Federal RuleAug 21
62
DOL Rewrites Disability Rules for 'Merit-Based Opportunity' Push
RuleLabor DepartmentFederal Contract Compliance Programs OfficeSignificant Wallet
119-s-2355119th CongressWALLET
Patients Deserve Price Tags Act
Sponsored By: Senator Marshall, Roger [R-KS]
In Committee
Summary
national price and data transparency would be created across hospitals, labs, imaging centers, ambulatory surgical centers, health plans, and plan service providers to make prices, negotiated rates, ownership, and related data public and machine-readable. The bill also would expand patient notices, itemized billing, hold-harmless protections, audits, and civil penalties.
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 4 benefits, 0 costs, 1 mixed.
Monthly public plan price files
If enacted, each health plan would have to publish three machine-readable files every month starting January 1, 2027. File one would list per-item and service in-network rates by provider (NPI). File two would list drug in-network rates and the plan's historical net price (rebates/discounts) for a 90-day window beginning 180 days before submission. File three would show billed charges and plan-allowed amounts for nonparticipating providers for that same 90-day window. Files must be in common, size-limited formats, free to access, and include calculation formulas, plan IDs, and plain-language descriptions to help cross-plan comparisons.
Plan data access and vendor rules
If enacted, group health plans and issuers would be able to get full claims, payment, rebate, and pricing-methodology data from TPAs, PBMs, and other service providers. For plan years starting two years after enactment, service providers must deliver this information at no cost at least quarterly in standard HIPAA electronic formats. Self-funded non-Federal government plans must get quarterly no-cost disclosures starting one year after enactment. Plans must annually attest to having timely access to required data, and contract terms that unduly delay or block access would be void. The Secretary could fine violators up to $10,000 per day for access violations and enforce corrective actions.
Patient billing notices and cost tools
If enacted, providers would have to give a written notice with any payment request telling you how to get an itemized bill. After final payment by a third party, the itemized bill must be provided within 30 days and show plain-language descriptions, billing codes, billed amounts, payments made, and charity-care info. Providers generally could not start collections unless they followed the notice and itemized-bill rules, and fines up to $10,000 per instance are possible for violations. Group plans would need to send expanded EOBs and AEBs and must reply within 45 days to payment requests starting in plan years on or after January 1, 2026; later, plans would be required to hold enrollees harmless when final bills are substantially above AEB estimates under rules the Secretary sets. The bill would also define a "discounted cash price" as the minimum dollar amount a provider accepts as full payment from a cash-paying person and require exchanges and plans to offer real-time online tools that give provider- and plan-specific cost estimates and hold members harmless for estimate gaps.
Provider price postings and cash rates
If enacted, hospitals, ambulatory surgical centers, clinical labs, and many imaging providers would have to post standard charges and consumer-friendly price files online. Hospitals would publish monthly starting January 1, 2026 and must list at least 300 shoppable services through December 31, 2026, then all shoppable services they furnish. ASCs, labs, and imaging providers face similar machine-readable posting rules with effective dates around one year after enactment or July 1, 2027, and labs must update monthly if prices change. Providers must show billing codes, gross charges, payer- and plan-specific negotiated rates, a disclosed discounted cash price (or recent minimum cash price) and a charity-care link, and they generally must accept the disclosed discounted cash price as payment in full for cash-paying patients. HHS would set the format, require senior-officer attestation, monitor compliance, require corrective action, and may fine persistent noncompliance; hospitals continuing to violate posting rules could be barred from extraordinary collection actions for debts incurred while noncompliant.
State price-transparency protections kept
If enacted, the federal price-transparency rules would not override state laws that require or ban price transparency, unless a state law prevents the federal rule from applying. The provision also says it does not change how ERISA group health plan rules apply.
Sponsors & CoSponsors
Sponsor
Marshall, Roger [R-KS]
KS • R
Cosponsors
Sen. Hassan, Margaret Wood [D-NH]
NH • D
Sponsored 7/17/2025
Sen. Ernst, Joni [R-IA]
IA • R
Sponsored 7/17/2025
Sen. Hickenlooper, John W. [D-CO]
CO • D
Sponsored 7/17/2025
Sen. Grassley, Chuck [R-IA]
IA • R
Sponsored 7/17/2025
Sen. Sheehy, Tim [R-MT]
MT • R
Sponsored 7/17/2025
Sen. Baldwin, Tammy [D-WI]
WI • D
Sponsored 10/23/2025
Sen. Moreno, Bernie [R-OH]
OH • R
Sponsored 11/7/2025
Sen. Scott, Rick [R-FL]
FL • R
Sponsored 11/20/2025
Sen. Kim, Andy [D-NJ]
NJ • D
Sponsored 11/20/2025
Sen. Husted, Jon [R-OH]
OH • R
Sponsored 12/3/2025
Sen. Blunt Rochester, Lisa [D-DE]
DE • D
Sponsored 12/3/2025
Sen. Tuberville, Tommy [R-AL]
AL • R
Sponsored 12/3/2025
Sen. Lummis, Cynthia M. [R-WY]
WY • R
Sponsored 12/9/2025
Sen. Coons, Christopher A. [D-DE]
DE • D
Sponsored 12/11/2025
Rep. Mullin, Markwayne [R-OK-2]
OK • R
Sponsored 12/15/2025
Sen. Booker, Cory A. [D-NJ]
NJ • D
Sponsored 12/17/2025
Sen. Welch, Peter [D-VT]
VT • D
Sponsored 1/12/2026
Sen. Peters, Gary C. [D-MI]
MI • D
Sponsored 1/15/2026
Sen. Warren, Elizabeth [D-MA]
MA • D
Sponsored 3/26/2026
Sen. Armstrong, Alan [R-OK]
OK • R
Sponsored 6/2/2026
Sen. Kelly, Mark [D-AZ]
AZ • D
Sponsored 6/4/2026
Sen. Schmitt, Eric [R-MO]
MO • R
Sponsored 6/18/2026
Sen. Fetterman, John [D-PA]
PA • D
Sponsored 6/23/2026
Sen. Gallego, Ruben [D-AZ]
AZ • D
Sponsored 7/14/2026
Sen. Shaheen, Jeanne [D-NH]
NH • D
Sponsored 9/23/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov