HR5582-119

What This Bill Does

The Patients Deserve Price Tags Act is a broad health price-transparency bill. Hospitals must publish monthly, free, machine-readable and consumer-friendly standard-charge information for each item and service, including plain-language descriptions, billing codes, gross charges, discounted cash prices, payer-specific negotiated charges, and at least 300 shoppable services through 2026, with all shoppable services after that. Clinical diagnostic laboratories must publish monthly test prices beginning July 1, 2027, including gross charges, discounted or minimum cash prices, payer-specific negotiated charges, de-identified minimum and maximum negotiated charges, and cash-price payment-in-full treatment. Imaging providers and suppliers must publish annual prices for specified imaging services beginning July 1, 2027, unless the hospital transparency rule already covers the service. Ambulatory surgical centers must publish annual machine-readable and consumer-friendly prices for items, services, and at least 300 shoppable services. Health plans must provide self-service tools, plus paper or phone disclosures on request, showing in-network rates, maximum allowed out-of-network amounts, cost sharing, deductible and out-of-pocket progress, frequency or volume limits, and bundled-service information. ERISA group health plan contracts with providers, networks, TPAs, PBMs, and other covered service providers must allow plan fiduciaries access to claims, encounter, documentation, payment, pricing, value-based payment, and related data. Service providers must give group health plans, issuers, and self-funded non-federal governmental plans quarterly information on rates, formulas, rebates, fees, discounts, remuneration, data sales, network payments, and subcontractors. Sections 2 through 5 preserve state price-transparency laws unless they block the federal requirements. Plans and issuers must provide post-service explanations of benefits within 45 days of payment requests beginning in 2026. Health care providers and facilities must give patients itemized bills within 30 days after final third-party payment, including plain-language descriptions, billing codes, prices, payments, language assistance, billing contact information, and charity-care policies.

Who Benefits and How

Patients comparing health care prices benefit because hospitals, labs, imaging providers, ASCs, plans, and providers must publish or disclose concrete prices, cash rates, codes, and cost sharing. Self-pay patients benefit because covered labs and imaging providers must accept disclosed discounted or minimum cash prices as payment in full. Group health plan fiduciaries benefit because contracts cannot block access to claims, encounter, pricing, payment, and documentation data needed to audit plan spending. Employers sponsoring health plans benefit from quarterly service-provider data about reimbursement formulas, rebates, fees, discounts, data sales, and network payments.

Who Bears the Burden and How

Hospitals must update monthly standard-charge files and consumer-friendly price information for shoppable and eventually all shoppable services. Clinical laboratories, imaging providers, and ambulatory surgical centers must publish specified cash, gross, negotiated, minimum, maximum, and billing-code price data. Health insurers, third-party administrators, pharmacy benefit managers, provider networks, and service providers must disclose plan data and cannot use contracts to block required transparency. Health care providers and facilities must issue itemized bills within 30 days after final third-party payment and include language-assistance, contact, and charity-care information.

Key Provisions

• Requires monthly hospital price transparency files and consumer-friendly prices for standard charges and shoppable services.
• Requires clinical laboratory and imaging-service price disclosures beginning July 1, 2027.
• Requires ambulatory surgical centers to publish annual machine-readable and consumer-friendly price information.
• Requires health plan tools and paper or phone disclosures for rates, cost sharing, deductibles, out-of-pocket progress, and service limits.
• Requires group health plan access to claims, encounter, payment, pricing, and documentation data from covered service providers.
• Requires quarterly service-provider reports on reimbursement methods, rebates, fees, discounts, remuneration, data sales, and subcontractors.
• Preserves state price-transparency laws unless they conflict and requires post-service explanations of benefits and itemized patient bills.