Patients Deserve Price Tags Act
Sponsored By: Representative James
Introduced
Summary
Would require broad price transparency across hospitals, clinical labs, imaging centers, and ambulatory surgical centers by making standard charges and payer‑specific negotiated prices public in machine‑readable and consumer‑friendly formats, while giving group health plans stronger access to claims data and new enforcement tools.
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Bill Overview
Analyzed Economic Effects
9 provisions identified: 9 benefits, 0 costs, 0 mixed.
Health plans must publish price files
By January 1, 2027, health plans would post three machine‑readable files each month. Files would show in‑network rates by provider, drug rates and historical net prices for a 90‑day lookback, and out‑of‑network billed and allowed amounts for a 90‑day lookback. An executive would attest that the data are complete and accurate, and federal agencies would audit plans. Plans that ignore notices could face up to $300 per member per day in penalties, capped at $10,000,000.
Plans get more data from vendors
Group health plans would gain the right to get all claims and encounter data and key documents from service providers within tight timelines. Vendors would have to share, at least quarterly and at no cost, claims files, pricing methods, rebates and fees received, payments to subcontractors, and reconciliation data. Limits that block access would be void, with HIPAA privacy rules still in place. Penalties could reach $100,000 per day for violations. Many rules would start one to two years after enactment, depending on plan type.
Hospitals would post monthly prices online
Starting January 1, 2026, hospitals would have to post prices online each month. Through December 31, 2026, they would list at least 300 shoppable services; after that they would list all shoppable services. Each listing would show billing codes, the gross charge, the discounted cash price (or a minimum cash price), and negotiated prices by payer and plan plus max and min rates. A senior hospital leader would attest the data are accurate. Daily penalties would apply if they do not comply: 30 or fewer beds, $300 per day; 31–100 beds, $12.50 per bed per day (rising to $15 after one year of continuous noncompliance); 101–300 beds, $17.50 per bed per day (rising to $20); 301–500 beds, $20 per bed per day (rising to $25); more than 500 beds, $25 per bed per day (rising to $35).
Real-time cost estimates from your plan
Your health plan would need a web tool that gives real-time cost estimates. It would show the in-network rate or the maximum allowed amount, your cost sharing, and your progress toward your deductible and out-of-pocket limit. You could search by billing code or by a named provider, in or out of network. If the tool overestimates what you owe, the plan would make you whole.
Clear, itemized medical bills required
Providers would have to send a written, itemized bill within 30 days after they get final payment from a third party. Each bill would list every service, codes, prices, and payments already made, plus how to get help and charity care. Providers could not start collections until they send this bill. If the bill is higher than a posted price or your good faith estimate, they would need proof of a medical need or a change you asked for.
Imaging providers must post prices
Starting July 1, 2027, imaging providers and suppliers would post prices online at least once a year. They would show billing codes, gross charges, and discounted cash prices in a standard format. If you pay cash, they would have to accept the posted discounted or minimum cash price as payment in full. Penalties could reach up to $300 per day after continued noncompliance.
Labs would post test prices
Starting July 1, 2027, many clinical labs would post prices for each test on a website. They would update prices at least monthly when changes happen and include common add-ons like collection and transport. A standard file format would be set by January 1, 2027. If a lab ignores notices, penalties could be up to $300 per day after 90 days.
Surgery centers would post prices
Starting July 1, 2027, certain ambulatory surgery centers with hospital ownership would post prices each year. They would list at least 300 shoppable services and use a standard file format set by January 1, 2027. If they stay out of compliance after notices and timelines, penalties could reach up to $300 per day.
Estimator tools cannot replace posted prices
Having a price estimator tool would not count as meeting the public posting rules. Hospitals, surgery centers, labs, and imaging providers would still need to publish machine‑readable files and consumer‑friendly price lists.
Sponsors & CoSponsors
Sponsor
James
MI • R
Cosponsors
Goodlander
NH • D
Sponsored 9/26/2025
Kiggans (VA)
VA • R
Sponsored 9/26/2025
Davis (NC)
NC • D
Sponsored 9/26/2025
Owens
UT • R
Sponsored 10/10/2025
Vindman
VA • D
Sponsored 10/21/2025
Calvert
CA • R
Sponsored 12/19/2025
Vasquez
NM • D
Sponsored 12/19/2025
Fulcher
ID • R
Sponsored 1/16/2026
Weber (TX)
TX • R
Sponsored 1/21/2026
Spartz
IN • R
Sponsored 2/5/2026
Roll Call Votes
No roll call votes available for this bill.
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