[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5582 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 5582
To amend the Public Health Service Act to provide for hospital and
insurer price transparency.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 26, 2025
Mr. James (for himself, Ms. Goodlander, Mrs. Kiggans of Virginia, and
Mr. Davis of North Carolina) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committees on Education and Workforce, and Ways and Means, 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 amend the Public Health Service Act to provide for hospital and
insurer price transparency.
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 ``Patients Deserve Price Tags Act''.
SEC. 2. STRENGTHENING HOSPITAL PRICE TRANSPARENCY REQUIREMENTS.
(a) In General.--Section 2718(e) of the Public Health Service Act
(42 U.S.C. 300gg-18(e)) is amended to read as follows:
``(e) Standard Hospital Charges.--
``(1) In general.--
``(A) Disclosure of standard charges.--Each
hospital shall, in accordance with a method and format
established by the Secretary under subparagraph (C), on
a monthly basis compile and make public (without
subscription and free of charge)--
``(i) all of the hospital's standard
charges (including the information described in
subparagraph (B)) for each item and service
furnished by such hospital; and
``(ii) hospital standard charge
information, including the information
described in subparagraph (B), in a consumer-
friendly format (as specified by the
Secretary), that includes--
``(I) 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 through December 31,
2026, after which the hospital's prices
shall include all shoppable services;
and
``(II) 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.
``(B) Standard charges described.--For purposes of
subparagraph (A), standard charges means:
``(i) A plain language description of each
item or service, accompanied by any applicable
billing codes, including modifiers, using
commonly recognized billing code sets,
including the Current Procedural Terminology
code, the Healthcare Common Procedure Coding
System code, the diagnosis-related group, the
National Drug Code, and other nationally
recognized identifier.
``(ii) The gross charge, expressed as a
dollar amount, for each such item or service,
when provided in, as applicable, the inpatient
setting and outpatient department setting.
``(iii) The discounted cash price expressed
as a dollar amount, for each such item or
service when provided in, as applicable, the
inpatient setting and outpatient department
setting (or, in the case no discounted cash
price is available for an item or service, the
minimum cash price accepted by the hospital
from self-pay individuals for such item or
service, expressed as a dollar amount, as well
as, 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). The hospital
shall accept the discounted cash price as
payment in full from any patient that chooses
to pay in cash without regard to the patient's
coverage.
``(iv) The payer-specific negotiated
charges, expressed as a dollar amount and
clearly associated with the name of the
applicable third-party payer and name of each
plan, that apply to each such item or service
when provided in, as applicable, the inpatient
setting and outpatient department setting. If
the charges are based on an algorithm,
percentage of another amount, or other formula
or criteria, the hospital also shall disclose
such algorithm, percentage, formula, or
criteria as set forth in its contract and any
other terms, schedules, exhibits, data, or
other information referenced in any such
contract as shall be required to determine and
disclose the negotiated charge.
``(v) The de-identified maximum and minimum
negotiated charges for each such item or
service, expressed as a non-zero dollar amount.
``(vi) Any other additional information the
Secretary may require 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. In the case of standard charges and
prices for an item or service included as part
of a bundled, per diem, episodic, or other
similar arrangement, the information described
in this subparagraph shall be made available as
determined appropriate by the Secretary.
``(C) Uniform method and format.--Not later than
January 1, 2026, 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 shall--
``(i) 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
spreadsheet format;
``(ii) meet such standards as determined
appropriate by the Secretary in order to ensure
the accessibility and usability of such charges
and prices; and
``(iii) be updated as determined
appropriate by the Secretary, in consultation
with stakeholders.
``(2) No deemed compliance.--The availability of a price
estimator tool shall not be considered to deem compliance with
or otherwise vitiate the requirements of paragraph (1)(A)(ii)
or any other requirements of this section. Furthermore, the use
of an estimator tool shall not be used for purposes of
compliance with any provisions in this Section.
``(3) Monitoring compliance.--The Secretary shall, in
consultation with the Inspector General of the Department of
Health and Human Services, establish a process to monitor
compliance with this subsection. Such process shall ensure that
each hospital's compliance with this subsection is reviewed not
less frequently than once every year.
``(4) Attestation.--A senior official from each hospital
(the Chief Executive Officer, Chief Financial Officer, or an
official of equivalent seniority) shall attest to the accuracy
and completeness of the disclosures made in accordance with the
hospital price transparency requirements set forth in this
regulation. Such attestation shall be deemed to be material to
payment from the Federal Government to the hospital.
``(5) Enforcement.--
``(A) In general.--In the case of a hospital that
fails to comply with the requirements of this
subsection, 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 shall include a request
for 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 law, a hospital that
has received a request for a corrective action
plan under subparagraph (A) and fails to comply
with the requirements of this subsection by the
date that is 45 days after such request is made
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;
``(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
301 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 300 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 2027 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 limitation on the
increase of any penalty applied under
clause (iii) pursuant to the amounts
specified in subclause (II) of such
clause.
``(iii) Persistent noncompliance.--
``(I) In general.--In the case of a
hospital that the Secretary has
determined to be knowingly and
willfully noncompliant with the
provisions of this subsection two or
more times during a 1-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, an amount that is not
less than $5,000,000 and not
more than $10,000,000.
``(iv) Provision of technical assistance.--
The Secretary may, to the extent practicable,
provide technical assistance relating to
compliance with the provisions of this section
to hospitals requesting such assistance.
``(v) 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.
``(C) No waiver.--The Secretary shall not grant or
extend any waiver, delay, tolling, or other mitigation
of a civil monetary penalty for violation of this
subsection.
``(6) Definitions.--For purposes of this subsection:
``(A) Discounted cash price.--The term `discounted
cash price' means the minimum charge, exclusive of any
hospital or third-party payer assistance, that the
hospital accepts from an ind