)``(3) AOwnership numericalinformation.--Beginning identifierJanuary for1 of the year that begins on or after the date that is 1 year after the date of enactment of the Patients Deserve Price Tags Act, and every quarter thereafter (if there have been any changes in the required information), each group health plan and/ or health insurance issuer (suchoffering ascoverage ain Healththe Insuranceindividual Oversightor Systemgroup identifier).market shall submit to the Secretary, the applicable State authority, and make available to the public, the name and business address of each person or entity that, with respect to such plan or coverage-- ``(A) has an ownership or investment interest;

``(BB)``(B) Ahas plain-a languagecontrolling descriptioninterest; of the item or service (including, for drugs, the proprietary and nonproprietary name assigned).

``(CC)``(C) Theis billinga code,management includingservices anyorganization; applicable modifiers, associated with such item or service, including the Healthcare Common Procedure Coding System code, diagnosis-related group, national drug code, or other commonly recognized code set.

``(DD)or The``(D) placeis ofa servicesignificant code.equity investor.

``(EE)``(4) TheEnforcement.-- National``(A) ProviderIn Identifiergeneral.--Each year, the Secretary shall audit the machine-readable files required by paragraph (2)(B) posted by not fewer than 50 group health plans or providerhealth Taxinsurance Identificationissuers Number.for compliance with format and accessibility standards.

``(III)``(B) TheNotification rate and paymentrequest informationfor disclosedcorrective underaction.--In subclausesthe (I)case throughof (III)a ofgroup clausehealth (ii)plan shallor behealth separatelyinsurance delineatedissuer forthat eachfails itemto orcomply service,with regardlessthe requirements of whetherthis paragraph, not later than 30 days after the date on which the Secretary determines such itemfailure orexists, servicethe isSecretary reimbursedshall assubmit to such plan or issuer a partnotification of such determination, which shall include a bundle,request episode,for ora othercorrective groupingaction ofplan itemsto andcomply services.with such requirements.

``(IV)``(C) AnCivil officermonetary penalty.--A plan or executiveissuer that has received a request for a corrective action plan under subparagraph (B) and fails to comply with the requirements of competentthis authorityparagraph by the date that is days after such request is made shall attestbe subject to thea accuracycivil andmonetary completenesspenalty of informationan submittedamount andspecified madeby availablethe underSecretary thisfor subparagraph.each day (beginning with the day on which such health plan or health insurance issuer was failing to comply with such paragraph) during which such failure was ongoing.

Such attestationamount shall benot subjectexceed to$300 enforcementper underparticipant, subparagraphbeneficiary, (H)or and,covered whereindividual applicable,per shallday be deemed material to payments from the Federal Government received by the group health plan or health$10,000,000, insurancewhichever issuer.is lesser.

``(V)``(5) RegulationsDefinitions.--In promulgated pursuant to this sectionsubsection: shall provide that:

``(aa)``(A) TheIn-network Secretaryprovider.--The shallterm audit`in-network theprovider' threehas machine-the readablemeaning filesgiven requiredsuch byterm subparagraphin (E)(ii)section posted54.9815-2715A1(a)(2)(xii) byof notitle fewer26, thanCode 20of groupFederal healthRegulations. plans or health insurance issuers.

``(bb)``(B) TheIn-network Secretaryrate.--The ofterm Labor`in-network shallrate' auditmeans, thewith threerespect machine-readableto filesa requiredhealth byplan subparagraphand (E)(ii)an posteditem or service furnished by noa fewerprovider thanthat 200is groupa healthparticipating plansprovider with respect to such plan and item or serviceservice, providersthe furnishingcontracted third-rate partyin administratoreffect servicesbetween tosuch aplan groupand healthsuch plan.provider for such item or service.

``(cc) Findings, conclusions, and enforcement actions taken based on audits of the machine-readable files shall be reported annually to Congress no later than July 1 of the calendar year during which the files were audited.

Such report to Congress shall be accessible to the public.

``(iv) User guide.--Each health plan shall make available to the public instructions written in plain language explaining how individuals may search for information described in clause (ii) in files submitted in accordance with clause (iii).

``(F) Definitions.--In this paragraph:

``(i) Participating provider.--The term `participating provider' has the meaning given such term in section 2799A-1 of the Public Health Service Act.

``(ii) In-network rate.--The term `in- network rate' means, with respect to a health plan and an item or service furnished by a provider that is a participating provider with respect to such plan and item or service, the contracted rate in effect between such plan and such provider for such item or service.

``(G)``(6) ApplicabilityRulemaking.-- to``(A) accountableIn caregeneral.--The organizations.--AnSecretary applicableshall ACOimplement participatingthis insubsection thethrough Medicarenotice Sharedand Savingscomment Program,rulemaking asin definedaccordance inwith Sectionsection 553 of thetitle Social5, SecurityUnited ActStates (42Code. U.S.C.

1395jjj),The shallSecretary bemay subjectimplement to the requirementsmanner of thissubmission paragraphof asdata ifdescribed suchin applicableparagraph ACO(2)(C) isthrough asubregulatory groupguidance. health plan or health insurance issuer.

``(H)``(B) Enforcement.--Regulations.--Regulations ``(i)promulgated Inpursuant general.--Eachto year,this thesubsection Secretary shall auditprovide the threefollowing: machine-readable files required by subparagraph (E)(ii) posted by no fewer than 20 group health plans or health insurance issuers.

``(ii)``(i) NotificationThe andSecretary requestshall forannually correctiveaudit action.--In the casemachine-readable offiles arequired healthby planparagraph that(2)(B) failsposted toby comply with the requirements of this subsection, not laterfewer than 3050 daysgroup afterhealth theplans dateor on which the Secretary determines such failure exists, the Secretary shall submit to such health planinsurance aissuers notification of such determination, which shall include a request for acompliance correctivewith actionformat planand toaccessibility complystandards. with such requirements.

``(iii)``(ii) CivilThe monetarySecretary penalty.--Aof healthLabor planshall thatannually hasaudit receivedthe amachine-readable requestfiles forrequired aby correctiveparagraph action(2)(B) planposted under clause (ii) and fails to comply with the requirements of this subsection by thenot datefewer thatthan is250 90group dayshealth afterplans suchor requestservice isproviders madefurnishing shallthird-party beadministrator subjectservices to a civilgroup monetaryhealth penaltyplan of an amount specified by the Secretary for eachcompliance day (beginning with theformat dayand onaccessibility whichstandards. the Secretary first determined that such laboratory was failing to comply with such paragraph) during which such failure was ongoing.

Such``(iii) amountThe Secretary of Health and Human Services, in conjunction with the Secretary of Labor and the Secretary of the Treasury, shall notannually exceedissue $300a perreport memberto perCongress daythat orincludes $10,000,000,findings, whicheverconclusions, isand lesser.enforcement actions taken based on audits of the machine- readable files.

``(I)Such Rulemaking.--Thereport Secretary shall implementbe subparagraphsprovided (E)no throughlater (H)than throughJuly notice1 andfollowing commentthe rulemakingcalendar inyear accordanceduring withwhich sectionthe 553audits ofwere titlecompleted. 5, United States Code.''.

(c)The EffectiveSecretary Date.--of (1)Health Inand general.--TheHuman amendmentsServices madeshall bymake subsectionssuch (a)report andto (b)Congress shallaccessible applyto beginningthe Januarypublic.''. 1, 2026.

(b) Effective Date.-- (1) In general.--The amendments made by subsections (a) and (b) shall apply beginning January 1 of the year that begins on or after the date that is 1 year after the date of enactment of the Patients Deserve Price Tags Act.

72158)72158), or amendments made to such rule that are applicable before Januarythe 1,date 2026.of enactment of the Patients Deserve Price Tags Act.

(a) Group Health Plan Access to Information.-- (1) In general.--Paragraphgeneral.--Section (2)2799A-9 of section 408(b) of the EmployeePublic RetirementHealth IncomeService Security Act of(42 1974 (29 U.S.C.

1108(b))300gg-119) is amended by adding at the end the followingfollowing: new subparagraphs:

``(C)``(1) NoGroup health plan access to information.-- ``(A) In general.--No contract or arrangement for services, and no extension or renewal of such contract or arrangement, between a group health plan (as that termis offered by a specified large employer or that is defineda inspecified sectionlarge 733(a)plan of(as thissuch title)terms andare partydefined in interest,subparagraph including(F)) and a health care provider (which for purposes of this subparagraph, includes a health care facility), network or association of providers, service provider offering access to a network of providers, third-party administrator, health insurance issuer offering group or individual health insurance coverage, or pharmacy benefit manager, or any entity acting as an intermediary between the group health plan and the health care provider, network association of providers, service provider offering access to a network or association of providers (including a licensed health insurance issuer or third-party administrator), or pharmacy benefit manager (collectively referred to in this subsection as `Covered Service Providers'), is reasonable within the meaning of this paragraphsubsection unless such contract or arrangement-- ``(i) allows the responsible plan fiduciary (as that term is defined in subparagraphsection (B)(ii)(I)(ee))408(b)(2)(B)(ii)(I)(ee)) access to all claims and encounter information or data, and any documentation supporting claim payments, including, but not limited to, medical records and policy documents, or information or data described in sectionsubsection 724(a)(1)(B)(a)(1)(B) to-- ``(I) enable such entity to comply with the terms of the plan and any applicable law;

and ``(II) determine the accuracy or reasonableness of claims payment;

and ``(ii) does not-- ``(I) unreasonably limit or delay access, as determined by the Secretary but in any event not longer than 15 days, after a request for access by a plan fiduciary to such information or data;

``(VI) otherwise limit or unduly delay the group health plan, the plan sponsor, the plan administrator, or a business associate of such plan from accessing claims and encounter information or datadata; in a daily batch;

or ``(IX) limit public disclosure of de-identified or aggregate information.information;

``(D)(i)``(X) Coveredlimit Servicethe Providersdisclosure shallof, providewith informationrespect orto data under this paragraph in a mannerprovider consistentthat withfiles theclaims privacy and security regulations promulgated under thesuch Healthplan, Insurancewhether Portabilitya andCovered AccountabilityService ActProvider-- (referred``(aa) tohas inan thisownership subparagraphor asinvestment `HIPAA').interest;

``(ii)``(bb) Ahas group health plan that receives a disclosurecontrolling frominterest; a party in interest pursuant to subparagraph (B) or (C) shall comply with the privacy and security regulations promulgated under HIPAA.

``(iii)``(cc) Nothingis ina thismanagement subparagraphservices shallorganization; be construed to modify the requirements for the creation, receipt, maintenance, or transmission of protected health information under the HIPAA privacy regulation (as defined in section 1180(b)(3) of the Social Security Act) as they apply directly or indirectly to an entity pursuant to this paragraph.

``(iv) This subparagraph shall not be read to abridge or limit``(dd) theis disclosurea requirementssignificant underequity thisinvestor; paragraph or to impose additional privacy or security requirements on Covered Service Providers or plan sponsors.

``(E) A group health plan receiving information or data``(XI) underlimit this paragraph may disclose such information only in a manner that is consistent with the Healthdisclosure Insuranceof Portability and Accountability Act (HIPAA) and the privacyname and securityaddress regulations promulgated thereunder, regardless of theireach directperson or indirectentity applicabilitythat, with respect to the health plan orservice anyprovider-- entities``(aa) thathas couldan beownership or areinvestment businessinterest; associates.

``(F)``(bb) Informationhas madea availablecontrolling underinterest; this section shall conform to the following standards:

or ``(cc) is a significant equity investor.

``(B) Manner of providing information or data.-- ``(i) In general.--A Covered Service Provider shall provide information or data under this subsection in a manner consistent with the privacy regulations promulgated under section 13402(a) of the Health Information Technology for Economic and Clinical Health Act (42 U.S.C.

17932(a)) and consistent with the privacy regulations promulgated under the Health Insurance Portability and Accountability Act of 1996 in part 160 and subparts A and E of part 164 of title 45, Code of Federal Regulations (or successor regulations) (referred to in this paragraph as the `HIPAA privacy regulations') and shall restrict the use and disclosure of such information according to such privacy regulations and such HIPAA privacy regulations.

A Covered Service Provider shall not be required to disclose information or data under this subsection that could reasonably identify a participant or beneficiary through individually identifiable health information (as such term is defined under HIPAA privacy regulations).

``(ii) Additional requirements.--In carrying out this subsection, a Covered Service Provider shall comply with section 164.504(f) of title 45, Code of Federal Regulations (or a successor regulation).

``(iii) Rule of construction.-- ``(I) In general.--Nothing in this subsection shall be construed to modify the requirements for the creation, receipt, maintenance, or transmission of protected health information under the HIPAA privacy regulations.

``(II) Civil rights laws.--Nothing in this subsection shall be construed to affect the application of any Federal or State privacy or civil rights law, including the HIPAA privacy regulations, the Genetic Information Nondiscrimination Act of 2008 (Public Law 110-233) (including the amendments made by such Act), the Americans with Disabilities Act of 1990 (42 U.S.C.

et seq.), section 504 of the Rehabilitation Act of 1973 (29 U.S.C.

794), section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C.

18116), title VI of the Civil Rights Act of 1964 (42 U.S.C.

2000d), and title VII of the Civil Rights Act of 1964 (42 U.S.C.

2000e).

``(iv) Written notice.--Each plan year, a Covered Service Provider shall provide to each participant or beneficiary written notice informing the participant or beneficiary of the requirement that Covered Service Providers respond to requests to submit information or data under paragraph (1), as applicable, which may include incorporating such notification in plan documents provided to the participant or beneficiary, or providing individual notification.

``(v) Clarification regarding public disclosure of information.--Nothing in this subsection shall prevent a Covered Service Provider from placing reasonable restrictions on the public disclosure of the information or data described in paragraph (1), except that such Provider may not restrict disclosure of such report to the Department of Health and Human Services, the Department of Labor, or the Department of the Treasury.

``(vi) Limitation.--This paragraph shall not be construed to abridge or limit the disclosure requirements under this subsection or to impose additional privacy or security requirements on Covered Service Providers or plan sponsors.

``(C) Limitation on disclosure.--A group health plan receiving information or data under this subsection may disclose such information only in a manner that is consistent with HIPAA and the privacy and security regulations promulgated thereunder, regardless of their direct or indirect applicability to the plan or any entities that could be or are business associates.

A group health plan (and any business associate or other entity acting on behalf of such plan) may use such information or data only for purposes of plan administration and may not sell, license, or otherwise commercially exploit such information or data or provide such information or data to any third party that may take such action.

``(D) Requirements of information.--Information made available under this subsection shall conform to the following standards:

``(I) Institutional, professional, and dental claims shall be in ASC X12N 837D format or any subsequent standard.standard as established by the Secretary.

``(II) Pharmacy claims shall be in the National Council for Prescription Drug Programs (NCPDP) format or any subsequent standard.standard as established by the Secretary.

``(III) The files shall be unmodified copies of the files sent from the provider.provider, or, upon request, delivered in a machine readable format.

``(ii) All claim payment (or EFT, electronic funds transfer) and electronic remittance advice (ERA) notices sent by a Covered Service Provider shall be made available to the group health plan as ASC X12N files (or any other format as identified by the Secretary) in accordance with standards adopted by regulation under HIPAA.

``(iii) The contractual terms containing calculationpayment formulae,calculations and formulas, pricing methodologies, and other information used to determine the dollar value of reimbursement.reimbursement, in a format as specified by the Secretary.

``(iv) All non-claim costs shall be itemized and made available to the group health plan inas realrequested time through a web-based portal, through an API,application andprogram interface (API), through a downloadable CSVComma-Separated file.Value (CSV) file, and, as appropriate, through other downloadable machine-readable file types.

``(G)``(E) TheImplementation.--The Secretary shall implement subparagraphsthis (C)subsection through (F) through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.Code.

(2)``(F) CivilDefinitions.-- enforcement.--Subsection``(i) (c)In general.--The provisions of sectionsections 502408 and 410 of suchthe Employee Retirement Income Security Act (29of U.S.C.1974 shall apply with respect to terms used under this subsection.

``(ii) Specified large employer.--In this subsection, the term `specified large employer' means, in connection with a group health plan (including group health insurance coverage offered in connection with such a plan) established or maintained by a single employer, with respect to a calendar year or a plan year, as applicable, an employer who employed an average of at least 50 employees on business days during the preceding calendar year or plan year and who employs at least 1 employee on the first day of the calendar year or plan year.

