Committees in the House and Senate each advanced healthcare price transparency legislation this week, both aiming to expand disclosure requirements for hospitals, insurers and other healthcare providers.
Both measures would expand the existing hospital and payer price transparency rules, bring ASCs and labs under similar mandates for the first time and add new reporting requirements for insurers, pharmacy benefit managers and health plan administrators, though they differ on penalty structures, effective dates and scope.
The measures come as committees in both chambers work to advance a slew of healthcare bills before lawmakers break for a summer recess.
Here’s what to know about each bill.
Patients Deserve Price Tags Act
The Senate Committee on Health, Education, Labor and Pensions advanced legislation July 22 that would implement new price transparency requirements for hospitals, insurers, laboratories, imaging providers and ASCs, while also expanding group health plans’ access to claims and reimbursement data held by insurers and PBMs.
The committee passed the Patients Deserve Price Tags Act by a vote of 21-1, one of several healthcare bills advanced together in the same en bloc vote. The bill now heads to the full Senate.
Nine notes:
Hospitals would lose the 300-service cap by 2027. Under current rules, hospitals only have to publicly post standard charges for at least 300 shoppable services — a combination of CMS-specified and hospital-selected services. Beginning Jan. 1, 2027, that cap would disappear: hospitals would be required to publish standard charges for every shoppable service they provide
Penalties would scale with bed count and escalate for repeat violations. Before any penalty applies, HHS would have to notify a hospital of noncompliance and request a corrective action plan. Penalties only kick in if the hospital hasn’t complied within 45 days of that notice. Civil monetary penalties would then range from $300 a day for hospitals with 30 or fewer beds up to $25 to $35 per bed per day for hospitals over 500 beds. Hospitals found knowingly and willfully noncompliant twice in a year would face additional penalties of $500,000 to $10 million, and HHS would have no authority to waive, delay or otherwise mitigate any of these penalties once triggered.
A C-suite executive would have to personally attest to accuracy. A hospital’s CEO, CFO or an official of equivalent seniority would have to attest that its price disclosures are accurate and complete. That attestation would be deemed material to federal payment, raising False Claims Act exposure for hospitals that get it wrong.
Price estimator tools would no longer count toward compliance. Under current CMS rules, hospitals can satisfy the consumer-friendly disclosure requirement either by posting a searchable list of standard charges for at least 300 shoppable services or by offering an internet-based price estimator tool that gives patients a personalized out-of-pocket estimate for those services. Under the new bill, hospitals would have to maintain the consumer-friendly list regardless of whether they already offer a compliant estimator tool.
Labs, imaging providers and hospital-affiliated ASCs would join the transparency mandate. Beginning July 1, 2027, independent clinical diagnostic laboratories, imaging providers and ASCs with hospital ownership ties would have to publish gross charges, cash prices, payer-specific negotiated rates and de-identified minimum and maximum rates, following the same general model as hospital disclosures.
ACA exchange plans would have to build real-time, self-service cost tools. Plans would have to replace static estimates with a self-service tool that returns real-time cost-sharing information by billing code or plain-language search. They would also be financially responsible for any difference between the tool’s estimate and the amount the member is ultimately charged.
Insurers would face new monthly machine-readable file requirements. Starting January 2027, plans would have to publish three separate files covering in-network rates, historical drug net prices and rebates, and out-of-network billed and allowed amounts. HHS would audit at least 20 plans a year and the Department of Labor at least 200, with penalties up to $300 per member per day or $10 million.
Group health plans would gain new leverage over PBMs and TPAs. The bill would void contract “gag clauses” that limit a plan’s access to its own claims data, reimbursement formulas, rebates and fees, and would create a new ERISA oversight section requiring quarterly disclosure from health plan service providers. Violations would carry penalties of $10,000 to $100,000 a day depending on the provision.
Providers would face new limits on billing and collections. Providers would have to issue itemized bills within 30 days of final payment and would be barred from collections if charges exceed a prior good-faith estimate — unless they document an unforeseen medical need or a patient-initiated change in care.
The American Hospital Association pushed back on the bill in a July 22 statement, citing concerns it will add more administrative burden for hospitals. The association opposes eliminating price estimator tools as a valid compliance method, expanding the requirement to all shoppable services, adding a new ownership disclosure requirement it says duplicates data CMS already collects, and the bar on collections actions it calls “overly broad.”
