HR8684-119

What This Bill Does

The Transparency in Billing Act of 2026 adds honest billing requirements to ERISA. Group health plans and group health insurance issuers may not pay claims for items and services furnished at an off-campus outpatient department unless the hospital claim includes a separate unique health identifier for the department where the care was furnished. A parallel hospital rule says a hospital may not submit such a claim to a group plan or issuer, and may not hold the patient liable, unless the off-campus department has its own unique identifier and the claim includes it. The Secretary must establish a suspected-violation reporting process within one year. The bill defines off-campus outpatient department by reference to provider-based department rules and applies the requirements to plan years beginning on or after January 1, 2027. Enforcement allows the Secretary to assess civil monetary penalties against hospitals of up to $300 per day for hospitals with not more than 30 beds and up to $5,500 per day for larger hospitals. The Secretary of Labor must implement the amendments by rulemaking.

Who Benefits and How

Patients using off-campus outpatient departments benefit because hospitals cannot hold them liable for claims that omit the required unique identifier. Group health plans benefit because they can reject noncompliant off-campus outpatient claims. Health insurance issuers benefit from clearer billing identifiers that distinguish off-campus departments. Employers sponsoring group plans benefit if identifier transparency improves site-of-service oversight. Labor Department enforcement staff benefit from explicit penalty authority and a reporting process.

Who Bears the Burden and How

Hospitals with off-campus outpatient departments must obtain separate unique identifiers, include them on claims, adapt billing systems, and risk daily civil penalties for violations. Hospital outpatient billing vendors must update claim workflows. Group health plans and issuers must check claims for the required identifier before payment. The Labor Secretary must write rules and create the reporting process. Small hospitals face lower penalties but still must comply with the billing requirements.

Key Provisions

• Bars group plans and issuers from paying off-campus outpatient department claims that lack the separate unique identifier.
• Bars hospitals from submitting noncompliant off-campus outpatient claims or holding patients liable for those claims.
• Requires a suspected-violation reporting process within one year.
• Authorizes daily civil penalties up to $300 for small hospitals and $5,500 for larger hospitals.
• Requires Labor Department rulemaking and applies the plan-payment rule starting with plan years on or after January 1, 2027.