``(iii) Specified large plan.--In this subsection, the term `specified large plan' means a group health plan (including group health insurance coverage offered in connection with such a plan) established or maintained by a plan sponsor described in clause (ii) or (iii) of section 3(16)(B) of the Employee Retirement Income Security Act of 1974 that had an average of at least 50 participants on business days during the preceding calendar year or plan year, as applicable.''.

(2) Civil enforcement.-- (A) Civil enforcement.--Subsection (c) of section of such Act (29 U.S.C.

``(13)``(13)(A) In the case of an agreement between a group health plan (as defined in section 733(a)), the plan sponsor of such plan (as defined in section 3(16)(B)), or the plan administrator of such plan (as defined in section 3(16)(A)) and a health care provider (which, for purposes of this paragraph, includes a health care facility), network or association of providers, service provider offering access to a network or association of providers, third-party administrator, or pharmacy benefit manager, that violates the provisions of section 724,724(b), the Secretary may assess a civil penalty against such provider, network or association, service provider offering access to a network or association of providers, third-party administrator, pharmacy benefit manager, or other service provider in the amount of up to $10,000 for each day during which such violation continues.

Such penalty shall be in addition to other penalties as may be prescribed by law.''.law.

(3)``(B) ExistingNothing provisionsin void.--Sectionsubparagraph 410(A) ofshall suchbe Actconstrued (29to U.S.C.permit the Secretary to regulate health care providers acting in their capacity as medical organizations furnishing items and services to patients.''.

(B) Existing provisions void.--Section 410 of such Act (29 U.S.C.

``(c) Any provision in an agreement or instrument shall be void as against public policy if such provision-- ``(1) unduly delays or limits a group health plan (as defined in section 733(a)), the plan sponsor of such plan (as defined in section 3(16)(B)), or the plan administrator of such plan (as defined in section 3(16)(A)) from accessing the claims and encounter information or data described in section 724(a)(1)(B);724(b)(1)(B);

(4)(C) Technical amendment.--Clauseamendments.--Section (i) of section 408(b)(2)(B) of such Act is(29 amendedU.S.C. by striking ``this clause'' and inserting ``this paragraph''.

(b)1108(b)(2)) Updatedis Attestationamended-- for(i) Pricein andclause Quality(i), Information.--Sectionby 724(a)(3)striking of``this theclause'' Employeeand Retirementinserting Income``this Securityparagraph''; Act of 1974 (29 U.S.C.

1185m(a)(3))and is(ii) amendedby toadding readat asthe follows:end the following:

``(3)``(xi) Attestation.--A ``(A)contract In general.--Subject to subparagraph (C), a group health plan or healtharrangement insuranceshall issuernot offeringbe groupreasonable healthunder insurancethis coveragesubparagraph shallif annuallyit submitfails to thecomply Secretary an attestation that such plan or issuer of such coverage is in compliance with thesection requirements724(b).''. of this subsection.

Such(b) attestationUpdated shallAttestation alsofor includePrice a statement verifying that-- ``(i) the information or data described under subparagraphs (A) and (B)Quality ofInformation.--Section paragraph2799A-9(a)(4) (1) is available upon request and provided to the group health plan, the plan sponsor, the plan administrator, or the business associate of such plan, or the issuerPublic inHealth aService timelyAct manner;(42 U.S.C.

300gg- 119(a)(4)) is amended to read as follows:

``(4) Attestation.-- ``(A) In general.--Subject to subparagraph (C), a group health plan or health insurance issuer offering group health insurance coverage shall annually submit to the Secretary an attestation that such plan or issuer of such coverage is in compliance with the requirements of this subsection.

Such attestation shall also include a statement verifying that-- ``(i) the information or data described under subparagraphs (A) and (B) of paragraph (1) is available upon request and provided to the group health plan, the plan sponsor, the plan administrator, or the business associate of such plan, or the issuer, as applicable, in a timely manner;

``(B) Limitation on submission.--Subjectsubmission.--A to clause (ii), a group health plan or issuer offering group health insurance coverage may not enter into an agreement with a third-party administrator or other service provider to submit the attestation required under subparagraph (A).

``(C) Exception.--In the case of a group health plan or health insurance issuer offering group health insurance coverage that is unable to obtain the information or data needed to submit the attestation required under subparagraph (A), such plan or issuer may submit a written statement in lieu of such attestation that includes-- ``(i) an explanation of why such plan or issuer was unsuccessful in obtaining such information or data, including whether such plan, the plan sponsor, or the plan administrator or issuer was limited or prevented from auditing, reviewing, or otherwise accessing such information or data;

(a) ERISAPHSA Amendments.--Amendment.--Part (1)D In general.--Subpart B of parttitle 7XXVII of subtitle B of the EmployeePublic RetirementHealth IncomeService Security Act of(42 1974 (29 U.S.C.

1021300gg-111 et seq.)seq.), as amended by section 6701(a) of the Consolidated Appropriations Act, 2026, is amended by adding at the end the following:

726.2799A-12.

``(a) In General.--For plan years beginning on or after January 1 of the year that begins on or after the date that is 21 yearsyear after the date of enactment of thisthe section,Patients Deserve Price Tags Act, no agreement between a group health plan (asthat definedis inoffered sectionby 733(a)),a thespecified planlarge sponsoremployer ofor suchthat planis (asa definedspecified inlarge section 3(16)(B)), the plan administrator(as of such planterms (asare defined in section 3(16)(A)),2799A-11(f)) or a businesshealth associateinsurance ofissuer suchoffering planindividual (asor definedgroup inhealth sectioncoverage 160.103(that ofmakes titlean 45,election Codesubject ofto Federalsubsection Regulations),(b)(5)) (orand a health insurance issuer offeringthat groupis healthoperating insuranceas coverage in connection with such a plan),third-party andadministrator, a health care provider, network or association of providers, third-party administrator, service provider offering access to a network of providers, pharmacy benefit managers, or any other third party (each referred to in this section as a `health plan service provider') is permissible if such agreement limits (or delays beyond the applicable reporting period described in subsection (b)(1)) the disclosure of information to such group health plans inand suchhealth insurance issuers in a manner that prevents suchany plan,health issuer,plan orservice entityprovider from providing the information described in subsection (b).(b)).

``(b) Required Disclosures.-- ``(1) Contents and frequency.--With respect to plan years beginning on or after the date that is 21 yearsyear after the date of enactment of this section, not less frequently than quarterly, a health plan service provider shall provide to the group health plan or the health insurance issuer offering individual or group health insurance coverage the following information at no cost to the group health plan or health insurance issuer:

``(A) The information described in section 724(a)(1)(B).

``(B) Any contractual and subcontractual calculation methodologies, pricing or fee schedules, or other formulae used to determine reimbursement amounts to providers and subcontractors, including methodologies, schedules, fee structures, and any applied adjustments or modifiers, with such information provided in a manner sufficiently detailed to enable the group health plan or health insurance issuer to accurately assess, verify, and ensure compliance with the terms of any contractual and subcontractual agreement governing the reimbursement amounts.

``(C) The total amount received or expected to be received by the health plan service provider or its subcontractors in provider or supplier rebates, fees, alternative discounts, and all other remuneration including amounts held in escrow or variance accounts that has been paid or is to be paid for claims incurred and administrative services including data sales or network payments.

``(D) The total amount paid or expected to be paid by the health plan service provider or to subcontractors in rebates, fees, contractual arrangements, and all other remuneration that has been paid or is expected to be paid for administrative and other services.

``(E) All payment data and reconciliation information related to alternative compensation arrangements including accountable care organizations, value-based programs, shared savings programs, incentive compensation, bundled payments, capitation arrangements, performance payments, and any other reimbursement or payment models, where the group health plan or health insurance issuer paid fees, incurred obligations, or made payments in connection with the group health plan related to such arrangements.

``(2) Privacy requirements.-- ``(A) In general.--Health plan service providers shall provide the information or data under paragraph (1) consistent with the privacy, security, and breach notification regulations at parts 160 and 164 of title 45, Code of Federal Regulations, promulgated under subtitle F of the Health Insurance Portability and Accountability Act of 1996, subtitle D of the Health Information Technology for Clinical Health Act of 2009, and section 1180 of the Social Security Act, and shall restrict the use and disclosure of such information according to such privacy, security, and breach notification regulations.

