Transparency in Billing Act of 2026
- Bill Number
- H.R. 8684
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-05-21: Ordered to be Reported (Amended) by the Yeas and Nays: 34 - 0.
- Last Updated
- 2026-05-22T08:07:48Z
AI-Generated Summary
Purpose
The Transparency in Billing Act of 2026 (H.R. 8684) aims to ensure accurate and transparent billing by hospitals for services provided at off-campus outpatient departments (facilities not on a hospital's main campus or nearby remote locations). It prevents hospitals from submitting claims without a unique identifier for these sites, reducing potential overbilling under group health plans.
Key Provisions
- Billing Requirements (New ERISA Section 727 and 901):
- Group health plans and insurers offering group coverage cannot pay hospital claims for off-campus outpatient services unless the claim includes a separate unique health identifier (like a specific ID number) for the exact department where services were provided.
- Hospitals cannot submit such claims or hold patients financially responsible unless they obtain and include this identifier.
- Definitions:
- Off-campus outpatient department: A provider department not on the hospital campus or within specified distances from it (per federal regulations).
- Reporting Violations:
- The Secretary of Labor must create a process within one year for reporting suspected violations.
- Enforcement (Amended ERISA Section 502):
- Civil monetary penalties for hospitals: Up to $300 per day for small hospitals (≤30 beds); up to $5,500 per day for larger ones.
- Effective Date and Implementation:
- Applies to plan years starting on or after January 1, 2027.
- Secretary of Labor implements via formal rulemaking.
Significant Changes to Existing Law
- Amends ERISA (1974): Adds new sections (727 in Subpart B, Part 9 with Section 901 in Subtitle B) imposing first-time federal requirements on private group health plans, insurers, and hospitals for site-specific billing identifiers.
- Expands enforcement tools under ERISA Section 502 to include penalties specifically for billing violations.
- No changes to Medicare/Medicaid or individual health plans; targets employer-sponsored group coverage.
Potential Impacts
- On Citizens/Patients: May lower out-of-pocket costs and surprise bills by ensuring off-campus services are billed at appropriate (often lower) rates, not full hospital rates.
- On Health Insurers and Plans: Reduces improper payments; could lower premiums over time but requires claim-processing updates.
- On Hospitals: Forces investment in unique identifiers and billing systems; smaller hospitals face lighter penalties, but non-compliance risks fines.
- On Government Agencies: Department of Labor gains new oversight, reporting process, and rulemaking duties; no direct international relations impact.
Main Stakeholders Affected
- Hospitals (especially those with off-campus outpatient sites): Must comply with identifier and billing rules.
- Group Health Plans and Insurers: Cannot pay non-compliant claims.
- Employees and Beneficiaries: Covered under employer group plans; potential cost savings.
- Department of Labor: Responsible for enforcement, rulemaking, and violation reporting.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens ERISA's consumer protections by tying payments to billing accuracy; civil penalties provide clear deterrence without criminal measures. Relies on existing Social Security Act definitions for identifiers.
- Constitutional: No apparent issues; regulates private contracts (plans/insurers) and commerce under Congress's authority.
- Political: Bipartisan introduction (Reps. Foxx and Scott); focuses on transparency without broad price controls, potentially appealing across aisles amid concerns over healthcare costs.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (1)
Rep. Scott, Robert C. "Bobby" [D-VA-3]
Recent Actions
- 2026-05-21: Ordered to be Reported (Amended) by the Yeas and Nays: 34 - 0.
- 2026-05-21: Committee Consideration and Mark-up Session Held
- 2026-05-07: Referred to the House Committee on Education and Workforce.
- 2026-05-07: Introduced in House
- 2026-05-07: Introduced in House
Bill Versions
- Transparency in Billing Act of 2026 — issued 2026-05-07 — PDF (5 pages)