Patients Deserve Price Tags Act
Sponsored By: Senator Roger Marshall
Introduced
Summary
Price transparency is the core goal. This bill would require hospitals, labs, imaging centers, ambulatory surgical centers, and health plans to publish standardized, machine‑readable prices and give patients real‑time cost tools.
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- Patients and families would get a web-based self‑service price estimator, itemized bills within 30 days, and explanations of benefits within 45 days that list codes, out‑of‑pocket responsibility, and prior‑authorization rules. Collections could be limited if providers fail to provide required estimates or itemized bills.
- Hospitals, clinical labs, imaging providers, and ambulatory surgical centers would have to post gross charges, discounted cash prices, payer‑specific negotiated charges, and de‑identified min/max negotiated rates in uniform, machine‑readable formats. Hospitals would start reporting by Jan 1, 2026, and smaller hospital penalty examples range from about $500,000 to $1,000,000 while other providers face daily penalties up to $300 for ongoing violations.
- Employers, group health plans, and plan fiduciaries would gain broad access to claims, encounter, and payment data and quarterly disclosure of pricing and rebate information. Contracts could not include gag clauses and violations carry civil penalties (for example $10,000 per day and up to $100,000 per day for certain service‑provider disclosure failures).
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Bill Overview
Analyzed Economic Effects
7 provisions identified: 5 benefits, 1 costs, 1 mixed.
Clear price lists and cash protections
If enacted, hospitals (from January 1, 2026) and clinical labs, imaging providers, and many ASCs (from July 1, 2027) would have to post machine‑readable price lists and consumer price displays. Lists would show gross charges, discounted cash prices (or a three‑year minimum cash price and a charity‑care link), payer‑specific negotiated rates with payer names, and de‑identified min/max negotiated amounts. Providers would have to accept the published discounted or minimum cash price as full payment when a patient pays cash. Regulators could require corrective plans and fine providers (commonly up to $300 per day) for ongoing noncompliance. If a provider fails to give a required good‑faith estimate, a presumption would favor the patient in billing disputes.
Exchange online cost estimator
If enacted, starting January 1, 2026, the Exchange would offer an online self‑service tool with real‑time cost answers. The tool would show in‑network rates (or the out‑of‑network maximum), your deductible, copay, coinsurance, amounts already applied to limits, any visit frequency limits, and prior authorization rules. You could search by billing code or description. Plans would have to hold you harmless for material differences between the tool estimate and the final bill. Paper or phone help would be free if requested.
Monthly plan rate files public
If enacted, starting January 1, 2027, health plans would post three monthly machine‑readable files. Files would show in‑network rates by provider, drug in‑network rates with a 90‑day historical net price, and billed/allowed amounts for out‑of‑network care. Plans would list plan IDs, billing codes, provider identifiers, and the formulas used to calculate payments. An executive must attest the files are accurate. Regulators would audit samples and could fine plans up to $300 per member per day or $10 million total for ongoing violations.
Stronger plan fiduciary data access
If enacted, for plan years starting one year after enactment, group health plan contracts would have to let plan fiduciaries get full claims and encounter data quickly and at no cost. Covered service providers would have to deliver data consistent with HIPAA transaction standards and not delay access more than 15 days. For self‑funded, non‑Federal government plans, service providers would also have to give detailed quarterly disclosures free of charge. Contract terms that unduly delay or limit access would be voidable and failure to provide data could trigger enforcement.
Larger penalties for plan violations
If enacted, the bill would let the Secretary assess civil penalties of up to $100,000 per day for violations of ERISA section 726 and for violations of PHSA section 2799A‑11 by health plan service providers. These new penalty authorities would apply to plan service providers and be enforced through existing procedures. The penalties target regulated entities rather than individual patients.
Faster, itemized EOBs for claims
If enacted, for plan years starting January 1, 2026, group health plans would have to give an itemized explanation of benefits within 45 days after a payment request or claim. The notice would say if the provider is in‑network and list each item, billing codes, what the plan will pay, your cost for each item, amounts already applied to your deductible and out‑of‑pocket limit, and the site of service. The Secretary would write implementing rules and notices may be mailed or sent electronically.
State price‑transparency laws preserved
If enacted, the bill would let State price‑transparency laws remain in force unless a State law actually prevents applying a federal requirement. The change would not alter how ERISA applies to group health plans. This mainly clarifies how federal and State rules interact.
Sponsors & CoSponsors
Sponsor
Roger Marshall
KS • R
Cosponsors
Maggie Hassan
NH • D
Sponsored 7/17/2025
Joni Ernst
IA • R
Sponsored 7/17/2025
John Hickenlooper
CO • D
Sponsored 7/17/2025
Chuck Grassley
IA • R
Sponsored 7/17/2025
Tim Sheehy
MT • R
Sponsored 7/17/2025
Tammy Baldwin
WI • D
Sponsored 10/23/2025
Bernie Moreno
OH • R
Sponsored 11/7/2025
Rick Scott
FL • R
Sponsored 11/20/2025
Andy Kim
NJ • D
Sponsored 11/20/2025
Jon Husted
OH • R
Sponsored 12/3/2025
Lisa Blunt Rochester
DE • D
Sponsored 12/3/2025
Tommy Tuberville
AL • R
Sponsored 12/3/2025
Cynthia Lummis
WY • R
Sponsored 12/9/2025
Christopher Coons
DE • D
Sponsored 12/11/2025
Markwayne Mullin
OK • R
Sponsored 12/15/2025
Cory Booker
NJ • D
Sponsored 12/17/2025
Peter Welch
VT • D
Sponsored 1/12/2026
Gary Peters
MI • D
Sponsored 1/15/2026
Roll Call Votes
No roll call votes available for this bill.
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