An entity that receives a disclosure from a party in interest pursuant to subparagraph (B) or (C) shall comply with the privacy and security regulations promulgated under HIPAA.

``(B) Restrictions.--A group health plan shall comply with section 164.504(f) of title 45, Code of Federal Regulations (or a successor regulation), and a plan sponsor shall act in accordance with the terms of the agreement described in such section.

``(C) Rule of construction.--Nothing in this section shall be construed to modify the requirements for the creation, receipt, maintenance, or transmission of protected health information under the HIPAA privacy regulations (45 C.F.R.

parts 160 and 164, subparts A and E).

``(3) Disclosure and redisclosure.-- ``(A) In general.--A group health plan receiving information under paragraph (1) may disclose such information only-- ``(i) to the entity from which the information was received or to that entity's business associates or to the group health plan's business associates as defined in section 160.103 of title 45, Code of Federal Regulations (or successor regulations);

or ``(ii) as permitted by the HIPAA Privacy Rule (45 C.F.R.

parts 160 and 164, subparts A and E).

``(B) Availability of information.--To the extent the information required by this subsection is made available to the health insurance issuer offering group health insurance in connection with a group health plan, the health insurance issuer shall make such information available, at the same time, in the same format, and at no cost, to the group health plan.

``(C) Failure to provide.--The obligation to provide information pursuant to this subsection shall exist notwithstanding the presence of any formal data- sharing agreement between the parties.

Failure to provide the required information as specified shall constitute a violation of this Act and the Secretary shall initiate enforcement action under section 502 within 90 days of becoming aware of a violation of this section, except that nothing in this section shall be construed to limit the Secretary's existing authority under the Act.

``(4) Data format standards.--All data and information provided pursuant to this subsection shall comply with the following standards:

``(A) All claims from a healthcare provider shall be made to the group health plan in accordance with transactions standards adopted under HIPAA, as follows:

``(i) Institutional, professional, and dental claims and adjustments to these claims shall be in ASC X12N 837 format, as transmitted by the provider, or, in the case of paper claims, converted to the ASC X12N 837 electronic format.

``(ii) Prescription drug claims shall be in the National Council for Prescription Drug Programs (NCPDP) format, as transmitted by the provider, or in the case of paper claims, converted to the NCPDP electronic format.

``(iii) Such data shall be provided at no cost to the group health plan.

``(B) All claim payment (or EFT, electronic funds transfer) and electronic remittance advice (ERA) information sent by a health plan service provider shall be provided to the group health plan or health insurance issuer in the ASC X12N 835 format in accordance with transaction standards adopted under HIPAA, unmodified from the form in which it was transmitted to the healthcare provider.

Such information shall be provided at no cost to the group health plan or health insurance issuer.

``(C) The Secretary may modify the standards set forth in this paragraph as necessary to align with any changes adopted by the Secretary of Health and Human Services pursuant to the authority provided under section 1173 of the Social Security Act (42 U.S.C.

1320d-2).

``(c) Prohibited Contractual Provisions.--Any provision in an agreement between a group health plan, the plan sponsor, the plan administrator, or a business associate of such plan or a health insurance issuer and a health plan service provider that unduly delays or limits a group health plan's or health insurance issuer's access to information described in this section or that restricts the format or timing of the provision of such information in a manner that is inconsistent with the requirements of this section shall be prohibited and, if a group health plan or health insurance issuer enters into such agreement, shall be deemed void as against public policy.

``(d) Penalties for Non-Compliance.--Any failure by a health plan service provider to comply with the requirements of this section shall result in the imposition of a civil penalty of $100,000 for each day the violation continues, in addition to any other penalties prescribed by law.

``(e) Regulations.--The Secretary shall implement this section through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.

(2) Penalty.-- (A) In general.--Section 502(a) of the Employee Retirement Income Security Act of 1974 (29 U.S.C.

1132(a)) is amended by adding at the end the following new paragraph:

``(14) The Secretary may assess a civil penalty against any person of $100,000 per day for each violation by any person of section 726.''.

(B) Technical amendment.--Paragraph (6) of section 502(a) of the Employee Retirement Income Security Act of 1974 (29 U.S.C.