“We continue to have serious concerns that the legislation does not yet sufficiently advance the goal of providing patients with clear, accurate healthcare price information in a manner that avoids unnecessary administrative burdens on providers,” the AHA said.
The Lower Costs, More Transparency Act
The House Energy and Commerce Committee advanced a broad healthcare price and cost transparency package July 21 in a 45-0 vote that would also expand price transparency rules for hospitals, insurers, ASCs and the administrators of employer-sponsored health plans if signed into law.
The bill was also referred to the House Ways and Means and Education and Workforce committees, which still have jurisdiction and would need to act before it reaches the House floor.
“In just the last seven months, we have held hearings with insurance CEOs, members of the drug supply chain, hospitals, and doctors,” Committee Chairman Brett Guthrie, R-Ky., said in a news release. “We’ve conducted critical oversight of waste, fraud, and abuse in the health care system, and we’ve assessed opportunities to enhance transparency for consumers. The AINS, which we are considering today, builds on each of those hearings and creates a comprehensive healthcare package that will strengthen health care price transparency, hold insurers accountable to their patients, lower drug prices, and expand access to care.”
Eight notes:
Hospitals face expanded price transparency requirements. Rules put in place during President Donald Trump’s first term already require hospitals to post standard prices, including discounted cash prices, for at least 300 shoppable services. Beginning in 2028, the bill would write those requirements into law and require hospitals to list the billing identifier for every administrative unit that bills under the hospital’s name and name any person or entity holding a 5% or higher stake in the hospital. Facility CEOs or CFOs would also have to attest that the data is complete and accurate. Monetary penalties would scale by a hospital’s overall bed count.
ASCs, labs and imaging centers get their own mandate. For the first time, freestanding ambulatory surgical centers, clinical diagnostic labs and imaging providers would also be subject to price transparency requirements, effective in 2028.
Payers must post negotiated rates. Current rules already require group plans and insurers to publish machine-readable files of their in-network negotiated rates and out-of-network allowed amounts, and to give members an online tool that estimates out-of-pocket costs. Starting in 2028, the bill would write those requirements into law.
Commercial plans must publish prior authorization data. Beginning in 2028, group plans and insurers would have to publicly report services subject to prior authorization, how many requests they approve and deny, how many denials are overturned on appeal, and their average decision times. Prior authorization reporting requirements to date have largely centered on government-program and exchange plans.
Insurers must show their overhead. The ACA already requires insurers to report their medical loss ratio, or the share of premiums spent on medical claims versus administrative costs, and to pay rebates when they fall short. Starting in 2028, the bill would build on that by requiring insurers to publish the breakdown on their websites and to add their share of premiums going to taxes and fees, along with the share they keep and don’t spend. Medicare Advantage plans would have to post comparable numbers at the plan level.
Electronic Medicare Advantage prior authorization. The package folds policies from the Improving Seniors’ Timely Access to Care Act, a bipartisan bill that passed the House unanimously in 2022 but stalled in the Senate over a $16 billion cost estimate. CMS has since implemented much of it through rulemaking. The agency’s 2024 Interoperability and Prior Authorization rule already requires MA and other plans to decide urgent requests within 72 hours and standard requests within seven days, and to implement electronic prior auth systems by 2027. Beginning in 2029, the bill would codify those and add new standards, including real-time decisions for routinely approved services.
Medicare Advantage supplemental benefits transparency. Supplemental benefits, such as dental, vision, meals and transportation, have been a quickly growing piece of the MA program, but regulators have little data on whether enrollees actually use them. CMS moved to address part of that gap with a Biden-era rule requiring plans to send enrollees a mid-year notice of their unused benefits, but the agency rescinded it in the 2027 MA final rule. Beginning in 2029, the bill would take a different route, requiring MA plans to report enrollee-level data on supplemental benefit use to CMS and to add detail to their encounter data.
Drug pricing and access provisions. The package would deem biosimilars interchangeable with their brand-name counterparts, making pharmacy substitution easier; let the FDA reject drug-approval delay tactics; and speed up some prescription-to-over-the-counter switches.
In a statement, the AHA said it supports giving patients clearer price information but warned that writing the requirements into law would limit CMS’s flexibility to keep improving them, cautioning that “certain innovations will be difficult to achieve absent additional legislative action.” The group also urged the committee to let hospitals keep using online price estimator tools to meet the shoppable-services requirement.
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