Patients Deserve Price Tags Act
- Bill Number
- S. 2355
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-03-19: Committee on Health, Education, Labor, and Pensions. Hearings held.
- Last Updated
- 2026-06-24T11:03:28Z
AI-Generated Summary
Patients Deserve Price Tags Act (S. 2355)
Purpose
This bill aims to improve transparency in healthcare pricing by requiring hospitals, clinical labs, imaging providers, ambulatory surgical centers (ASCs), health plans, and administrative service providers to publicly disclose detailed pricing information. The goal is to help patients understand and compare costs, make informed decisions about care, and reduce unexpected bills, ultimately promoting competition and lowering prices in the healthcare system.
Key Provisions
- Hospital Price Transparency (Section 2): Hospitals must compile and publicly post (free, no subscription) all standard charges monthly starting January 1, 2026. This includes:
- Plain-language descriptions with billing codes (e.g., CPT, HCPCS).
- Gross charge (full list price from the hospital's "chargemaster").
- Discounted cash price (lowest cash payment accepted, which hospitals must honor for cash-paying patients regardless of insurance).
- Payer-specific negotiated charges (rates with each insurer/plan, including formulas or algorithms if used).
- De-identified maximum and minimum negotiated charges.
- Links to charity care policies for uninsured or low-income patients.
- By December 31, 2026, coverage expands to all "shoppable services" (procedures patients can schedule in advance, totaling at least 300).
- Disclosures in machine-readable formats (e.g., spreadsheets) set by the Secretary of Health and Human Services (HHS). Price estimator tools do not count toward compliance.
- Annual compliance monitoring, senior official attestation (tied to federal payments), and technical assistance available.
- Enforcement: Notification of violations, required corrective plans, and civil penalties scaled by hospital size (e.g., $300/day for small hospitals ≤30 beds; up to $35 per bed per day for large ones >500 beds, or higher for repeat willful violations up to $10 million). No waivers for penalties; penalties adjustable via rulemaking starting 2027.
- Clinical Diagnostic Lab Price Transparency (Section 3): Starting July 1, 2027, labs (except those covered by hospital disclosures) must post pricing for specified tests (shoppable lab tests not unique to one provider) on websites, updated monthly. Includes similar details as hospitals (gross charge, discounted cash price, negotiated rates, etc.), plus ancillary services (e.g., specimen collection). Machine-readable formats required by January 1, 2027. Enforcement: Penalties up to $300/day after 90 days of noncompliance, adjustable from 2028.
- Imaging Services Price Transparency (Section 4): Starting July 1, 2027, non-hospital imaging providers (e.g., for X-rays, MRIs) must post pricing annually for specified shoppable imaging services. Similar disclosure details. Formats set by January 1, 2027. Monitoring via audits; penalties up to $300/day after 90 days, no waivers or reductions.
- Ambulatory Surgical Center Price Transparency (Section 5): ASCs with hospital ownership/control must post standard charges and prices annually starting July 1, 2027, covering at least 300 shoppable services. Similar details to hospitals. Machine-readable formats by January 1, 2027. Annual reviews; penalties up to $300/day after 90 days, no waivers.
- Health Coverage Transparency (Section 6): Amends the Affordable Care Act (ACA) to require:
- Exchanges and plans to offer self-service tools (internet-based, real-time) for consumers to get personalized cost estimates (in-network rates, out-of-pocket costs, deductibles, prior authorizations) using billing codes or descriptions. Paper/phone options available.
- Plans to submit monthly machine-readable files (three separate files) of rates, payments, and historical prices (e.g., in-network rates by provider, drug net prices net of rebates, out-of-network allowed amounts) to Exchanges, HHS, state commissioners, and the public starting January 1, 2027. Includes formulas for calculations; attestations required.
- Applies to accountable care organizations (ACOs) in Medicare Shared Savings.
- Annual audits of at least 20 plans; public reports to Congress. Penalties up to $300 per member per day or $10 million for noncompliance after 90 days.
- Group Health Plan Access to Health Data (Section 7): Amends ERISA to require contracts with providers, networks, third-party administrators (TPAs), or pharmacy benefit managers (PBMs) to allow full, timely access (within 15 days) to claims data, medical records, and pricing details (e.g., no limits on audits, value-based payments, or fees). Voids "gag clauses" restricting data sharing. Annual attestations required; exceptions for inability to obtain data with explanations. Civil penalties up to $10,000/day. Effective 1 year after enactment.
- Oversight of Administrative Service Providers (Section 8): Amends ERISA and Public Health Service Act (PHSA) to prohibit contracts limiting quarterly disclosures (at no cost) of reimbursement formulas, fees, rebates, and alternative payment data (e.g., bundled payments). Must comply with HIPAA privacy rules; data in standard electronic formats (e.g., X12N 837 for claims). Voids restrictive provisions. Penalties $100,000/day. Effective 1-2 years after enactment, depending on plan type.
- State Preemption Only in Event of Conflict (Section 9): Federal rules do not override state price transparency laws unless they directly conflict. No impact on ERISA-preempted plans.
- Requirement for Explanation of Benefits (Section 10): Amends PHSA, Internal Revenue Code, and ERISA to require plans/issuers to send detailed explanations of benefits (EOBs) within 45 days of a claim, including provider participation status, itemized costs with codes, plan payments, patient cost-sharing, progress toward deductibles/out-of-pocket limits, and service sites. Matches advanced EOB format for emergency services. Effective January 1, 2026.
- Provision of Itemized Bills (Section 11): Providers/facilities must send itemized bills within 30 days of final third-party payment, including descriptions, codes, prices, payments received, charity care info, and contact for questions. No collection actions without compliance or if bills exceed good faith estimates without proof of unforeseen needs (burden on provider). Penalties up to $10,000 per violation; presumption of excess charges in disputes.
Significant Changes to Existing Law
- Builds on 2019 HHS hospital transparency rules (45 CFR Part 180) by mandating full payer-specific rates (previously optional/aggregated), algorithms, all shoppable services by 2026, and stronger enforcement (e.g., no estimator tool loophole, scaled penalties).
- Extends transparency to labs, imaging, and hospital-affiliated ASCs, previously unregulated federally.
- Enhances 2020 ACA "Transparency in Coverage" rule by adding real-time consumer tools, monthly public files with historical/drug data, and ACO inclusion.
- Amends ERISA to ban data access barriers (e.g., gag clauses), add quarterly reporting mandates, and impose new penalties, closing loopholes in fiduciary oversight.
- Introduces standardized EOBs with billing codes and itemized patient bills, expanding beyond current surprise billing protections (No Surprises Act).
- All changes implemented via HHS/DOL/Treasury rulemaking; preserves prior rules until effective dates.
Potential Impacts
- Government Agencies: HHS (with DOL/Treasury) gains rulemaking, monitoring, auditing, and enforcement duties (e.g., annual reviews, audits of 20+ plans/200+ TPAs). Increased workload for compliance checks and penalty collection; public reports to Congress enhance oversight.
- Citizens: Patients gain free access to comparable pricing, reducing surprise bills and enabling cost shopping (e.g., for shoppable services). Uninsured/low-income benefit from mandatory cash prices and charity info. May lower overall costs via competition but requires digital literacy.
- International Relations: No direct impacts; focuses on U.S. domestic healthcare.
Main Stakeholders Affected
- Healthcare Providers/Facilities: Hospitals, labs, imaging centers, ASCs face disclosure burdens, potential penalties, and data system upgrades; must honor cash prices.
- Insurers and Plans: Health plans, issuers, TPAs, PBMs required to share proprietary rates/formulas publicly and with plans; audits and penalties increase accountability.
- Patients and Consumers: Primary beneficiaries through better cost visibility and protections against overbilling/collections.
- Employers/Plan Sponsors: Gain data access for cost oversight in self-funded plans, aiding negotiations and compliance.
- Government and Regulators: HHS, states, DOL/Treasury handle implementation/enforcement; states retain complementary roles.
Notable Legal, Constitutional, or Political Implications
- Legal: Introduces tiered civil monetary penalties (modeled on Social Security Act Section 1128A, with no waivers), voids anti-transparency contract terms as against public policy, and mandates HIPAA-compliant data sharing. Rulemaking ensures due process; burden of proof on providers in billing disputes. Aligns with existing transparency laws without preempting states unless conflicting.
- Constitutional: Supports interstate commerce regulation of healthcare markets; disclosures may raise proprietary data concerns but are justified as public interest (no takings clause issues). Privacy protected via HIPAA; no First Amendment conflicts as requirements are factual disclosures.
- Political: Bipartisan (introduced by Sens. Marshall, Hickenlooper, et al.); advances market-driven cost controls amid rising healthcare expenses. May face industry pushback over revealing negotiated rates (seen as trade secrets), but empowers consumers/employers. Referred to Senate HELP Committee; potential for amendments on enforcement or timelines.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (23)
Sen. Hickenlooper, John W. [D-CO], Sen. Grassley, Chuck [R-IA], Sen. Hassan, Margaret Wood [D-NH], Sen. Sheehy, Tim [R-MT], Sen. Ernst, Joni [R-IA], Sen. Baldwin, Tammy [D-WI], Sen. Moreno, Bernie [R-OH], Sen. Scott, Rick [R-FL], Sen. Kim, Andy [D-NJ], Sen. Husted, Jon [R-OH], Sen. Blunt Rochester, Lisa [D-DE], Sen. Tuberville, Tommy [R-AL], Sen. Lummis, Cynthia M. [R-WY], Sen. Coons, Christopher A. [D-DE], Sen. Mullin, Markwayne [R-OK], Sen. Booker, Cory A. [D-NJ], Sen. Welch, Peter [D-VT], Sen. Peters, Gary C. [D-MI], Sen. Warren, Elizabeth [D-MA], Sen. Armstrong, Alan [R-OK], Sen. Kelly, Mark [D-AZ], Sen. Schmitt, Eric [R-MO], Sen. Fetterman, John [D-PA]
Recent Actions
- 2026-03-19: Committee on Health, Education, Labor, and Pensions. Hearings held.
- 2025-07-17: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- 2025-07-17: Introduced in Senate
Bill Versions
- Patients Deserve Price Tags Act — issued 2025-07-17 — PDF (100 pages)