I 

118TH CONGRESS 

1ST SESSION H. R. 4882 

To amend title XVIII of the Social Security Act to promote laboratory 

price transparency under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 25, 2023 

Mrs. MILLER of West Virginia introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the 

Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to promote 

laboratory price transparency under the Medicare program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Clinical Laboratory 

5 Price Transparency Act of 2023’’. 


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1 SEC. 2. PROMOTING LABORATORY PRICE TRANSPARENCY 

2 UNDER THE MEDICARE PROGRAM. 

3 Part E of title XVIII of the Social Security Act (42 

4 U.S.C. 1395x et seq.) is amended by adding at the end 

5 the following new section: 

6 ‘‘SEC. 1899C. LABORATORY PRICE TRANSPARENCY RE7 QUIREMENT. 

8 ‘‘(a) IN GENERAL.—Beginning January 1, 2025, 

9 each applicable laboratory that receives payment under 

10 this title for furnishing a specified clinical diagnostic lab11 oratory test shall— 

12 ‘‘(1) make publicly available (in a manner and 

13 form specified by the Secretary) on an Internet 

14 website the information described in subsection (b) 

15 with respect to each such specified clinical diagnostic 

16 laboratory test that such laboratory is so available to 

17 furnish; and 

18 ‘‘(2) ensure that such information is updated 

19 not less frequently than annually. 

20 ‘‘(b) INFORMATION DESCRIBED.—For purposes of 

21 subsection (a), the information described in this sub22 section is, with respect to an applicable laboratory and a 

23 specified clinical diagnostic laboratory test, the following: 

24 ‘‘(1) The discounted cash price for such test 

25 (or, if no such price exists, the gross charge for such 

26 test). 


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1 ‘‘(2) If required by the Secretary, the 

2 deidentified minimum negotiated rate in effect be3 tween such laboratory and any group health plan or 

4 group or individual health insurance coverage for 

5 such test and the deidentified maximum negotiated 

6 rate in effect between such laboratory and any such 

7 plan or coverage for such test. 

8 ‘‘(c) METHOD AND FORMAT.—Not later than Janu9 ary 1, 2028, the Secretary shall establish one or more 

10 methods and formats for each provider of services and 

11 supplier to use in compiling and making public standard 

12 charges and prices (as applicable) pursuant to subsection 

13 (a). Any such method and format— 

14 ‘‘(1) may be similar to any template made 

15 available by the Centers for Medicare & Medicaid 

16 Services as of the date of the enactment of this sub17 section; 

18 ‘‘(2) shall meet such standards as determined 

19 appropriate by the Secretary in order to ensure the 

20 accessibility and usability of such charges and 

21 prices; and 

22 ‘‘(3) shall be updated as determined appro23 priate by the Secretary, in consultation with stake24 holders. 


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1 ‘‘(d) MONITORING COMPLIANCE.—The Secretary 

2 shall, through notice and comment rulemaking and in con3 sultation with the Inspector General of the Department 

4 of Health and Human Services, establish a process to 

5 monitor compliance with this section. 

6 ‘‘(e) ENFORCEMENT.— 

7 ‘‘(1) IN GENERAL.—In the case that the Sec8 retary determines that an applicable laboratory is 

9 not in compliance with subsection (a)— 

10 ‘‘(A) not later than 30 days after such de11 termination, the Secretary shall notify such lab12 oratory of such determination; 

13 ‘‘(B) upon request of the Secretary, such 

14 laboratory shall submit to the Secretary, not 

15 later than 45 days after such request is sent, a 

16 corrective action plan to comply with such sub17 section; and 

18 ‘‘(C) if such laboratory continues to fail to 

19 comply with such paragraph after the date that 

20 is 90 days after such notification is sent (or, in 

21 the case of such a laboratory that has sub22 mitted a corrective action plan described in sub23 paragraph (B) in response to a request so de24 scribed, after the date that is 90 days after 

25 such submission), the Secretary may impose a 


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1 civil monetary penalty in an amount not to ex2 ceed $300 for each subsequent day during 

3 which such failure to comply is ongoing. 

4 ‘‘(2) INCREASE AUTHORITY.—In applying this 

5 paragraph with respect to violations occurring in 

6 2027 or a subsequent year, the Secretary may 

7 through notice and comment rulemaking increase 

8 the amount of the civil monetary penalty under 

9 paragraph (1)(C). 

10 ‘‘(3) APPLICATION OF CERTAIN PROVISIONS.— 

11 The provisions of section 1128A (other than sub12 sections (a) and (b) of such section) shall apply to 

13 a civil monetary penalty imposed under this sub14 section in the same manner as such provisions apply 

15 to a civil monetary penalty imposed under subsection 

16 (a) of such section. 

17 ‘‘(4) AUTHORITY TO WAIVE OR REDUCE PEN18 ALTY.—The Secretary may waive or reduce any pen19 alty otherwise applicable with respect to an applica20 ble laboratory under this paragraph if the Secretary 

21 determines that imposition of such penalty would re22 sult in a significant hardship for such laboratory 

23 (such as in the case of an applicable laboratory lo24 cated in a rural or underserved area where imposiVerDate Sep 11 2014 04:03 Aug 11, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4882.IH H4882

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1 tion of such penalty may result in, or contribute to, 

2 a lack of access to care for individuals in such area). 

3 ‘‘(5) CLARIFICATION OF NONAPPLICABILITY OF

4 OTHER ENFORCEMENT PROVISIONS.—Notwith5 standing any other provision of this title, this sub6 section shall be the sole means of enforcing the pro7 visions of this section. 

8 ‘‘(f) DEFINITIONS.—In this section: 

9 ‘‘(1) APPLICABLE LABORATORY.—The term 

10 ‘applicable laboratory’ has the meaning given such 

11 term in section 414.502, of title 42, Code of Federal 

12 Regulations (or any successor regulation). 

13 ‘‘(2) GROUP HEALTH PLAN; GROUP HEALTH IN14 SURANCE COVERAGE; INDIVIDUAL HEALTH INSUR15 ANCE COVERAGE.—The terms ‘group health plan’, 

16 ‘group health insurance coverage’, and ‘individual 

17 health insurance coverage’ have the meaning given 

18 such terms in section 2791 of the Public Health 

19 Service Act. 

20 ‘‘(3) SPECIFIED CLINICAL DIAGNOSTIC LABORA21 TORY TEST.—The term ‘specified clinical diagnostic 

22 laboratory test’ means a clinical diagnostic labora23 tory test that is included on the list of shoppable 

24 services specified by the Centers for Medicare & 

25 Medicaid Services pursuant to section 180.60 of title 


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1 45, Code of Federal Regulations (or a successor reg2 ulation), other than such a test that is an advanced 

3 diagnostic laboratory test (as defined in section 

4 1834A(d)(5)).’’. 

Æ 


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