H.R. 9393

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9393 Introduced in House (IH)]

<DOC>

119th CONGRESS
2d Session
H. R. 9393

To promote price transparency in the health care sector.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

June 23, 2026

Mr. Guthrie (for himself and Mr. Pallone) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committees on Ways and Means, and Education and 
Workforce, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the 
jurisdiction of the committee concerned

_______________________________________________________________________

A BILL

To promote price transparency in the health care sector.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Lower Costs, More Transparency Act 
of 2026''.

SEC. 2. HOSPITAL PRICE TRANSPARENCY.

(a) Medicare.--
(1) In general.--Part E of title XVIII of the Social 
Security Act (42 U.S.C. 1395x et seq.) is amended by adding at 
the end the following new section:

``SEC. 1899D. HOSPITAL PRICE TRANSPARENCY.

``(a) Transparency Requirement.--
``(1) In general.--Beginning January 1, 2028, each 
specified hospital that receives payment under this title for 
furnishing items and services shall comply with the price 
transparency requirement described in paragraph (2).
``(2) Requirement described.--
``(A) In general.--For purposes of paragraph (1), 
the price transparency requirement described in this 
paragraph is, with respect to a specified hospital, 
that such hospital, in accordance with a method and 
format established by the Secretary under subparagraph 
(C), compile and make public (without subscription and 
free of charge) for each year--
``(i) all of the hospital's standard 
charges (including the information described in 
subparagraph (B)) for each item and service 
furnished by such hospital;
``(ii) information in a consumer-friendly 
format (as specified by the Secretary)--
``(I) on the hospital's prices 
(including the information described in 
subparagraph (B)) for 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; and
``(II) that includes, 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;
``(iii) each type 2 national provider 
identifier associated with the hospital or a 
unit of the hospital; and
``(iv) an attestation that all information 
made public pursuant to this subparagraph is 
complete and accurate.
``(B) Information described.--For purposes of 
subparagraph (A), the information described in this 
subparagraph is, with respect to standard charges and 
prices, as applicable, made public by a specified 
hospital, the following:
``(i) A plain language description (as 
specified by the Secretary) of each item or 
service, accompanied by, as applicable, the 
Healthcare Common Procedure Coding System code, 
the diagnosis-related group, the national drug 
code, or other identifier used or approved by 
the Centers for Medicare & Medicaid Services.
``(ii) The gross charge, as applicable, 
expressed as a dollar amount, for each such 
item or service, when provided in, as 
applicable, the inpatient setting and 
outpatient department setting.
``(iii) For each such item or service when 
provided in, as applicable, the inpatient and 
outpatient department settings--
``(I) the discounted cash price, as 
applicable, expressed as a dollar 
amount; or
``(II) in the case no discounted 
cash price is available for such item 
or service, the median cash price 
charged by the hospital (not including 
charity care) to self-pay individuals 
for such item or service when provided 
in such settings for the previous three 
years, expressed as a dollar amount.
``(iv) With respect to prices made public 
pursuant to subparagraph (A)(ii), a link to a 
consumer-friendly document that clearly 
explains the hospital's charity care policy 
that includes, if applicable, any sliding scale 
payment structure employed for determining 
prices.
``(v) The payer-specific negotiated 
charges, as applicable, clearly associated with 
the name of the third party payer and plan and 
expressed as a dollar amount, that apply to 
each such item or service when provided in, as 
applicable, the inpatient setting and 
outpatient department setting.
``(vi) The de-identified maximum and 
minimum negotiated charges, as applicable, for 
each such item or service, not including any 
such charge that is $0.
``(vii) Any other additional information 
the Secretary may require (in consultation with 
stakeholders) 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.
``(C) Uniform method and format.--Not later than 
January 1, 2028, the Secretary shall establish a 
standard, uniform method and format for specified 
hospitals to use in compiling and making public 
standard charges pursuant to subparagraph (A)(i) and a 
standard, uniform method and format for such hospitals 
to use in compiling and making public prices pursuant 
to subparagraph (A)(ii). Such methods and formats--
``(i) shall, in the case of such method and 
format for making public standard charges 
pursuant to subparagraph (A)(i), ensure that 
such charges are made available in a machine-
readable format (or a successor technology 
specified by the Secretary);
``(ii) may be similar to any template made 
available by the Centers for Medicare & 
Medicaid Services as of the date of the 
enactment of this subparagraph;
``(iii) shall meet such standards as 
determined appropriate by the Secretary in 
order to ensure the accessibility and usability 
of such charges and prices; and
``(iv) shall be updated as determined 
appropriate by the Secretary, in consultation 
with stakeholders.
``(3) Monitoring compliance.--The Secretary shall establish 
processes to monitor and assess specified hospitals' compliance 
with this subsection. Such processes shall include processes 
relating to the following:
``(A) The evaluation and analysis of complaints 
made by individuals or other entities relating to such 
hospitals' compliance with this subsection.
``(B) The use of audits to ensure such hospitals' 
compliance with this subsection.
``(C) The obtaining of additional information from 
such hospitals to determine such hospitals' compliance 
with this subsection (as determined appropriate by the 
Secretary).
``(4) Enforcement.--
``(A) In general.--In the case of a specified 
hospital that fails to comply with the requirements of 
this subsection--
``(i) not later than 30 days after the date 
on which the Secretary determines such failure 
exists, the Secretary shall submit to such 
hospital a notification of such determination 
(which may include, as determined appropriate 
by the Secretary, a request for a corrective 
action plan (to be submitted not later than 45 
days after such request is made) to comply with 
such requirements); and
``(ii) in the case of a hospital that does 
not receive a request for a corrective action 
plan as part of a notification submitted by the 
Secretary under clause (i)--
``(I) the Secretary shall, not 
later than 60 days after such 
notification is sent, determine whether 
such hospital is in compliance with 
such requirements; and
``(II) if the Secretary determines 
under subclause (I) that such hospital 
is not in compliance with such 
requirements, the Secretary shall 
either--
``(aa) submit to such 
hospital a request for a 
corrective action plan (to be 
submitted not later than 45 
days after such request is 
made) to comply with such 
requirements; or
``(bb) if the Secretary 
determines that such hospital 
has not taken meaningful 
actions to come into compliance 
since such notification was 
sent, impose a civil monetary 
penalty in accordance with 
subparagraph (B).
``(B) Civil monetary penalty.--
``(i) In general.--Subject to clause (vii), 
in addition to any other enforcement actions or 
penalties that may apply under another 
provision of Federal law, a specified hospital 
that has received a request for a corrective 
action plan under clause (i) or (ii) of 
subparagraph (A) and fails to comply with the 
requirements of this subsection by the date 
that is 90 days after such request is made (or, 
if such hospital has submitted such a 
corrective action plan not later than 45 days 
after the date such request was made, by the 
date that is 90 days after the date of the 
submission of such corrective action plan), and 
a specified hospital with respect to which the 
Secretary has made a determination described in 
clause (ii)(II)(bb) of such subparagraph, shall 
be subject to a civil monetary penalty of an 
amount specified by the Secretary for each day 
(beginning with the day on which the Secretary 
first determined that such hospital was not 
complying with such requirements) during which 
such failure was ongoing. Such amount shall not 
exceed--
``(I) in the case of a specified 
hospital with 30 or fewer beds, $300 
per day (or, in the case of such a 
hospital that has been noncompliant 
with such requirements for a 1-year 
period or longer, beginning with the 
first day following such 1-year period, 
$400 per day);
``(II) in the case of a specified 
hospital with more than 30 beds but 
fewer than 101 beds, $12.50 per bed per 
day (or, in the case of such a hospital 
that has been noncompliant with such 
requirements for a 1-year period or 
longer, beginning with the first day 
following such 1-year period, $15 per 
bed per day);
``(III) in the case of a specified 
hospital with more than 100 beds but 
fewer than 201 beds, $17.50 per bed per 
day (or, in the case of such a hospital 
that has been noncompliant with such 
requirements for a 1-year period or 
longer, beginning with the first day 
following such 1-year period, $20 per 
bed per day);
``(IV) in the case of a specified 
hospital with more than 200 beds but 
fewer than 501 beds, $20 per bed per 
day (or, in the case of such a hospital 
that has been noncompliant with such 
requirements for a 1-year period or 
longer, beginning with the first day 
following such 1-year period, $25 per 
bed per day); and
``(V) in the case of a specified 
hospital with more than 500 beds, $25 
per bed per day (or, in the case of 
such a hospital that has been 
noncompliant with such requirements for 
a 1-year period or longer, beginning 
with the first day following such 1-
year period, $35 per bed per day).
``(ii) Increase authority.--In applying 
this subparagraph with respect to violations 
occurring in 2029 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 
specified hospital under clause (i)(I);
``(II) the limitations on the per 
bed per day amount of any penalty 
applicable under any of subclauses (II) 
through (V) of clause (i); and
``(III) the amounts specified in 
clause (iii)(II).
``(iii) Persistent noncompliance.--
``(I) In general.--In the case of a 
specified hospital (other than a 
specified hospital with 30 or fewer 
beds) that the Secretary has determined 
to be knowingly and willfully 
noncompliant with the provisions of 
this subsection for two or more 6-month 
periods during any 3-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.
``(II) Specified amount.--For 
purposes of subclause (I), the amount 
specified in this subclause is, with 
respect to a specified hospital--
``(aa) with more than 30 
beds but fewer than 101 beds, 
an amount that is not less than 
$500,000 and not more than 
$1,000,000;
``(bb) with more than 100 
beds but fewer than 301 beds, 
an amount that is greater than 
$1,000,000 and not more than 
$2,000,000;
``(cc) with more than 300 
beds but fewer than 501 beds, 
an amount that is greater than 
$2,000,000 and not more than 
$4,000,000; and
``(dd) with more than 500 
beds, and amount that is not 
less than $5,000,000 and not 
more than $10,000,000.
``(iv) Authority to waive or reduce 
penalty.--
``(I) Hospitals located in rural or 
underserved areas.--
``(aa) In general.--Subject 
to item (bb), the Secretary may 
waive any penalty, or reduce 
any penalty by not more than 75 
percent, otherwise applicable 
under this subparagraph with 
respect to a specified hospital 
located in a rural or 
underserved area if the 
Secretary certifies that 
imposition of such penalty 
would result in an immediate 
threat to access to care for 
individuals in the service area 
of such hospital.
``(bb) Limitation on 
application.--The Secretary may 
not elect to waive a penalty 
under item (aa) with respect to 
a specified hospital more than 
once in a 6-year period and may 
not elect to reduce such a 
penalty with respect to such a 
hospital more than once in such 
a period. Nothing in the 
preceding sentence shall be 
construed as prohibiting the 
Secretary from both waiving and 
reducing a penalty with respect 
to a specified hospital during 
a 6-year period.
``(II) Reduction if hearing 
waived.--The Secretary may reduce any 
penalty otherwise applicable under this 
subparagraph (as reduced, if 
applicable, under subclause (I)) by not 
more than 35 percent if the specified 
hospital that is the subject of such 
penalty agrees to waive any right of 
such hospital to a hearing before an 
administrative law judge with respect 
to the imposition of such penalty.
``(v) Hardship exemption.--Notwithstanding 
any limit on the waiver or reduction of a 
penalty under clause (iv), the Secretary may 
waive any penalty with respect to a specified 
hospital on a case-by-case basis if the 
Secretary determines that a circumstance exists 
interfering with such hospital's ability to 
comply with the provisions of this subsection 
(such as a natural disaster (as defined in 
section 602(a) of the Robert T. Stafford 
Disaster Relief and Emergency Assistance Act), 
a public health emergency, or other similar or 
unexpected catastrophe or similar situation).
``(vi) 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 hospitals requesting 
such assistance.
``(vii) 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.
``(viii) Nonduplication of certain 
penalties.--
``(I) In general.--The Secretary 
may not subject a specified hospital to 
a civil monetary penalty under this 
subparagraph with respect to 
noncompliance with the provisions of 
this subsection for a period if the 
Secretary has imposed a civil monetary 
penalty on such hospital under section 
2718(f) of the Public Health Service 
Act for failure to comply with the 
provisions of such section for such 
period.
``(II) Prioritization.--In the case 
of a hospital that the Secretary 
determines to be in violation of the 
provisions of this subsection and of 
section 2718(f) of the Public Health 
Service Act, the Secretary shall impose 
penalties as prescribed in such section 
2718(f) in lieu of any penalties 
prescribed in this subsection.
``(C) Publication of hospital price transparency 
information.--Beginning on January 1, 2028, the 
Secretary shall make publicly available on the public 
website of the Centers for Medicare & Medicaid Services 
information with respect to compliance with the 
requirements of this subsection and enforcement 
activities undertaken by the Secretary under this 
subsection. Such information shall be updated in real 
time (if practicable) and include--
``(i) the number of reviews of compliance 
with this subsection undertaken by the 
Secretary;
``(ii) the number of notifications 
described in subparagraph (A)(i) sent by the 
Secretary;
``(iii) the identity of each specified 
hospital that was sent such a notification and 
a description of the nature of such hospital's 
noncompliance with this subsection;
``(iv) the amount of any civil monetary 
penalty imposed on such hospital under 
subparagraph (B);
``(v) whether such hospital subsequently 
came into compliance with this subsection;
``(vi) any waivers or reductions of 
penalties made pursuant to a certification by 
the Secretary under subparagraph (B)(iv), 
including--
``(I) the name of any specified 
hospital that received such a waiver or 
reduction;
``(II) the dollar amount of each 
such penalty so waived or reduced; and
``(III) the rationale for the 
granting of each such waiver or 
reduction, but only to the extent that 
such rationale does not make public 
commercially sensitive information; and
``(vii) any other information as determined 
by the Secretary.
``(b) Ensuring Accessibility Through Implementation.--In 
implementing this section, the Secretary shall through rulemaking 
ensure that a hospital making public charges and prices pursuant to 
this section takes reasonable steps (as specified by the Secretary) to 
ensure the accessibility of such charges and information to individuals 
with limited English proficiency. Such steps may include the hospital's 
provision of interpretation services or the hospital's provision of 
translations of charges and information.
``(c) Definitions.--For purposes of this section:
``(1) 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.
``(2) Gross charge.--The term `gross charge' means the 
charge for an individual item or service that is reflected on a 
specified hospital's chargemaster or provider of service or 
supplier's, as applicable, chargemaster (or similar list of 
prices), absent any discounts.
``(3) 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.
``(4) 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.
``(5) Specified hospital.--The term `specified hospital' 
means a hospital (as defined in section 1861(e)), a critical 
access hospital (as defined in section 1861(mmm)(1)), or a 
rural emergency hospital (as defined in section 1861(kkk)).
``(6) 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.''.
(2) Rule of construction.--Nothing in the amendments made 
by this subsection may be construed to impede, prohibit, or 
prevent the Secretary of Health and Human Services from 
implementing, executing, carrying out, or enforcing the 
requirements of section 2718(f) of the Public Health Service 
Act.
(b) PHSA.--
(1) In general.--Section 2718 of the Public Health Service 
Act (42 U.S.C. 300gg-18) is amended by adding at the end the 
following new subsection:
``(f) Hospital Transparency Requirement.--
``(1) In general.--Beginning January 1, 2028, each hospital 
operating within the United States (including a specified 
hospital (as defined in section 1899D of the Social Security 
Act)) shall comply with the price transparency requirement 
described in paragraph (2).
``(2) Requirement described.--
``(A) In general.--For purposes of paragraph (1), 
the price transparency requirement described in this 
paragraph is, with respect to a hospital, that such 
hospital, in accordance with a method and format 
established by the Secretary under subparagraph (C), 
compile and make public (without subscription and free 
of charge) for each year--
``(i) all of the hospital's standard 
charges (including the information described in 
subparagraph (B)) for each item and service 
furnished by such hospital;
``(ii) information in a consumer-friendly 
format (as specified by the Secretary)--
``(I) on the hospital's prices 
(including the information described in 
subparagraph (B)) for 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; and
``(II) that includes, 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;
``(iii) each type 2 national provider 
identifier associated with the hospital or a 
unit of the hospital; and
``(iv) an attestation that all information 
made public pursuant to this subparagraph is 
complete and accurate.
``(B) Information described.--For purposes of 
subparagraph (A), the information described in this 
subparagraph is, with respect to standard charges and 
prices, as applicable, made public by a hospital, the 
following:
``(i) A plain language description (as 
specified by the Secretary) of each item or 
service, accompanied by, as applicable, the 
Healthcare Common Procedure Coding System code, 
the diagnosis-related group, the national drug 
code, current procedure terminology codes, or 
other identifier used or approved by the 
Centers for Medicare & Medicaid Services.
``(ii) The gross charge, as applicable, 
expressed as a dollar amount (as specified by 
the Secretary), for each such item or service, 
when provided in, as applicable, the inpatient 
setting and outpatient department setting.
``(iii) For each such item or service when 
provided in, as applicable, the inpatient and 
outpatient department settings--
``(I) the discounted cash price, as 
applicable, expressed as a dollar 
amount; or
``(II) in the case no discounted 
cash price is available for such item 
or service, the median cash price 
charged by the hospital (not including 
charity care) to self-pay individuals 
for such item or service when provided 
in such settings for the previous three 
years, expressed as a dollar amount.
``(iv) With respect to prices made public 
pursuant to subparagraph (A)(ii), a link to a 
consumer-friendly document that clearly 
explains the hospital's charity care policy 
that includes, if applicable, any sliding scale 
payment structure employed for determining 
prices.
``(v) The payer-specific negotiated 
charges, as applicable, clearly associated with 
the name of the third party payer and plan and 
expressed as a dollar amount, that apply to 
each such item or service when provided in, as 
applicable, the inpatient setting and 
outpatient department setting.
``(vi) The de-identified maximum and 
minimum negotiated charges, as applicable, for 
each such item or service, not including any 
such charge that is $0.
``(vii) Any other additional information 
the Secretary may require (in consultation with 
stakeholders) 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.
``(C) Uniform method and format.--Not later than 
January 1, 2028, the Secretary shall establish a 
standard, uniform method and format for hospitals to 
use in compiling and making public standard charges 
pursuant to subparagraph (A)(i) and a standard, uniform 
method and format for such hospitals to use in 
compiling and making public prices pursuant to 
subparagraph (A)(ii). Such methods and formats--
``(i) shall, in the case of such method and 
format for making public standard charges 
pursuant to subparagraph (A)(i), ensure that 
such charges are made available in a machine-
readable format (or a successor technology 
specified by the Secretary);
``(ii) may be similar to any template made 
available by the Centers for Medicare & 
Medicaid Services as of the date of the 
enactment of this subparagraph;
``(iii) shall meet such standards as 
determined appropriate by the Secretary in 
order to ensure the accessibility and usability 
of such charges and prices; and
``(iv) shall be updated as determined 
appropriate by the Secretary, in consultation 
with stakeholders.
``(3) Monitoring compliance.--The Secretary shall establish 
processes to monitor and assess specified hospitals' compliance 
with this subsection. Such processes shall include processes 
relating to the following:
``(A) The evaluation and analysis of complaints 
made by individuals or other entities relating to such 
hospitals' compliance with this subsection.
``(B) The use of audits to ensure such hospitals' 
compliance with this subsection.
``(C) The obtaining of additional information from 
such hospitals to determine such hospitals' compliance 
with this subsection (as determined appropriate by the 
Secretary).
``(4) Enforcement.--
``(A) In general.--In the case of a hospital that 
fails to comply with the requirements of this 
subsection--
``(i) not later than 30 days after the date 
on which the Secretary determines such failure 
exists, the Secretary shall submit to such 
hospital a notification of such determination 
(which may include, as determined appropriate 
by the Secretary, a request for a corrective 
action plan (to be submitted not later than 45 
days after such request is made) to comply with 
such requirements); and
``(ii) in the case of a hospital that does 
not receive a request for a corrective action 
plan as part of a notification submitted by the 
Secretary under clause (i)--
``(I) the Secretary shall, not 
later than 60 days after such 
notification is sent, determine whether 
such hospital is in compliance with 
such requirements; and
``(II) if the Secretary determines 
under subclause (I) that such hospital 
is not in compliance with such 
requirements, the Secretary shall 
either--
``(aa) submit to such 
hospital a request for a 
corrective action plan (to be 
submitted not later than 45 
days after such request is 
made) to comply with such 
requirements; or
``(bb) if the Secretary 
determines that such hospital 
has not taken meaningful 
actions to come into compliance 
since such notification was 
sent, impose a civil monetary 
penalty in accordance with 
subparagraph (B).
``(B) Civil monetary penalty.--
``(i) In general.--In addition to any other 
enforcement actions or penalties that may apply 
under another provision of Federal law, a 
hospital that has received a request for a 
corrective action plan under clause (i) or (ii) 
of subparagraph (A) and fails to comply with 
the requirements of this subsection by the date 
that is 90 days after such request is made (or, 
if such hospital has submitted such a 
corrective action plan not later than 45 days 
after the date such request was made, by the 
date that is 90 days after the date of the 
submission of such corrective action plan), and 
a hospital with respect to which the Secretary 
has made a determination described in clause 
(ii)(II)(bb) of such subparagraph, shall be 
subject to a civil monetary penalty of an 
amount specified by the Secretary for each day 
(beginning with the day on which the Secretary 
first determined that such hospital was not 
complying with such requirements) during which 
such failure was ongoing. Such amount shall not 
exceed--
``(I) in the case of a hospital 
with 30 or fewer beds, $300 per day 
(or, in the case of such a hospital 
that has been noncompliant with such 
requirements for a 1-year period or 
longer, beginning with the first day 
following such 1-year period, $400 per 
bed per day);
``(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);
``(III) in the case of a hospital 
with more than 100 beds but fewer than 
201 beds, $17.50 per bed per day (or, 
in the case of such a hospital that has 
been noncompliant with such 
requirements for a 1-year period or 
longer, beginning with the first day 
following such 1-year period, $20 per 
bed per day);
``(IV) in the case of a hospital 
with more than 200 beds but fewer than 
501 beds, $20 per bed per day (or, in 
the case of such a hospital that has 
been noncompliant with such 
requirements for a 1-year period or 
longer, beginning with the first day 
following such 1-year period, $25 per 
bed per day); and
``(V) in the case of a hospital 
with more than 500 beds, $25 per bed 
per day (or, in the case of such a 
hospital that has been noncompliant 
with such requirements for a 1-year 
period or longer, beginning with the 
first day following such 1-year period, 
$35 per bed per day).
``(ii) Increase authority.--In applying 
this subparagraph with respect to violations 
occurring in 2029 or a subsequent year, the 
Secretary may through notice and comment 
rulemaking increase--
``(I) the limitation on the per day 
amount of any penalty applicable to a 
hospital under clause (i)(I);
``(II) the limitations on the per 
bed per day amount of any penalty 
applicable under any of subclauses (II) 
through (V) of clause (i); and
``(III) the amounts specified in 
clause (iii)(II).
``(iii) Persistent noncompliance.--
``(I) In general.--In the case of a 
hospital (other than a hospital with 30 
or fewer beds) that the Secretary has 
determined to be knowingly and 
willfully noncompliant with the 
provisions of this subsection for two 
or more 6-month periods during any 3-
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.
``(II) Specified amount.--For 
purposes of subclause (I), the amount 
specified in this subclause is, with 
respect to a hospital--
``(aa) with more than 30 
beds but fewer than 101 beds, 
an amount that is not less than 
$500,000 and not more than 
$1,000,000;
``(bb) with more than 100 
beds but fewer than 301 beds, 
an amount that is greater than 
$1,000,000 and not more than 
$2,000,000;
``(cc) with more than 300 
beds but fewer than 501 beds, 
an amount that is greater than 
$2,000,000 and not more than 
$4,000,000; and
``(dd) with more than 500 
beds, and amount that is not 
less than $5,000,000 and not 
more than $10,000,000.
``(iv) Authority to waive or reduce 
penalty.--
``(I) Hospitals located in rural or 
underserved areas.--
``(aa) In general.--Subject 
to item (bb), the Secretary may 
waive any penalty, or reduce 
any penalty by not more than 75 
percent, otherwise applicable 
under this subparagraph with 
respect to a hospital located 
in a rural or underserved area 
if the Secretary certifies that 
imposition of such penalty 
would result in an immediate 
threat to access to care for 
individuals in the service area 
of such hospital.
``(bb) Limitation on 
application.--The Secretary may 
not elect to waive a penalty 
under item (aa) with respect to 
a hospital more than once in a 
6-year period and may not elect 
to reduce such a penalty with 
respect to such a hospital more 
than once in such a period. 
Nothing in the preceding 
sentence shall be construed as 
prohibiting the Secretary from 
both waiving and reducing a 
penalty with respect to a 
hospital during a 6-year 
period.
``(II) Reduction if hearing 
waived.--The Secretary may reduce any 
penalty otherwise applicable under this 
subparagraph (as reduced, if 
applicable, under subclause (I)) by not 
more than 35 percent if the specified 
hospital that is subject of such 
penalty agrees to waive any right of 
such hospital to a hearing before an 
administrative law judge with respect 
to the imposition of such penalty.
``(v) Provision of technical assistance.--
The Secretary shall, to the extent practicable, 
provide technical assistance relating to 
compliance with the provisions of this 
subsection to hospitals requesting such 
assistance.
``(vi) Hardship exemption.--Notwithstanding 
any limit on the waiver or reduction of a 
penalty under clause (iv), the Secretary may 
waive any penalty with respect to a hospital on 
a case-by-case basis if the Secretary 
determines that a circumstance exists 
interfering with such hospital's ability to 
comply with the provisions of this subsection 
(such as a natural disaster (as defined in 
section 602(a) of the Robert T. Stafford 
Disaster Relief and Emergency Assistance Act), 
a public health emergency, or other similar or 
unexpected catastrophe or similar situation).
``(vii) 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.
``(viii) Nonduplication of penalties.--
``(I) In general.--The Secretary 
may not subject a hospital to a civil 
monetary penalty under this 
subparagraph with respect to 
noncompliance with the provisions of 
this subsection for a period if the 
Secretary has imposed a civil monetary 
penalty on such hospital under section 
1899D of the Social Security Act for 
failure to comply with the provisions 
of such section for such period.
``(II) Prioritization.--In the case 
of a hospital that the Secretary 
determines to be in violation of the 
provisions of this subsection and of 
section 1899D of the Social Security 
Act, the Secretary shall impose 
penalties as prescribed in this 
subsection in lieu of any penalties 
prescribed in such section 1899D.
``(C) Publication of hospital price transparency 
information.--Beginning on January 1, 2028, the 
Secretary shall make publicly available on the public 
website of the Centers for Medicare & Medicaid Services 
information with respect to compliance with the 
requirements of this subsection and enforcement 
activities undertaken by the Secretary under this 
subsection. Such information shall be updated in real 
time (if practicable) and include--
``(i) the number of reviews of compliance 
with this subsection undertaken by the 
Secretary;
``(ii) the number of notifications 
described in subparagraph (A)(i) sent by the 
Secretary;
``(iii) the identity of each hospital that 
was sent such a notification and a description 
of the nature of such hospital's noncompliance 
with this subsection;
``(iv) the amount of any civil monetary 
penalty imposed on such hospital under 
subparagraph (B);
``(v) whether such hospital subsequently 
came into compliance with this subsection;
``(vi) any waivers or reductions of 
penalties made pursuant to a certification by 
the Secretary under subparagraph (B)(iv), 
including--
``(I) the name of any hospital that 
received such a waiver or reduction;
``(II) the dollar amount of each 
such penalty so waived or reduced; and
``(III) the rationale for the 
granting of each such waiver or 
reduction, but only to the extent that 
such rationale does not make public 
commercially sensitive information; and
``(vii) any other information as determined 
by the Secretary.
``(5) Ensuring accessibility through implementation.--In 
implementing this subsection, the Secretary shall through 
rulemaking ensure that a hospital making public charges and 
prices pursuant to this section takes reasonable steps (as 
specified by the Secretary) to ensure the accessibility of such 
charges and information to individuals with limited English 
proficiency. Such steps may include the hospital's provision of 
interpretation services or the hospital's provision of 
translations of charges and information.
``(6) Definitions.--For purposes of this subsection:
``(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 
hospital-furnished item or service.
``(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.
``(C) 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.
``(D) 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.
``(E) 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.''.
(2) Conforming amendments.--Section 2718 of the Public 
Health Service Act (42 U.S.C. 300gg-18) is amended--
(A) in subsection (b)(3), by inserting ``(other 
than the provisions of subsection (f))'' after ``this 
section''; and
(B) in subsection (e), by adding at the end the 
following new sentence: ``The preceding provisions of 
this subsection shall not apply beginning on January 1, 
2028.''.
(3) Rule of construction.--Nothing in the amendments made 
by this subsection may be construed to impede, prohibit, or 
prevent the Secretary of Health and Human Services from 
implementing, executing, carrying out, or enforcing the 
requirements of section 1899D of the Social Security Act.

SEC. 3. CLINICAL DIAGNOSTIC LABORATORY TEST PRICE TRANSPARENCY.

Section 1846 of the Social Security Act (42 U.S.C. 1395w-2) is 
amended--
(1) in the header, by inserting ``and additional 
requirements'' after ``sanctions''; and
(2) by adding at the end the following new subsection:
``(c) Price Transparency Requirement.--
``(1) In general.--Beginning January 1, 2028, any 
applicable laboratory that receives payment under this title 
for furnishing any specified clinical diagnostic laboratory 
test under this title shall--
``(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;
``(B) ensure that such information is updated not 
less frequently than annually; and
``(C) include on the website described in 
subparagraph (A) an attestation that all such 
information is complete and accurate.
``(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 discounted cash price for such 
test (or, if no such price exists, the gross charge for such 
test).
``(3) Uniform method and format.--Not later than January 1, 
2028, 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--
``(A) may be similar to any template made available 
by the Centers for Medicare & Medicaid Services (as 
described in section 1899D(a)(2)(C)(ii));
``(B) shall meet such standards as determined 
appropriate by the Secretary in order to ensure the 
accessibility and usability of such information; and
``(C) shall be updated as determined appropriate by 
the Secretary, in consultation with stakeholders.
``(4) Inclusion of ancillary services.--Any price or charge 
for a specified clinical diagnostic laboratory test furnished 
by an applicable laboratory made publicly available in 
accordance with paragraph (1) shall include the price or charge 
(as applicable) for any ancillary item or service (such as 
specimen collection services) that would normally be furnished 
by such laboratory as part of such test, as specified by the 
Secretary.
``(5) Enforcement.--
``(A) In general.--In the case that the Secretary 
determines that an applicable laboratory is not in 
compliance with paragraph (1)--
``(i) not later than 30 days after such 
determination, the Secretary shall notify such 
laboratory of such determination; and
``(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.
``(B) Increase authority.--In applying this 
paragraph with respect to violations occurring in 2029 
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).
``(C) 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 paragraph in the 
same manner as such provisions apply to a civil 
monetary penalty imposed under subsection (a) of such 
section.
``(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.
``(7) Definitions.--In this subsection:
``(A) Applicable laboratory.--The term `applicable 
laboratory' has the meaning given such term in section 
414.502, 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--
``(i) a specified hospital pursuant to 
section 1899D;
``(ii) a hospital pursuant to section 
2718(f) of the Public Health Service Act; or
``(iii) an ambulatory surgical center 
pursuant to section 1834(bb).
``(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.
``(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 
(or similar list of prices), absent any discounts.
``(D) 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 section 
1899D(a)(2)(A)(ii)(I)), other than an advanced 
diagnostic laboratory test (as defined in section 
1834A(d)(5)).
``(E) Specified hospital.--The term `specified 
hospital' has the meaning given such term in section 
1899D.''.

SEC. 4. IMAGING PRICE TRANSPARENCY.

Section 1899D of the Social Security Act, as added by section 2, is 
amended--
(1) by redesignating subsections (b) and (c) as subsections 
(c) and (d), respectively;
(2) by inserting after subsection (a) the following new 
subsection:
``(b) Imaging Services Price Transparency.--
``(1) In general.--Beginning January 1, 2028, each provider 
of services and supplier that receives payment under this title 
for furnishing 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 specified hospital pursuant to 
subsection (a), a hospital pursuant to section 2718(f) of the 
Public Health Service Act, or an ambulatory surgical center 
pursuant to section 1834(bb), shall--
``(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;
``(B) ensure that such information is updated not 
less frequently than annually; and
``(C) include on the website described in 
subparagraph (A) an attestation that all such 
information is complete and accurate.
``(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 discounted cash price for such service 
(or, if no such price exists, the gross charge for such 
service).
``(3) Uniform method and format.--Not later than January 1, 
2028, 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--
``(A) may be similar to any template made available 
by the Centers for Medicare & Medicaid Services (as 
described in subsection (a)(2)(C)(ii));
``(B) shall meet such standards as determined 
appropriate by the Secretary in order to ensure the 
accessibility and usability of such information; and
``(C) shall be updated as determined appropriate by 
the Secretary, in consultation with stakeholders.
``(4) Monitoring compliance.--The Secretary shall, through 
notice and comment rulemaking, establish a process to monitor 
compliance with this subsection.
``(5) Enforcement.--
``(A) In general.--In the case that the Secretary 
determines that a provider of services or supplier is 
not in compliance with paragraph (1)--
``(i) not later than 30 days after such 
determination, the Secretary shall notify such 
provider or supplier of such determination;
``(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
``(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.
``(B) Increase authority.--In applying this 
paragraph with respect to violations occurring in 2029 
or a subsequent year, the Secretary may through notice 
and comment rulemaking increase the amount of the civil 
monetary penalty under subparagraph (A)(iii).
``(C) 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 paragraph in the 
same manner as such provisions apply to a civil 
monetary penalty imposed under subsection (a) of such 
section.
``(D) Authority to waive or reduce penalty.--
``(i) In general.--Subject to clause (ii), 
the Secretary may waive or reduce any penalty 
otherwise applicable with respect to a provider 
of services or supplier under this subparagraph 
if the Secretary determines that imposition of 
such penalty would result in an immediate 
threat to access to care for individuals in the 
service area of such provider or supplier.
``(ii) Limitation.--The Secretary may not 
elect to waive or reduce a penalty under clause 
(i) with respect to a specific provider of 
services or supplier more than 3 times in a 10 
year period.
``(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.
``(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.''; and
(3) in subsection (d), as so redesignated by paragraph (1), 
by adding at the end the following new paragraph:
``(5) Specified imaging service.--the term `specified 
imaging service' means an imaging service that is included on 
the list of Centers for Medicare & Medicaid Services-specified 
shoppable services (as described in subsection 
(a)(2)(A)(ii)(I)).''.

SEC. 5. AMBULATORY SURGICAL CENTER PRICE TRANSPARENCY.

Section 1834 of the Social Security Act (42 U.S.C. 1395m) is 
amended by adding at the end the following new subsection:
``(bb) Ambulatory Surgical Center Price Transparency.--
``(1) In general.--Beginning January 1, 2028, each 
ambulatory surgical center that receives payment under this 
title for furnishing items and services shall comply with the 
price transparency requirement described in paragraph (2).
``(2) Requirement described.--
``(A) In general.--For purposes of paragraph (1), 
the price transparency requirement described in this 
subsection is, with respect to an ambulatory surgical 
center, that such surgical center in accordance with a 
method and format established by the Secretary under 
subparagraph (C), compile and make public (without 
subscription and free of charge), for each year--
``(i) all 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) 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 
(as specified by the Secretary) 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;
``(iii) with respect to each Centers for 
Medicare & Medicaid Services-specified 
shoppable service that is not furnished by the 
ambulatory surgical center, an indication that 
such service is not so furnished; and
``(iv) an attestation that all standard 
charges described in clause (i), information 
described in clause (ii), and indications 
described in clause (iii) are complete and 
accurate.
``(B) Information described.--For purposes of 
subparagraph (A), the information described in this 
subparagraph is, with respect to standard charges and 
prices, as applicable, made public by an ambulatory 
surgical center, the following:
``(i) A plain language description (as 
specified by the Secretary) of each item or 
service, accompanied by, as applicable, the 
Healthcare Common Procedure Coding System code, 
the national drug code, or other identifier 
used or approved by the Centers for Medicare & 
Medicaid Services.
``(ii) The gross charge, as applicable, 
expressed as a dollar amount, for each such 
item or service.
``(iii) For each such item or service--
``(I) the discounted cash price, as 
applicable, expressed as a dollar 
amount; or
``(II) in the case no discounted 
cash price is available for an item or 
service, the median cash price charged 
to self-pay individuals for such item 
or service for the previous three 
years, expressed as a dollar amount.
``(iv) Any other additional information the 
Secretary may require (in consultation with 
stakeholders) 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.
``(C) Uniform method and format.--Not later than 
January 1, 2028, the Secretary shall establish a 
standard, uniform method and format for 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--
``(i) shall, 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 (or successor 
technology);
``(ii) may be similar to any template made 
available by the Centers for Medicare & 
Medicaid Services (as described in section 
1899D(a)(2)(C)(ii));
``(iii) shall meet such standards as 
determined appropriate by the Secretary in 
order to ensure the accessibility and usability 
of such charges and prices; and
``(iv) shall be updated as determined 
appropriate by the Secretary, in consultation 
with stakeholders.
``(3) Monitoring compliance.--The Secretary shall establish 
processes to monitor and assess ambulatory surgical centers' 
compliance with this subsection. Such processes shall include 
processes relating to the following:
``(A) The evaluation and analysis of complaints 
made by individuals or other entities relating to such 
centers' compliance with this subsection.
``(B) The use of audits to ensure such centers' 
compliance with this subsection.
``(C) The obtaining of additional information from 
such centers to determine such centers' compliance with 
this subsection (as determined appropriate by the 
Secretary).
``(4) Enforcement.--
``(A) In general.--In the case of an ambulatory 
surgical center that fails to comply with the 
requirements of this subsection--
``(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
``(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.
``(B) Civil monetary penalty.--
``(i) In general.--In addition to any other 
enforcement actions or penalties that may apply 
under another provision of Federal law, an 
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 and has failed to comply with such 
requirements 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 center was not 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 violations 
occurring in 2029 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 an 
ambulatory surgical center under clause (i).
``(iii) 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.
``(iv) Authority to waive or reduce 
penalty.--
``(I) Centers located in rural or 
underserved areas.--
``(aa) In general.--Subject 
to item (bb), the Secretary may 
waive any penalty, or reduce 
any penalty by not more than 75 
percent, otherwise applicable 
under this subparagraph with 
respect to an ambulatory 
surgical center located in a 
rural or underserved area if 
the Secretary certifies that 
imposition of such penalty 
would result in an immediate 
threat to access to care for 
individuals in the service area 
of such center.
``(bb) Limitation on 
application.--The Secretary may 
not elect to waive a penalty 
under item (aa) with respect to 
an ambulatory surgical center 
more than once in a 6-year 
period and may not elect to 
reduce such a penalty with 
respect to such a center more 
than once in such a period. 
Nothing in the preceding 
sentence shall be construed as 
prohibiting the Secretary from 
both waiving and reducing a 
penalty with respect to an 
ambulatory surgical center 
during a 6-year period.
``(II) Reduction if hearing 
waived.--The Secretary may reduce any 
penalty otherwise applicable under this 
subparagraph (as reduced, if 
applicable, under subclause (I)) by not 
more than 35 percent if the ambulatory 
surgical center that is the subject of 
such penalty agrees to waive any right 
of such center to a hearing before an 
administrative law judge with respect 
to the imposition of such penalty.
``(5) Provision of technical assistance.--The Secretary 
shall, to the extent practicable, provide technical assistance 
relating to compliance with the provisions of this subsection 
to ambulatory surgical centers requesting such assistance.
``(6) Definitions.--For purposes of this subsection:
``(A) 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 furnished by an ambulatory surgical 
center.
``(B) Gross charge.--The term `gross charge' means 
the charge for an individual item or service that is 
reflected on an ambulatory surgical center's 
chargemaster, absent any discounts.
``(C) 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.''.

SEC. 6. HEALTH COVERAGE PRICE TRANSPARENCY.

(a) Price Transparency Requirements.--
(1) IRC.--
(A) In general.--Section 9819 of the Internal 
Revenue Code of 1986 is amended--
(i) in the header, by striking 
``maintenance of price comparison tool'' and 
inserting ``transparency in coverage'';
(ii) by striking ``A group health plan'' 
and inserting the following:
``(a) Maintenance of Price Comparison Tool for Plan Years Before 
2028.--
``(1) In general.--A group health plan'';
(iii) in subsection (a), as inserted by 
clause (ii), by adding at the end the following 
new paragraph:
``(2) Sunset.--Paragraph (1) shall not apply with respect 
to plan years beginning on or after January 1, 2028.''; and
(iv) by adding at the end the following new 
subsections:
``(b) Cost-sharing Transparency.--
``(1) In general.--For plan years beginning on or after 
January 1, 2028, a group health plan shall provide a 
participant or beneficiary, in a timely manner upon request of 
the participant or beneficiary, information on the amount of 
cost-sharing (including deductibles, copayments, and 
coinsurance) under the participant or beneficiary's plan that 
the participant or beneficiary would be responsible for paying 
with respect to the furnishing of a specific item or service by 
a provider. At a minimum, such information shall include the 
information specified in paragraph (2) and shall be made 
available to such participant or beneficiary through a self-
service tool that meets the requirements of paragraph (3) or, 
at the option of such participant or beneficiary, through a 
paper disclosure or phone or other electronic disclosure (as 
selected by such participant or beneficiary and provided at no 
cost to such participant or beneficiary) that meets such 
requirements as the Secretary may specify.
``(2) Specified information.--For purposes of paragraph 
(1), the information specified in this paragraph is, with 
respect to an item or service for which benefits are available 
under a group health plan furnished by a health care provider 
to a participant or beneficiary of such plan, the following:
``(A) If such provider is a participating provider 
with respect to such item or service, the in-network 
rate for such item or service.
``(B) If such provider is not a participating 
provider with respect to such item or service, the 
maximum allowed amount or other dollar amount that such 
plan will recognize as payment for such item or 
service, along with a notice that such participant or 
beneficiary may be liable for additional charges.
``(C) The estimated amount of cost sharing 
(including deductibles, copayments, and coinsurance) 
that the participant or beneficiary will incur for such 
item or service (which, in the case such item or 
service is to be furnished by a provider described in 
subparagraph (B), shall be calculated using the maximum 
allowed amount or other dollar amount described in such 
subparagraph).
``(D) The amount the participant or beneficiary 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 a 
participant and such participant's beneficiaries 
enrolled in the plan, by such separate deductibles or 
maximums, in addition to any cumulative deductible or 
maximum).
``(E) 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 participant or beneficiary has 
accrued towards such limitation with respect to such 
item or service.
``(F) Any prior authorization, concurrent review, 
step therapy, fail first, or similar requirements 
applicable to coverage of such item or service under 
such plan.
``(G) Any financial incentives (such as any credit, 
payment, or other benefit provided by such plan) 
available to the participant or beneficiary with 
respect to such item or service furnished by such 
provider known at the time such request is made.
``(H) In the case such item or service is an 
applicable spread price drug dispensed by a pharmacy--
``(i) a specification that such item or 
service is such an applicable spread price 
drug;
``(ii) the amount of the difference (if 
any) between the specified payment amount for 
such drug so dispensed by such pharmacy and the 
specified reimbursement amount for such drug so 
dispensed by such pharmacy;
``(iii) a plain language statement 
specified by the Secretary that explains the 
concept of spread pricing and how such item's 
status as such an applicable spread price drug 
may impact the amount such plan pays for such 
drug and cost sharing amounts for such drug 
described in subparagraph (C); and
``(iv) a plain language statement specified 
by the Secretary informing the participant or 
beneficiary of the participant's or 
beneficiary's ability to obtain a summary 
document relating to drug pricing information 
described in section 9826(b)(2)(B)(ii).
``(3) Self-service tool.--For purposes of paragraph (1), a 
self-service tool established by a group health plan meets the 
requirements of this paragraph if such tool--
``(A) is based on an Internet website (or successor 
technology specified by the Secretary);
``(B) provides for real-time responses to requests 
described in paragraph (1);
``(C) is updated in a manner such that information 
provided through such tool is timely and accurate at 
the time such request is made;
``(D) allows such a request to be made with respect 
to an item or service furnished by--
``(i) a specific provider that is a 
participating provider with respect to such 
item or service;
``(ii) all providers that are participating 
providers with respect to such item or service; 
or
``(iii) a provider located in a relevant 
geographic region that is not a participating 
provider with respect to such item or service;
``(E) provides that such a request may be made with 
respect to an item or service through use of the 
billing code for such item or service or through use of 
a descriptive term for such item or service; and
``(F) meets any other requirement determined 
appropriate by the Secretary, including requirements to 
ensure the accessibility and usability of information 
provided through such tool.
The Secretary may require such tool, as a condition of 
complying with subparagraph (E), to link multiple billing codes 
to a single descriptive term if the Secretary determines that 
the billing codes to be so linked correspond to similar items 
and services.
``(c) Rate and Payment Information.--
``(1) In general.--For plan years beginning on or after 
January 1, 2028, each group health plan (other than a 
grandfathered health plan (as defined in section 1251(e) of the 
Patient Protection and Affordable Care Act)) shall make 
available to the public the rate and payment information 
described in paragraph (2) in accordance with paragraph (3).
``(2) Rate and payment information described.--For purposes 
of paragraph (1), the rate and payment information described in 
this paragraph is, with respect to a group health plan, the 
following:
``(A) With respect to each item or service (other 
than a drug) for which benefits are available under 
such plan--
``(i) the in-network rate (expressed as a 
dollar amount) in effect as of the date on 
which such information is made public with each 
provider that is a participating provider with 
respect to such item or service;
``(ii) with respect to each such provider, 
an indication of whether, during the 1-year 
period beginning 18 months before the date such 
information is made public, such provider 
submitted a claim for such item or service to 
such plan; and
``(iii) in the case that such plan provides 
benefits for such item or service only when 
furnished by a specific type of provider, a 
specification of each type of provider that may 
furnish such item or service under such plan;
``(B) With respect to each drug (identified by 
national drug code) for which benefits are available 
under such plan--
``(i) the in-network rate (expressed as a 
dollar amount) 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;
``(ii) the average amount paid by such plan 
(accounting for, in a manner determined 
appropriate by the Secretary, rebates, 
discounts, price concessions, and any other 
remuneration specified by the Secretary) for 
such drug dispensed or administered during the 
90-day period beginning 180 days before such 
date of publication to each provider that was a 
participating provider with respect to such 
drug, broken down by each such provider, unless 
fewer than 20 claims for such drug were 
submitted to such plan during such period; and
``(iii) in the case such drug is an 
applicable spread price drug dispensed by a 
pharmacy--
``(I) a specification that such 
drug is such an applicable spread price 
drug; and
``(II) for each pharmacy that has a 
contractual relationship for dispensing 
such drug under such plan, a 
specification of the difference (if 
any) between the specified payment 
amount for such drug so dispensed by 
such pharmacy and the specified 
reimbursement amount for such drug so 
dispensed by such pharmacy.
``(C) With respect to each item or service for 
which benefits are available under such plan, the 
amount billed, and the amount allowed by the plan, for 
each such item or service furnished during the 6-month 
period beginning 9 months before the date such 
information is made public by a provider that was not a 
participating provider with respect to such item or 
service, broken down by each such provider, other than 
such an amount with respect to an item or service 
furnished by a provider that, during such period, 
submitted fewer than 11 claims for such item or service 
to such plan.
``(3) Manner of publication.--
``(A) In general.--Rate and payment information 
required to be made available under this subsection 
shall be so made available in dollar amounts through 
separate machine-readable files (and any successor 
technology, as applicable, such as application 
programming interface technology, determined 
appropriate by the Secretary) corresponding to the 
information described in each of subparagraphs (A) 
through (C) of paragraph (2) that meet such 
requirements as specified by the Secretary (which may 
be so specified through subregulatory guidance). Such 
requirements shall ensure that such files are limited 
to an appropriate size, do not include disclosure of 
unnecessary duplicative information contained in other 
files made available under this subsection, are made 
available in a widely available format through a 
publicly available website that allows for information 
contained in such files to be compared across group 
health plans and group or individual health insurance 
coverage, and are accessible to individuals at no cost 
and without the need to establish a user account or 
provide other credentials.
``(B) Timing.--Rate and payment information--
``(i) described in subparagraph (A) or (B) 
of paragraph (2) shall be made public on a 
quarterly basis; and
``(ii) described in subparagraph (C) of 
paragraph (2) shall be made public on a monthly 
basis.
``(4) User instructions.--Each group health plan shall make 
available to the public instructions written in plain language 
explaining how individuals may search for information described 
in paragraph (2) in files submitted in accordance with 
paragraph (3). The Secretary shall develop and publish through 
subregulatory guidance a template that such a plan may use in 
developing instructions for purposes of the preceding sentence.
``(5) Summary.--For each plan year beginning on or after 
January 1, 2028, each group health plan shall make public a 
data file, in a manner that ensures that such file may be 
easily downloaded and read by standard spreadsheet software and 
that meets such requirements as established by the Secretary, 
containing a summary of all rate and payment information made 
public by such plan with respect to such plan during such plan 
year. Such file shall include the following:
``(A) The mean, median, and interquartile range of 
the in-network rate, and the amount allowed for an item 
or service when not furnished by a participating 
provider, in effect as of the first day of such plan 
year for each item or service (identified by payer 
identifier approved or used by the Centers for Medicare 
& Medicaid Services) for which benefits are available 
under the plan, broken down by the type of provider 
furnishing the item or service and by the geographic 
area in which such item or service is furnished.
``(B) Trends in payment rates for such items and 
services over such plan year, including an 
identification of instances in which such rates have 
increased, decreased, or remained the same.
``(C) The name of such plan, a description of the 
type of network of participating providers used by such 
plan, and a description of whether such plan is self-
insured or fully-insured.
``(D) For each item or service which is paid as 
part of a bundled or capitated rate--
``(i) a description of the formulae, 
pricing methodologies, or other information 
used to calculate the payment rate for such 
rate; and
``(ii) a list of the items and services 
included in such rate.
``(E) The percentage of items and services that are 
paid for on a fee-for-service basis and the percentage 
of items and services that are paid for as part of a 
bundled rate, capitated payment rate, or other 
alternative payment model.
``(d) Attestation.--Each group health plan shall annually submit to 
the Secretary an attestation of such plan's compliance with the 
provisions of this section. Such attestation shall include a link to 
the website (or other successor technology) where rate and payment 
information required to be made public under subsection (c) may be 
accessed.
``(e) Accessibility.--A group health plan shall take reasonable 
steps (as specified by the Secretary) to ensure that information 
provided in response to a request described in subsection (b), and rate 
and payment information made public under subsection (c), is provided 
in plain, easily understandable language and that interpretation, 
translations, and assistive services are provided to those with limited 
English proficiency and those with disabilities.
``(f) PBM Disclosure of Applicable Spread Price Drugs.--An entity 
providing pharmacy benefit management services on behalf of a group 
health plan shall disclose to such plan, at such time and in such 
manner as specified by the Secretary to ensure that information 
provided under subsection (b) and rate and payment information made 
public under subsection (c) is timely and accurate--
``(1) a list of drugs (identified by national drug codes) 
for which benefits are available under such plan that are 
applicable spread price drugs; and
``(2) with respect to each drug included on such list and 
each pharmacy with a contractual relationship for furnishing 
such drug under such plan, a specification of the difference 
(if any) between the specified payment amount for such drug so 
dispensed by such pharmacy and the specified reimbursement 
amount for such drug so dispensed by such pharmacy.
``(g) Definitions.--In this section:
``(1) Applicable spread price drug.--The term `applicable 
spread price drug' means, with respect to a group health plan, 
a drug for which benefits are available under such plan and 
with respect to which, at the time a disclosure described in 
subsection (f) is required to be made by an entity providing 
pharmacy benefit management services on behalf of such plan--
``(A) a contract is in effect between such entity 
and a pharmacy for the dispensing of such drug under 
such plan; and
``(B) the specified payment amount for such drug so 
dispensed is less than the specified reimbursement 
amount for such drug so dispensed.
``(2) In-network rate.--The term `in-network rate' means, 
with respect to a group 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 
(reflected as a dollar amount) in effect between such plan and 
such provider for such item or service, regardless of whether 
such rate is calculated based on a set amount, a fee schedule, 
or an amount derived from another amount, or a formula, or 
other method.
``(3) Participating provider.--The term `participating 
provider' means, with respect to an item or service and a group 
health plan, a physician or other health care provider (as 
defined in paragraph (4)) who is acting within the scope of 
practice of that provider's license or certification under 
applicable State law and who has a contractual relationship 
with the plan for furnishing such item or service under the 
plan.
``(4) Provider.--The term `provider' includes a health care 
facility and a pharmacy.
``(5) Specified payment amount.--The term `specified 
payment amount' means, with respect to a drug to be dispensed 
by a pharmacy to a participant or beneficiary of a group health 
plan where such pharmacy has in effect a contract with an 
entity providing pharmacy benefit management services on behalf 
of such plan for the dispensing of such drug under such plan, 
the amount that such entity has agreed to pay such pharmacy for 
the ingredient costs and any applicable dispensing fee for such 
drug (or the amount that such entity has agreed to pay such 
pharmacy for such drug under any other compensation structure 
specified by the Secretary) under such contract, taking into 
account any cost sharing requirement applicable to such drug 
and participant or beneficiary.
``(6) Specified reimbursement amount.--The term `specified 
reimbursement amount' means, with respect to a drug to be 
dispensed by a pharmacy to a participant or beneficiary of a 
group health plan where such pharmacy has in effect a contract 
with an entity providing pharmacy benefit management services 
on behalf of such plan for the dispensing of such drug under 
such plan, that amount that such plan has agreed to pay to such 
entity for the ingredient costs and any applicable dispensing 
fee for such drug (or the amount that such plan has agreed to 
pay such entity for such drug under any other compensation 
structure specified by the Secretary), taking into account any 
cost sharing requirement applicable to such drug and 
participant or beneficiary.''.
(B) Clerical amendment.--The item relating to 
section 9819 of the table of sections for subchapter B 
of chapter 100 of the Internal Revenue Code of 1986 is 
amended to read as follows:

``Sec. 9819. Transparency in coverage.''.
(2) PHSA.--Section 2799A-4 of the Public Health Service Act 
(42 U.S.C. 300gg-114) is amended--
(A) in the header, by striking ``maintenance of 
price comparison tool'' and inserting ``transparency in 
coverage'';
(B) by striking ``A group health plan'' and 
inserting the following:
``(a) Maintenance of Price Comparison Tool for Plan Years Before 
2028.--
``(1) In general.--A group health plan'';
(C) in subsection (a), as inserted by subparagraph 
(B), by adding at the end the following new paragraph:
``(2) Sunset.--Paragraph (1) shall not apply with respect 
to plan years beginning on or after January 1, 2028.''; and
(D) by adding at the end the following new 
subsections:
``(b) Cost-sharing Transparency.--
``(1) In general.--For plan years beginning on or after 
January 1, 2028, a group health plan and a health insurance 
issuer offering group or individual health insurance coverage 
shall provide a participant, beneficiary, or enrollee, in a 
timely manner upon request of the participant, beneficiary, or 
enrollee, information on the amount of cost-sharing (including 
deductibles, copayments, and coinsurance) under the 
participant, beneficiary, or enrollee's plan or coverage that 
the participant, beneficiary, or enrollee would be responsible 
for paying with respect to the furnishing of a specific item or 
service by a provider. At a minimum, such information shall 
include the information specified in paragraph (2) and shall be 
made available to such participant, beneficiary, or enrollee 
through a self-service tool that meets the requirements of 
paragraph (3) or, at the option of such participant, 
beneficiary, or enrollee, through a paper disclosure or phone 
or other electronic disclosure (as selected by such individual 
and provided at no cost to such individual) that meets such 
requirements as the Secretary may specify.
``(2) Specified information.--For purposes of paragraph 
(1), the information specified in this paragraph is, with 
respect to an item or service for which benefits are available 
under a group health plan or group or individual health 
insurance coverage furnished by a health care provider to an 
individual enrolled under such plan or coverage, the following:
``(A) If such provider is a participating provider 
with respect to such item or service, the in-network 
rate for such item or service.
``(B) If such provider is not a participating 
provider with respect to such item or service, the 
maximum allowed amount or other dollar amount that such 
plan or coverage will recognize as payment for such 
item or service, along with a notice that such 
individual may be liable for additional charges.
``(C) The estimated 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 subparagraph (B), 
shall be calculated using the maximum allowed amount or 
other dollar amount described in such subparagraph).
``(D) The amount the individual has already 
accumulated with respect to any deductible or out of 
pocket maximum under the plan or coverage (broken down, 
in the case separate deductibles or maximums apply to 
individuals enrolled in the plan or coverage, by such 
separate deductibles or maximums, in addition to any 
cumulative deductible or maximum).
``(E) 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.
``(F) Any prior authorization, concurrent review, 
step therapy, fail first, or similar requirements 
applicable to coverage of such item or service under 
such plan or coverage.
``(G) Any financial incentives (such as any credit, 
payment, or other benefit provided by such plan or 
issuer) available to the individual with respect to 
such item or service furnished by such provider known 
at the time such request is made.
``(H) In the case such item or service is an 
applicable spread price drug dispensed by a pharmacy--
``(i) a specification that such item or 
service is such an applicable spread price 
drug;
``(ii) the amount of the difference (if 
any) between the specified payment amount for 
such drug so dispensed by such pharmacy and the 
specified reimbursement amount for such drug so 
dispensed by such pharmacy;
``(iii) a plain language statement 
specified by the Secretary that explains the 
concept of spread pricing and how such item's 
status as such an applicable spread price drug 
may impact the amount such plan or coverage 
pays for such drug and cost sharing amounts for 
such drug described in subparagraph (C); and
``(iv) except in the case of individual 
health insurance coverage, a plain language 
statement specified by the Secretary informing 
the participant or beneficiary of the 
participant's or beneficiary's ability to 
obtain a summary document relating to drug 
pricing information described in section 2799A-
11(b)(2)(B)(ii).
``(3) Self-service tool.--For purposes of paragraph (1), a 
self-service tool established by a group health plan or health 
insurance issuer offering group or individual health insurance 
coverage meets the requirements of this paragraph if such 
tool--
``(A) is based on an internet website (or successor 
technology specified by the Secretary);
``(B) provides for real-time responses to requests 
described in paragraph (1);
``(C) is updated in a manner such that information 
provided through such tool is timely and accurate at 
the time such request is made;
``(D) allows such a request to be made with respect 
to an item or service furnished by--
``(i) a specific provider that is a 
participating provider with respect to such 
item or service;
``(ii) all providers that are participating 
providers with respect to such item or service; 
or
``(iii) a provider located in a relevant 
geographic region that is not a participating 
provider with respect to such item or service;
``(E) provides that such a request may be made with 
respect to an item or service through use of the 
billing code for such item or service or through use of 
a descriptive term for such item or service; and
``(F) meets any other requirement determined 
appropriate by the Secretary, including requirements to 
ensure the accessibility and usability of information 
provided through such tool.
The Secretary may require such tool, as a condition of 
complying with subparagraph (E), to link multiple billing codes 
to a single descriptive term if the Secretary determines that 
the billing codes to be so linked correspond to similar items 
and services.
``(c) Rate and Payment Information.--
``(1) In general.--For plan years beginning on or after 
January 1, 2028, each group health plan and health insurance 
issuer offering group or individual health insurance coverage 
(other than a grandfathered health plan (as defined in section 
1251(e) of the Patient Protection and Affordable Care Act)) 
shall make available to the public the rate and payment 
information described in paragraph (2) in accordance with 
paragraph (3).
``(2) Rate and payment information described.--For purposes 
of paragraph (1), the rate and payment information described in 
this paragraph is, with respect to a group health plan or group 
or individual health insurance coverage, the following:
``(A) With respect to each item or service (other 
than a drug) for which benefits are available under 
such plan or coverage,--
``(i) the in-network rate (expressed as a 
dollar amount) in effect as of the date on 
which such information is made public with each 
provider that is a participating provider with 
respect to such item or service;
``(ii) with respect to each such provider, 
an indication of whether, during the 1-year 
period beginning 18 months before the date such 
information is made public, such provider 
submitted a claim for such item or service to 
such plan or coverage; and
``(iii) in the case that such plan or 
coverage provides benefits for such item or 
service only when furnished by a specific type 
of provider, a specification of each type of 
provider that may furnish such item or service 
under such plan or coverage;
``(B) With respect to each drug (identified by 
national drug code) for which benefits are available 
under such plan or coverage--
``(i) the in-network rate (expressed as a 
dollar amount) 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;
``(ii) the average amount paid by such plan 
or coverage (accounting for, in a manner 
determined appropriate by the Secretary, 
rebates, discounts, price concessions, and any 
other remuneration specified by the Secretary) 
for such drug dispensed or administered during 
the 90-day period beginning 180 days before 
such date of publication to each provider that 
was a participating provider with respect to 
such drug, broken down by each such provider, 
unless fewer than 20 claims for such drug were 
submitted to such plan or coverage during such 
period; and
``(iii) in the case such drug is an 
applicable spread price drug dispensed by a 
pharmacy--
``(I) a specification that such 
drug is such an applicable spread price 
drug; and
``(II) for each pharmacy that has a 
contractual relationship for dispensing 
such drug under such plan or coverage, 
a specification of the difference (if 
any) between the specified payment 
amount for such drug so dispensed by 
such pharmacy and the specified 
reimbursement amount for such drug so 
dispensed by such pharmacy.
``(C) With respect to each item or service for 
which benefits are available under such plan or 
coverage, the amount billed, and the amount allowed by 
the plan, for each such item or service furnished 
during the 6-month period beginning 9 months before the 
date such information is made public by a provider that 
was not a participating provider with respect to such 
item or service, broken down by each such provider, 
other than such an amount with respect to an item or 
service furnished by a provider that, during such 
period, submitted fewer than 11 claims for such item or 
service to such plan or coverage.
``(3) Manner of publication.--
``(A) In general.--Rate and payment information 
required to be made available under this subsection 
shall be so made available in dollar amounts through 
separate machine-readable files (and any successor 
technology, as applicable, such as application 
programming interface technology, determined 
appropriate by the Secretary) corresponding to the 
information described in each of subparagraphs (A) 
through (C) of paragraph (2) that meet such 
requirements as specified by the Secretary (which may 
be so specified through subregulatory guidance). Such 
requirements shall ensure that such files are limited 
to an appropriate size, do not include disclosure of 
unnecessary duplicative information contained in other 
files made available under this subsection, are made 
available in a widely-available format through a 
publicly-available website that allows for information 
contained in such files to be compared across group 
health plans and group or individual health insurance 
coverage, and are accessible to individuals at no cost 
and without the need to establish a user account or 
provide other credentials.
``(B) Timing.--Rate and payment information--
``(i) described in subparagraph (A) or (B) 
of paragraph (2) shall be made public on a 
quarterly basis; and
``(ii) described in subparagraph (C) of 
paragraph (2) shall be made public on a monthly 
basis.
``(4) User instructions.--Each group health plan and health 
insurance issuer offering group or individual health insurance 
coverage shall make available to the public instructions 
written in plain language explaining how individuals may search 
for information described in paragraph (2) in files submitted 
in accordance with paragraph (3). The Secretary shall develop 
and publish through subregulatory guidance a template that such 
a plan may use in developing instructions for purposes of the 
preceding sentence.
``(5) Summary.--For each plan year beginning on or after 
January 1, 2028, each group health plan and health insurance 
issuer offering group or individual health insurance coverage 
shall make public a data file, in a manner that ensures that 
such file may be easily downloaded and read by standard 
spreadsheet software and that meets such requirements as 
established by the Secretary, containing a summary of all rate 
and payment information made public by such plan or issuer with 
respect to such plan or coverage during such plan year. Such 
file shall include the following:
``(A) The mean, median, and interquartile range of 
the in-network rate, and the amount allowed for an item 
or service when not furnished by a participating 
provider, in effect as of the first day of such plan 
year for each item or service (identified by payer 
identifier approved or used by the Centers for Medicare 
& Medicaid Services) for which benefits are available 
under the plan or coverage, broken down by the type of 
provider furnishing the item or service and by the 
geographic area in which such item or service is 
furnished.
``(B) Trends in payment rates for such items and 
services over such plan year, including an 
identification of instances in which such rates have 
increased, decreased, or remained the same.
``(C) The name of such plan, a description of the 
type of network of participating providers used by such 
plan or coverage, and, in the case of a group health 
plan, a description of whether such plan is self-
insured or fully-insured.
``(D) For each item or service which is paid as 
part of a bundled or capitated rate--
``(i) a description of the formulae, 
pricing methodologies, or other information 
used to calculate the payment rate for such 
rate; and
``(ii) a list of the items and services 
included in such rate.
``(E) The percentage of items and services that are 
paid for on a fee-for-service basis and the percentage 
of items and services that are paid for as part of a 
bundled rate, capitated payment rate, or other 
alternative payment model.
``(d) Attestation.--Each group health plan and health insurance 
issuer offering group or individual health insurance coverage shall 
annually submit to the Secretary an attestation of such plan's or 
coverage's compliance with the provisions of this section. Such 
attestation shall include a link to the website (or other successor 
technology) where rate and payment information required to be made 
public under subsection (c) may be accessed.
``(e) Accessibility.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage shall 
take reasonable steps (as specified by the Secretary) to ensure that 
information provided in response to a request described in subsection 
(b), and rate and payment information made public under subsection (c), 
is provided in plain, easily understandable language and that 
interpretation, translations, and assistive services are provided to 
those with limited English proficiency and those with disabilities.
``(f) PBM Disclosure of Applicable Spread Price Drugs.--An entity 
providing pharmacy benefit management services on behalf of a group 
health plan or group or individual health insurance coverage shall 
disclose to such plan or coverage, at such time and in such manner as 
specified by the Secretary to ensure that information provided under 
subsection (b) and rate and payment information made public under 
subsection (c) is timely and accurate--
``(1) a list of drugs (identified by national drug codes) 
for which benefits are available under such plan that are 
applicable spread price drugs; and
``(2) with respect to each drug included on such list and 
each pharmacy with a contractual relationship for furnishing 
such drug under such plan or coverage, a specification of the 
difference (if any) between the specified payment amount for 
such drug so dispensed by such pharmacy and the specified 
reimbursement amount for such drug so dispensed by such 
pharmacy.
``(g) Definitions.--In this section:
``(1) Applicable spread price drug.--The term `applicable 
spread price drug' means, with respect to a group health plan 
or group or individual health insurance coverage, a drug for 
which benefits are available under such plan or coverage and 
with respect to which, at the time a disclosure described in 
subsection (f) is required to be made by an entity providing 
pharmacy benefit management services on behalf of such plan or 
coverage--
``(A) a contract is in effect between such entity 
and a pharmacy for the dispensing of such drug under 
such plan or coverage; and
``(B) the specified payment amount for such drug so 
dispensed is less than the specified reimbursement 
amount for such drug so dispensed.
``(2) In-network rate.--The term `in-network rate' means, 
with respect to a group health plan or group or individual 
health insurance coverage and an item or service furnished by a 
provider that is a participating provider with respect to such 
plan or coverage and item or service, the contracted rate 
(reflected as a dollar amount) in effect between such plan or 
coverage and such provider for such item or service, regardless 
of whether such rate is calculated based on a set amount, a fee 
schedule, or an amount derived from another amount, or a 
formula, or other method.
``(3) Participating provider.--The term `participating 
provider' means, with respect to an item or service and a group 
health plan or health insurance issuer offering group or 
individual health insurance coverage, a physician or other 
health care provider (as defined in paragraph (4)) who is 
acting within the scope of practice of that provider's license 
or certification under applicable State law and who has a 
contractual relationship with the plan or issuer, respectively, 
for furnishing such item or service under the plan or coverage, 
respectively.
``(4) Provider.--The term `provider' includes a health care 
facility and a pharmacy.
``(5) Specified payment amount.--The term `specified 
payment amount' means, with respect to a drug to be dispensed 
by a pharmacy to a participant, beneficiary, or enrollee of a 
group health plan or group or individual health insurance 
coverage where such pharmacy has in effect a contract with an 
entity providing pharmacy benefit management services on behalf 
of such plan or coverage for the dispensing of such drug under 
such plan or coverage, the amount that such entity has agreed 
to pay such pharmacy for the ingredient costs and any 
applicable dispensing fee for such drug (or the amount that 
such entity has agreed to pay such pharmacy for such drug under 
any other compensation structure specified by the Secretary) 
under such contract, taking into account any cost sharing 
requirement applicable to such drug and participant, 
beneficiary, or enrollee.
``(6) Specified reimbursement amount.--The term `specified 
reimbursement amount' means, with respect to a drug to be 
dispensed by a pharmacy to a participant, beneficiary, or 
enrollee of a group health plan or group or individual health 
insurance coverage where such pharmacy has in effect a contract 
with an entity providing pharmacy benefit management services 
on behalf of such plan or coverage for the dispensing of such 
drug under such plan or coverage, that amount that such plan or 
coverage has agreed to pay to such entity for the ingredient 
costs and any applicable dispensing fee for such drug (or the 
amount that such plan or coverage has agreed to pay such entity 
for such drug under any other compensation structure specified 
by the Secretary), taking into account any cost sharing 
requirement applicable to such drug and participant, 
beneficiary, or enrollee.''.
(3) ERISA.--
(A) In general.--Section 719 of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 
1185h) is amended--
(i) in the header, by striking 
``maintenance of price comparison tool'' and 
inserting ``transparency in coverage'';
(ii) by striking ``A group health plan'' 
and inserting the following:
``(a) Maintenance of Price Comparison Tool for Plan Years Before 
2028.--
``(1) In general.--A group health plan'';
(iii) in subsection (a), as inserted by 
clause (ii), by adding at the end the following 
new paragraph:
``(2) Sunset.--Paragraph (1) shall not apply with respect 
to plan years beginning on or after January 1, 2028.''; and
(iv) by adding at the end the following new 
subsections:
``(b) Cost-Sharing Transparency.--
``(1) In general.--For plan years beginning on or after 
January 1, 2028, a group health plan and a health insurance 
issuer offering group health insurance coverage shall provide a 
participant or beneficiary, in a timely manner upon request of 
the participant or beneficiary, information on the amount of 
cost-sharing (including deductibles, copayments, and 
coinsurance) under the participant or beneficiary's plan or 
coverage that the participant or beneficiary would be 
responsible for paying with respect to the furnishing of a 
specific item or service by a provider. At a minimum, such 
information shall include the information specified in 
paragraph (2) and shall be made available to such participant 
or beneficiary through a self-service tool that meets the 
requirements of paragraph (3) or, at the option of such 
participant or beneficiary, through a paper disclosure or phone 
or other electronic disclosure (as selected by such participant 
or beneficiary and provided at no cost to such participant or 
beneficiary) that meets such requirements as the Secretary may 
specify.
``(2) Specified information.--For purposes of paragraph 
(1), the information specified in this paragraph is, with 
respect to an item or service for which benefits are available 
under a group health plan or group health insurance coverage 
furnished by a health care provider to a participant or 
beneficiary of such plan or coverage, the following:
``(A) If such provider is a participating provider 
with respect to such item or service, the in-network 
rate for such item or service.
``(B) If such provider is not a participating 
provider with respect to such item or service, the 
maximum allowed amount or other dollar amount that such 
plan or coverage will recognize as payment for such 
item or service, along with a notice that such 
participant or beneficiary may be liable for additional 
charges.
``(C) The estimated amount of cost-sharing 
(including deductibles, copayments, and coinsurance) 
that the participant or beneficiary will incur for such 
item or service (which, in the case such item or 
service is to be furnished by a provider described in 
subparagraph (B), shall be calculated using the maximum 
allowed amount or other dollar amount described in such 
subparagraph).
``(D) The amount the participant or beneficiary has 
already accumulated with respect to any deductible or 
out of pocket maximum under the plan or coverage 
(broken down, in the case separate deductibles or 
maximums apply to a participant and such participant's 
beneficiaries enrolled in the plan or coverage, by such 
separate deductibles or maximums, in addition to any 
cumulative deductible or maximum).
``(E) 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 participant or beneficiary has 
accrued towards such limitation with respect to such 
item or service.
``(F) Any prior authorization, concurrent review, 
step therapy, fail first, or similar requirements 
applicable to coverage of such item or service under 
such plan or coverage.
``(G) Any financial incentives (such as any credit, 
payment, or other benefit provided by such plan or 
issuer) available to the participant or beneficiary 
with respect to such item or service furnished by such 
provider known at the time such request is made.
``(H) In the case such item or service is an 
applicable spread price drug dispensed by a pharmacy--
``(i) a specification that such item or 
service is such an applicable spread price 
drug;
``(ii) the amount of the difference (if 
any) between the specified payment amount for 
such drug so dispensed by such pharmacy and the 
specified reimbursement amount for such drug so 
dispensed by such pharmacy;
``(iii) a plain language statement 
specified by the Secretary that explains the 
concept of spread pricing and how such item's 
status as such an applicable spread price drug 
may impact the amount such plan or coverage 
pays for such drug and cost sharing amounts for 
such drug described in subparagraph (C); and
``(iv) a plain language statement specified 
by the Secretary informing the participant or 
beneficiary of the participant's or 
beneficiary's ability to obtain a summary 
document relating to drug pricing information 
described in section 726(b)(2)(B)(ii).
``(3) Self-service tool.--For purposes of paragraph (1), a 
self-service tool established by a group health plan or health 
insurance issuer offering group health insurance coverage meets 
the requirements of this paragraph if such tool--
``(A) is based on an internet website (or successor 
technology specified by the Secretary);
``(B) provides for real-time responses to requests 
described in paragraph (1);
``(C) is updated in a manner such that information 
provided through such tool is timely and accurate at 
the time such request is made;
``(D) allows such a request to be made with respect 
to an item or service furnished by--
``(i) a specific provider that is a 
participating provider with respect to such 
item or service;
``(ii) all providers that are participating 
providers with respect to such item or service; 
or
``(iii) a provider located in a relevant 
geographic region that is not a participating 
provider with respect to such item or service;
``(E) provides that such a request may be made with 
respect to an item or service through use of the 
billing code for such item or service or through use of 
a descriptive term for such item or service; and
``(F) meets any other requirement determined 
appropriate by the Secretary, including requirements to 
ensure the accessibility and usability of information 
provided through such tool.
The Secretary may require such tool, as a condition of 
complying with subparagraph (E), to link multiple billing codes 
to a single descriptive term if the Secretary determines that 
the billing codes to be so linked correspond to similar items 
and services.
``(c) Rate and Payment Information.--
``(1) In general.--For plan years beginning on or after 
January 1, 2028, each group health plan and health insurance 
issuer offering group health insurance coverage (other than a 
grandfathered health plan (as defined in section 1251(e) of the 
Patient Protection and Affordable Care Act)) shall make 
available to the public the rate and payment information 
described in paragraph (2) in accordance with paragraph (3).
``(2) Rate and payment information described.--For purposes 
of paragraph (1), the rate and payment information described in 
this paragraph is, with respect to a group health plan or group 
health insurance coverage, the following:
``(A) With respect to each item or service (other 
than a drug) for which benefits are available under 
such plan or coverage--
``(i) the in-network rate (expressed as a 
dollar amount) in effect as of the date on 
which such information is made public with each 
provider that is a participating provider with 
respect to such item or service;
``(ii) with respect to each such provider, 
an indication of whether, during the 1-year 
period beginning 18 months before the date such 
information is made public, such provider 
submitted a claim for such item or service to 
such plan or coverage; and
``(iii) in the case that such plan or 
coverage provides benefits for such item or 
service only when furnished by a specific type 
of provider, a specification of each type of 
provider that may furnish such item or service 
under such plan or coverage;
``(B) With respect to each drug (identified by 
national drug code) for which benefits are available 
under such plan or coverage--
``(i) the in-network rate (expressed as a 
dollar amount) 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;
``(ii) the average amount paid by such plan 
or coverage (accounting for, in a manner 
determined appropriate by the Secretary, 
rebates, discounts, price concessions, and any 
other remuneration specified by the Secretary) 
for such drug dispensed or administered during 
the 90-day period beginning 180 days before 
such date of publication to each provider that 
was a participating provider with respect to 
such drug, broken down by each such provider, 
unless fewer than 20 claims for such drug were 
submitted to such plan or coverage during such 
period; and
``(iii) in the case such drug is an 
applicable spread price drug dispensed by a 
pharmacy--
``(I) a specification that such 
drug is such an applicable spread price 
drug; and
``(II) for each pharmacy that has a 
contractual relationship for dispensing 
such drug under such plan or coverage, 
a specification of the difference (if 
any) between the specified payment 
amount for such drug so dispensed by 
such pharmacy and the specified 
reimbursement amount for such drug so 
dispensed by such pharmacy.
``(C) With respect to each item or service for 
which benefits are available under such plan or 
coverage, the amount billed, and the amount allowed by 
the plan, for each such item or service furnished 
during the 6-month period beginning 9 months before the 
date such information is made public by a provider that 
was not a participating provider with respect to such 
item or service, broken down by each such provider, 
other than such an amount with respect to an item or 
service furnished by a provider that, during such 
period, submitted fewer than 11 claims for such item or 
service to such plan or coverage.
``(3) Manner of publication.--
``(A) In general.--Rate and payment information 
required to be made available under this subsection 
shall be so made available in dollar amounts through 
separate machine-readable files (and any successor 
technology, as applicable, such as application 
programming interface technology, determined 
appropriate by the Secretary) corresponding to the 
information described in each of subparagraphs (A) 
through (C) of paragraph (2) that meet such 
requirements as specified by the Secretary (which may 
be so specified through subregulatory guidance). Such 
requirements shall ensure that such files are limited 
to an appropriate size, do not include disclosure of 
unnecessary duplicative information contained in other 
files made available under this subsection, are made 
available in a widely available format through a 
publicly available website that allows for information 
contained in such files to be compared across group 
health plans and group or individual health insurance 
coverage, and are accessible to individuals at no cost 
and without the need to establish a user account or 
provide other credentials.
``(B) Timing.--Rate and payment information--
``(i) described in subparagraph (A) or (B) 
of paragraph (2) shall be made public on a 
quarterly basis; and
``(ii) described in subparagraph (C) of 
paragraph (2) shall be made public on a monthly 
basis.
``(4) User instructions.--Each group health plan and health 
insurance issuer offering group health insurance coverage shall 
make available to the public instructions written in plain 
language explaining how individuals may search for information 
described in paragraph (2) in files submitted in accordance 
with paragraph (3). The Secretary shall develop and publish 
through subregulatory guidance a template that such a plan may 
use in developing instructions for purposes of the preceding 
sentence.
``(5) Summary.--For each plan year beginning on or after 
January 1, 2028, each group health plan and health insurance 
issuer offering group health insurance coverage shall make 
public a data file, in a manner that ensures that such file may 
be easily downloaded and read by standard spreadsheet software 
and that meets such requirements as established by the 
Secretary, containing a summary of all rate and payment 
information made public by such plan or issuer with respect to 
such plan or coverage during such plan year. Such file shall 
include the following:
``(A) The mean, median, and interquartile range of 
the in-network rate, and the amount allowed for an item 
or service when not furnished by a participating 
provider, in effect as of the first day of such plan 
year for each item or service (identified by payer 
identifier approved or used by the Centers for Medicare 
& Medicaid Services) for which benefits are available 
under the plan or coverage, broken down by the type of 
provider furnishing the item or service and by the 
geographic area in which such item or service is 
furnished.
``(B) Trends in payment rates for such items and 
services over such plan year, including an 
identification of instances in which such rates have 
increased, decreased, or remained the same.
``(C) The name of such plan, a description of the 
type of network of participating providers used by such 
plan or coverage, and, in the case of a group health 
plan, a description of whether such plan is self-
insured or fully-insured.
``(D) For each item or service which is paid as 
part of a bundled or capitated rate--
``(i) a description of the formulae, 
pricing methodologies, or other information 
used to calculate the payment rate for such 
rate; and
``(ii) a list of the items and services 
included in such rate.
``(E) The percentage of items and services that are 
paid for on a fee-for-service basis and the percentage 
of items and services that are paid for as part of a 
bundled rate, capitated payment rate, or other 
alternative payment model.
``(d) Attestation.--Each group health plan and health insurance 
issuer offering group health insurance coverage shall annually submit 
to the Secretary an attestation of such plan's or coverage's compliance 
with the provisions of this section. Such attestation shall include a 
link to the website (or other successor technology) where rate and 
payment information required to be made public under subsection (c) may 
be accessed.
``(e) Accessibility.--A group health plan and a health insurance 
issuer offering group health insurance coverage shall take reasonable 
steps (as specified by the Secretary) to ensure that information 
provided in response to a request described in subsection (b), and rate 
and payment information made public under subsection (c), is provided 
in plain, easily understandable language and that interpretation, 
translations, and assistive services are provided to those with limited 
English proficiency and those with disabilities.
``(f) PBM Disclosure of Applicable Spread Price Drugs.--An entity 
providing pharmacy benefit management services on behalf of a group 
health plan or group health insurance coverage shall disclose to such 
plan or coverage, at such time and in such manner as specified by the 
Secretary to ensure that information provided under subsection (b) and 
rate and payment information made public under subsection (c) is timely 
and accurate--
``(1) a list of drugs (identified by national drug codes) 
for which benefits are available under such plan that are 
applicable spread price drugs; and
``(2) with respect to each drug included on such list and 
each pharmacy with a contractual relationship for furnishing 
such drug under such plan or coverage, a specification of the 
difference (if any) between the specified payment amount for 
such drug so dispensed by such pharmacy and the specified 
reimbursement amount for such drug so dispensed by such 
pharmacy.
``(g) Definitions.--In this section:
``(1) Applicable spread price drug.--The term `applicable 
spread price drug' means, with respect to a group health plan 
or group health insurance coverage, a drug for which benefits 
are available under such plan or coverage and with respect to 
which, at the time a disclosure described in subsection (f) is 
required to be made by an entity providing pharmacy benefit 
management services on behalf of such plan or coverage--
``(A) a contract is in effect between such entity 
and a pharmacy for the dispensing of such drug under 
such plan or coverage; and
``(B) the specified payment amount for such drug so 
dispensed is less than the specified reimbursement 
amount for such drug so dispensed.
``(2) In-network rate.--The term `in-network rate' means, 
with respect to a group health plan or group health insurance 
coverage and an item or service furnished by a provider that is 
a participating provider with respect to such plan or coverage 
and item or service, the contracted rate (reflected as a dollar 
amount) in effect between such plan or coverage and such 
provider for such item or service, regardless of whether such 
rate is calculated based on a set amount, a fee schedule, or an 
amount derived from another amount, or a formula, or other 
method.
``(3) Participating provider.--The term `participating 
provider' means, with respect to an item or service and a group 
health plan or health insurance issuer offering group health 
insurance coverage, a physician or other health care provider 
(as defined in paragraph (4)) who is acting within the scope of 
practice of that provider's license or certification under 
applicable State law and who has a contractual relationship 
with the plan or issuer, respectively, for furnishing such item 
or service under the plan or coverage, respectively.
``(4) Provider.--The term `provider' includes a health care 
facility and a pharmacy.
``(5) Specified payment amount.--The term `specified 
payment amount' means, with respect to a drug to be dispensed 
by a pharmacy to a participant or beneficiary of a group health 
plan or group health insurance coverage where such pharmacy has 
in effect a contract with an entity providing pharmacy benefit 
management services on behalf of such plan or coverage for the 
dispensing of such drug under such plan or coverage, the amount 
that such entity has agreed to pay such pharmacy for the 
ingredient costs and any applicable dispensing fee for such 
drug (or the amount that such entity has agreed to pay such 
pharmacy for such drug under any other compensation structure 
specified by the Secretary) under such contract, taking into 
account any cost sharing requirement applicable to such drug 
and participant or beneficiary.
``(6) Specified reimbursement amount.--The term `specified 
reimbursement amount' means, with respect to a drug to be 
dispensed by a pharmacy to a participant or beneficiary of a 
group health plan or group health insurance coverage where such 
pharmacy has in effect a contract with an entity providing 
pharmacy benefit management services on behalf of such plan or 
coverage for the dispensing of such drug under such plan or 
coverage, that amount that such plan or coverage has agreed to 
pay to such entity for the ingredient costs and any applicable 
dispensing fee for such drug (or the amount that such plan or 
coverage has agreed to pay such entity for such drug under any 
other compensation structure specified by the Secretary), 
taking into account any cost sharing requirement applicable to 
such drug and participant or beneficiary.''.
(B) Clerical amendment.--The table of contents in 
section 1 of the Employee Retirement Income Security 
Act of 1974 is amended by striking the item relating to 
section 719 and inserting the following new item:

``Sec. 719. Transparency in coverage.''.
(b) Application Programming Interface Report.--Not later than 
January 1, 2028, and annually thereafter, the Secretary of Health and 
Human Services shall, in consultation with the Office of the National 
Coordinator for Health Information Technology, Department of Labor, the 
Department of the Treasury, and stakeholders, submit to the House 
Committees on Education and the Workforce, Energy and Commerce, and 
Ways and Means, and the Senate Committees on Finance and Health, 
Education, Labor, and Pensions a report on the use of standards-based 
application programming interfaces (in this subsection referred to as 
``APIs'') to facilitate access to health care price transparency 
information and the interoperability of other medical information. Such 
report shall include an evaluation of the capacity of the Department of 
Health and Human Services, the Department of Labor, and the Department 
of the Treasury to regulate and implement standards related to APIs and 
recommendations for improving such capacity. Such report shall include 
the following:
(1) A description of current use, and proposed use, of APIs 
under Federal rules to facilitate interoperability, including 
information related to capacity constraints within the 
agencies, barriers to adoption, privacy and security, 
administrative burdens and efficiencies, care coordination, and 
levels of compliance.
(2) A description of the feasibility of agency 
participation in the development of APIs to enable application 
access to price transparency data under the amendments made by 
subsection (a).
(3) A specification of the timeline for which such data 
standards can be required to make such data accessible via an 
API.
(4) An analysis of the benefits and challenges of 
implementing standards-based APIs for price transparency data, 
including the ability for consumers to access rate and payment 
information and the amount of cost-sharing (including 
deductibles, copayments, and coinsurance) under the consumer's 
plan through third-party internet-based tools and applications.
(5) An analysis of the impact that APIs which provide real-
time access to pricing and cost-sharing information may have in 
increasing the amount of services shoppable for individuals, 
such as by standardizing more health care spend via episode 
bundles.
(6) An analysis of which health care items and services may 
be useful under API, such as those for which prices change with 
the greatest frequency.
(7) An analysis of the cost of API standards implementation 
on issuers, employers, and other private-sector entities.
(8) An analysis of the ability of State regulators to 
enforce API standards and the costs to the Federal Government 
and States to regulate and enforce API standards.
(9) An analysis of the interaction with API standards and 
Federal health information privacy standards.
(c) Provider Tool Report.--
(1) In general.--Not later than 1 year after the date of 
the enactment of this Act, The Secretary of Health and Human 
Services, acting through the Administrator of the Centers for 
Medicare & Medicaid Services, shall, in consultation with 
stakeholders, conduct a study and submit to the House 
Committees on Education and the Workforce, Energy and Commerce, 
and Ways and Means, and the Senate Committees on Finance and 
Health, Education, Labor, and Pensions a report on the 
usefulness and feasibility of the establishment of a provider 
tool by a group health plan, or a health insurance issuer 
offering group or individual health insurance coverage, in 
facilitating the provision of information made available 
pursuant to the amendments made by subsection (a). Such report 
shall include the following:
(A) A description of the feasibility of 
establishing a requirement for the various types of 
plans and coverage to offer such a provider tool, 
including any challenges to establishing a provider 
tool using the same technology platform as the self-
service tool described in such amendments.
(B) An evaluation on the usefulness of a provider 
tool to aid patient-decision making and how such tool 
would coordinate with other information available to a 
patient and their provider under other Federal 
requirements in place or under consideration.
(C) An evaluation of whether the information 
provided by such tool would be duplicative of the 
advanced explanation of benefits required under Federal 
law or any other existing requirement.
(D) A description of the usability and expected 
utilization of such tool among providers, including 
among different provider types.
(E) An analysis of the impact of a provider tool in 
value-based care arrangements.
(F) An analysis on the potential impact of the 
provider tool on--
(i) patients' out-of-pocket spending;
(ii) plan design, including impacts on 
cost-sharing requirements;
(iii) care coordination and quality;
(iv) plan premiums;
(v) overall health care spending and 
utilization; and
(vi) health care access in rural areas.
(G) An analysis of the feasibility of a provider 
tool to include additional functionality to facilitate 
and improve the administration of the requirements on 
providers to submit notifications to such plan or 
coverage under section 2799B-6 of the Public Health 
Service Act and the requirements on such plan or 
coverage to provide an advanced explanation of benefits 
to individuals under section 2799A-1(f) of such Act.
(H) An analysis of which health care items and 
services, would be most useful for providers utilizing 
a provider tool.
(I) An analysis of rulemaking required to ensure 
such a tool complies with federal health information 
privacy standards.
(J) An analysis of the burden and cost of the 
creation of a provider tool by plans and coverage on 
providers, issuers, employers, and other private-sector 
entities.
(K) An analysis of the ability of state regulators 
to enforce provider tool standards and the costs to the 
Department and states to regulate and enforce provider 
tool standards.
(2) Definition.--The term ``provider tool'' means a tool 
designed to facilitate the provision of information made 
available pursuant to the amendments made by subsection (a) and 
established by a group health plan or a health insurance issuer 
offering group or individual health insurance coverage that 
allows providers to access the information such plan or 
coverage must provide through the self-service tool described 
in such amendments to an individual with whom the provider is 
actively treating at the time of such request, upon the request 
of the provider, and with the consent of such individual.
(d) Reports.--
(1) Compliance.--Not later than January 1, 2029, the 
Comptroller General of the United States shall submit to 
Congress a report containing--
(A) an analysis of compliance with the amendments 
made by this section;
(B) an analysis of enforcement of such amendments 
by the Secretaries of Health and Human Services, Labor, 
and the Treasury;
(C) recommendations relating to improving such 
enforcement; and
(D) recommendations relating to improving public 
disclosure, and public awareness, of information 
required to be made available by group health plans and 
health insurance issuers pursuant to such amendments.
(2) Prices.--Not later than January 1, 2029, and biennially 
thereafter, the Secretaries of Health and Human Services, 
Labor, and the Treasury shall jointly submit to Congress a 
report containing an assessment of differences in negotiated 
prices (and any trends in such prices) in the private market 
between--
(A) rural and urban areas;
(B) the individual, small group, and large group 
markets;
(C) consolidated and nonconsolidated health care 
provider areas (as specified by the Secretary of Health 
and Human Services);
(D) nonprofit and for-profit hospitals;
(E) nonprofit and for-profit insurers; and
(F) insurers serving local or regional areas and 
insurers serving multistate or national areas.
(e) Quality Report.--Not later than 1 year after the date of 
enactment of this subsection, the Secretaries of Health and Human 
Services, Labor, and the Treasury shall jointly submit to Congress a 
report on the feasibility of including data relating to the quality of 
health care items and services with the price transparency information 
required to be made available under the amendments made by subsection 
(a). Such report shall include recommendations for legislative and 
regulatory actions to identify appropriate metrics for assessing and 
comparing quality of care.
(f) Continued Applicability of Rules for Previous Years.--Nothing 
in the amendments made by subsection (a) 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), for any plan year beginning before January 1, 
2028.
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