Transparency in Billing Act of 2026
Sponsored By: Representative Foxx, Virginia [R-NC-5]
Introduced
Summary
This bill would require hospitals to use a separate, department-specific billing identifier for services provided at off‑campus outpatient departments. It would tie payment by group health plans and insurers to that identifier and set up reporting and penalties for violations.
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- Hospitals would need to obtain and include a unique health identifier for each off‑campus outpatient department on claims. Smaller and larger hospitals face tiered fines for noncompliance: up to $300 per day for hospitals with 30 or fewer beds and up to $5,500 per day for hospitals with more than 30 beds.
- Group health plans and health insurance issuers would be barred from paying hospital claims for off‑campus outpatient department care unless the claim includes the department-specific identifier. The requirement would apply to plan years beginning on or after January 1, 2027.
- Patients and families would see clearer billing about which hospital department provided care because claims must show the department identifier and hospitals must follow new "honest billing" rules. A federal reporting process for suspected violations would be created within one year and implementation would proceed through rulemaking by the Secretary of Labor.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 0 benefits, 0 costs, 2 mixed.
Hospital billing fines and rules
This bill would require the Secretary to set up a way to report suspected billing violations within one year. It would let the Secretary assess civil fines on hospitals that break the department‑ID billing rule: up to $300 per day for hospitals with 30 or fewer beds, and up to $5,500 per day for hospitals with more than 30 beds (bed counts set by the cited HHS rule at enactment). The bill would also direct the Secretary of Labor to write rules to implement these changes.
New hospital department billing ID rule
This bill would require hospitals to get a separate unique health identifier for each off‑campus outpatient department. A hospital would not be able to bill you or make you liable for services from an off‑campus department unless the claim includes that department's identifier. Group health plans and issuers would not pay a hospital claim for those off‑campus services unless the claim includes the department identifier, starting in plan years beginning on or after January 1, 2027. The bill would use the off‑campus department rules in 42 C.F.R. § 413.65 to decide which departments this applies to.
Sponsors & CoSponsors
Sponsor
Foxx, Virginia [R-NC-5]
NC • R
Cosponsors
Scott (VA)
VA • D
Sponsored 5/7/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov