To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
The Transparency in Billing Act of 2023 amends ERISA to require hospitals to include separate unique health identifiers for off-campus outpatient departments when submitting claims to group health plans. Hospitals must obtain these identifiers and cannot bill plans or hold patients liable for services unless the claim includes the correct department-level identifier. The Secretary of Labor must establish a violation reporting process.
Who Benefits and How
Group health plans and insurers benefit from improved billing transparency, enabling them to identify where services were actually provided rather than having off-campus facilities billed as if they were main hospital departments (which typically command higher reimbursement rates). Patients benefit from potentially lower costs as the billing distinction could reduce hospital facility fee exploitation. Employers sponsoring group health plans benefit from lower plan costs.
Who Bears the Burden and How
Hospitals bear significant compliance burdens, including obtaining unique health identifiers for each off-campus outpatient department and restructuring their billing systems. Hospitals with off-campus outpatient departments face potential revenue reductions as transparent billing may lead to lower reimbursement rates. Non-compliant hospitals face civil penalties of up to /day (30 beds or fewer) or ,500/day (more than 30 beds). The Secretary of Labor must establish violation reporting and implement rules.
Key Provisions
- Group health plans may not pay hospital claims for off-campus outpatient departments unless claims include separate unique health identifiers (Section 2)
- Hospitals may not submit claims or hold patients liable without proper department-level identifiers (Section 3)
- Secretary must establish violation reporting process within one year (Section 3)
- Civil penalties up to /day for small hospitals, ,500/day for larger hospitals (Section 4)
- Effective for plan years beginning on or after January 1, 2024 (Section 2)
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Requires hospitals to use separate unique health identifiers when billing group health plans for services provided at off-campus outpatient departments, with enforcement through civil monetary penalties.
Key Policy Areas
Healthcare, Insurance
Primary Purpose
Requires hospitals to use separate unique health identifiers when billing group health plans for services provided at off-campus outpatient departments, with enforcement through civil monetary penalties.
Policy Domains
Transparency in Billing Act of 2023
Identified Gains
Contextual inference, no direct clause citation- Group health plans and insurers
- Patients
- Employers sponsoring group health plans
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Hospitals with off-campus outpatient departments
- Secretary of Labor
- Hospital billing departments
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
ReportedReported with an amendment, committed to the Committee of the …
Ms. Foxx (for herself and Mr. Scott of Virginia) introduced …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Hospitals billing for off-campus outpatient services, Hospitals with off-campus outpatient departments, Large hospitals (more than 30 beds)
Group health plans and health insurers, Group health plans and insurers
Patients, Patients receiving off-campus outpatient services
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Labor
Key Definitions
Terms defined in this bill
A department of a provider (per 42 CFR 413.65) not located on the campus of the provider or within the distance described in the campus definition from a remote location of a hospital facility.
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology