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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5378 Introduced in House (IH)]

<DOC>

118th CONGRESS
  1st Session
                                H. R. 5378

To promote price transparency in the health care sector, and for other 
                               purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           September 8, 2023

  Mrs. Rodgers of Washington (for herself, Mr. Pallone, Mr. Smith of 
   Missouri, and Ms. Foxx) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
the Committees on Ways and Means, and Education and the Workforce, 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 promote price transparency in the health care sector, and for other 
                               purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Lower Costs, More Transparency 
Act''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
              TITLE I--IMPROVING HEALTH CARE TRANSPARENCY

Sec. 101. Hospital price transparency.
Sec. 102. Clinical diagnostic laboratory test price transparency.
Sec. 103. Imaging price transparency.
Sec. 104. Ambulatory surgical center price transparency.
Sec. 105. Health coverage price transparency.
Sec. 106. Pharmacy benefits price transparency.
Sec. 107. Reports on health care transparency tools and data.
Sec. 108. Report on integration in Medicare.
Sec. 109. Advisory Committee.
Sec. 110. Report on impact of Medicare regulations on provider and 
                            payer consolidation.
Sec. 111. Implementation funding.
           TITLE II--REDUCING HEALTH CARE COSTS FOR PATIENTS

Sec. 201. Increasing transparency in generic drug applications.
Sec. 202. Improving transparency and preventing the use of abusive 
                            spread pricing and related practices in 
                            Medicaid.
Sec. 203. Parity in Medicare payments for hospital outpatient 
                            department services furnished off-campus.
Sec. 204. Requiring a separate identification number and an attestation 
                            for each off-campus outpatient department 
                            of a provider.
 TITLE III--SUPPORTING PATIENTS, HEALTH CARE WORKERS, COMMUNITY HEALTH 
                         CENTERS, AND HOSPITALS

Sec. 301. Extension for community health centers, the national health 
                            service corps, and teaching health centers 
                            that operate GME programs.
Sec. 302. Extension of special diabetes programs.
Sec. 303. Delaying certain disproportionate share hospital payment 
                            reductions under the Medicaid program.
Sec. 304. Medicaid improvement fund.
TITLE IV--INCREASING ACCESS TO QUALITY HEALTH DATA AND LOWERING HIDDEN 
                                  FEES

Sec. 401. Increasing Plan Fiduciaries' Access to Health Data.
Sec. 402. Hidden Fees Disclosure Requirements.
Sec. 403. Prescription drug price information requirement.
Sec. 404. Implementation funding.

              TITLE I--IMPROVING HEALTH CARE TRANSPARENCY

SEC. 101. HOSPITAL PRICE TRANSPARENCY.

    (a) Medicare.--Part E of title XVIII of the Social Security Act (42 
U.S.C. 1395x et seq.) is amended by adding at the end the following new 
section:

``SEC. 1899C. HOSPITAL PRICE TRANSPARENCY.

    ``(a) Transparency Requirement.--
            ``(1) In general.--Beginning January 1, 2026, each 
        specified hospital that receives payment under this title for 
        furnishing items and services shall comply with the price 
        transparency requirement described in paragraph (2).
            ``(2) Requirement described.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the price transparency requirement described in this 
                paragraph is, with respect to a specified hospital, 
                that such hospital, in accordance with a method and 
                format established by the Secretary under subparagraph 
                (C), compile and make public (without subscription and 
                free of charge) for each year--
                            ``(i) all of the hospital's standard 
                        charges (including the information described in 
                        subparagraph (B)) for each item and service 
                        furnished by such hospital;
                            ``(ii) information in a consumer-friendly 
                        format (as specified by the Secretary)--
                                    ``(I) on the hospital's prices 
                                (including the information described in 
                                subparagraph (B)) for as many of the 
                                Centers for Medicare & Medicaid 
                                Services-specified shoppable services 
                                that are furnished by the hospital, and 
                                as many additional hospital-selected 
                                shoppable services (or all such 
                                additional services, if such hospital 
                                furnishes fewer than 300 shoppable 
                                services) as may be necessary for a 
                                combined total of at least 300 
                                shoppable services; and
                                    ``(II) that includes, with respect 
                                to each Centers for Medicare & Medicaid 
                                Services-specified shoppable service 
                                that is not furnished by the hospital, 
                                an indication that such service is not 
                                so furnished; and
                            ``(iii) an attestation that all information 
                        made public pursuant to this subparagraph is 
                        complete and accurate.
                    ``(B) Information described.--For purposes of 
                subparagraph (A), the information described in this 
                subparagraph is, with respect to standard charges and 
                prices, as applicable, made public by a specified 
                hospital, the following:
                            ``(i) A plain language description of each 
                        item or service, accompanied by, as applicable, 
                        the Healthcare Common Procedure Coding System 
                        code, the diagnosis-related group, the national 
                        drug code, or other identifier used or approved 
                        by the Centers for Medicare & Medicaid 
                        Services.
                            ``(ii) The gross charge, as applicable, 
                        expressed as a dollar amount, for each such 
                        item or service, when provided in, as 
                        applicable, the inpatient setting and 
                        outpatient department setting.
                            ``(iii) The discounted cash price, as 
                        applicable, expressed as a dollar amount, for 
                        each such item or service when provided in, as 
                        applicable, the inpatient setting and 
                        outpatient department setting (or, in the case 
                        no discounted cash price is available for an 
                        item or service, the median cash price charged 
                        by the hospital to self-pay individuals for 
                        such item or service when provided in such 
                        settings for the previous three years, 
                        expressed as a dollar amount, as well as, with 
                        respect to prices made public pursuant to 
                        subparagraph (A)(ii), a link to a consumer-
                        friendly document that clearly explains the 
                        hospital's charity care policy that includes, 
                        if applicable, any sliding scale payment 
                        structure employed for determining charges for 
                        a self-pay individual).
                            ``(iv) The payer-specific negotiated 
                        charges, as applicable, clearly associated with 
                        the name of the third party payer and plan and 
                        expressed as a dollar amount, that apply to 
                        each such item or service when provided in, as 
                        applicable, the inpatient setting and 
                        outpatient department setting.
                            ``(v) The de-identified maximum and minimum 
                        negotiated charges, as applicable, for each 
                        such item or service.
                            ``(vi) Any other additional information the 
                        Secretary may require for the purpose of 
                        improving the accuracy of, or enabling 
                        consumers to easily understand and compare, 
                        standard charges and prices for an item or 
                        service, except information that is duplicative 
                        of any other reporting requirement under this 
                        subsection.
                In the case of standard charges and prices for an item 
                or service included as part of a bundled, per diem, 
                episodic, or other similar arrangement, the information 
                described in this subparagraph shall be made available 
                as determined appropriate by the Secretary.
                    ``(C) Uniform method and format.--Not later than 
                January 1, 2026, the Secretary shall establish a 
                standard, uniform method and format for specified 
                hospitals to use in compiling and making public 
                standard charges pursuant to subparagraph (A)(i) and a 
                standard, uniform method and format for such hospitals 
                to use in compiling and making public prices pursuant 
                to subparagraph (A)(ii). Such methods and formats--
                            ``(i) shall, in the case of such method and 
                        format for making public standard charges 
                        pursuant to subparagraph (A)(i), ensure that 
                        such charges are made available in a machine-
                        readable format (or a successor technology 
                        specified by the Secretary);
                            ``(ii) may be similar to any template made 
                        available by the Centers for Medicare & 
                        Medicaid Services as of the date of the 
                        enactment of this subparagraph;
                            ``(iii) shall meet such standards as 
                        determined appropriate by the Secretary in 
                        order to ensure the accessibility and usability 
                        of such charges and prices; and
                            ``(iv) shall be updated as determined 
                        appropriate by the Secretary, in consultation 
                        with stakeholders.
            ``(3) Monitoring compliance.--The Secretary shall, through 
        notice and comment rulemaking and in consultation with the 
        Inspector General of the Department of Health and Human 
        Services, establish a process to monitor compliance with this 
        subsection. Such process shall ensure that each specified 
        hospital's compliance with this subsection is reviewed not less 
        frequently than once every 3 years.
            ``(4) Enforcement.--
                    ``(A) In general.--In the case of a specified 
                hospital that fails to comply with the requirements of 
                this subsection--
                            ``(i) not later than 30 days after the date 
                        on which the Secretary determines such failure 
                        exists, the Secretary shall submit to such 
                        hospital a notification of such determination 
                        (which may include, as determined appropriate 
                        by the Secretary, a request for a corrective 
                        action plan to comply with such requirements); 
                        and
                            ``(ii) in the case of a hospital that does 
                        not receive a request for a corrective action 
                        plan as part of a notification submitted by the 
                        Secretary under clause (i)--
                                    ``(I) the Secretary shall, not 
                                later than 45 days after such 
                                notification is sent, determine whether 
                                such hospital is in compliance with 
                                such requirements; and
                                    ``(II) if the Secretary determines 
                                under subclause (I) that such hospital 
                                is not in compliance with such 
                                requirements, the Secretary shall 
                                either--
                                            ``(aa) submit to such 
                                        hospital a request for a 
                                        corrective action plan to 
                                        comply with such requirements; 
                                        or
                                            ``(bb) if the Secretary 
                                        determines that such hospital 
                                        has not taken meaningful 
                                        actions to come into compliance 
                                        since such notification was 
                                        sent, impose a civil monetary 
                                        penalty in accordance with 
                                        subparagraph (B).
                    ``(B) Civil monetary penalty.--
                            ``(i) In general.--Subject to clause (vii), 
                        in addition to any other enforcement actions or 
                        penalties that may apply under another 
                        provision of law, a specified hospital that has 
                        received a request for a corrective action plan 
                        under clause (i) or (ii) of subparagraph (A) 
                        and fails to comply with the requirements of 
                        this subsection by the date that is 45 days 
                        after such request is made, and a specified 
                        hospital with respect to which the Secretary 
                        has made a determination described in clause 
                        (ii)(II)(bb) of such subparagraph, shall be 
                        subject to a civil monetary penalty of an 
                        amount specified by the Secretary for each day 
                        (beginning with the day on which the Secretary 
                        first determined that such hospital was not 
                        complying with such requirements) during which 
                        such failure was ongoing. Such amount shall not 
                        exceed--
                                    ``(I) in the case of a specified 
                                hospital with 30 or fewer beds, $300 
                                per day (or, in the case of such a 
                                hospital that has been noncompliant 
                                with such requirements for a 1-year 
                                period or longer, beginning with the 
                                first day following such 1-year period, 
                                $400 per day);
                                    ``(II) in the case of a specified 
                                hospital with more than 30 beds but 
                                fewer than 101 beds, $12.50 per bed per 
                                day (or, in the case of such a hospital 
                                that has been noncompliant with such 
                                requirements for a 1-year period or 
                                longer, beginning with the first day 
                                following such 1-year period, $15 per 
                                bed per day);
                                    ``(III) in the case of a specified 
                                hospital with more than 100 beds but 
                                fewer than 201 beds, $17.50 per bed per 
                                day (or, in the case of such a hospital 
                                that has been noncompliant with such 
                                requirements for a 1-year period or 
                                longer, beginning with the first day 
                                following such 1-year period, $20 per 
                                bed per day);
                                    ``(IV) in the case of a specified 
                                hospital with more than 200 beds but 
                                fewer than 501 beds, $20 per bed per 
                                day (or, in the case of such a hospital 
                                that has been noncompliant with such 
                                requirements for a 1-year period or 
                                longer, beginning with the first day 
                                following such 1-year period, $25 per 
                                bed per day); and
                                    ``(V) in the case of a specified 
                                hospital with more than 500 beds, $25 
                                per bed per day (or, in the case of 
                                such a hospital that has been 
                                noncompliant with such requirements for 
                                a 1-year period or longer, beginning 
                                with the first day following such 1-
                                year period, $35 per bed per day).
                            ``(ii) Increase authority.--In applying 
                        this subparagraph with respect to violations 
                        occurring in 2027 or a subsequent year, the 
                        Secretary may through notice and comment 
                        rulemaking increase--
                                    ``(I) the limitation on the per day 
                                amount of any penalty applicable to a 
                                specified hospital under clause (i)(I);
                                    ``(II) the limitations on the per 
                                bed per day amount of any penalty 
                                applicable under any of subclauses (II) 
                                through (V) of clause (i); and
                                    ``(III) the amounts specified in 
                                clause (iii)(II).
                            ``(iii) Persistent noncompliance.--
                                    ``(I) In general.--In the case of a 
                                specified hospital (other than a 
                                specified hospital with 30 or fewer 
                                beds) that the Secretary has determined 
                                to be knowingly and willfully 
                                noncompliant with the provisions of 
                                this subsection two or more times 
                                during a 1-year period, the Secretary 
                                may increase any penalty otherwise 
                                applicable under this subparagraph by 
                                the amount specified in subclause (II) 
                                with respect to such hospital and may 
                                require such hospital to complete such 
                                additional corrective actions plans as 
                                the Secretary may specify.
                                    ``(II) Specified amount.--For 
                                purposes of subclause (I), the amount 
                                specified in this subclause is, with 
                                respect to a specified hospital--
                                            ``(aa) with more than 30 
                                        beds but fewer than 101 beds, 
                                        an amount that is not less than 
                                        $500,000 and not more than 
                                        $1,000,000;
                                            ``(bb) with more than 100 
                                        beds but fewer than 301 beds, 
                                        an amount that is greater than 
                                        $1,000,000 and not more than 
                                        $2,000,000;
                                            ``(cc) with more than 300 
                                        beds but fewer than 501 beds, 
                                        an amount that is greater than 
                                        $2,000,000 and not more than 
                                        $4,000,000; and
                                            ``(dd) with more than 500 
                                        beds, and amount that is not 
                                        less than $5,000,000 and not 
                                        more than $10,000,000.
                            ``(iv) Authority to waive or reduce 
                        penalty.--
                                    ``(I) In general.--Subject to 
                                subclause (II), the Secretary may waive 
                                any penalty, or reduce any penalty by 
                                not more than 75 percent, otherwise 
                                applicable under this subparagraph with 
                                respect to a specified hospital located 
                                in a rural or underserved area if the 
                                Secretary certifies that imposition of 
                                such penalty would result in an 
                                immediate threat to access to care for 
                                individuals in the service area of such 
                                hospital.
                                    ``(II) Limitation on application.--
                                The Secretary may not elect to waive a 
                                penalty under subclause (I) with 
                                respect to a specified hospital more 
                                than once in a 6-year period and may 
                                not elect to reduce such a penalty with 
                                respect to such a hospital more than 
                                once in such a period. Nothing in the 
                                preceding sentence shall be construed 
                                as prohibiting the Secretary from both 
                                waiving and reducing a penalty with 
                                respect to a specified hospital during 
                                a 6-year period.
                            ``(v) Provision of technical assistance.--
                        The Secretary shall, to the extent practicable, 
                        provide technical assistance relating to 
                        compliance with the provisions of this 
                        subsection to specified hospitals requesting 
                        such assistance.
                            ``(vi) Application of certain provisions.--
                        The provisions of section 1128A (other than 
                        subsections (a) and (b) of such section) shall 
                        apply to a civil monetary penalty imposed under 
                        this subparagraph in the same manner as such 
                        provisions apply to a civil monetary penalty 
                        imposed under subsection (a) of such section.
                            ``(vii) Nonduplication of certain 
                        penalties.--The Secretary may not subject a 
                        specified hospital to a civil monetary penalty 
                        under this subparagraph with respect to 
                        noncompliance with the provisions of this 
                        section for a period if the Secretary has 
                        imposed a civil monetary penalty on such 
                        hospital under section 2718(f) of the Public 
                        Health Service Act for failure to comply with 
                        the provisions of such section for such period.
                    ``(C) Publication of hospital price transparency 
                information.--Beginning on January 1, 2026, the 
                Secretary shall make publicly available on the public 
                website of the Centers for Medicare & Medicaid Services 
                information with respect to compliance with the 
                requirements of this subsection and enforcement 
                activities undertaken by the Secretary under this 
                subsection. Such information shall be updated in real 
                time and include--
                            ``(i) the number of reviews of compliance 
                        with this subsection undertaken by the 
                        Secretary;
                            ``(ii) the number of notifications 
                        described in subparagraph (A)(i) sent by the 
                        Secretary;
                            ``(iii) the identity of each specified 
                        hospital that was sent such a notification and 
                        a description of the nature of such hospital's 
                        noncompliance with this subsection;
                            ``(iv) the amount of any civil monetary 
                        penalty imposed on such hospital under 
                        subparagraph (B);
                            ``(v) whether such hospital subsequently 
                        came into compliance with this subsection;
                            ``(vi) any waivers or reductions of 
                        penalties made pursuant to a certification by 
                        the Secretary under subparagraph (B)(iv), 
                        including--
                                    ``(I) the name of any specified 
                                hospital that received such a waiver or 
                                reduction;
                                    ``(II) the dollar amount of each 
                                such penalty so waived or reduced; and
                                    ``(III) the rationale for the 
                                granting of each such waiver or 
                                reduction; and
                            ``(vii) any other information as determined 
                        by the Secretary.
    ``(b) Ensuring Accessibility Through Implementation.--In 
implementing the amendments made by this section, the Secretary of 
Health and Human Services shall through rulemaking ensure that a 
hospital submitting charges and information pursuant to such amendments 
takes reasonable steps (as specified by the Secretary) to ensure the 
accessibility of such charges and information to individuals with 
limited English proficiency. Such steps may include the hospital's 
provision of interpretation services or the hospital's provision of 
translations of charges and information.
    ``(c) Definitions.--For purposes of this section:
            ``(1) Discounted cash price.--The term `discounted cash 
        price' means the charge that applies to an individual who pays 
        cash, or cash equivalent, for an item or service.
            ``(2) Federal health care program.--The term `Federal 
        health care program' has the meaning given such term in section 
        1128B.
            ``(3) Gross charge.--The term `gross charge' means the 
        charge for an individual item or service that is reflected on a 
        specified hospital's or provider of service's or supplier's, as 
        applicable, chargemaster, absent any discounts.
            ``(4) Group health plan; group health insurance coverage; 
        individual health insurance coverage.--The terms `group health 
        plan', `group health insurance coverage', and `individual 
        health insurance coverage' have the meaning given such terms in 
        section 2791 of the Public Health Service Act.
            ``(5) Payer-specific negotiated charge.--The term `payer-
        specific negotiated charge' means the charge that a specified 
        hospital or provider of services or supplier, as applicable, 
        has negotiated with a third party payer for an item or service.
            ``(6) Shoppable service.--The term `shoppable service' 
        means a service that can be scheduled by a health care consumer 
        in advance and includes all ancillary items and services 
        customarily furnished as part of such service.
            ``(7) Specified hospital.--The term `specified hospital' 
        means a hospital (as defined in section 1861(e)), a critical 
        access hospital (as defined in section 1861(mmm)(1)), or a 
        rural emergency hospital (as defined in section 1861(kkk)).
            ``(8) Third party payer.--The term `third party payer' 
        means an entity that is, by statute, contract, or agreement, 
        legally responsible for payment of a claim for a health care 
        item or service.''.
    (b) PHSA.--
            (1) In general.--Section 2718 of the Public Health Service 
        Act (42 U.S.C. 300gg-18) is amended by adding at the end the 
        following new subsection:
    ``(f) Hospital Transparency Requirement.--
            ``(1) In general.--Beginning January 1, 2026, each hospital 
        shall comply with the price transparency requirement described 
        in paragraph (2).
            ``(2) Requirement described.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the price transparency requirement described in this 
                paragraph is, with respect to a hospital, that such 
                hospital, in accordance with a method and format 
                established by the Secretary under subparagraph (C), 
                compile and make public (without subscription and free 
                of charge) for each year--
                            ``(i) all of the hospital's standard 
                        charges (including the information described in 
                        subparagraph (B)) for each item and service 
                        furnished by such hospital;
                            ``(ii) information in a consumer-friendly 
                        format (as specified by the Secretary)--
                                    ``(I) on the hospital's prices 
                                (including the information described in 
                                subparagraph (B)) for as many of the 
                                Centers for Medicare & Medicaid 
                                Services-specified shoppable services 
                                that are furnished by the hospital, and 
                                as many additional hospital-selected 
                                shoppable services (or all such 
                                additional services, if such hospital 
                                furnishes fewer than 300 shoppable 
                                services) as may be necessary for a 
                                combined total of at least 300 
                                shoppable services; and
                                    ``(II) that includes, with respect 
                                to each Centers for Medicare & Medicaid 
                                Services-specified shoppable service 
                                that is not furnished by the hospital, 
                                an indication that such service is not 
                                so furnished; and
                            ``(iii) an attestation that all information 
                        made public pursuant to this subparagraph is 
                        complete and accurate.
                    ``(B) Information described.--For purposes of 
                subparagraph (A), the information described in this 
                subparagraph is, with respect to standard charges and 
                prices, as applicable, made public by a hospital, the 
                following:
                            ``(i) A plain language description of each 
                        item or service, accompanied by, as applicable, 
                        the Healthcare Common Procedure Coding System 
                        code, the diagnosis-related group, the national 
                        drug code, current procedure terminology codes, 
                        or other identifier used or approved by the 
                        Centers for Medicare & Medicaid Services.
                            ``(ii) The gross charge, as applicable, 
                        expressed as a dollar amount, for each such 
                        item or service, when provided in, as 
                        applicable, the inpatient setting and 
                        outpatient department setting.
                            ``(iii) The discounted cash price, as 
                        applicable, expressed as a dollar amount, for 
                        each such item or service when provided in, as 
                        applicable, the inpatient setting and 
                        outpatient department setting (or, in the case 
                        no discounted cash price is available for an 
                        item or service, the median cash price charged 
                        by the hospital to self-pay individuals for 
                        such item or service when provided in such 
                        settings for the previous three years, 
                        expressed as a dollar amount, as well as, with 
                        respect to prices made public pursuant to 
                        subparagraph (A)(ii), a link to a consumer-
                        friendly document that clearly explains the 
                        hospital's charity care policy that includes, 
                        if applicable, any sliding scale payment 
                        structure employed for determining charges for 
                        a self-pay individual).
                            ``(iv) The payer-specific negotiated 
                        charges, as applicable, clearly associated with 
                        the name of the third party payer and plan and 
                        expressed as a dollar amount, that apply to 
                        each such item or service when provided in, as 
                        applicable, the inpatient setting and 
                        outpatient department setting.
                            ``(v) The de-identified maximum and minimum 
                        negotiated charges, as applicable, for each 
                        such item or service.
                            ``(vi) Any other additional information the 
                        Secretary may require for the purpose of 
                        improving the accuracy of, or enabling 
                        consumers to easily understand and compare, 
                        standard charges and prices for an item or 
                        service, except information that is duplicative 
                        of any other reporting requirement under this 
                        subsection.
                In the case of standard charges and prices for an item 
                or service included as part of a bundled, per diem, 
                episodic, or other similar arrangement, the information 
                described in this subparagraph shall be made available 
                as determined appropriate by the Secretary.
                    ``(C) Uniform method and format.--Not later than 
                January 1, 2026, the Secretary shall establish a 
                standard, uniform method and format for hospitals to 
                use in compiling and making public standard charges 
                pursuant to subparagraph (A)(i) and a standard, uniform 
                method and format for such hospitals to use in 
                compiling and making public prices pursuant to 
                subparagraph (A)(ii). Such methods and formats--
                            ``(i) shall, in the case of such method and 
                        format for making public standard charges 
                        pursuant to subparagraph (A)(i), ensure that 
                        such charges are made available in a machine-
                        readable format (or a successor technology 
                        specified by the Secretary);
                            ``(ii) may be similar to any template made 
                        available by the Centers for Medicare & 
                        Medicaid Services as of the date of the 
                        enactment of this subparagraph;
                            ``(iii) shall meet such standards as 
                        determined appropriate by the Secretary in 
                        order to ensure the accessibility and usability 
                        of such charges and prices; and
                            ``(iv) shall be updated as determined 
                        appropriate by the Secretary, in consultation 
                        with stakeholders.
            ``(3) Monitoring compliance.--The Secretary shall, through 
        notice and comment rulemaking and in consultation with the 
        Inspector General of the Department of Health and Human 
        Services, establish a process to monitor compliance with this 
        subsection. Such process shall ensure that each hospital's 
        compliance with this subsection is reviewed not less frequently 
        than once every 3 years.
            ``(4) Enforcement.--
                    ``(A) In general.--In the case of a hospital that 
                fails to comply with the requirements of this 
                subsection--
                            ``(i) not later than 30 days after the date 
                        on which the Secretary determines such failure 
                        exists, the Secretary shall submit to such 
                        hospital a notification of such determination 
                        (which may include, as determined appropriate 
                        by the Secretary, a request for a corrective 
                        action plan to comply with such requirements); 
                        and
                            ``(ii) in the case of a hospital that does 
                        not receive a request for a corrective action 
                        plan as part of a notification submitted by the 
                        Secretary under clause (i)--
                                    ``(I) the Secretary shall, not 
                                later than 45 days after such 
                                notification is sent, determine whether 
                                such hospital is in compliance with 
                                such requirements; and
                                    ``(II) if the Secretary determines 
                                under subclause (I) that such hospital 
                                is not in compliance with such 
                                requirements, the Secretary shall 
                                either--
                                            ``(aa) submit to such 
                                        hospital a request for a 
                                        corrective action plan to 
                                        comply with such requirements; 
                                        or
                                            ``(bb) if the Secretary 
                                        determines that such hospital 
                                        has not taken meaningful 
                                        actions to come into compliance 
                                        since such notification was 
                                        sent, impose a civil monetary 
                                        penalty in accordance with 
                                        subparagraph (B).
                    ``(B) Civil monetary penalty.--
                            ``(i) In general.--In addition to any other 
                        enforcement actions or penalties that may apply 
                        under another provision of law, a hospital that 
                        has received a request for a corrective action 
                        plan under clause (i) or (ii) of subparagraph 
                        (A) and fails to comply with the requirements 
                        of this subsection by the date that is 45 days 
                        after such request is made, and a hospital with 
                        respect to which the Secretary has made a 
                        determination described in clause (ii)(II)(bb) 
                        of such subparagraph, shall be subject to a 
                        civil monetary penalty of an amount specified 
                        by the Secretary for each day (beginning with 
                        the day on which the Secretary first determined 
                        that such hospital was not complying with such 
                        requirements) during which such failure was 
                        ongoing. Such amount shall not exceed--
                                    ``(I) in the case of a hospital 
                                with 30 or fewer beds, $300 per day 
                                (or, in the case of such a hospital 
                                that has been noncompliant with such 
                                requirements for a 1-year period or 
                                longer, beginning with the first day 
                                following such 1-year period, $400 per 
                                bed per day);
                                    ``(II) in the case of a hospital 
                                with more than 30 beds but fewer than 
                                101 beds, $12.50 per bed per day (or, 
                                in the case of such a hospital that has 
                                been noncompliant with such 
                                requirements for a 1-year period or 
                                longer, beginning with the first day 
                                following such 1-year period, $15 per 
                                bed per day);
                                    ``(III) in the case of a hospital 
                                with more than 100 beds but fewer than 
                                201 beds, $17.50 per bed per day (or, 
                                in the case of such a hospital that has 
                                been noncompliant with such 
                                requirements for a 1-year period or 
                                longer, beginning with the first day 
                                following such 1-year period, $20 per 
                                bed per day);
                                    ``(IV) in the case of a hospital 
                                with more than 200 beds but fewer than 
                                501 beds, $20 per bed per day (or, in 
                                the case of such a hospital that has 
                                been noncompliant with such 
                                requirements for a 1-year period or 
                                longer, beginning with the first day 
                                following such 1-year period, $25 per 
                                bed per day); and
                                    ``(V) in the case of a hospital 
                                with more than 500 beds, $25 per bed 
                                per day (or, in the case of such a 
                                hospital that has been noncompliant 
                                with such requirements for a 1-year 
                                period or longer, beginning with the 
                                first day following such 1-year period, 
                                $35 per bed per day).
                            ``(ii) Increase authority.--In applying 
                        this subparagraph with respect to violations 
                        occurring in 2027 or a subsequent year, the 
                        Secretary may through notice and comment 
                        rulemaking increase--
                                    ``(I) the limitation on the per day 
                                amount of any penalty applicable to a 
                                hospital under clause (i)(I);
                                    ``(II) the limitations on the per 
                                bed per day amount of any penalty 
                                applicable under any of subclauses (II) 
                                through (V) of clause (i); and
                                    ``(III) the amounts specified in 
                                clause (iii)(II).
                            ``(iii) Persistent noncompliance.--
                                    ``(I) In general.--In the case of a 
                                hospital (other than a hospital with 30 
                                or fewer beds) that the Secretary has 
                                determined to be knowingly and 
                                willfully noncompliant with the 
                                provisions of this subsection two or 
                                more times during a 1-year period, the 
                                Secretary may increase any penalty 
                                otherwise applicable under this 
                                subparagraph by the amount specified in 
                                subclause (II) with respect to such 
                                hospital and may require such hospital 
                                to complete such additional corrective 
                                actions plans as the Secretary may 
                                specify.
                                    ``(II) Specified amount.--For 
                                purposes of subclause (I), the amount 
                                specified in this subclause is, with 
                                respect to a hospital--
                                            ``(aa) with more than 30 
                                        beds but fewer than 101 beds, 
                                        an amount that is not less than 
                                        $500,000 and not more than 
                                        $1,000,000;
                                            ``(bb) with more than 100 
                                        beds but fewer than 301 beds, 
                                        an amount that is greater than 
                                        $1,000,000 and not more than 
                                        $2,000,000;
                                            ``(cc) with more than 300 
                                        beds but fewer than 501 beds, 
                                        an amount that is greater than 
                                        $2,000,000 and not more than 
                                        $4,000,000; and
                                            ``(dd) with more than 500 
                                        beds, and amount that is not 
                                        less than $5,000,000 and not 
                                        more than $10,000,000.
                            ``(iv) Authority to waive or reduce 
                        penalty.--
                                    ``(I) In general.--Subject to 
                                subclause (II), the Secretary may waive 
                                any penalty, or reduce any penalty by 
                                not more than 75 percent, otherwise 
                                applicable under this subparagraph with 
                                respect to a hospital located in a 
                                rural or underserved area if the 
                                Secretary certifies that imposition of 
                                such penalty would result in an 
                                immediate threat to access to care for 
                                individuals in the service area of such 
                                hospital.
                                    ``(II) Limitation on application.--
                                The Secretary may not elect to waive a 
                                penalty under subclause (I) with 
                                respect to a hospital more than once in 
                                a 6-year period and may not elect to 
                                reduce such a penalty with respect to 
                                such a hospital more than once in such 
                                a period. Nothing in the preceding 
                                sentence shall be construed as 
                                prohibiting the Secretary from both 
                                waiving and reducing a penalty with 
                                respect to a hospital during a 6-year 
                                period.
                            ``(v) Provision of technical assistance.--
                        The Secretary shall, to the extent practicable, 
                        provide technical assistance relating to 
                        compliance with the provisions of this section 
                        to hospitals requesting such assistance.
                            ``(vi) Application of certain provisions.--
                        The provisions of section 1128A (other than 
                        subsections (a) and (b) of such section) shall 
                        apply to a civil monetary penalty imposed under 
                        this subparagraph in the same manner as such 
                        provisions apply to a civil monetary penalty 
                        imposed under subsection (a) of such section.
                            ``(vii) Nonduplication of penalties.--The 
                        Secretary may not subject a hospital to a civil 
                        monetary penalty under this subparagraph with 
                        respect to noncompliance with the provisions of 
                        this subsection for a period if the Secretary 
                        has imposed a civil monetary penalty on such 
                        hospital under section 1899C of the Social 
                        Security Act for failure to comply with the 
                        provisions of such section for such period.
                    ``(C) Publication of hospital price transparency 
                information.--Beginning on January 1, 2026, the 
                Secretary shall make publicly available on the public 
                website of the Centers for Medicare & Medicaid Services 
                information with respect to compliance with the 
                requirements of this subsection and enforcement 
                activities undertaken by the Secretary under this 
                subsection. Such information shall be updated in real 
                time and include--
                            ``(i) the number of reviews of compliance 
                        with this subsection undertaken by the 
                        Secretary;
                            ``(ii) the number of notifications 
                        described in subparagraph (A)(i) sent by the 
                        Secretary;
                            ``(iii) the identity of each hospital that 
                        was sent such a notification and a description 
                        of the nature of such hospital's noncompliance 
                        with this subsection;
                            ``(iv) the amount of any civil monetary 
                        penalty imposed on such hospital under 
                        subparagraph (B);
                            ``(v) whether such hospital subsequently 
                        came into compliance with this subsection;
                            ``(vi) any waivers or reductions of 
                        penalties made pursuant to a certification by 
                        the Secretary under subparagraph (B)(iv), 
                        including--
                                    ``(I) the name of any hospital that 
                                received such a waiver or reduction;
                                    ``(II) the dollar amount of each 
                                such penalty so waived or reduced; and
                                    ``(III) the rationale for the 
                                granting of each such waiver or 
                                reduction; and
                            ``(vii) any other information as determined 
                        by the Secretary.
            ``(5) Ensuring accessibility through implementation.--In 
        implementing the amendments made by this section, the Secretary 
        of Health and Human Services shall through rulemaking ensure 
        that a hospital submitting charges and information pursuant to 
        such amendments takes reasonable steps (as specified by the 
        Secretary) to ensure the accessibility of such charges and 
        information to individuals with limited English proficiency. 
        Such steps may include the hospital's provision of 
        interpretation services or the hospital's provision of 
        translations of charges and information.
            ``(6) Definitions.--For purposes of this subsection:
                    ``(A) Discounted cash price.--The term `discounted 
                cash price' means the charge that applies to an 
                individual who pays cash, or cash equivalent, for a 
                hospital-furnished item or service.
                    ``(B) Federal health care program.--The term 
                `Federal health care program' has the meaning given 
                such term in section 1128B of the Social Security Act.
                    ``(C) Gross charge.--The term `gross charge' means 
                the charge for an individual item or service that is 
                reflected on a hospital's chargemaster, absent any 
                discounts.
                    ``(D) Payer-specific negotiated charge.--The term 
                `payer-specific negotiated charge' means the charge 
                that a hospital has negotiated with a third party payer 
                for an item or service.
                    ``(E) Shoppable service.--The term `shoppable 
                service' means a service that can be scheduled by a 
                health care consumer in advance and includes all 
                ancillary items and services customarily furnished as 
                part of such service.
                    ``(F) Third party payer.--The term `third party 
                payer' means an entity that is, by statute, contract, 
                or agreement, legally responsible for payment of a 
                claim for a health care item or service.''.
            (2) Conforming amendments.--Section 2718 of the Public 
        Health Service Act (42 U.S.C. 300gg-18) is amended--
                    (A) in subsection (b)(3), by inserting ``(other 
                than the provisions of subsection (f))'' after ``this 
                section''; and
                    (B) in subsection (e), by adding at the end the 
                following new sentence: ``The preceding provisions of 
                this subsection shall not apply beginning on January 1, 
                2026.''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply beginning January 1, 2026.
    (c) Accessibility Through Implementation.--In implementing the 
amendments made by this section, the Secretary of Health and Human 
Services shall through rulemaking ensure that a hospital submitting 
charges and information pursuant to such amendments takes reasonable 
steps (as specified by the Secretary) to ensure the accessibility of 
such charges and information to individuals with limited English 
proficiency. Such steps may include the hospital's provision of 
interpretation services or the hospital's provision of translations of 
charges and information.

SEC. 102. CLINICAL DIAGNOSTIC LABORATORY TEST PRICE TRANSPARENCY.

    Section 1846 of the Social Security Act (42 U.S.C. 1395w-2) is 
amended--
            (1) in the header, by inserting ``and additional 
        requirements'' after ``sanctions''; and
            (2) by adding at the end the following new subsection:
    ``(c) Price Transparency Requirement.--
            ``(1) In general.--Beginning January 1, 2026, any 
        applicable laboratory that receives payment under this title 
        for furnishing any specified clinical diagnostic laboratory 
        test under this title shall--
                    ``(A) make publicly available on an internet 
                website the information described in paragraph (2) with 
                respect to each such specified clinical diagnostic 
                laboratory test that such laboratory so furnishes; and
                    ``(B) ensure that such information is updated not 
                less frequently than annually.
            ``(2) Information described.--For purposes of paragraph 
        (1), the information described in this paragraph is, with 
        respect to an applicable laboratory and a specified clinical 
        diagnostic laboratory test, the following:
                    ``(A) The discounted cash price for such test (or, 
                if no such price exists, the gross charge for such 
                test).
                    ``(B) The deidentified minimum payer-specific 
                negotiated charge for such test.
                    ``(C) The deidentified maximum payer-specific 
                negotiated charge between such laboratory and any third 
                party payer for such test.
            ``(3) Uniform method and format.--Not later than January 1, 
        2026, the Secretary shall establish a standard, uniform method 
        and format for applicable laboratories to use in compiling and 
        making public information pursuant to paragraph (1). Such 
        method and format--
                    ``(A) may be similar to any template made available 
                by the Centers for Medicare & Medicaid Services (as 
                described in section 1899C(a)(2)(C)(ii));
                    ``(B) shall meet such standards as determined 
                appropriate by the Secretary in order to ensure the 
                accessibility and usability of such information; and
                    ``(C) shall be updated as determined appropriate by 
                the Secretary, in consultation with stakeholders.
            ``(4) Inclusion of ancillary services.--Any price or rate 
        for a specified clinical diagnostic laboratory test available 
        to be furnished by an applicable laboratory made publicly 
        available in accordance with paragraph (1) shall include the 
        price or rate (as applicable) for any ancillary item or service 
        (such as specimen collection services) that would normally be 
        furnished by such laboratory as part of such test, as specified 
        by the Secretary.
            ``(5) Enforcement.--
                    ``(A) In general.--In the case that the Secretary 
                determines that an applicable laboratory is not in 
                compliance with paragraph (1)--
                            ``(i) not later than 30 days after such 
                        determination, the Secretary shall notify such 
                        laboratory of such determination; and
                            ``(ii) if such laboratory continues to fail 
                        to comply with such paragraph after the date 
                        that is 90 days after such notification is 
                        sent, the Secretary may impose a civil monetary 
                        penalty in an amount not to exceed $300 for 
                        each (beginning with the day on which the 
                        Secretary first determined that such laboratory 
                        was failing to comply with such paragraph) 
                        during which such failure is ongoing.
                    ``(B) Increase authority.--In applying this 
                paragraph with respect to violations occurring in 2027 
                or a subsequent year, the Secretary may through notice 
                and comment rulemaking increase the per day limitation 
                on civil monetary penalties under subparagraph (A)(ii).
                    ``(C) Application of certain provisions.--The 
                provisions of section 1128A (other than subsections (a) 
                and (b) of such section) shall apply to a civil 
                monetary penalty imposed under this paragraph in the 
                same manner as such provisions apply to a civil 
                monetary penalty imposed under subsection (a) of such 
                section.
            ``(6) Provision of technical assistance.--The Secretary 
        shall, to the extent practicable, provide technical assistance 
        relating to compliance with the provisions of this subsection 
        to applicable laboratories requesting such assistance.
            ``(7) Definitions.--In this subsection:
                    ``(A) Applicable laboratory.--The term `applicable 
                laboratory' has the meaning given such term in section 
                414.502, of title 42, Code of Federal Regulations (or a 
                successor regulation), except that such term does not 
                include a laboratory with respect to which standard 
                charges and prices for specified clinical diagnostic 
                laboratory tests furnished by such laboratory are made 
                available by a hospital pursuant to section 1899C or 
                section 2718(f) of the Public Health Service Act.
                    ``(B) Discounted cash price.--The term `discounted 
                cash price' means the charge that applies to an 
                individual who pays cash, or cash equivalent, for an 
                item or service.
                    ``(C) Gross charge.--The term `gross charge' means 
                the charge for an individual item or service that is 
                reflected on an applicable laboratory's chargemaster, 
                absent any discounts.
                    ``(D) Payer-specific negotiated charge.--The term 
                `payer-specific negotiated charge' means the charge 
                that an applicable laboratory has negotiated with a 
                third party payer for an item or service.
                    ``(E) Specified clinical diagnostic laboratory 
                test.--the term `specified clinical diagnostic 
                laboratory test' means a clinical diagnostic laboratory 
                test that is included on the list of shoppable services 
                specified by the Centers for Medicare & Medicaid 
                Services (as described in section 
                1899C(a)(2)(A)(ii)(I)), other than such a test that is 
                only available to be furnished by a single provider of 
                services or supplier.
                    ``(F) Third party payer.--The term `third party 
                payer' means an entity that is, by statute, contract, 
                or agreement, legally responsible for payment of a 
                claim for a health care item or service.''.

SEC. 103. IMAGING PRICE TRANSPARENCY.

    Section 1899C of the Social Security Act, as added by section 101, 
is amended--
            (1) by redesignating subsection (b) as subsection (c);
            (2) by inserting after subsection (a) the following new 
        subsection:
    ``(b) Imaging Services Price Transparency.--
            ``(1) In general.--Beginning January 1, 2028, each provider 
        of services and supplier that receives payment under this title 
        for furnishing a specified imaging service, other than such a 
        provider or supplier with respect to which standard charges and 
        prices for such services furnished by such provider or supplier 
        are made available by a hospital pursuant to section 1899C or 
        section 2718(f) of the Public Health Service Act, shall--
                    ``(A) make publicly available (in accordance with 
                paragraph (3)) on an internet website the information 
                described in paragraph (2) with respect to each such 
                service that such provider of services or supplier 
                furnishes; and
                    ``(B) ensure that such information is updated not 
                less frequently than annually.
            ``(2) Information described.--For purposes of paragraph 
        (1), the information described in this paragraph is, with 
        respect to a provider of services or supplier and a specified 
        imaging service, the following:
                    ``(A) The discounted cash price for such service 
                (or, if no such price exists, the gross charge for such 
                service).
                    ``(B) If required by the Secretary, the 
                deidentified minimum payer-specific negotiated charge 
                for such service and the deidentified maximum payer-
                specific negotiated charge for such service.
            ``(3) Uniform method and format.--Not later than January 1, 
        2028, the Secretary shall establish a standard, uniform method 
        and format for providers of services and suppliers to use in 
        making public information described in paragraph (2). Any such 
        method and format--
                    ``(A) may be similar to any template made available 
                by the Centers for Medicare & Medicaid Services (as 
                described in section 1899C(a)(2)(C)(ii));
                    ``(B) shall meet such standards as determined 
                appropriate by the Secretary in order to ensure the 
                accessibility and usability of such information; and
                    ``(C) shall be updated as determined appropriate by 
                the Secretary, in consultation with stakeholders.
            ``(4) Monitoring compliance.--The Secretary shall, through 
        notice and comment rulemaking and in consultation with the 
        Inspector General of the Department of Health and Human 
        Services, establish a process to monitor compliance with this 
        subsection.
            ``(5) Enforcement.--
                    ``(A) In general.--In the case that the Secretary 
                determines that a provider of services or supplier is 
                not in compliance with paragraph (1)--
                            ``(i) not later than 30 days after such 
                        determination, the Secretary shall notify such 
                        provider or supplier of such determination;
                            ``(ii) upon request of the Secretary, such 
                        provider or supplier shall submit to the 
                        Secretary, not later than 45 days after the 
                        date of such request, a corrective action plan 
                        to comply with such paragraph; and
                            ``(iii) if such provider or supplier 
                        continues to fail to comply with such paragraph 
                        after the date that is 90 days after such 
                        notification is sent (or, in the case of such a 
                        provider or supplier that has submitted a 
                        corrective action plan described in clause (ii) 
                        in response to a request so described, after 
                        the date that is 90 days after such 
                        submission), the Secretary may impose a civil 
                        monetary penalty in an amount not to exceed 
                        $300 for each day (beginning with the day on 
                        which the Secretary first determined that such 
                        provider or supplier was failing to comply with 
                        such paragraph) during which such failure to 
                        comply or failure to submit is ongoing.
                    ``(B) Increase authority.--In applying this 
                paragraph with respect to violations occurring in 2029 
                or a subsequent year, the Secretary may through notice 
                and comment rulemaking increase the amount of the civil 
                monetary penalty under subparagraph (A)(iii).
                    ``(C) Application of certain provisions.--The 
                provisions of section 1128A (other than subsections (a) 
                and (b) of such section) shall apply to a civil 
                monetary penalty imposed under this paragraph in the 
                same manner as such provisions apply to a civil 
                monetary penalty imposed under subsection (a) of such 
                section.
                    ``(D) Authority to waive or reduce penalty.--
                            ``(i) In general.--Subject to clause (ii), 
                        the Secretary may waive or reduce any penalty 
                        otherwise applicable with respect to a provider 
                        of services or supplier under this subparagraph 
                        if the Secretary certifies that imposition of 
                        such penalty would result in an immediate 
                        threat to access to care for individuals in the 
                        service area of such provider or supplier.
                            ``(ii) Limitation.--The Secretary may not 
                        elect to waive or reduce a penalty under clause 
                        (i) with respect to a specific provider of 
                        services or supplier more than 3 times.
                    ``(E) Provision of technical assistance.--The 
                Secretary shall, to the extent practicable, provide 
                technical assistance relating to compliance with the 
                provisions of this subsection to providers of services 
                and suppliers requesting such assistance.
                    ``(F) Clarification of nonapplicability of other 
                enforcement provisions.--Notwithstanding any other 
                provision of this title, this paragraph shall be the 
                sole means of enforcing the provisions of this 
                subsection.''; and
            (3) in subsection (c), as so redesignated by paragraph 
        (1)--
                    (A) by redesignating paragraph (8) as paragraph 
                (9); and
                    (B) by inserting after paragraph (7) the following 
                new paragraph:
            ``(8) Specified imaging service.--the term `specified 
        imaging service' means an imaging service that is a Centers for 
        Medicare & Medicaid Services-specified shoppable service (as 
        described in subsection (a)(2)(A)(ii)(I)).''.

SEC. 104. AMBULATORY SURGICAL CENTER PRICE TRANSPARENCY.

    Section 1834 of the Social Security Act (42 U.S.C. 1395m) is 
amended by adding at the end the following new subsection:
    ``(aa) Ambulatory Surgical Center Price Transparency.--
            ``(1) In general.--Beginning January 1, 2026, each 
        specified ambulatory surgical center that receives payment 
        under this title for furnishing items and services shall comply 
        with the price transparency requirement described in paragraph 
        (2).
            ``(2) Requirement described.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the price transparency requirement described in this 
                subsection is, with respect to a specified ambulatory 
                surgical center, that such surgical center in 
                accordance with a method and format established by the 
                Secretary under subparagraph (C), compile and make 
                public (without subscription and free of charge), for 
                each year--
                            ``(i) all of the ambulatory surgical 
                        center's standard charges (including the 
                        information described in subparagraph (B)) for 
                        each item and service furnished by such 
                        surgical center;
                            ``(ii) information on the ambulatory 
                        surgical center's prices (including the 
                        information described in subparagraph (B)) for 
                        as many of the Centers for Medicare & Medicaid 
                        Services-specified shoppable services that are 
                        furnished by such surgical center, and as many 
                        additional ambulatory surgical center-selected 
                        shoppable services (or all such additional 
                        services, if such surgical center furnishes 
                        fewer than 300 shoppable services) as may be 
                        necessary for a combined total of at least 300 
                        shoppable services; and
                            ``(iii) with respect to each Centers for 
                        Medicare & Medicaid Services-specified 
                        shoppable service that is not furnished by the 
                        ambulatory surgical center, an indication that 
                        such service is not so furnished.
                    ``(B) Information described.--For purposes of 
                subparagraph (A), the information described in this 
                subparagraph is, with respect to standard charges and 
                prices (as applicable) made public by a specified 
                ambulatory surgical center, the following:
                            ``(i) A plain language description of each 
                        item or service, accompanied by, as applicable, 
                        the Healthcare Common Procedure Coding System 
                        code, the diagnosis-related group, the national 
                        drug code, or other identifier used or approved 
                        by the Centers for Medicare & Medicaid 
                        Services.
                            ``(ii) The gross charge, as applicable, 
                        expressed as a dollar amount, for each such 
                        item or service.
                            ``(iii) The discounted cash price, as 
                        applicable, expressed as a dollar amount, for 
                        each such item or service (or, in the case no 
                        discounted cash price is available for an item 
                        or service, the median cash price charged to 
                        self-pay individuals for such item or service 
                        for the previous three years, expressed as a 
                        dollar amount).
                            ``(iv) The current payer-specific 
                        negotiated charges, clearly associated with the 
                        name of the third party payer and plan and 
                        expressed as a dollar amount, that applies to 
                        each such item or service.
                            ``(v) The de-identified maximum and minimum 
                        negotiated charges, as applicable, for each 
                        such item or service.
                            ``(vi) Any other additional information the 
                        Secretary may require for the purpose of 
                        improving the accuracy of, or enabling 
                        consumers to easily understand and compare, 
                        standard charges and prices for an item or 
                        service, except information that is duplicative 
                        of any other reporting requirement under this 
                        subsection.
                    ``(C) Uniform method and format.--Not later than 
                January 1, 2026, the Secretary shall establish a 
                standard, uniform method and format for specified 
                ambulatory surgical centers to use in making public 
                standard charges and a standard, uniform method and 
                format for such centers to use in making public prices 
                pursuant to subparagraph (A). Any such method and 
                format--
                            ``(i) shall, in the case of such charges 
                        made public by an ambulatory surgical center, 
                        ensure that such charges are made available in 
                        a machine-readable format (or successor 
                        technology);
                            ``(ii) may be similar to any template made 
                        available by the Centers for Medicare & 
                        Medicaid Services as of the date of the 
                        enactment of this paragraph;
                            ``(iii) shall meet such standards as 
                        determined appropriate by the Secretary in 
                        order to ensure the accessibility and usability 
                        of such charges and prices; and
                            ``(iv) shall be updated as determined 
                        appropriate by the Secretary, in consultation 
                        with stakeholders.
            ``(3) Monitoring compliance.--The Secretary shall, through 
        notice and comment rulemaking and in consultation with the 
        Inspector General of the Department of Health and Human 
        Services, establish a process to monitor compliance with this 
        subsection. Such process shall ensure that each specified 
        ambulatory surgical center's compliance with this subsection is 
        reviewed not less frequently than once every 3 years.
            ``(4) Enforcement.--
                    ``(A) In general.--In the case of a specified 
                ambulatory surgical center that fails to comply with 
                the requirements of this subsection--
                            ``(i) the Secretary shall notify such 
                        ambulatory surgical center of such failure not 
                        later than 30 days after the date on which the 
                        Secretary determines such failure exists; and
                            ``(ii) upon request of the Secretary, the 
                        ambulatory surgical center shall submit to the 
                        Secretary, not later than 45 days after the 
                        date of such request, a corrective action plan 
                        to comply with such requirements.
                    ``(B) Civil monetary penalty.--
                            ``(i) In general.--In addition to any other 
                        enforcement actions or penalties that may apply 
                        under another provision of law, a specified 
                        ambulatory surgical center that has received a 
                        notification under subparagraph (A)(i) and 
                        fails to comply with the requirements of this 
                        subsection by the date that is 90 days after 
                        such notification (or, in the case of an 
                        ambulatory surgical center that has submitted a 
                        corrective action plan described in 
                        subparagraph (A)(ii) in response to a request 
                        so described, by the date that is 90 days after 
                        such submission) shall be subject to a civil 
                        monetary penalty of an amount specified by the 
                        Secretary for each subsequent day during which 
                        such failure is ongoing (not to exceed $300 per 
                        day).
                            ``(ii) Increase authority.--In applying 
                        this subparagraph with respect to violations 
                        occurring in 2027 or a subsequent year, the 
                        Secretary may through notice and comment 
                        rulemaking increase the limitation on the per 
                        day amount of any penalty applicable to a 
                        specified ambulatory surgical center under 
                        clause (i).
                            ``(iii) Application of certain 
                        provisions.--The provisions of section 1128A 
                        (other than subsections (a) and (b) of such 
                        section) shall apply to a civil monetary 
                        penalty imposed under this subparagraph in the 
                        same manner as such provisions apply to a civil 
                        monetary penalty imposed under subsection (a) 
                        of such section.
                            ``(iv) Authority to waive or reduce 
                        penalty.--
                                    ``(I) In general.--Subject to 
                                subclause (II), the Secretary may waive 
                                any penalty, or reduce any penalty by 
                                not more than 75 percent, otherwise 
                                applicable under this subparagraph with 
                                respect to a specified ambulatory 
                                surgical center located in a rural or 
                                underserved area if the Secretary 
                                certifies that imposition of such 
                                penalty would result in an immediate 
                                threat to access to care for 
                                individuals in the service area of such 
                                surgical center.
                                    ``(II) Limitation on application.--
                                The Secretary may not elect to waive a 
                                penalty under subclause (I) with 
                                respect to a specified ambulatory 
                                surgical center more than once in a 6-
                                year period and may not elect to reduce 
                                such a penalty with respect to such a 
                                surgical center more than once in such 
                                a period. Nothing in the preceding 
                                sentence shall be construed as 
                                prohibiting the Secretary from both 
                                waiving and reducing a penalty with 
                                respect to a specified surgical center 
                                during a 6-year period.
            ``(5) Definitions.--For purposes of this section:
                    ``(A) Discounted cash price.--The term `discounted 
                cash price' means the charge that applies to an 
                individual who pays cash, or cash equivalent, for a 
                item or service furnished by an ambulatory surgical 
                center.
                    ``(B) Federal health care program.--The term 
                `Federal health care program' has the meaning given 
                such term in section 1128B.
                    ``(C) Gross charge.--The term `gross charge' means 
                the charge for an individual item or service that is 
                reflected on a specified surgical center's 
                chargemaster, absent any discounts.
                    ``(D) Group health plan; group health insurance 
                coverage; individual health insurance coverage.--The 
                terms `group health plan', `group health insurance 
                coverage', and `individual health insurance coverage' 
                have the meaning given such terms in section 2791 of 
                the Public Health Service Act.
                    ``(E) Payer-specific negotiated charge.--The term 
                `payer-specific negotiated charge' means the charge 
                that a specified surgical center has negotiated with a 
                third party payer for an item or service.
                    ``(F) Shoppable service.--The term `shoppable 
                service' means a service that can be scheduled by a 
                health care consumer in advance and includes all 
                ancillary items and services customarily furnished as 
                part of such service.
                    ``(G) Specified ambulatory surgical center.--The 
                term `specified ambulatory surgical center' means an 
                ambulatory surgical center with respect to which a 
                hospital (or any person with an ownership or control 
                interest (as defined in section 1124(a)(3)) in a 
                hospital) is a person with an ownership or control 
                interest (as so defined).
                    ``(H) Third party payer.--The term `third party 
                payer' means an entity that is, by statute, contract, 
                or agreement, legally responsible for payment of a 
                claim for a health care item or service.''.

SEC. 105. HEALTH COVERAGE PRICE TRANSPARENCY.

    (a) Price Transparency Requirements.--
            (1) IRC.--
                    (A) In general.--Section 9819 of the Internal 
                Revenue Code of 1986 is amended to read as follows:

``SEC. 9819. TRANSPARENCY IN COVERAGE.

    ``(a) Cost-sharing Transparency.--
            ``(1) In general.--For plan years beginning on or after 
        January 1, 2026, a group health plan shall permit a participant 
        or beneficiary to learn the amount of cost-sharing (including 
        deductibles, copayments, and coinsurance) under the participant 
        or beneficiary's plan that the participant or beneficiary would 
        be responsible for paying with respect to the furnishing of a 
        specific item or service by a provider in a timely manner upon 
        the request of the participant or beneficiary. At a minimum, 
        such information shall include the information specified in 
        paragraph (2) and shall be made available to such participant 
        or beneficiary through a self-service tool that meets the 
        requirements of paragraph (3) or, at the option of such 
        participant or beneficiary, through a paper disclosure or phone 
        or other electronic disclosure (as selected by such participant 
        or beneficiary and provided at no cost to such participant or 
        beneficiary) that meets such requirements as the Secretary may 
        specify.
            ``(2) Specified information.--For purposes of paragraph 
        (1), the information specified in this paragraph is, with 
        respect to an item or service for which benefits are available 
        under a group health plan furnished by a health care provider 
        to a participant or beneficiary of such plan, the following:
                    ``(A) If such provider is a participating provider 
                with respect to such item or service, the in-network 
                rate (as defined in subsection (c)) for such item or 
                service.
                    ``(B) If such provider is not a participating 
                provider with respect to such item or service, the 
                maximum allowed amount or other dollar amount that such 
                plan or coverage will recognize as payment for such 
                item or service, along with a notice that such 
                participant or beneficiary may be liable for additional 
                charges.
                    ``(C) The estimated amount of cost sharing 
                (including deductibles, copayments, and coinsurance) 
                that the participant or beneficiary will incur for such 
                item or service (which, in the case such item or 
                service is to be furnished by a provider described in 
                subparagraph (B), shall be calculated using the maximum 
                allowed amount or other dollar amount described in such 
                subparagraph).
                    ``(D) The amount the participant or beneficiary has 
                already accumulated with respect to any deductible or 
                out of pocket maximum under the plan (broken down, in 
                the case separate deductibles or maximums apply to 
                separate participants and beneficiaries enrolled in the 
                plan, by such separate deductibles or maximums, in 
                addition to any cumulative deductible or maximum).
                    ``(E) In the case such plan imposes any frequency 
                or volume limitations with respect to such item or 
                service (excluding medical necessity determinations), 
                the amount that such participant or beneficiary has 
                accrued towards such limitation with respect to such 
                item or service.
                    ``(F) Any prior authorization, concurrent review, 
                step therapy, fail first, or similar requirements 
                applicable to coverage of such item or service under 
                such plan.
                    ``(G) Any shared savings (such as any credit, 
                payment, or other benefit provided by such plan) 
                available to the participant or beneficiary with 
                respect to such item or service furnished by such 
                provider known at the time such request is made.
            ``(3) Self-service tool.--For purposes of paragraph (1), a 
        self-service tool established by a group health plan meets the 
        requirements of this paragraph if such tool--
                    ``(A) is based on an Internet website (or successor 
                technology specified by the Secretary);
                    ``(B) provides for real-time responses to requests 
                described in paragraph (1);
                    ``(C) is updated in a manner such that information 
                provided through such tool is timely and accurate at 
                the time such request is made;
                    ``(D) allows such a request to be made with respect 
                to an item or service furnished by--
                            ``(i) a specific provider that is a 
                        participating provider with respect to such 
                        item or service;
                            ``(ii) all providers that are participating 
                        providers with respect to such item or service; 
                        or
                            ``(iii) a provider in a relevant geographic 
                        region that is not described in clause (i) or 
                        (ii);
                    ``(E) provides that such a request may be made with 
                respect to an item or service through use of the 
                billing code for such item or service or through use of 
                a descriptive term for such item or service; and
                    ``(F) meets any other requirement determined 
                appropriate by the Secretary to ensure the 
                accessibility and usability of information provided 
                through such tool.
        The Secretary may require such tool, as a condition of 
        complying with subparagraph (E), to link multiple billing codes 
        to a single descriptive term if the Secretary determines that 
        the billing codes to be so linked correspond to similar items 
        and services.
    ``(b) Rate and Payment Information.--
            ``(1) In general.--For plan years beginning on or after 
        January 1, 2026, each group health plan (other than a 
        grandfathered health plan (as defined in section 1251(e) of the 
        Patient Protection and Affordable Care Act)) shall, for each 
        month, not later than the tenth day of such month, make 
        available to the public the rate and payment information 
        described in paragraph (2) in accordance with paragraph (3).
            ``(2) Rate and payment information described.--For purposes 
        of paragraph (1), the rate and payment information described in 
        this paragraph is, with respect to a group health plan, the 
        following:
                    ``(A) With respect to each item or service (other 
                than a drug) for which benefits are available under 
                such plan, the in-network rate (expressed as a dollar 
                amount) in effect as of the date on which such 
                information is made public with each provider that is a 
                participating provider with respect to such item or 
                service.
                    ``(B) With respect to each drug (identified by 
                national drug code) for which benefits are available 
                under such plan--
                            ``(i) the in-network rate (expressed as a 
                        dollar amount) in effect as of the first day of 
                        the month in which such information is made 
                        public with each provider that is a 
                        participating provider with respect to such 
                        drug; and
                            ``(ii) the average amount paid by such plan 
                        (net of rebates, discounts, and price 
                        concessions) for such drug dispensed or 
                        administered during the 90-day period beginning 
                        180 days before such date of publication to 
                        each provider that was a participating provider 
                        with respect to such drug, broken down by each 
                        such provider, other than such an amount paid 
                        to a provider that, during such period, 
                        submitted fewer than 20 claims for such drug to 
                        such plan.
                    ``(C) With respect to each item or service for 
                which benefits are available under such plan, the 
                amount billed, and the amount allowed by the plan, for 
                each such item or service furnished during the 90-day 
                period specified in subparagraph (B) by a provider that 
                was not a participating provider with respect to such 
                item or service, broken down by each such provider.
            ``(3) Manner of publication.--Rate and payment information 
        required to be made available under this subsection shall be so 
        made available in dollar amounts through separate machine-
        readable files (and any successor technology, such as 
        application program interface technology, determined 
        appropriate by the Secretary) corresponding to the information 
        described in each of subparagraphs (A) through (C) of paragraph 
        (2) that meet such requirements as specified by the Secretary 
        through subregulatory guidance. Such requirements shall ensure 
        that such files are limited to an appropriate size, do not 
        include disclosure of unnecessary duplicative information 
        contained in other files made available under this subsection, 
        are made available in a widely available format through a 
        publicly available website that allows for information 
        contained in such files to be compared across group health 
        plans and group or individual health insurance coverage, and 
        are accessible to individuals at no cost and without the need 
        to establish a user account or provide other credentials.
            ``(4) User instructions.--Each group health plan shall make 
        available to the public instructions written in plain language 
        explaining how individuals may search for information described 
        in paragraph (2) in files submitted in accordance with 
        paragraph (3). The Secretary shall develop and publish through 
        subregulatory guidance a template that such a plan may use in 
        developing instructions for purposes of the preceding sentence.
            ``(5) Summary.--For each plan year beginning on or after 
        January 1, 2026, each group health plan shall make public a 
        data file, in a manner that ensures that such file may be 
        easily downloaded and read by standard spreadsheet software and 
        that meets such requirements as established by the Secretary, 
        containing a summary of all rate and payment information made 
        public by such plan with respect to such plan during such plan 
        year. Such file shall include the following:
                    ``(A) The mean, median, and interquartile range of 
                the in-network rate, and the amount allowed for an item 
                or service when not furnished by a participating 
                provider, in effect as of the first day of such plan 
                year for each item or service (identified by payer 
                identifier approved or used by the Centers for Medicare 
                & Medicaid Services) for which benefits are available 
                under the plan, broken down by the type of provider 
                furnishing the item or service and by the geographic 
                area in which such item or service is furnished.
                    ``(B) Trends in payment rates for such items and 
                services over such plan year, including an 
                identification of instances in which such rates have 
                increased, decreased, or remained the same.
                    ``(C) The name of such plan, a description of the 
                type of network of participating providers used by such 
                plan, and a description of whether such plan is self-
                insured or fully-insured.
                    ``(D) For each item or service which is paid as 
                part of a bundled rate--
                            ``(i) a description of the formulae, 
                        pricing methodologies, or other information 
                        used to calculate the payment rate for such 
                        bundle; and
                            ``(ii) a list of the items and services 
                        included in such bundle.
                    ``(E) The percentage of items and services that are 
                paid for on a fee-for-service basis and the percentage 
                of items and services that are paid for as part of a 
                bundled rate, capitated payment rate, or other 
                alternative payment model.
            ``(6) Attestation.--Each group health plan shall post, 
        along with rate and payment information made public by such 
        plan, an attestation that such information is complete and 
        accurate.
    ``(c) Accessibility.--A group health plan shall take reasonable 
steps (as specified by the Secretary) to ensure that information 
provided in response to a request described in subsection (a), and rate 
and payment information made public under subsection (b), is provided 
in plain, easily understandable language and that interpretation, 
translations, and assistive services are provided to those with limited 
English proficiency and those with disabilities.
    ``(d) Definitions.--In this section:
            ``(1) Participating provider.--The term `participating 
        provider' means, with respect to an item or service and a group 
        health plan, a physician or other health care provider who is 
        acting within the scope of practice of that provider's license 
        or certification under applicable State law and who has a 
        contractual relationship with the plan, respectively, for 
        furnishing such item or service under the plan, and includes 
        facilities, respectively.
            ``(2) Provider.--The term `provider' includes a health care 
        facility.
            ``(3) In-network rate.--The term `in-network rate' means, 
        with respect to a group health plan and an item or service 
        furnished by a provider that is a participating provider with 
        respect to such plan and item or service, the contracted rate 
        (reflected as a dollar amount) in effect between such plan and 
        such provider for such item or service, regardless of whether 
        such rate is calculated based on a set amount, a fee schedule, 
        or an amount derived from another amount, or a formula, or 
        other method.''.
                    (B) Clerical amendment.--The item relating to 
                section 9819 of the table of sections for subchapter B 
                of chapter 100 of the Internal Revenue Code of 1986 is 
                amended to read as follows:

``Sec. 9819. Transparency in coverage.''.
            (2) PHSA.--Section 2799A-4 of the Public Health Service Act 
        (42 U.S.C. 300gg-114) is amended to read as follows:

``SEC. 2799A-4. TRANSPARENCY IN COVERAGE.

    ``(a) Cost-sharing Transparency.--
            ``(1) In general.--For plan years beginning on or after 
        January 1, 2026, a group health plan and a health insurance 
        issuer offering group or individual health insurance coverage 
        shall permit an individual enrolled under such plan or coverage 
        to learn the amount of cost-sharing (including deductibles, 
        copayments, and coinsurance) under the individual's plan or 
        coverage that the individual would be responsible for paying 
        with respect to the furnishing of a specific item or service by 
        a provider in a timely manner upon the request of the 
        individual. At a minimum, such information shall include the 
        information specified in paragraph (2) and shall be made 
        available to such individual through a self-service tool that 
        meets the requirements of paragraph (3) or, at the option of 
        such individual, through a paper disclosure or phone or other 
        electronic disclosure (as selected by such individual and 
        provided at no cost to such individual) that meets such 
        requirements as the Secretary may specify.
            ``(2) Specified information.--For purposes of paragraph 
        (1), the information specified in this paragraph is, with 
        respect to an item or service for which benefits are available 
        under a group health plan or group or individual health 
        insurance coverage furnished by a health care provider to an 
        individual enrolled under such plan or coverage, the following:
                    ``(A) If such provider is a participating provider 
                with respect to such item or service, the in-network 
                rate (as defined in subsection (c)) for such item or 
                service.
                    ``(B) If such provider is not a participating 
                provider with respect to such item or service, the 
                maximum allowed amount or other dollar amount that such 
                plan or coverage will recognize as payment for such 
                item or service, along with a notice that such 
                individual may be liable for additional charges.
                    ``(C) The estimated amount of cost sharing 
                (including deductibles, copayments, and coinsurance) 
                that the individual will incur for such item or service 
                (which, in the case such item or service is to be 
                furnished by a provider described in subparagraph (B), 
                shall be calculated using the maximum allowed amount or 
                other dollar amount described in such subparagraph).
                    ``(D) The amount the individual has already 
                accumulated with respect to any deductible or out of 
                pocket maximum under the plan or coverage (broken down, 
                in the case separate deductibles or maximums apply to 
                separate individuals enrolled in the plan or coverage, 
                by such separate deductibles or maximums, in addition 
                to any cumulative deductible or maximum).
                    ``(E) In the case such plan imposes any frequency 
                or volume limitations with respect to such item or 
                service (excluding medical necessity determinations), 
                the amount that such individual has accrued towards 
                such limitation with respect to such item or service.
                    ``(F) Any prior authorization, concurrent review, 
                step therapy, fail first, or similar requirements 
                applicable to coverage of such item or service under 
                such plan or coverage.
                    ``(G) Any shared savings (such as any credit, 
                payment, or other benefit provided by such plan or 
                issuer) available to the individual with respect to 
                such item or service furnished by such provider known 
                at the time such request is made.
            ``(3) Self-service tool.--For purposes of paragraph (1), a 
        self-service tool established by a group health plan or health 
        insurance issuer offering group or individual health insurance 
        coverage meets the requirements of this paragraph if such 
        tool--
                    ``(A) is based on an internet website (or successor 
                technology specified by the Secretary);
                    ``(B) provides for real-time responses to requests 
                described in paragraph (1);
                    ``(C) is updated in a manner such that information 
                provided through such tool is timely and accurate at 
                the time such request is made;
                    ``(D) allows such a request to be made with respect 
                to an item or service furnished by--
                            ``(i) a specific provider that is a 
                        participating provider with respect to such 
                        item or service;
                            ``(ii) all providers that are participating 
                        providers with respect to such item or service; 
                        or
                            ``(iii) a provider in a relevant geographic 
                        region that is not described in clause (i) or 
                        (ii);
                    ``(E) provides that such a request may be made with 
                respect to an item or service through use of the 
                billing code for such item or service or through use of 
                a descriptive term for such item or service; and
                    ``(F) meets any other requirement determined 
                appropriate by the Secretary to ensure the 
                accessibility and usability of information provided 
                through such tool.
        The Secretary may require such tool, as a condition of 
        complying with subparagraph (E), to link multiple billing codes 
        to a single descriptive term if the Secretary determines that 
        the billing codes to be so linked correspond to similar items 
        and services.
    ``(b) Rate and Payment Information.--
            ``(1) In general.--For plan years beginning on or after 
        January 1, 2026, each group health plan and health insurance 
        issuer offering group or individual health insurance coverage 
        (other than a grandfathered health plan (as defined in section 
        1251(e) of the Patient Protection and Affordable Care Act)) 
        shall, for each month, not later than the tenth day of such 
        month, make available to the public the rate and payment 
        information described in paragraph (2) in accordance with 
        paragraph (3).
            ``(2) Rate and payment information described.--For purposes 
        of paragraph (1), the rate and payment information described in 
        this paragraph is, with respect to a group health plan or group 
        or individual health insurance coverage, the following:
                    ``(A) With respect to each item or service (other 
                than a drug) for which benefits are available under 
                such plan or coverage, the in-network rate (expressed 
                as a dollar amount) in effect as of the date on which 
                such information is made public with each provider that 
                is a participating provider with respect to such item 
                or service.
                    ``(B) With respect to each drug (identified by 
                national drug code) for which benefits are available 
                under such plan or coverage--
                            ``(i) the in-network rate (expressed as a 
                        dollar amount) in effect as of the first day of 
                        the month in which such information is made 
                        public with each provider that is a 
                        participating provider with respect to such 
                        drug; and
                            ``(ii) the average amount paid by such plan 
                        (net of rebates, discounts, and price 
                        concessions) for such drug dispensed or 
                        administered during the 90-day period beginning 
                        180 days before such date of publication to 
                        each provider that was a participating provider 
                        with respect to such drug, broken down by each 
                        such provider, other than such an amount paid 
                        to a provider that, during such period, 
                        submitted fewer than 20 claims for such drug to 
                        such plan or coverage.
                    ``(C) With respect to each item or service for 
                which benefits are available under such plan or 
                coverage, the amount billed, and the amount allowed by 
                the plan, for each such item or service furnished 
                during the 90-day period specified in subparagraph (B) 
                by a provider that was not a participating provider 
                with respect to such item or service, broken down by 
                each such provider.
            ``(3) Manner of publication.--Rate and payment information 
        required to be made available under this subsection shall be so 
        made available in dollar amounts through separate machine-
        readable files (and any successor technology, such as 
        application program interface technology, determined 
        appropriate by the Secretary) corresponding to the information 
        described in each of subparagraphs (A) through (C) of paragraph 
        (2) that meet such requirements as specified by the Secretary 
        through subregulatory guidance. Such requirements shall ensure 
        that such files are limited to an appropriate size, do not 
        include disclosure of unnecessary duplicative information 
        contained in other files made available under this subsection, 
        are made available in a widely-available format through a 
        publicly-available website that allows for information 
        contained in such files to be compared across group health 
        plans and group or individual health insurance coverage, and 
        are accessible to individuals at no cost and without the need 
        to establish a user account or provide other credentials.
            ``(4) User instructions.--Each group health plan and health 
        insurance issuer offering group or individual health insurance 
        coverage shall make available to the public instructions 
        written in plain language explaining how individuals may search 
        for information described in paragraph (2) in files submitted 
        in accordance with paragraph (3). The Secretary shall develop 
        and publish through subregulatory guidance a template that such 
        a plan may use in developing instructions for purposes of the 
        preceding sentence.
            ``(5) Summary.--For each plan year beginning on or after 
        January 1, 2026, each group health plan and health insurance 
        issuer offering group or individual health insurance coverage 
        shall make public a data file, in a manner that ensures that 
        such file may be easily downloaded and read by standard 
        spreadsheet software and that meets such requirements as 
        established by the Secretary, containing a summary of all rate 
        and payment information made public by such plan or issuer with 
        respect to such plan or coverage during such plan year. Such 
        file shall include the following:
                    ``(A) The mean, median, and interquartile range of 
                the in-network rate, and the amount allowed for an item 
                or service when not furnished by a participating 
                provider, in effect as of the first day of such plan 
                year for each item or service (identified by payer 
                identifier approved or used by the Centers for Medicare 
                & Medicaid Services) for which benefits are available 
                under the plan or coverage, broken down by the type of 
                provider furnishing the item or service and by the 
                geographic area in which such item or service is 
                furnished.
                    ``(B) Trends in payment rates for such items and 
                services over such plan year, including an 
                identification of instances in which such rates have 
                increased, decreased, or remained the same.
                    ``(C) The name of such plan, a description of the 
                type of network of participating providers used by such 
                plan or coverage, and, in the case of a group health 
                plan, a description of whether such plan is self-
                insured or fully-insured.
                    ``(D) For each item or service which is paid as 
                part of a bundled rate--
                            ``(i) a description of the formulae, 
                        pricing methodologies, or other information 
                        used to calculate the payment rate for such 
                        bundle; and
                            ``(ii) a list of the items and services 
                        included in such bundle.
                    ``(E) The percentage of items and services that are 
                paid for on a fee-for-service basis and the percentage 
                of items and services that are paid for as part of a 
                bundled rate, capitated payment rate, or other 
                alternative payment model.
            ``(6) Attestation.--Each group health plan and health 
        insurance issuer offering group or individual health insurance 
        coverage shall post, along with rate and payment information 
        made public by such plan or issuer, an attestation that such 
        information is complete and accurate.
    ``(c) Accessibility.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage shall 
take reasonable steps (as specified by the Secretary) to ensure that 
information provided in response to a request described in subsection 
(a), and rate and payment information made public under subsection (b), 
is provided in plain, easily understandable language and that 
interpretation, translations, and assistive services are provided to 
those with limited English proficiency and those with disabilities.
    ``(d) Definitions.--In this section:
            ``(1) Participating provider.--The term `participating 
        provider' means, with respect to an item or service and a group 
        health plan or health insurance issuer offering group or 
        individual health insurance coverage, a physician or other 
        health care provider who is acting within the scope of practice 
        of that provider's license or certification under applicable 
        State law and who has a contractual relationship with the plan 
        or issuer, respectively, for furnishing such item or service 
        under the plan or coverage, and includes facilities, 
        respectively.
            ``(2) Provider.--The term `provider' includes a health care 
        facility.
            ``(3) In-network rate.--The term `in-network rate' means, 
        with respect to a group health plan or group or individual 
        health insurance coverage and an item or service furnished by a 
        provider that is a participating provider with respect to such 
        plan or coverage and item or service, the contracted rate 
        (reflected as a dollar amount) in effect between such plan or 
        coverage and such provider for such item or service, regardless 
        of whether such rate is calculated based on a set amount, a fee 
        schedule, or an amount derived from another amount, or a 
        formula, or other method.''.
            (3) ERISA.--
                    (A) In general.--Section 719 of the Employee 
                Retirement Income Security Act of 1974 (29 U.S.C. 
                1185h) is amended to read as follows:

``SEC. 719. TRANSPARENCY IN COVERAGE.

    ``(a) Cost-Sharing Transparency.--
            ``(1) In general.--For plan years beginning on or after 
        January 1, 2026, a group health plan and a health insurance 
        issuer offering group health insurance coverage shall permit a 
        participant or beneficiary to learn the amount of cost-sharing 
        (including deductibles, copayments, and coinsurance) under the 
        participant or beneficiary's plan or coverage that the 
        participant or beneficiary would be responsible for paying with 
        respect to the furnishing of a specific item or service by a 
        provider in a timely manner upon the request of the participant 
        or beneficiary. At a minimum, such information shall include 
        the information specified in paragraph (2) and shall be made 
        available to such participant or beneficiary through a self-
        service tool that meets the requirements of paragraph (3) or, 
        at the option of such participant or beneficiary, through a 
        paper disclosure or phone or other electronic disclosure (as 
        selected by such participant or beneficiary and provided at no 
        cost to such participant or beneficiary) that meets such 
        requirements as the Secretary may specify.
            ``(2) Specified information.--For purposes of paragraph 
        (1), the information specified in this paragraph is, with 
        respect to an item or service for which benefits are available 
        under a group health plan or group health insurance coverage 
        furnished by a health care provider to a participant or 
        beneficiary of such plan or coverage, the following:
                    ``(A) If such provider is a participating provider 
                with respect to such item or service, the in-network 
                rate (as defined in subsection (c)) for such item or 
                service.
                    ``(B) If such provider is not a participating 
                provider with respect to such item or service, the 
                maximum allowed amount or other dollar amount that such 
                plan or coverage will recognize as payment for such 
                item or service, along with a notice that such 
                participant or beneficiary may be liable for additional 
                charges.
                    ``(C) The estimated amount of cost-sharing 
                (including deductibles, copayments, and coinsurance) 
                that the participant or beneficiary will incur for such 
                item or service (which, in the case such item or 
                service is to be furnished by a provider described in 
                subparagraph (B), shall be calculated using the maximum 
                allowed amount or other dollar amount described in such 
                subparagraph).
                    ``(D) The amount the participant or beneficiary has 
                already accumulated with respect to any deductible or 
                out of pocket maximum under the plan or coverage 
                (broken down, in the case separate deductibles or 
                maximums apply to separate participants and 
                beneficiaries enrolled in the plan or coverage, by such 
                separate deductibles or maximums, in addition to any 
                cumulative deductible or maximum).
                    ``(E) In the case such plan imposes any frequency 
                or volume limitations with respect to such item or 
                service (excluding medical necessity determinations), 
                the amount that such participant or beneficiary has 
                accrued towards such limitation with respect to such 
                item or service.
                    ``(F) Any prior authorization, concurrent review, 
                step therapy, fail first, or similar requirements 
                applicable to coverage of such item or service under 
                such plan or coverage.
                    ``(G) Any shared savings (such as any credit, 
                payment, or other benefit provided by such plan or 
                issuer) available to the participant or beneficiary 
                with respect to such item or service furnished by such 
                provider known at the time such request is made.
            ``(3) Self-service tool.--For purposes of paragraph (1), a 
        self-service tool established by a group health plan or health 
        insurance issuer offering group health insurance coverage meets 
        the requirements of this paragraph if such tool--
                    ``(A) is based on an internet website (or successor 
                technology specified by the Secretary);
                    ``(B) provides for real-time responses to requests 
                described in paragraph (1);
                    ``(C) is updated in a manner such that information 
                provided through such tool is timely and accurate at 
                the time such request is made;
                    ``(D) allows such a request to be made with respect 
                to an item or service furnished by--
                            ``(i) a specific provider that is a 
                        participating provider with respect to such 
                        item or service;
                            ``(ii) all providers that are participating 
                        providers with respect to such item or service; 
                        or
                            ``(iii) a provider in a relevant geographic 
                        region that is not described in clause (i) or 
                        (ii);
                    ``(E) provides that such a request may be made with 
                respect to an item or service through use of the 
                billing code for such item or service or through use of 
                a descriptive term for such item or service; and
                    ``(F) meets any other requirement determined 
                appropriate by the Secretary to ensure the 
                accessibility and usability of information provided 
                through such tool.
        The Secretary may require such tool, as a condition of 
        complying with subparagraph (E), to link multiple billing codes 
        to a single descriptive term if the Secretary determines that 
        the billing codes to be so linked correspond to similar items 
        and services.
    ``(b) Rate and Payment Information.--
            ``(1) In general.--For plan years beginning on or after 
        January 1, 2026, each group health plan and health insurance 
        issuer offering group health insurance coverage (other than a 
        grandfathered health plan (as defined in section 1251(e) of the 
        Patient Protection and Affordable Care Act)) shall, for each 
        month, not later than the tenth day of such month, make 
        available to the public the rate and payment information 
        described in paragraph (2) in accordance with paragraph (3).
            ``(2) Rate and payment information described.--For purposes 
        of paragraph (1), the rate and payment information described in 
        this paragraph is, with respect to a group health plan or group 
        health insurance coverage, the following:
                    ``(A) With respect to each item or service (other 
                than a drug) for which benefits are available under 
                such plan or coverage, the in-network rate (expressed 
                as a dollar amount) in effect as of the date on which 
                such information is made public with each provider that 
                is a participating provider with respect to such item 
                or service.
                    ``(B) With respect to each drug (identified by 
                national drug code) for which benefits are available 
                under such plan or coverage--
                            ``(i) the in-network rate (expressed as a 
                        dollar amount) in effect as of the first day of 
                        the month in which such information is made 
                        public with each provider that is a 
                        participating provider with respect to such 
                        drug; and
                            ``(ii) the average amount paid by such plan 
                        (net of rebates, discounts, and price 
                        concessions) for such drug dispensed or 
                        administered during the 90-day period beginning 
                        180 days before such date of publication to 
                        each provider that was a participating provider 
                        with respect to such drug, broken down by each 
                        such provider, other than such an amount paid 
                        to a provider that, during such period, 
                        submitted fewer than 20 claims for such drug to 
                        such plan or coverage.
                    ``(C) With respect to each item or service for 
                which benefits are available under such plan or 
                coverage, the amount billed, and the amount allowed by 
                the plan, for each such item or service furnished 
                during the 90-day period specified in subparagraph (B) 
                by a provider that was not a participating provider 
                with respect to such item or service, broken down by 
                each such provider.
            ``(3) Manner of publication.--Rate and payment information 
        required to be made available under this subsection shall be so 
        made available in dollar amounts through separate machine-
        readable files (and any successor technology, such as 
        application program interface technology, determined 
        appropriate by the Secretary) corresponding to the information 
        described in each of subparagraphs (A) through (C) of paragraph 
        (2) that meet such requirements as specified by the Secretary 
        through subregulatory guidance. Such requirements shall ensure 
        that such files are limited to an appropriate size, do not 
        include disclosure of unnecessary duplicative information 
        contained in other files made available under this subsection, 
        are made available in a widely available format through a 
        publicly available website that allows for information 
        contained in such files to be compared across group health 
        plans and group or individual health insurance coverage, and 
        are accessible to individuals at no cost and without the need 
        to establish a user account or provide other credentials.
            ``(4) User instructions.--Each group health plan and health 
        insurance issuer offering group health insurance coverage shall 
        make available to the public instructions written in plain 
        language explaining how individuals may search for information 
        described in paragraph (2) in files submitted in accordance 
        with paragraph (3). The Secretary shall develop and publish 
        through subregulatory guidance a template that such a plan may 
        use in developing instructions for purposes of the preceding 
        sentence.
            ``(5) Summary.--For each plan year beginning on or after 
        January 1, 2026, each group health plan and health insurance 
        issuer offering group health insurance coverage shall make 
        public a data file, in a manner that ensures that such file may 
        be easily downloaded and read by standard spreadsheet software 
        and that meets such requirements as established by the 
        Secretary, containing a summary of all rate and payment 
        information made public by such plan or issuer with respect to 
        such plan or coverage during such plan year. Such file shall 
        include the following:
                    ``(A) The mean, median, and interquartile range of 
                the in-network rate, and the amount allowed for an item 
                or service when not furnished by a participating 
                provider, in effect as of the first day of such plan 
                year for each item or service (identified by payer 
                identifier approved or used by the Centers for Medicare 
                & Medicaid Services) for which benefits are available 
                under the plan or coverage, broken down by the type of 
                provider furnishing the item or service and by the 
                geographic area in which such item or service is 
                furnished.
                    ``(B) Trends in payment rates for such items and 
                services over such plan year, including an 
                identification of instances in which such rates have 
                increased, decreased, or remained the same.
                    ``(C) The name of such plan, a description of the 
                type of network of participating providers used by such 
                plan or coverage, and, in the case of a group health 
                plan, a description of whether such plan is self-
                insured or fully-insured.
                    ``(D) For each item or service which is paid as 
                part of a bundled rate--
                            ``(i) a description of the formulae, 
                        pricing methodologies, or other information 
                        used to calculate the payment rate for such 
                        bundle; and
                            ``(ii) a list of the items and services 
                        included in such bundle.
                    ``(E) The percentage of items and services that are 
                paid for on a fee-for-service basis and the percentage 
                of items and services that are paid for as part of a 
                bundled rate, capitated payment rate, or other 
                alternative payment model.
            ``(6) Attestation.--Each group health plan and health 
        insurance issuer offering group health insurance coverage shall 
        post, along with rate and payment information made public by 
        such plan or issuer, an attestation that such information is 
        complete and accurate.
    ``(c) Accessibility.--A group health plan and a health insurance 
issuer offering group health insurance coverage shall take reasonable 
steps (as specified by the Secretary) to ensure that information 
provided in response to a request described in subsection (a), and rate 
and payment information made public under subsection (b), is provided 
in plain, easily understandable language and that interpretation, 
translations, and assistive services are provided to those with limited 
English proficiency and those with disabilities.
    ``(d) Definitions.--In this section:
            ``(1) Participating provider.--The term `participating 
        provider' means, with respect to an item or service and a group 
        health plan or health insurance issuer offering group or 
        individual health insurance coverage, a physician or other 
        health care provider who is acting within the scope of practice 
        of that provider's license or certification under applicable 
        State law and who has a contractual relationship with the plan 
        or issuer, respectively, for furnishing such item or service 
        under the plan or coverage, and includes facilities, 
        respectively.
            ``(2) Provider.--The term `provider' includes a health care 
        facility.
            ``(3) In-network rate.--The term `in-network rate' means, 
        with respect to a group health plan or group health insurance 
        coverage and an item or service furnished by a provider that is 
        a participating provider with respect to such plan or coverage 
        and item or service, the contracted rate (reflected as a dollar 
        amount) in effect between such plan or coverage and such 
        provider for such item or service, regardless of whether such 
        rate is calculated based on a set amount, a fee schedule, or an 
        amount derived from another amount, or a formula, or other 
        method.''.
                    (B) Clerical amendment.--The table of contents in 
                section 1 of the Employee Retirement Income Security 
                Act of 1974 is amended by striking the item relating to 
                section 719 and inserting the following new item:

``Sec. 719. Transparency in coverage.''.
    (b) Application Programming Interface Report.--Not later than 
January 1, 2025, the Secretary of Health and Human Services shall, in 
consultation with the Office of the National Coordinator for Health 
Information Technology, Department of Labor, the Department of the 
Treasury, and stakeholders, submit to the House Committees on Education 
and the Workforce, Energy and Commerce, and Ways and Means, and the 
Senate Committees on Finance and Health, Education, Labor, and Pensions 
a report on the use of standards-based application programming 
interfaces (in this subsection referred to as ``APIs'') to facilitate 
access to health care price transparency information and the 
interoperability of other medical information. Such report shall 
include an evaluation of the capacity of the Department of Health and 
Human Services, the Department of Labor, and the Department of the 
Treasury to regulate and implement standards related to APIs and 
recommendations for improving such capacity. Such report shall include 
the following:
            (1) A description of current use, and proposed use, of APIs 
        under Federal rules to facilitate interoperability, including 
        information related to capacity constraints within the 
        agencies, barriers to adoption, privacy and security, 
        administrative burdens and efficiencies, care coordination, and 
        levels of compliance.
            (2) A description of the feasibility of agency 
        participation in the development of APIs to enable application 
        access to price transparency data under the amendments made by 
        subsection (a).
            (3) A specification of the timeline for which such data 
        standards can be required to make such data accessible via an 
        API.
            (4) An analysis of the benefits and challenges of 
        implementing standards-based APIs for price transparency data, 
        including the ability for consumers to access rate and payment 
        information and the amount of cost-sharing (including 
        deductibles, copayments, and coinsurance) under the consumer's 
        plan through third-party internet-based tools and applications.
            (5) An analysis of the impact that APIs which provide real-
        time access to pricing and cost-sharing information may have in 
        increasing the amount of services shoppable for individuals, 
        such as by standardizing more health care spend via episode 
        bundles.
            (6) An analysis of which health care items and services may 
        be useful under API, such as those for which prices change with 
        the greatest frequency.
            (7) An analysis of the cost of API standards implementation 
        on issuers, employers, and other private-sector entities.
            (8) An analysis of the ability of State regulators to 
        enforce API standards and the costs to the Federal Government 
        and States to regulate and enforce API standards.
            (9) An analysis of the interaction with API standards and 
        Federal health information privacy standards.
    (c) Provider Tool Report.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, The Secretary of Health and Human 
        Services, acting through the Administrator of the Centers for 
        Medicare & Medicaid Services, shall, in consultation with 
        stakeholders, conduct a study and submit to the House 
        Committees on Education and the Workforce, Energy and Commerce, 
        and Ways and Means, and the Senate Committees on Finance and 
        Health, Education, Labor, and Pensions a report on the 
        usefulness and feasibility of the establishment of a provider 
        tool by a group health plan, or a health insurance issuer 
        offering group and individual health insurance coverage, in 
        facilitating the provision of information made available 
        pursuant to the amendments made by subsection (a). Such report 
        shall include the following:
                    (A) A description of the feasibility of 
                establishing a requirement for the various types of 
                plans and coverage to offer such a provider tool, 
                including any challenges to establishing a provider 
                tool using the same technology platform as the self-
                service tool described in such amendments.
                    (B) An evaluation on the usefulness of a provider 
                tool to aid patient-decision making and how such tool 
                would coordinate with other information available to a 
                patient and their provider under other Federal 
                requirements in place or under consideration.
                    (C) An evaluation of whether the information 
                provided by such tool would be duplicative of the 
                advanced explanation of benefits required under Federal 
                law or any other existing requirement.
                    (D) A description of the usability and expected 
                utilization of such tool among providers, including 
                among different provider types.
                    (E) An analysis of the impact of a provider tool in 
                value-based care arrangements.
                    (F) An analysis on the potential impact of the 
                provider tool on--
                            (i) patients' out-of-pocket spending;
                            (ii) plan design, including impacts on 
                        cost-sharing requirements;
                            (iii) care coordination and quality;
                            (iv) plan premiums;
                            (v) overall health care spending and 
                        utilization; and
                            (vi) health care access in rural areas.
                    (G) An analysis of the feasibility of a provider 
                tool to include additional functionality to facilitate 
                and improve the administration of the requirements on 
                providers to submit notifications to such plan or 
                coverage under section 2799B-6 of the Public Health 
                Service Act and the requirements on such plan or 
                coverage to provide an advanced explanation of benefits 
                to individuals under section 2799A-1(f) of such Act.
                    (H) An analysis of which health care items and 
                services, would be most useful for patients utilizing a 
                provider tool.
                    (I) An analysis of rulemaking required to ensure 
                such a tool complies with federal health information 
                privacy standards.
                    (J) An analysis of the burden and cost of the 
                creation of a provider tool by plans and coverage on 
                providers, issuers, employers, and other private-sector 
                entities.
                    (K) An analysis of the ability of state regulators 
                to enforce provider tool standards and the costs to the 
                Department and states to regulate and enforce provider 
                tool standards.
            (2) Definition.--The term ``provider tool'' means a tool 
        designed to facilitate the provision of information made 
        available pursuant to the amendments made by subsection (a) and 
        established by a group health plan or a health insurance issuer 
        offering group and individual health insurance coverage that 
        allows providers to access the information such plan or 
        coverage must provide through the self-service tool described 
        in such amendments to an individual with whom the provider is 
        actively treating at the time of such request, upon the request 
        of the provider, and with the consent of such individual.
    (d) Reports.--
            (1) Compliance.--Not later than January 1, 2027, the 
        Comptroller General of the United States shall submit to 
        Congress a report containing--
                    (A) an analysis of compliance with the amendments 
                made by this section;
                    (B) an analysis of enforcement of such amendments 
                by the Secretaries of Health and Human Services, Labor, 
                and the Treasury;
                    (C) recommendations relating to improving such 
                enforcement; and
                    (D) recommendations relating to improving public 
                disclosure, and public awareness, of information 
                required to be made available by group health plans and 
                health insurance issuers pursuant to such amendments.
            (2) Prices.--Not later than January 1, 2028, and biennially 
        thereafter, the Secretaries of Health and Human Services, 
        Labor, and the Treasury shall jointly submit to Congress a 
        report containing an assessment of differences in negotiated 
        prices (and any trends in such prices) in the private market 
        between--
                    (A) rural and urban areas;
                    (B) the individual, small group, and large group 
                markets;
                    (C) consolidated and nonconsolidated health care 
                provider areas (as specified by the Secretary of Health 
                and Human Services);
                    (D) nonprofit and for-profit hospitals;
                    (E) nonprofit and for-profit insurers; and
                    (F) insurers serving local or regional areas and 
                insurers serving multistate or national areas.
    (e) Quality Report.--Not later than 1 year after the date of 
enactment of this subsection, the Secretaries of Health and Human 
Services, Labor, and the Treasury shall jointly submit to Congress a 
report on the feasibility of including data relating to the quality of 
health care items and services with the price transparency information 
required to be made available under the amendments made by subsection 
(a). Such report shall include recommendations for legislative and 
regulatory actions to identify appropriate metrics for assessing and 
comparing quality of care.
    (f) Continued Applicability of Rules for Previous Years.--Nothing 
in the amendments made by subsection (a) may be construed as affecting 
the applicability of the rule entitled ``Transparency in Coverage'' 
published by the Department of the Treasury, the Department of Labor, 
and the Department of Health and Human Services on November 12, 2020 
(85 Fed. Reg. 72158), for any plan year beginning before January 1, 
2026.

SEC. 106. PHARMACY BENEFITS PRICE TRANSPARENCY.

    (a) PHSA.--Title XXVII of the Public Health Service Act (42 U.S.C. 
300gg et seq.) is amended--
            (1) in part D (42 U.S.C. 300gg-111 et seq.), by adding at 
        the end the following new section:

``SEC. 2799A-11. OVERSIGHT OF PHARMACY BENEFITS MANAGER SERVICES.

    ``(a) In General.--For plan years beginning on or after the date 
that is 2 years after the date of enactment of this section, a group 
health plan or a health insurance issuer offering group health 
insurance coverage, or an entity or subsidiary providing pharmacy 
benefits management services on behalf of such a plan or issuer, shall 
not enter into a contract with a drug manufacturer, distributor, 
wholesaler, subcontractor, rebate aggregator, or any other third party 
that limits (or delays beyond the applicable reporting period described 
in subsection (b)(1)) the disclosure of information to plan sponsors in 
such a manner that prevents such plan, issuer, or entity from making 
the reports described in subsection (b).
    ``(b) Reports.--
            ``(1) In general.--With respect to plan years beginning on 
        or after the date that is 2 years after the date of enactment 
        of this section, not less frequently than every 6 months (or at 
        the request of a plan sponsor, not less frequently than 
        quarterly, but under the same conditions, terms, and cost of 
        the semiannual report under this subsection), a group health 
        plan or health insurance issuer offering group health insurance 
        coverage, or an entity providing pharmacy benefits management 
        services on behalf of such a plan or issuer, shall submit to 
        the plan sponsor (as defined in section 3(16)(B) of the 
        Employee Retirement Income Security Act of 1974) of such plan 
        or coverage a report in accordance with this section. Each such 
        report shall be made available to such plan sponsor in a 
        machine-readable format and shall include the information 
        described in paragraph (2).
            ``(2) Information described.--For purposes of paragraph 
        (1), the information described in this paragraph is, with 
        respect to drugs covered by a group health plan or health 
        insurance issuer offering group health insurance coverage 
        during each reporting period--
                    ``(A) a list of drugs for which a claim was filed 
                and, with respect to each such drug on such list--
                            ``(i) the brand name, chemical entity, and 
                        National Drug Code;
                            ``(ii) the type of dispensing channel used 
                        to furnish such drug, including retail, mail 
                        order, or specialty pharmacy;
                            ``(iii) with respect to each drug dispensed 
                        under each type of dispensing channel 
                        (including retail, mail order, or specialty 
                        pharmacy)--
                                    ``(I) whether such drug is a brand 
                                name drug or a generic drug, and--
                                            ``(aa) in the case of a 
                                        brand name drug, the wholesale 
                                        acquisition cost, listed as 
                                        cost per days supply and cost 
                                        per dosage unit, on the date 
                                        such drug was dispensed; and
                                            ``(bb) in the case of a 
                                        generic drug, the average 
                                        wholesale price, listed as cost 
                                        per days supply and cost per 
                                        dosage unit, on the date such 
                                        drug was dispensed; and
                                    ``(II) the total number of--
                                            ``(aa) prescription claims 
                                        (including original 
                                        prescriptions and refills);
                                            ``(bb) participants, 
                                        beneficiaries, and enrollees 
                                        for whom a claim for such drug 
                                        was filed;
                                            ``(cc) dosage units per 
                                        fill of such drug; and
                                            ``(dd) days supply of such 
                                        drug per fill;
                            ``(iv) the net price per course of 
                        treatment or single fill, such as a 30-day 
                        supply or 90-day supply to the plan or coverage 
                        after manufacturer rebates, fees, and other 
                        remuneration or adjustments;
                            ``(v) the total amount of out-of-pocket 
                        spending by participants, beneficiaries, and 
                        enrollees on such drug, including spending 
                        through copayments, coinsurance, and 
                        deductibles;
                            ``(vi) the total net spending by the plan 
                        or coverage;
                            ``(vii) total amount received, or expected 
                        to be received, by the plan or coverage from 
                        any entity in drug manufacturer rebates, fees, 
                        alternative discounts, and all other 
                        remuneration received from an entity or any 
                        third party (including group purchasing 
                        organizations) other than the plan sponsor;
                            ``(viii) the total amount received, or 
                        expected to be received by the plan or issuer, 
                        from drug manufacturers in rebates, fees, 
                        alternative discounts, or other remuneration--
                                    ``(I) that has been paid, or is to 
                                be paid, by drug manufacturers for 
                                claims incurred during the reporting 
                                period; and
                                    ``(II) that is related to 
                                utilization rebates for such drug; and
                            ``(ix) to the extent feasible, information 
                        on the total amount of remuneration, including 
                        copayment assistance dollars paid, copayment 
                        cards applied, or other discounts provided by 
                        each drug manufacturer (or entity administering 
                        copay assistance on behalf of such drug 
                        manufacturer) to the participants, 
                        beneficiaries, and enrollees enrolled in such 
                        plan or coverage;
                    ``(B) for each category or class of drugs for which 
                a claim was filed, a breakdown of the total gross 
                spending on drugs in such category or class before 
                rebates, price concessions, alternative discounts, or 
                other remuneration from drug manufacturers, and the net 
                spending after such rebates, price concessions, 
                alternative discounts, or other remuneration from drug 
                manufacturers, including--
                            ``(i) the number of participants, 
                        beneficiaries, and enrollees who filled a 
                        prescription for a drug in such category or 
                        class, including the National Drug Code for 
                        each such drug;
                            ``(ii) if applicable, a description of the 
                        formulary tiers and utilization mechanisms 
                        (such as prior authorization or step therapy) 
                        employed for drugs in that category or class; 
                        and
                            ``(iii) the total out-of-pocket spending 
                        under the plan or coverage by participants, 
                        beneficiaries, and enrollees, including 
                        spending through copayments, coinsurance, and 
                        deductibles;
                    ``(C) in the case of a drug for which gross 
                spending by such plan, coverage, or entity exceeded 
                $10,000 during the reporting period--
                            ``(i) a list of all other drugs in the same 
                        therapeutic category or class; and
                            ``(ii) the rationale for the formulary 
                        placement of such drug in that therapeutic 
                        category or class, if applicable;
                    ``(D) amounts paid directly or indirectly in 
                rebates, fees, or any other type of compensation (as 
                defined in section 408(b)(2)(B)(ii)(dd)(AA) of the 
                Employee Retirement Income Security Act) to brokers, 
                consultants, advisors, or any other individual or firm, 
                for the referral of the group health plan's or health 
                insurance issuer's business to an entity providing 
                pharmacy benefits management services, including the 
                identity of the recipient of such amounts;
                    ``(E) an explanation of any benefit design 
                parameters that encourage or require participants, 
                beneficiaries, and enrollees in such plan or coverage 
                to fill prescriptions at mail order, specialty, or 
                retail pharmacies that are affiliated with or under 
                common ownership with the entity providing pharmacy 
                benefit management services under such plan or 
                coverage, including mandatory mail and specialty home 
                delivery programs, retail and mail auto-refill 
                programs, and cost-sharing assistance incentives 
                directly or indirectly funded by such entity; and
                    ``(F) in the case of a plan or coverage (or an 
                entity providing pharmacy benefits management services 
                on behalf of such plan or coverage) that has an 
                affiliated pharmacy or pharmacy under common 
                ownership--
                            ``(i) the percentage of total prescriptions 
                        dispensed by such pharmacies to individuals 
                        enrolled in such plan or coverage;
                            ``(ii) a list of all drugs dispensed by 
                        such pharmacies to individuals enrolled in such 
                        plan or coverage, and, with respect to each 
                        drug dispensed--
                                    ``(I) the amount charged, per 
                                dosage unit, per 30-day supply, or per 
                                90-day supply (as applicable) to the 
                                plan or issuer, and to participants, 
                                beneficiaries, and enrollees enrolled 
                                in such plan or coverage;
                                    ``(II) the median amount charged to 
                                such plan or issuer, and the 
                                interquartile range of the costs, per 
                                dosage unit, per 30-day supply, and per 
                                90-day supply, including amounts paid 
                                by the participants, beneficiaries, and 
                                enrollees, when the same drug is 
                                dispensed by other pharmacies that are 
                                not affiliated with or under common 
                                ownership with the entity and that are 
                                included in the pharmacy network of 
                                such plan or coverage;
                                    ``(III) the lowest cost per dosage 
                                unit, per 30-day supply and per 90-day 
                                supply, for each such drug, including 
                                amounts charged to the plan and 
                                participants, beneficiaries, and 
                                enrollees, that is available from any 
                                pharmacy included in the network of 
                                such plan or coverage; and
                                    ``(IV) the net acquisition cost per 
                                dosage unit, per 30-day supply, and per 
                                90-day supply, if such drug is subject 
                                to a maximum price discount.
            ``(3) Privacy requirements.--Health insurance issuers 
        offering group health insurance coverage and entities providing 
        pharmacy benefits management services on behalf of a group 
        health plan shall provide information under paragraph (1) in a 
        manner consistent with the privacy, security, and breach 
        notification regulations promulgated under section 13402(a) of 
        the Health Information Technology for Clinical Health Act, and 
        shall restrict the use and disclosure of such information 
        according to such privacy regulations.
            ``(4) Disclosure and redisclosure.--
                    ``(A) Limitation to business associates.--A plan 
                sponsor receiving a report under paragraph (1) may 
                disclose such information only to the entity from which 
                the report was received, the group health plan for 
                which the report pertains, or to that entity's business 
                associates as defined in section 160.103 of title 45, 
                Code of Federal Regulations (or successor regulations) 
                or as permitted by the HIPAA Privacy Rule (45 CFR parts 
                160 and 164, subparts A and E).
                    ``(B) Clarification regarding public disclosure of 
                information.--Nothing in this section shall prevent a 
                group health plan or health insurance issuer offering 
                group health insurance coverage, or an entity providing 
                pharmacy benefits management services on behalf of such 
                a plan or coverage, from placing reasonable 
                restrictions on the public disclosure of the 
                information contained in a report described in 
                paragraph (1), except that such plan, issuer, or entity 
                may not restrict disclosure of such report to the 
                Department of Health and Human Services, the Department 
                of Labor, the Department of the Treasury, or the 
                Comptroller General of the United States.
                    ``(C) Limited form of report.--The Secretary shall 
                define through rulemaking a limited form of the report 
                under paragraph (1) required of plan sponsors who are 
                drug manufacturers, drug wholesalers, or other direct 
                participants in the drug supply chain, in order to 
                prevent anti-competitive behavior.
            ``(5) Report to gao.--A group health plan or health 
        insurance issuer offering group health insurance coverage, or 
        an entity providing pharmacy benefits management services on 
        behalf of such plan or coverage, shall submit to the 
        Comptroller General of the United States each of the first 4 
        reports submitted to a plan sponsor under paragraph (1) and 
        other such reports as requested, in accordance with the privacy 
        requirements under paragraph (3), the disclosure and 
        redisclosure standards under paragraph (4), the standards 
        specified pursuant to paragraph (6), and such other information 
        that the Comptroller General determines necessary to carry out 
        the study under section 106(d) of the Lower Costs, More 
        Transparency Act.
            ``(6) Standard format.--Not later than 1 year after the 
        date of enactment of this section, the Secretary shall specify 
        through rulemaking standards for group health plans, health 
        insurance issuers offering group health insurance coverage, and 
        entities providing pharmacy benefits management services on 
        behalf of such plans or coverage, required to submit reports 
        under paragraph (1) to submit such reports in a standard 
        format.
    ``(c) Enforcement.--
            ``(1) In general.--The Secretary shall enforce this 
        section.
            ``(2) Failure to provide timely information.--A health 
        insurance issuer or an entity providing pharmacy benefits 
        management services on behalf of such plan or coverage that 
        violates sub-section (a) or fails to provide the information 
        required under subsection (b) shall be subject to a civil 
        monetary penalty in the amount of $10,000 for each day during 
        which such violation continues or such information is not 
        disclosed or reported.
            ``(3) False information.--A health insurance issuer or an 
        entity providing pharmacy benefits management services on 
        behalf of such a plan or coverage that knowingly provides false 
        information under this section shall be subject to a civil 
        money penalty in an amount not to exceed $100,000 for each item 
        of false information. Such civil money penalty shall be in 
        addition to other penalties as may be prescribed by law.
            ``(4) Procedure.--The provisions of section 1128A of the 
        Social Security Act, other than subsections (a) and (b) and the 
        first sentence of subsection (c)(1) of such section shall apply 
        to civil monetary penalties under this subsection in the same 
        manner as such provisions apply to a penalty or proceeding 
        under such section.
            ``(5) Waivers.--The Secretary may waive penalties under 
        paragraph (2), or extend the period of time for compliance with 
        a requirement of this section, for an entity in violation of 
        this section that has made a good-faith effort to comply with 
        the requirements in this section.
    ``(d) Rule of Construction.--Nothing in this section shall be 
construed to permit a group health plan, health insurance issuer, or 
entity providing pharmacy benefits management services on behalf of 
such plan or coverage, to restrict disclosure to, or otherwise limit 
the access of, the Department of Health and Human Services to a report 
described in subsection (b)(1) or information related to compliance 
with subsection (a) or (b) by entities subject to such subsection.
    ``(e) Definition.--In this section, the term `wholesale acquisition 
cost' has the meaning given such term in section 1847A(c)(6)(B) of the 
Social Security Act.''; and
            (2) in section 2723 (42 U.S.C. 300gg-22)--
                    (A) in subsection (a)--
                            (i) in paragraph (1), by inserting ``(other 
                        than subsections (a) and (b) of section 2799A-
                        11)'' after ``part D''; and
                            (ii) in paragraph (2), by inserting 
                        ``(other than subsections (a) and (b) of 
                        section 2799A-11)'' after ``part D''; and
                    (B) in subsection (b)--
                            (i) in paragraph (1), by inserting ``(other 
                        than subsections (a) and (b) of section 2799A-
                        11)'' after ``part D'';
                            (ii) in paragraph (2)(A), by inserting 
                        ``(other than subsections (a) and (b) of 
                        section 2799A-11)'' after ``part D''; and
                            (iii) in paragraph (2)(C)(ii), by inserting 
                        ``(other than subsections (a) and (b) of 
                        section 2799A-11)'' after ``part D''.
    (b) ERISA.--
            (1) In general.--Subtitle B of title I of the Employee 
        Retirement Income Security Act of 1974 (29 U.S.C. 1021 et seq.) 
        is amended--
                    (A) in subpart B of part 7 (29 U.S.C. 1185 et 
                seq.), by adding at the end the following:

``SEC. 726. OVERSIGHT OF PHARMACY BENEFIT MANAGER SERVICES.

    ``(a) In General.--For plan years beginning on or after the date 
that is 2 years after the date of enactment of this section, a group 
health plan or a health insurance issuer offering group health 
insurance coverage, or an entity or subsidiary providing pharmacy 
benefits management services on behalf of such a plan or issuer, shall 
not enter into a contract with a drug manufacturer, distributor, 
wholesaler, subcontractor, rebate aggregator, or any other third party 
that limits (or delays beyond the applicable reporting period described 
in subsection (b)(1)) the disclosure of information to plan sponsors in 
such a manner that prevents such plan, issuer, or entity from making 
the reports described in subsection (b).
    ``(b) Reports.--
            ``(1) In general.--With respect to plan years beginning on 
        or after the date that is 2 years after the date of enactment 
        of this section, not less frequently than every 6 months (or at 
        the request of a plan sponsor, not less frequently than 
        quarterly, but under the same conditions, terms, and cost of 
        the semiannual report under this subsection), a group health 
        plan or health insurance issuer offering group health insurance 
        coverage, or an entity providing pharmacy benefits management 
        services on behalf of such a plan or issuer, shall submit to 
        the plan sponsor (as defined in section 3(16)(B)) of such plan 
        or coverage a report in accordance with this section. Each such 
        report shall be made available to such plan sponsor in a 
        machine-readable format and shall include the information 
        described in paragraph (2).
            ``(2) Information described.--For purposes of paragraph 
        (1), the information described in this paragraph is, with 
        respect to drugs covered by a group health plan or health 
        insurance issuer offering group health insurance coverage 
        during each reporting period--
                    ``(A) a list of drugs for which a claim was filed 
                and, with respect to each such drug on such list--
                            ``(i) the brand name, chemical entity, and 
                        National Drug Code;
                            ``(ii) the type of dispensing channel used 
                        to furnish such drug, including retail, mail 
                        order, or specialty pharmacy;
                            ``(iii) with respect to each drug dispensed 
                        under each type of dispensing channel 
                        (including retail, mail order, or specialty 
                        pharmacy)--
                                    ``(I) whether such drug is a brand 
                                name drug or a generic drug, and--
                                            ``(aa) in the case of a 
                                        brand name drug, the wholesale 
                                        acquisition cost, listed as 
                                        cost per days supply and cost 
                                        per dosage unit, on the date 
                                        such drug was dispensed; and
                                            ``(bb) in the case of a 
                                        generic drug, the average 
                                        wholesale price, listed as cost 
                                        per days supply and cost per 
                                        dosage unit, on the date such 
                                        drug was dispensed; and
                                    ``(II) the total number of--
                                            ``(aa) prescription claims 
                                        (including original 
                                        prescriptions and refills);
                                            ``(bb) participants, 
                                        beneficiaries, and enrollees 
                                        for whom a claim for such drug 
                                        was filed;
                                            ``(cc) dosage units per 
                                        fill of such drug; and
                                            ``(dd) days supply of such 
                                        drug per fill;
                            ``(iv) the net price per course of 
                        treatment or single fill, such as a 30-day 
                        supply or 90-day supply to the plan or coverage 
                        after manufacturer rebates, fees, and other 
                        remuneration or adjustments;
                            ``(v) the total amount of out-of-pocket 
                        spending by participants, beneficiaries, and 
                        enrollees on such drug, including spending 
                        through copayments, coinsurance, and 
                        deductibles;
                            ``(vi) the total net spending by the plan 
                        or coverage;
                            ``(vii) total amount received, or expected 
                        to be received, by the plan or coverage from 
                        any entity in drug manufacturer rebates, fees, 
                        alternative discounts, and all other 
                        remuneration received from an entity or any 
                        third party (including group purchasing 
                        organizations) other than the plan sponsor;
                            ``(viii) the total amount received, or 
                        expected to be received by the plan or issuer, 
                        from drug manufacturers in rebates, fees, 
                        alternative discounts, or other remuneration--
                                    ``(I) that has been paid, or is to 
                                be paid, by drug manufacturers for 
                                claims incurred during the reporting 
                                period; and
                                    ``(II) that is related to 
                                utilization rebates for such drug; and
                            ``(ix) to the extent feasible, information 
                        on the total amount of remuneration, including 
                        copayment assistance dollars paid, copayment 
                        cards applied, or other discounts provided by 
                        each drug manufacturer (or entity administering 
                        copay assistance on behalf of such drug 
                        manufacturer) to the participants, 
                        beneficiaries, and enrollees enrolled in such 
                        plan or coverage;
                    ``(B) for each category or class of drugs for which 
                a claim was filed, a breakdown of the total gross 
                spending on drugs in such category or class before 
                rebates, price concessions, alternative discounts, or 
                other remuneration from drug manufacturers, and the net 
                spending after such rebates, price concessions, 
                alternative discounts, or other remuneration from drug 
                manufacturers, including--
                            ``(i) the number of participants, 
                        beneficiaries, and enrollees who filled a 
                        prescription for a drug in such category or 
                        class, including the National Drug Code for 
                        each such drug;
                            ``(ii) if applicable, a description of the 
                        formulary tiers and utilization mechanisms 
                        (such as prior authorization or step therapy) 
                        employed for drugs in that category or class; 
                        and
                            ``(iii) the total out-of-pocket spending 
                        under the plan or coverage by participants, 
                        beneficiaries, and enrollees, including 
                        spending through copayments, coinsurance, and 
                        deductibles;
                    ``(C) in the case of a drug for which gross 
                spending by such plan, coverage, or entity exceeded 
                $10,000 during the reporting period--
                            ``(i) a list of all other drugs in the same 
                        therapeutic category or class; and
                            ``(ii) the rationale for the formulary 
                        placement of such drug in that therapeutic 
                        category or class, if applicable;
                    ``(D) amounts paid directly or indirectly in 
                rebates, fees, or any other type of compensation (as 
                defined in section 408(b)(2)(B)(ii)(dd)(AA)) to 
                brokers, consultants, advisors, or any other individual 
                or firm, for the referral of the group health plan's or 
                health insurance issuer's business to an entity 
                providing pharmacy benefits management services, 
                including the identity of the recipient of such 
                amounts;
                    ``(E) an explanation of any benefit design 
                parameters that encourage or require participants, 
                beneficiaries, and enrollees in such plan or coverage 
                to fill prescriptions at mail order, specialty, or 
                retail pharmacies that are affiliated with or under 
                common ownership with the entity providing pharmacy 
                benefit management services under such plan or 
                coverage, including mandatory mail and specialty home 
                delivery programs, retail and mail auto-refill 
                programs, and cost-sharing assistance incentives 
                directly or indirectly funded by such entity; and
                    ``(F) in the case of a plan or coverage (or an 
                entity providing pharmacy benefits management services 
                on behalf of such plan or coverage) that has an 
                affiliated pharmacy or pharmacy under common 
                ownership--
                            ``(i) the percentage of total prescriptions 
                        dispensed by such pharmacies to individuals 
                        enrolled in such plan or coverage;
                            ``(ii) a list of all drugs dispensed by 
                        such pharmacies to individuals enrolled in such 
                        plan or coverage, and, with respect to each 
                        drug dispensed--
                                    ``(I) the amount charged, per 
                                dosage unit, per 30-day supply, or per 
                                90-day supply (as applicable) to the 
                                plan or issuer, and to participants, 
                                beneficiaries, and enrollees enrolled 
                                in such plan or coverage;
                                    ``(II) the median amount charged to 
                                such plan or issuer, and the 
                                interquartile range of the costs, per 
                                dosage unit, per 30-day supply, and per 
                                90-day supply, including amounts paid 
                                by the participants, beneficiaries, and 
                                enrollees, when the same drug is 
                                dispensed by other pharmacies that are 
                                not affiliated with or under common 
                                ownership with the entity and that are 
                                included in the pharmacy network of 
                                such plan or coverage;
                                    ``(III) the lowest cost per dosage 
                                unit, per 30-day supply and per 90-day 
                                supply, for each such drug, including 
                                amounts charged to the plan and 
                                participants, beneficiaries, and 
                                enrollees, that is available from any 
                                pharmacy included in the network of 
                                such plan or coverage; and
                                    ``(IV) the net acquisition cost per 
                                dosage unit, per 30-day supply, and per 
                                90-day supply, if such drug is subject 
                                to a maximum price discount.
            ``(3) Privacy requirements.--Health insurance issuers 
        offering group health insurance coverage and entities providing 
        pharmacy benefits management services on behalf of a group 
        health plan shall provide information under paragraph (1) in a 
        manner consistent with the privacy, security, and breach 
        notification regulations promulgated under section 13402(a) of 
        the Health Information Technology for Clinical Health Act, and 
        shall restrict the use and disclosure of such information 
        according to such privacy regulations.
            ``(4) Disclosure and redisclosure.--
                    ``(A) Limitation to business associates.--A plan 
                sponsor receiving a report under paragraph (1) may 
                disclose such information only to the entity from which 
                the report was received, the group health plan for 
                which the report pertains, or to that entity's business 
                associates as defined in section 160.103 of title 45, 
                Code of Federal Regulations (or successor regulations) 
                or as permitted by the HIPAA Privacy Rule (45 CFR parts 
                160 and 164, subparts A and E).
                    ``(B) Clarification regarding public disclosure of 
                information.--Nothing in this section shall prevent a 
                group health plan or health insurance issuer offering 
                group health insurance coverage, or an entity providing 
                pharmacy benefits management services on behalf of such 
                a plan or coverage, from placing reasonable 
                restrictions on the public disclosure of the 
                information contained in a report described in 
                paragraph (1), except that such plan, issuer, or entity 
                may not restrict disclosure of such report to the 
                Department of Health and Human Services, the Department 
                of Labor, the Department of the Treasury, or the 
                Comptroller General of the United States.
                    ``(C) Limited form of report.--The Secretary shall 
                define through rulemaking a limited form of the report 
                under paragraph (1) required of plan sponsors who are 
                drug manufacturers, drug wholesalers, or other direct 
                participants in the drug supply chain, in order to 
                prevent anti-competitive behavior.
            ``(5) Report to gao.--A group health plan or health 
        insurance issuer offering group health insurance coverage, or 
        an entity providing pharmacy benefits management services on 
        behalf of such plan or coverage, shall submit to the 
        Comptroller General of the United States each of the first 4 
        reports submitted to a plan sponsor under paragraph (1) and 
        other such reports as requested, in accordance with the privacy 
        requirements under paragraph (3), the disclosure and 
        redisclosure standards under paragraph (4), the standards 
        specified pursuant to paragraph (6), and such other information 
        that the Comptroller General determines necessary to carry out 
        the study under section 106(d) of the Lower Costs, More 
        Transparency Act.
            ``(6) Standard format.--Not later than 1 year after the 
        date of enactment of this section, the Secretary shall specify 
        through rulemaking standards for group health plans, health 
        insurance issuers offering group health insurance coverage, and 
        entities providing pharmacy benefits management services on 
        behalf of such plans or coverage, required to submit reports 
        under paragraph (1) to submit such reports in a standard 
        format.
    ``(c) Rule of Construction.--Nothing in this section shall be 
construed to permit a group health plan, health insurance issuer, or 
entity providing pharmacy benefits management services on behalf of 
such plan or coverage, to restrict disclosure to, or otherwise limit 
the access of, the Secretary of Labor to a report described in 
subsection (b)(1) or information related to compliance with subsection 
(a) or (b) by entities subject to such subsection.
    ``(d) Definition.--In this section, the term `wholesale acquisition 
cost' has the meaning given such term in section 1847A(c)(6)(B) of the 
Social Security Act.''.
                    (B) in section 502 (29 U.S.C. 1132)--
                            (i) in subsection (b)(3), by striking 
                        ``under subsection (c)(9))'' and inserting 
                        ``under paragraphs (9) and (13) of subsection 
                        (c))''; and
                            (ii) in subsection (c), by adding at the 
                        end the following new paragraph:
            ``(13) Secretarial enforcement authority relating to 
        oversight of pharmacy benefits manager services.--
                    ``(A) Failure to provide timely information.--The 
                Secretary may impose a penalty against any health 
                insurance issuer or entity providing pharmacy benefits 
                management services that violates section 726(a) or 
                fails to provide information required under section 
                726(b) in the amount of $10,000 for each day during 
                which such violation continues or such information is 
                not disclosed or reported.
                    ``(B) False information.--The Secretary may impose 
                a penalty against a health insurance issuer or entity 
                providing pharmacy benefits management services that 
                knowingly provides false information under section 726 
                in an amount not to exceed $100,000 for each item of 
                false information. Such penalty shall be in addition to 
                other penalties as may be prescribed by law.
                    ``(C) Waivers.--The Secretary may waive penalties 
                under subparagraph (A), or extend the period of time 
                for compliance with a requirement of section 726, for 
                an entity in violation of such section that has made a 
                good-faith effort to comply with such section.''.
            (2) Clerical amendment.--The table of contents in section 1 
        of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1001 et seq.) is amended by inserting after the item 
        relating to section 725 the following new item:

``Sec. 726. Oversight of pharmacy benefits manager services.''.
    (c) IRC.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following:

``SEC. 9826. OVERSIGHT OF PHARMACY BENEFIT MANAGER SERVICES.

    ``(a) In General.--For plan years beginning on or after the date 
that is 2 years after the date of enactment of this section, a group 
health plan, or an entity or subsidiary providing pharmacy benefits 
management services on behalf of such a plan, shall not enter into a 
contract with a drug manufacturer, distributor, wholesaler, 
subcontractor, rebate aggregator, or any other third party that limits 
(or delays beyond the applicable reporting period described in 
subsection (b)(1)) the disclosure of information to plan sponsors in 
such a manner that prevents such plan or entity from making the reports 
described in subsection (b).
    ``(b) Reports.--
            ``(1) In general.--With respect to plan years beginning on 
        or after the date that is 2 years after the date of enactment 
        of this section, not less frequently than every 6 months (or at 
        the request of a plan sponsor, not less frequently than 
        quarterly, but under the same conditions, terms, and cost of 
        the semiannual report under this subsection), a group health 
        plan, or an entity providing pharmacy benefits management 
        services on behalf of such a plan, shall submit to the plan 
        sponsor (as defined in section 3(16)(B) of the Employee 
        Retirement Income Security Act of 1974) of such plan a report 
        in accordance with this section. Each such report shall be made 
        available to such plan sponsor in a machine-readable format and 
        shall include the information described in paragraph (2).
            ``(2) Information described.--For purposes of paragraph 
        (1), the information described in this paragraph is, with 
        respect to drugs covered by a group health plan during each 
        reporting period--
                    ``(A) a list of drugs for which a claim was filed 
                and, with respect to each such drug on such list--
                            ``(i) the brand name, chemical entity, and 
                        National Drug Code;
                            ``(ii) the type of dispensing channel used 
                        to furnish such drug, including retail, mail 
                        order, or specialty pharmacy;
                            ``(iii) with respect to each drug dispensed 
                        under each type of dispensing channel 
                        (including retail, mail order, or specialty 
                        pharmacy)--
                                    ``(I) whether such drug is a brand 
                                name drug or a generic drug, and--
                                            ``(aa) in the case of a 
                                        brand name drug, the wholesale 
                                        acquisition cost, listed as 
                                        cost per days supply and cost 
                                        per dosage unit, on the date 
                                        such drug was dispensed; and
                                            ``(bb) in the case of a 
                                        generic drug, the average 
                                        wholesale price, listed as cost 
                                        per days supply and cost per 
                                        dosage unit, on the date such 
                                        drug was dispensed; and
                                    ``(II) the total number of--
                                            ``(aa) prescription claims 
                                        (including original 
                                        prescriptions and refills);
                                            ``(bb) participants and 
                                        beneficiaries for whom a claim 
                                        for such drug was filed;
                                            ``(cc) dosage units per 
                                        fill of such drug; and
                                            ``(dd) days supply of such 
                                        drug per fill;
                            ``(iv) the net price per course of 
                        treatment or single fill, such as a 30-day 
                        supply or 90-day supply to the plan after 
                        manufacturer rebates, fees, and other 
                        remuneration or adjustments;
                            ``(v) the total amount of out-of-pocket 
                        spending by participants and beneficiaries on 
                        such drug, including spending through 
                        copayments, coinsurance, and deductibles;
                            ``(vi) the total net spending by the plan;
                            ``(vii) total amount received, or expected 
                        to be received, by the plan from any entity in 
                        drug manufacturer rebates, fees, alternative 
                        discounts, and all other remuneration received 
                        from an entity or any third party (including 
                        group purchasing organizations) other than the 
                        plan sponsor;
                            ``(viii) the total amount received, or 
                        expected to be received, by the plan from drug 
                        manufacturers in rebates, fees, alternative 
                        discounts, or other remuneration--
                                    ``(I) that has been paid, or is to 
                                be paid, by drug manufacturers for 
                                claims incurred during the reporting 
                                period; and
                                    ``(II) that is related to 
                                utilization rebates for such drug; and
                            ``(ix) to the extent feasible, information 
                        on the total amount of remuneration, including 
                        copayment assistance dollars paid, copayment 
                        cards applied, or other discounts provided by 
                        each drug manufacturer (or entity administering 
                        copay assistance on behalf of such drug 
                        manufacturer) to the participants and 
                        beneficiaries enrolled in such plan;
                    ``(B) for each category or class of drugs for which 
                a claim was filed, a breakdown of the total gross 
                spending on drugs in such category or class before 
                rebates, price concessions, alternative discounts, or 
                other remuneration from drug manufacturers, and the net 
                spending after such rebates, price concessions, 
                alternative discounts, or other remuneration from drug 
                manufacturers, including--
                            ``(i) the number of participants and 
                        beneficiaries who filled a prescription for a 
                        drug in such category or class, including the 
                        National Drug Code for each such drug;
                            ``(ii) if applicable, a description of the 
                        formulary tiers and utilization mechanisms 
                        (such as prior authorization or step therapy) 
                        employed for drugs in that category or class; 
                        and
                            ``(iii) the total out-of-pocket spending 
                        under the plan by participants and 
                        beneficiaries, including spending through 
                        copayments, coinsurance, and deductibles;
                    ``(C) in the case of a drug for which gross 
                spending by such plan or entity exceeded $10,000 during 
                the reporting period--
                            ``(i) a list of all other drugs in the same 
                        therapeutic category or class; and
                            ``(ii) the rationale for the formulary 
                        placement of such drug in that therapeutic 
                        category or class, if applicable;
                    ``(D) amounts paid directly or indirectly in 
                rebates, fees, or any other type of compensation (as 
                defined in section 408(b)(2)(B)(ii)(dd)(AA) of the 
                Employee Retirement Income Security Act) to brokers, 
                consultants, advisors, or any other individual or firm, 
                for the referral of the group health plan's business to 
                an entity providing pharmacy benefits management 
                services, including the identity of the recipient of 
                such amounts;
                    ``(E) an explanation of any benefit design 
                parameters that encourage or require participants, 
                beneficiaries, and enrollees in such plan to fill 
                prescriptions at mail order, specialty, or retail 
                pharmacies that are affiliated with or under common 
                ownership with the entity providing pharmacy benefit 
                management services under such plan, including 
                mandatory mail and specialty home delivery programs, 
                retail and mail auto-refill programs, and cost-sharing 
                assistance incentives directly or indirectly funded by 
                such entity; and
                    ``(F) in the case of a plan (or an entity providing 
                pharmacy benefits management services on behalf of such 
                plan) that has an affiliated pharmacy or pharmacy under 
                common ownership--
                            ``(i) the percentage of total prescriptions 
                        dispensed by such pharmacies to individuals 
                        enrolled in such plan;
                            ``(ii) a list of all drugs dispensed by 
                        such pharmacies to individuals enrolled in such 
                        plan and, with respect to each drug dispensed--
                                    ``(I) the amount charged, per 
                                dosage unit, per 30-day supply, or per 
                                90-day supply (as applicable) to the 
                                plan and to participants and 
                                beneficiaries enrolled in such plan;
                                    ``(II) the median amount charged to 
                                such plan, and the interquartile range 
                                of the costs, per dosage unit, per 30-
                                day supply, and per 90-day supply, 
                                including amounts paid by the 
                                participants and beneficiaries, when 
                                the same drug is dispensed by other 
                                pharmacies that are not affiliated with 
                                or under common ownership with the 
                                entity and that are included in the 
                                pharmacy network of such plan;
                                    ``(III) the lowest cost per dosage 
                                unit, per 30-day supply and per 90-day 
                                supply, for each such drug, including 
                                amounts charged to the plan and to 
                                participants and beneficiaries, that is 
                                available from any pharmacy included in 
                                the network of such plan; and
                                    ``(IV) the net acquisition cost per 
                                dosage unit, per 30-day supply, and per 
                                90-day supply, if such drug is subject 
                                to a maximum price discount.
            ``(3) Privacy requirements.--Health insurance issuers 
        offering group health insurance coverage and entities providing 
        pharmacy benefits management services on behalf of a group 
        health plan shall provide information under paragraph (1) in a 
        manner consistent with the privacy, security, and breach 
        notification regulations promulgated under section 13402(a) of 
        the Health Information Technology for Clinical Health Act, and 
        shall restrict the use and disclosure of such information 
        according to such privacy regulations.
            ``(4) Disclosure and redisclosure.--
                    ``(A) Limitation to business associates.--A plan 
                sponsor receiving a report under paragraph (1) may 
                disclose such information only to the entity from which 
                the report was received, the group health plan for 
                which the report pertains, or to that entity's business 
                associates as defined in section 160.103 of title 45, 
                Code of Federal Regulations (or successor regulations) 
                or as permitted by the HIPAA Privacy Rule (45 CFR parts 
                160 and 164, subparts A and E).
                    ``(B) Clarification regarding public disclosure of 
                information.--Nothing in this section shall prevent a 
                group health plan or health insurance issuer offering 
                group health insurance coverage, or an entity providing 
                pharmacy benefits management services on behalf of such 
                a plan or coverage, from placing reasonable 
                restrictions on the public disclosure of the 
                information contained in a report described in 
                paragraph (1), except that such plan, issuer, or entity 
                may not restrict disclosure of such report to the 
                Department of Health and Human Services, the Department 
                of Labor, the Department of the Treasury, or the 
                Comptroller General of the United States.
                    ``(C) Limited form of report.--The Secretary shall 
                define through rulemaking a limited form of the report 
                under paragraph (1) required of plan sponsors who are 
                drug manufacturers, drug wholesalers, or other direct 
                participants in the drug supply chain, in order to 
                prevent anti-competitive behavior.
            ``(5) Report to gao.--A group health plan, or an entity 
        providing pharmacy benefits management services on behalf of 
        such plan, shall submit to the Comptroller General of the 
        United States each of the first 4 reports submitted to a plan 
        sponsor under paragraph (1) and other such reports as 
        requested, in accordance with the privacy requirements under 
        paragraph (3), the disclosure and redisclosure standards under 
        paragraph (4), the standards specified pursuant to paragraph 
        (6), and such other information that the Comptroller General 
        determines necessary to carry out the study under section 
        106(d) of the Lower Costs, More Transparency Act.
            ``(6) Standard format.--Not later than 1 year after the 
        date of enactment of this section, the Secretary shall specify 
        through rulemaking standards for group health plans, and 
        entities providing pharmacy benefits management services on 
        behalf of such plans, required to submit reports under 
        paragraph (1) to submit such reports in a standard format.
    ``(c) Rule of Construction.--Nothing in this section shall be 
construed to permit a group health plan or entity providing pharmacy 
benefits management services on behalf of such plan, to restrict 
disclosure to, or otherwise limit the access of, the Secretary of 
Health and Human Services to a report described in subsection (b)(1) or 
information related to compliance with subsections (a) or (b) by 
entities subject to such subsection.
    ``(d) Definition.--In this section, the term `wholesale acquisition 
cost' has the meaning given such term in section 1847A(c)(6)(B) of the 
Social Security Act.''.
            (2) Clerical amendment.--The table of sections for 
        subchapter B of chapter 100 of the Internal Revenue Code of 
        1986 is amended by adding at the end the following new item:

``Sec. 9826. Oversight of pharmacy benefits manager services.''.
    (d) GAO Reports.--
            (1) Report on pharmacy network design.--
                    (A) In general.--Not later than 3 years after the 
                date of enactment of this Act, the Comptroller General 
                of the United States shall submit to Congress a report 
                on--
                            (i) pharmacy networks that have contracted 
                        with group health plans, health insurance 
                        issuers offering group health insurance 
                        coverage, or entities providing pharmacy 
                        benefits management services on behalf of such 
                        plans or issuers, including networks with 
                        pharmacies that are under common ownership (in 
                        whole or part) with such plans, issuers, or 
                        entities (including entities that provide 
                        pharmacy benefits administrative services on 
                        behalf of such plans or issuers);
                            (ii) pharmacy network design parameters 
                        that encourage individuals enrolled in such 
                        plans or coverage to fill prescriptions at mail 
                        order, specialty, or retail pharmacies that are 
                        wholly or partially owned by a plan, issuer, or 
                        entity;
                            (iii) whether such plans and issuers have 
                        options to elect different network pricing 
                        arrangements in the marketplace with entities 
                        that provide pharmacy benefits management 
                        services and the prevalence of electing such 
                        different network pricing arrangements;
                            (iv) with respect to pharmacy networks that 
                        include pharmacies under common ownership 
                        described in clause (i)--
                                    (I) whether such networks are 
                                designed to encourage individuals 
                                enrolled in a group health plan or 
                                health insurance coverage to use such 
                                pharmacies over other network 
                                pharmacies for specific services or 
                                drugs, and if so, the reasons the 
                                networks give for encouraging use of 
                                such pharmacies; and
                                    (II) whether such pharmacies are 
                                used by enrollees disproportionately 
                                more in the aggregate or for specific 
                                services or drugs compared to other 
                                network pharmacies;
                            (v) the degree to which mail order, 
                        specialty, or retail pharmacies that dispense 
                        prescription drugs to an enrollee in a plan or 
                        coverage that are under common ownership (in 
                        whole or part) with plans, issuers, or entities 
                        providing pharmacy benefits management services 
                        or pharmacy benefits administrative services on 
                        behalf of such plan or coverage receive 
                        reimbursement that is greater than the median 
                        price charged to the plan or issuer when the 
                        same drug is dispensed to enrollees in the plan 
                        or coverage by other pharmacies included in the 
                        pharmacy network of that plan, issuer, or 
                        entity that are not wholly or partially owned 
                        by the plan or issuer, or entity providing 
                        pharmacy benefits management services on behalf 
                        of such plan or issuer.
                    (B) Requirement.--The Comptroller General of the 
                United States shall ensure that the report under 
                subparagraph (A) does not contain information that 
                would identify a specific group health plan or health 
                insurance issuer (or an entity providing pharmacy 
                benefits management services on behalf of such plan or 
                issuer), or otherwise contain commercial or financial 
                information that is privileged or confidential.
                    (C) Definitions.--In this paragraph, the terms 
                ``group health plan'', ``health insurance coverage'', 
                and ``health insurance issuer'' have the meanings given 
                such terms in section 2791 of the Public Health Service 
                Act (42 U.S.C. 300gg-91).
            (2) Report on copay assistance programs.--Not later than 18 
        months after the date of the enactment of this Act, the 
        Comptroller General of the United States shall submit to 
        Congress a report on what is known about the role of copay 
        assistance programs and the impact of such programs on 
        commercial health insurance, stop loss, and drug prices. Such 
        report shall include to the extent feasible--
                    (A) a description of copay assistance programs, 
                including--
                            (i) the types of programs available and the 
                        methods of providing copay assistance through 
                        such programs, including cash discounts, copay 
                        cards, or drugs provided to an individual at no 
                        cost;
                            (ii) how such programs are funded;
                            (iii) the types of entities that own, 
                        operate, or otherwise conduct such programs, 
                        the types of information such entities collect, 
                        and the direct and indirect contractual 
                        relationships between the entities in the drug 
                        supply chain that interact with such programs, 
                        such as a drug manufacturer, pharmacy, 
                        wholesaler, switch, rebate aggregator, pharmacy 
                        benefit manager, and other entities in the drug 
                        supply chain;
                            (iv) the effect of such programs on patient 
                        out-of-pocket spending, including for stop-loss 
                        insurance, and drug utilization, including drug 
                        adherence; and
                            (v) patient eligibility criteria for such 
                        programs; and
                    (B) an analysis of--
                            (i) the sources of funding for such 
                        programs; and
                            (ii) the effects of such programs on 
                        Federal health care programs and the 
                        individuals enrolled in such Federal health 
                        care programs.

SEC. 107. REPORTS ON HEALTH CARE TRANSPARENCY TOOLS AND DATA.

    (a) Initial Report.--Not later than December 31, 2024, the 
Comptroller General of the United States shall submit to the Committees 
(as defined in subsection (d)) an initial report that--
            (1) identifies and describes health care transparency tools 
        and Federal health care reporting requirements (as described in 
        subsection (d)) that are in effect as of the date of the 
        submission of such initial report, including the frequency of 
        reports with respect to each such requirement and whether any 
        such requirements are duplicative;
            (2) reviews how such reporting requirements are enforced;
            (3) analyzes whether the public availability of health care 
        transparency tools, and the publication of data pursuant to 
        such reporting requirements, has--
                    (A) been utilized and valued by consumers, 
                including reasons for such utilization (or lack 
                thereof); and
                    (B) assisted health insurance plan sponsors and 
                fiduciaries improve benefits, lower health care costs 
                for plan participants, and meet fiduciary requirements;
            (4) includes recommendations to the Committees, the 
        Secretary of Health and Human Services, the Secretary of Labor, 
        and the Secretary of the Treasury to--
                    (A) improve the efficiency, accuracy, and usability 
                of health care transparency tools;
                    (B) streamline Federal health care reporting 
                requirements to eliminate duplicative requirements and 
                reduce the burden on entities required to submit 
                reports pursuant to such provisions;
                    (C) improve the accuracy and efficiency of such 
                reports while maintaining the integrity and usability 
                of the data provided by such reports;
                    (D) address any gaps in data provided by such 
                reports; and
                    (E) ensure that the data and information reported 
                is comparable and usable to consumers, including 
                patients, plan sponsors, and policy makers.
    (b) Final Report.--Not later than December 31, 2028, the 
Comptroller General of the United States shall submit to the Committees 
a report that includes--
            (1) the information provided in the initial report, along 
        with any updates to such information; and
            (2) any new information with respect to health care 
        transparency tools that have been released following the 
        submission of such initial report, or new reporting 
        requirements in effect as of the date of the submission of the 
        final report.
    (c) Report on Expanding Price Transparency Requirements.--Not later 
than December 31, 2025, the Comptroller General of the United States, 
in consultation with the Secretary of Health and Human Services, health 
care provider groups, and patient advocacy groups, shall submit to the 
Committees a report that includes recommendations to expand price 
transparency reporting requirements to additional care settings, with 
an emphasis on settings where shoppable services (as defined in 
subsection (d)) are furnished.
    (d) Definitions.--In this section:
            (1) Committees.--The term ``Committees'' means the 
        Committee on Ways and Means, the Committee on Energy and 
        Commerce, and the Committee on Education and the Workforce of 
        the House of Representatives, and the Committee on Finance and 
        the Committee on Health, Education, Labor, and Pensions of the 
        Senate.
            (2) Federal health care reporting requirements.--The term 
        ``Federal health care reporting requirements'' includes 
        regulatory and statutory requirements with respect to the 
        reporting and publication of health care price, cost access, 
        and quality data, including requirements established by the 
        Consolidated Appropriations Act of 2021 (Public Law 116-260), 
        this Act, and other reporting and publication requirements with 
        respect to transparency in health care as identified by the 
        Comptroller General of the United States.
            (3) Shoppable service.--The term ``shoppable service'' 
        means a service that can be scheduled by a health care consumer 
        in advance and includes all ancillary items and services 
        customarily furnished as part of such service.

SEC. 108. REPORT ON INTEGRATION IN MEDICARE.

    (a) Required MA and PDP Reporting.--
            (1) MA plans.--Section 1857(e) of the Social Security Act 
        (42 U.S.C. 1395w-27(e)) is amended by adding at the end the 
        following new paragraph:
            ``(6) Required disclosure of certain information relating 
        to health care provider ownership.--
                    ``(A) In general.--For plan year 2025 and for every 
                third plan year thereafter, each applicable MA 
                organization offering an MA plan under this part during 
                such plan year shall submit to the Secretary, at a time 
                and in a manner specified by the Secretary--
                            ``(i) the taxpayer identification number 
                        for each health care provider that was a 
                        specified health care provider with respect to 
                        such organization during such year;
                            ``(ii) the total amount of incentive-based 
                        payments made to, and the total amount of 
                        shared losses recoupments collected from, such 
                        specified health care providers during such 
                        plan year; and
                            ``(iii) the total amount of incentive-based 
                        payments made to, and the total amount of 
                        shared losses recoupments collected from, 
                        providers of services and suppliers not 
                        described in clause (ii) during such plan year.
                    ``(B) Definitions.--For purposes of this paragraph:
                            ``(i) Applicable ma organization.--The term 
                        `applicable MA organization' means, with 
                        respect to a plan year, an MA organization with 
                        at least 25,000 individuals enrolled under 
                        Medicare Advantage plans offered by such 
                        organization during such plan year.
                            ``(ii) Specified health care provider.--The 
                        term `specified health care provider' means, 
                        with respect to an applicable MA organization 
                        and a plan year, a provider of services or 
                        supplier with respect to which such 
                        organization (or any person with an ownership 
                        or control interest (as defined in section 
                        1124(a)(3)) in such organization) is a person 
                        with an ownership or control interest (as so 
                        defined).''.
            (2) Prescription drug plans.--Section 1860D-12(b) of the 
        Social Security Act (42 U.S.C. 1395w-112(b)) is amended by 
        adding at the end the following new paragraph:
            ``(9) Provision of information relating to pharmacy 
        ownership.--
                    ``(A) In general.--For plan year 2025 and for every 
                third plan year thereafter, each PDP sponsor offering a 
                prescription drug plan under this part during such plan 
                year shall submit to the Secretary, at a time and in a 
                manner specified by the Secretary, the taxpayer 
                identification number and National Provider Identifier 
                for each pharmacy that was a specified pharmacy with 
                respect to such sponsor during such year.
                    ``(B) Definition.--For purposes of this paragraph, 
                the term `specified pharmacy' means, with respect to an 
                PDP sponsor offering a prescription drug plan and a 
                plan year, a pharmacy with respect to which--
                            ``(i) such sponsor (or any person with an 
                        ownership or control interest (as defined in 
                        section 1124(a)(3)) in such sponsor) is a 
                        person with an ownership or control interest 
                        (as so defined); or
                            ``(ii) a pharmacy benefit manager offering 
                        services under such plan (or any person with an 
                        ownership or control interest (as so defined) 
                        in such sponsor) is a person with an ownership 
                        or control interest (as so defined).''.
    (b) MedPAC Reports.--Part E of title XVIII of the Social Security 
Act (42 U.S.C. 1395x et seq.), as amended by section 101, is further 
amended by adding at the end the following new section:

``SEC. 1899D. REPORTS ON VERTICAL INTEGRATION UNDER MEDICARE.

    ``(a) In General.--Not later than June 15, 2029, and every 3 years 
thereafter, the Medicare Payment Advisory Commission shall submit to 
Congress a report on the state of vertical integration in the health 
care sector during the applicable year with respect to entities 
participating in the Medicare program, including health care providers, 
pharmacies, prescription drug plan sponsors, Medicare Advantage 
organizations, and pharmacy benefit managers. Such report shall 
include--
            ``(1) with respect to Medicare Advantage organizations, the 
        evaluation described in subsection (b);
            ``(2) with respect to prescription drug plans, pharmacy 
        benefit managers, and pharmacies, the comparisons and 
        evaluations described in subsection (c);
            ``(3) with respect to Medicare Advantage plans under which 
        benefits are available for physician-administered drugs, the 
        information described in subsection (d);
            ``(4) the identifications described in subsection (e); and
            ``(5) an analysis of the impact of such integration on 
        health care access, price, quality, and outcomes.
    ``(b) Medicare Advantage Organizations.--For purposes of subsection 
(a)(1), the evaluation described in this subsection is, with respect to 
Medicare Advantage organizations and an applicable year, an evaluation, 
taking into account patient acuity and the types of areas serviced by 
such organization, of--
            ``(1) the average number of qualifying diagnoses made 
        during such year with respect to enrollees of a Medicare 
        Advantage plan offered by such organization who, during such 
        year, received a health risk assessment from a specified health 
        care provider;
            ``(2) the average risk score for such enrollees who 
        received such an assessment during such year;
            ``(3) any relationship between such risk scores for such 
        enrollees receiving such an assessment from such a provider 
        during such year and incentive payments made to such providers;
            ``(4) the average risk score for enrollees of such plan who 
        received any item or service from a specified health care 
        provider during such year;
            ``(5) any relationship between the risk scores of enrollees 
        under such plan and whether the enrollees have received any 
        item or service from a specified provider; and
            ``(6) any relationship between the risk scores of enrollees 
        under such plan that have received any item or service from a 
        specified provider and incentive payments made under the plan 
        to specified providers.
    ``(c) Prescription Drug Plans.--For purposes of subsection (a)(2), 
the comparisons and evaluations described in this subsection are, with 
respect to prescription drug plans and an applicable year, the 
following:
            ``(1) For each covered part D drug for which benefits are 
        available under such a plan, a comparison of the average 
        negotiated rate in effect with specified pharmacies with such 
        rates in effect for in-network pharmacies that are not 
        specified pharmacies.
            ``(2) Comparisons of the following:
                    ``(A) The total amount paid by pharmacy benefit 
                managers to specified pharmacies for covered part D 
                drugs and the total amount so paid to pharmacies that 
                are not specified pharmacies for such drugs.
                    ``(B) The total amount paid by such sponsors to 
                specified pharmacy benefit managers as reimbursement 
                for covered part D drugs and the total amount so paid 
                to pharmacy benefit managers that are not specified 
                pharmacy benefit managers as such reimbursement.
                    ``(C) Fees paid under by plan to specified pharmacy 
                benefit managers compared to such fees paid to pharmacy 
                benefit managers that are not specified pharmacy 
                benefit managers.
            ``(3) An evaluation of the total amount of direct and 
        indirect remuneration for covered part D drugs passed through 
        to prescription drug plan sponsors and the total amount 
        retained by pharmacy benefit managers (including entities under 
        contract with such a manager).
            ``(4) To the extent that the available data permits, an 
        evaluation of fees charged by rebate aggregators that are 
        affiliated with plan sponsors.
    ``(d) Physician-administered Drugs.--For purposes of subsection 
(a)(3), the information described in this subsection is, with respect 
to physician-administered drugs for which benefits are available under 
a Medicare Advantage plan during an applicable year, the following:
            ``(1) With respect to each such plan, an identification of 
        each drug for which benefits were available under such plan 
        only when administered by a health care provider that acquired 
        such drug from an affiliated pharmacy.
            ``(2) An evaluation of the difference between the total 
        number of drugs administered by a health care provider that 
        were acquired from affiliated pharmacies compared to the number 
        of such drugs so administered that were acquired from 
        pharmacies other than affiliated pharmacies, and an evaluation 
        of the difference in payments for such drugs so administered 
        when acquired from a specified pharmacy and when acquired from 
        a pharmacy that is not a specified pharmacy.
            ``(3) An evaluation of the dollar value of all such drugs 
        that were not so administered because of a delay attributable 
        to an affiliated pharmacy compared to the dollar value of all 
        such drugs that were not so administered because of a delay 
        attributable to pharmacy that is not an affiliated pharmacy.
            ``(4) The number of enrollees administered such a drug that 
        was acquired from an affiliated pharmacy.
            ``(5) The number of enrollees furnished such a drug that 
        was acquired from a pharmacy that is not an affiliated 
        pharmacy.
    ``(e) Identifications.--For purposes of subsection (a)(4), the 
identifications described in this subsection are, with respect to an 
applicable year, identifications of each health care entity 
participating under the Medicare program with respect to which another 
health care entity so participating is a person with an ownership or 
control interest (as defined in section 1124(a)(3)).
    ``(f) Definitions.--In this section:
            ``(1) Affiliated pharmacy.--The term `affiliated pharmacy' 
        means, with respect to a Medicare Advantage plan offered by a 
        Medicare Advantage organization, a pharmacy with respect to 
        which such organization (or any person with an ownership or 
        control interest (as defined in section 1124(a)(3)) in such 
        organization) is a person with an ownership or control interest 
        (as so defined).
            ``(2) Applicable year.--The term `applicable year' means, 
        with respect to a report submitted under subsection (a), the 
        first calendar year beginning at least 4 years prior to the 
        date of the submission of such report.
            ``(3) Covered part d drug.--The term `covered part D drug' 
        has the meaning given such term in section 1860D-2(e).
            ``(4) Direct and indirect remuneration.--The term `direct 
        and indirect remuneration' has the meaning given such term in 
        section 423.308 of title 42, Code of Federal Regulations (or 
        any successor regulation).
            ``(5) Qualifying diagnosis.--The term `qualifying 
        diagnosis' means, with respect to an enrollee of a Medicare 
        Advantage plan, a diagnosis that is taken into account in 
        calculating a risk score for such enrollee under the risk 
        adjustment methodology established by the Secretary pursuant to 
        section 1853(a)(3).
            ``(6) Risk score.--The term `risk score' means, with 
        respect to an enrollee of a Medicare Advantage plan, the score 
        calculated for such individual using the methodology described 
        in paragraph (5).
            ``(7) Physician-administered drug.--The term `physician-
        administered drug' means a drug furnished to an individual 
        that, had such individual been enrolled under part B and not 
        enrolled under part C, would have been payable under section 
        1842(o).
            ``(8) Specified health care provider.--The term `specified 
        health care provider' means, with respect to a Medicare 
        Advantage plan offered by a Medicare Advantage organization, a 
        health care provider with respect to which such organization 
        (or any person with an ownership or control interest (as 
        defined in section 1124(a)(3)) in such organization) is a 
        person with an ownership or control interest (as so defined).
            ``(9) Specified pharmacy.--The term `specified pharmacy' 
        means, with respect to a prescription drug plan offered by a 
        prescription drug plan sponsor, a pharmacy with respect to 
        which--
                    ``(A) such sponsor (or any person with an ownership 
                or control interest (as defined in section 1124(a)(3)) 
                in such sponsor) is a person with an ownership or 
                control interest (as so defined); or
                    ``(B) a pharmacy benefit manager offering services 
                under such plan (or any person with an ownership or 
                control interest (as so defined) in such sponsor) is a 
                person with an ownership or control interest (as so 
                defined).
            ``(10) Specified pharmacy benefit manager.--The term 
        `specified pharmacy benefit manager' means, with respect to a 
        prescription drug plan offered by a prescription drug plan 
        sponsor, a pharmacy benefit manager with respect to which such 
        sponsor (or any person with an ownership or control interest 
        (as defined in section 1124(a)(3)) in such sponsor) is a person 
        with an ownership or control interest (as so defined).''.

SEC. 109. ADVISORY COMMITTEE.

    (a) In General.--Not later than January 1, 2025, the Secretary of 
Labor, the Secretary of Health and Human Services, and the Secretary of 
the Treasury shall jointly convene an advisory committee (in this 
section referred to as the ``committee'') consisting of 9 members to 
advise the Secretaries on how to improve the usefulness, accessibility, 
and usability of information made available in accordance the 
amendments made by sections 105 and 106, and by section 204 of division 
BB of the Consolidated Appropriation Act, 2021 (Public Law 116-260), 
streamline the reporting of such information, and ensure that--
            (1) such information is accurate, accessible, and is 
        delivered in a form and manner consistent with the requirements 
        of such section;
            (2) the form and manner in which such information is 
        delivered is routinely updated in accordance with widely-used 
        practices in order to ensure accessibility; and
            (3) such information is available for audit (including by 
        making recommendations relating to how Federal and State actors 
        may conduct such audits).
    (b) Membership.--The Secretaries shall jointly appoint members 
representing end-users of the information described in subsection (a). 
Vacancies on the committee shall be filled by appointment consistent 
with this subsection not later than 3 months after the vacancy arises.
    (c) Termination.--The committee shall terminate on January 1, 2028.
    (d) Nonapplicaiton of FACA.--The Federal Advisory Committee Act (5 
U.S.C. App.) shall not apply to the committee.

SEC. 110. REPORT ON IMPACT OF MEDICARE REGULATIONS ON PROVIDER AND 
              PAYER CONSOLIDATION.

    (a) Annual Report on the Impact of Certain Medicare Regulations on 
Provider and Payer Consolidation; Public Comment on Provider and Payer 
Consolidation for Certain Proposed Rules.--
            (1) Annual report.--Not later than December 30, 2026, and 
        annually thereafter, the Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall submit 
        to Congress a report on the impact in the aggregate on provider 
        and payer consolidation with respect to regulations for parts 
        A, B, C, and D of title XVIII of the Social Security Act (42 
        U.S.C. 1395 et seq.) implemented in the calendar year 
        immediately prior to such report. Such report shall include 
        regulations that--
                    (A) implement a change to an applicable payment 
                system, a rate schedule, or another payment system 
                under part A, B, C, or D of such title; or
                    (B) result in a significant rule effecting provider 
                or payer consolidation.
            (2) Public comment on impact to provider and payer 
        consolidation.--Beginning for 2025, as part of any notice and 
        comment rulemaking process that will result in a significant 
        rule effecting provider or payer consolidation with respect to 
        a proposed rule for parts A, B, C, and D of title XVIII of the 
        Social Security Act (42 U.S.C. 1395j et seq.), the Secretary 
        shall seek public comment on the projected impact of such 
        proposed rule on provider and payer consolidation in the 
        aggregate.
            (3) Definitions.--In this section:
                    (A) Provider and payer consolidation.--The term 
                ``provider and payer consolidation'' includes the 
                vertical or horizontal integration among providers of 
                services (as defined in subsection (u) of section 1861 
                of the Social Security Act (42 U.S.C. 1395x)), 
                suppliers (as defined in subsection (d) of such 
                section), accountable care organizations under section 
                1899 of the Social Security Act (42 U.S.C. 1395jjj), 
                Medicare Advantage organizations, PDP sponsors, 
                pharmacy benefit managers, pharmacies, and integrated 
                delivery systems.
                    (B) Applicable payment system.--The term 
                ``applicable payment system'' includes--
                            (i) with respect to outpatient hospital 
                        services, the prospective payment system for 
                        covered OPD services established under section 
                        1833(t) of such Act (42 U.S.C. 1395(l)); and
                            (ii) with respect to physicians' services, 
                        the physician fee schedules established under 
                        section 1848 of such Act (42 U.S.C. 1395w-4).
    (b) Consideration of Effects on Provider and Payer Consolidation 
With Respect to CMI Models.--
            (1) In general.--Section 1115A(b)(4)(A) of the Social 
        Security Act (42 U.S.C. 1315a(b)(4)(A)) is amended--
                    (A) in clause (i), by striking at the end ``and'';
                    (B) in clause (ii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new clause:
                            ``(iii) the extent to which, and how, the 
                        model has effected and could effect provider 
                        and payer consolidation, which includes the 
                        vertical or horizontal integration among 
                        providers of services (as defined in subsection 
                        (u) of section 1861), suppliers (as defined in 
                        subsection (d) of such section), and 
                        accountable care organizations under section 
                        1899.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply with respect to models tested on or after January 
        1, 2025.

SEC. 111. IMPLEMENTATION FUNDING.

    (a) In General.--For the purposes described in subsection (b), 
there are appropriated, out of amounts in the Treasury not otherwise 
appropriated, to the Secretary of Health and Human Services and the 
Secretary of the Treasury, $25,000,000 for fiscal year 2024, to remain 
available through fiscal year 2029.
    (b) Permitted Purposes.--The purposes described in this subsection 
are the following purposes, insofar as such purposes are to carry out 
the provisions of, including the amendments made by, this title:
            (1) Preparing, drafting, and issuing proposed and final 
        regulations or interim regulations.
            (2) Preparing, drafting, and issuing guidance and public 
        information.
            (3) Preparing, drafting, and publishing reports.
            (4) Enforcement of such provisions.
            (5) Reporting, collection, and analysis of data.
            (6) Other administrative duties necessary for 
        implementation of such provisions.
    (c) Transparency of Implementation Funds.--Each Secretary described 
in subsection (a) shall annually submit, no later than September 1st of 
each year, to the Committees on Energy and Commerce, on Ways and Means, 
on Education and Workforce, and on Appropriations of the House of 
Representatives and on the Committees on Health, Education, Labor, and 
Pensions and on Appropriations of the Senate a report on funds expended 
pursuant to funds appropriated under this section.

           TITLE II--REDUCING HEALTH CARE COSTS FOR PATIENTS

SEC. 201. INCREASING TRANSPARENCY IN GENERIC DRUG APPLICATIONS.

    (a) In General.--Section 505(j)(3) of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 355(j)(3)) is amended by adding at the end the 
following:
    ``(H)(i) Upon request (in controlled correspondence or an analogous 
process) by a person that has submitted or intends to submit an 
abbreviated application under this subsection for a drug that is 
required by regulation to contain one or more of the same inactive 
ingredients in the same concentrations as the listed drug referred to, 
or for which the Secretary determines there is a scientific 
justification for an approach that is in vitro in whole or in part to 
be used to demonstrate bioequivalence for a drug if such a drug 
contains one or more of the same inactive ingredients in the same 
concentrations as the listed drug, the Secretary shall inform the 
person whether such drug is qualitatively and quantitatively the same 
as the listed drug. The Secretary may also provide such information to 
such a person on the Secretary's own initiative during the review of an 
abbreviated application under this subsection for such drug.
    ``(ii) Notwithstanding section 301(j), if the Secretary determines 
that such drug is not qualitatively or quantitatively the same as the 
listed drug, the Secretary shall identify and disclose to the person--
            ``(I) the ingredient or ingredients that cause such drug 
        not to be qualitatively or quantitatively the same as the 
        listed drug; and
            ``(II) for any ingredient for which there is an identified 
        quantitative deviation, the amount of such deviation.
    ``(iii) If the Secretary determines that such drug is qualitatively 
and quantitatively the same as the listed drug, the Secretary shall not 
change or rescind such determination after the submission of an 
abbreviated application for such drug under this subsection unless--
            ``(I) the formulation of the listed drug has been changed 
        and the Secretary has determined that the prior listed drug 
        formulation was withdrawn for reasons of safety or 
        effectiveness; or
            ``(II) the Secretary makes a written determination that the 
        prior determination must be changed because an error has been 
        identified.
    ``(iv) If the Secretary makes a written determination described in 
clause (iii)(II), the Secretary shall provide notice and a copy of the 
written determination to the person making the request under clause 
(i).
    ``(v) The disclosures required by this subparagraph are disclosures 
authorized by law, including for purposes of section 1905 of title 18, 
United States Code.''.
    (b) Guidance.--
            (1) In general.--Not later than one year after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall issue draft guidance, or update guidance, 
        describing how the Secretary will determine whether a drug is 
        qualitatively and quantitatively the same as the listed drug 
        (as such terms are used in section 505(j)(3)(H) of the Federal 
        Food, Drug, and Cosmetic Act, as added by subsection (a)), 
        including with respect to assessing pH adjusters.
            (2) Process.--In issuing guidance under this subsection, 
        the Secretary of Health and Human Services shall--
                    (A) publish draft guidance;
                    (B) provide a period of at least 60 days for 
                comment on the draft guidance; and
                    (C) after considering any comments received and not 
                later than one year after the close of the comment 
                period on the draft guidance, publish final guidance.
    (c) Applicability.--Section 505(j)(3)(H) of the Federal Food, Drug, 
and Cosmetic Act, as added by subsection (a), applies beginning on the 
date of enactment of this Act, irrespective of the date on which the 
guidance required by subsection (b) is finalized.

SEC. 202. IMPROVING TRANSPARENCY AND PREVENTING THE USE OF ABUSIVE 
              SPREAD PRICING AND RELATED PRACTICES IN MEDICAID.

    (a) Pharmacy Price Reimbursement Requirements.--
            (1) In general.--Section 1927(e) of the Social Security Act 
        (42 U.S.C. 1396r-8(e)) is amended by adding at the end the 
        following:
            ``(6) Pharmacy price reimbursement required.--
                    ``(A) In general.--A contract between the State and 
                a pharmacy benefit manager (in this paragraph referred 
                to as a `PBM'), or a contract between the State and a 
                designated entity (as defined in subparagraph (C)) that 
                includes provisions making the designated entity 
                responsible for the administration of medical 
                assistance consisting of covered outpatient drugs for 
                individuals enrolled with the designated entity, shall 
                require that payment for such drugs and related 
                administrative services (as applicable), including 
                payments made by a PBM on behalf of the State or 
                designated entity, is based on pharmacy price 
                reimbursement model under which--
                            ``(i) any payment made by the designated 
                        entity or the PBM (as applicable) for such a 
                        drug--
                                    ``(I) is limited to--
                                            ``(aa) ingredient cost; and
                                            ``(bb) a professional 
                                        dispensing fee that is not less 
                                        than the professional 
                                        dispensing fee that the State 
                                        plan or waiver would pay if the 
                                        plan or waiver was making the 
                                        payment directly;
                                    ``(II) is passed through in its 
                                entirety by the designated entity or 
                                PBM to the pharmacy or provider that 
                                dispenses the drug and is not 
                                retroactively denied or reduced except 
                                as the result of an audit performed 
                                pursuant to a contract between such 
                                designated entity or PBM and such 
                                pharmacy or provider, or as otherwise 
                                permitted or required by law (including 
                                in response to instances of fraud, 
                                waste, or abuse); and
                                    ``(III) is made in a manner that is 
                                consistent with sections 447.502, 
                                447.512, 447.514, and 447.518 of title 
                                42, Code of Federal Regulations (or any 
                                successor regulation) as if such 
                                requirements applied directly to the 
                                designated entity or the PBM, except 
                                that any payment by the designated 
                                entity or the PBM for the ingredient 
                                cost of such a drug purchased by a 
                                covered entity (as defined in 
                                subsection (a)(5)(B)) may exceed the 
                                actual acquisition cost (as defined in 
                                section 447.502 of title 42, Code of 
                                Federal Regulations (or any successor 
                                regulation)) for such drug if--
                                            ``(aa) such drug was 
                                        subject to an agreement under 
                                        section 340B of the Public 
                                        Health Service Act;
                                            ``(bb) such payment for 
                                        such cost of such drug does not 
                                        exceed the maximum payment that 
                                        would have been made by the 
                                        designated entity or the PBM 
                                        for the ingredient cost of such 
                                        drug had such drug not been 
                                        purchased by such a covered 
                                        entity; and
                                            ``(cc) such covered entity 
                                        reports to the Secretary, on an 
                                        annual basis (in a form and 
                                        manner specified by the 
                                        Secretary) and with respect to 
                                        payments for such costs of such 
                                        drugs so purchased by such 
                                        covered entity that are in 
                                        excess of the actual 
                                        acquisition costs for such 
                                        drugs, the aggregate amount of 
                                        such excess;
                            ``(ii) payment to the designated entity or 
                        the PBM (as applicable) for administrative 
                        services performed by the designated entity or 
                        PBM is limited to an administrative fee that 
                        reflects the fair market value of providing 
                        such services;
                            ``(iii) the designated entity or the PBM 
                        (as applicable) makes available to the State, 
                        and the Secretary upon request, all costs and 
                        payments related to covered outpatient drugs 
                        and accompanying administrative services 
                        incurred, received, or made by the designated 
                        entity or the PBM, including ingredient costs, 
                        professional dispensing fees, administrative 
                        fees, post-sale and post-invoice fees, 
                        discounts, or related adjustments such as 
                        direct and indirect remuneration fees, and any 
                        and all other remuneration; and
                            ``(iv) any form of spread pricing whereby 
                        any amount charged or claimed by the designated 
                        entity or the PBM (as applicable) is in excess 
                        of the amount paid to the pharmacies by the 
                        designated entity or the PBM, including any 
                        post-sale or post-invoice fees, discounts, or 
                        related adjustments such as direct and indirect 
                        remuneration fees or assessments (after 
                        allowing for a fair market administrative fee 
                        as described in clause (ii)), is not allowable 
                        for purposes of claiming Federal matching 
                        payments under this title.
                    ``(B) Making certain information available.--The 
                Secretary shall publish, not less frequently than on an 
                annual basis, information received by the Secretary 
                pursuant to subparagraph (A)(i)(III)(cc). Such 
                information shall be so published in an electronic and 
                searchable format, such as through the 340B Office of 
                Pharmacy Affairs Information System (or a successor 
                system).
                    ``(C) Definitions.--In this paragraph:
                            ``(i) Designated entity.--The term 
                        `designated entity' means a managed care entity 
                        or other specified entity.
                            ``(ii) Managed care entity; other specified 
                        entity.--The terms `managed care entity' and 
                        `other specified entity' have the meaning given 
                        such terms in section 1903(m)(9)(D).''.
            (2) Conforming amendments.--Section 1903(m)(2)(A) of such 
        Act (42 U.S.C. 1396b(m)(2)(A)) is amended--
                    (A) in clause (i), by inserting before the 
                semicolon at the end the following: ``(or, in the case 
                of a contract described in section 1927(e)(6), is an 
                other specified entity (as defined in paragraph 
                (9)(D))''; and
                    (B) in clause (xiii)--
                            (i) by striking ``and (III)'' and inserting 
                        ``(III)'';
                            (ii) by inserting before the period at the 
                        end the following: ``, and (IV) the pharmacy 
                        benefit provided by the entity (or pharmacy 
                        benefit manager on behalf of the entity under a 
                        contract), the other specified entity (as 
                        defined in paragraph (9)(D)) (or pharmacy 
                        benefit manager on behalf of the other 
                        specified entity under a contract), or by 
                        another arrangement between the entity or other 
                        specified entity and the pharmacy benefit 
                        manager, shall comply with the requirements of 
                        section 1927(e)(6)''; and
                            (iii) by moving the margin 2 ems to the 
                        left.
            (3) Effective date.--The amendments made by this subsection 
        apply to contracts between States and pharmacy benefit managers 
        and designated entities (as defined in section 1927(e)(6) of 
        the Social Security Act, as added by paragraph (1)) that have 
        an effective date beginning on or after the date that is 18 
        months after the date of enactment of this Act.
    (b) Ensuring Accurate Payments to Pharmacies Under Medicaid.--
            (1) In general.--Section 1927(f) of the Social Security Act 
        (42 U.S.C. 1396r-8(f)) is amended--
                    (A) by striking ``and'' after the semicolon at the 
                end of paragraph (1)(A)(i) and all that precedes it 
                through ``(1)'' and inserting the following:
            ``(1) Determining pharmacy actual acquisition costs.--The 
        Secretary shall conduct a survey of retail community pharmacy 
        drug prices to determine the national average drug acquisition 
        cost as follows:
                    ``(A) Use of vendor.--The Secretary may contract 
                services for--
                            ``(i) with respect to retail community 
                        pharmacies, the determination of retail survey 
                        prices of the national average drug acquisition 
                        cost for covered outpatient drugs based on a 
                        monthly survey of such pharmacies; and'';
                    (B) by adding at the end of paragraph (1) the 
                following:
                    ``(F) Survey reporting.--A State shall require that 
                any retail community pharmacy in the State that 
                receives any payment, reimbursement, administrative 
                fee, discount, or rebate related to the dispensing of 
                covered outpatient drugs to individuals receiving 
                benefits under this title, regardless of whether such 
                payment, reimbursement, administrative fee, discount, 
                or rebate is received from the State or a designated 
                entity (as defined in subsection (e)(6)(C)) directly or 
                from a pharmacy benefit manager that has a contract 
                with the State or a designated entity, shall respond to 
                surveys of retail prices conducted under this 
                subsection.
                    ``(G) Survey information.--Information on national 
                drug acquisition prices obtained under this paragraph 
                shall be made publicly available in a timely manner 
                following the collection of such information and shall 
                include at least the following:
                            ``(i) The monthly response rate to the 
                        survey including a list of pharmacies not in 
                        compliance with subparagraph (F).
                            ``(ii) The sampling frame and number of 
                        pharmacies sampled monthly.
                            ``(iii) Information on price concessions to 
                        the pharmacy, including discounts, rebates, and 
                        other price concessions, to the extent that 
                        such information may be publicly released and 
                        is available during the survey period.
                    ``(H) Report on specialty pharmacies.--Not later 
                than 1 year after the date that this subparagraph takes 
                effect, the Secretary shall submit to Congress a report 
                examining specialty drug coverage and reimbursement 
                under this title, including--
                            ``(i) a description of how State Medicaid 
                        programs define specialty drugs and specialty 
                        pharmacies;
                            ``(ii) the amount State Medicaid programs 
                        pay for specialty drugs;
                            ``(iii) how States and designated entities 
                        (as defined in subsection (e)(6)(C)) determine 
                        payment for specialty drugs;
                            ``(iv) the settings in which specialty 
                        drugs are dispensed to individuals receiving 
                        benefits under this title (such as retail 
                        community pharmacies or specialty pharmacies);
                            ``(v) the extent to which specialty drugs 
                        (as defined by the respective States) are 
                        captured in the national average drug 
                        acquisition cost survey (or through another 
                        process);
                            ``(vi) examples of specialty drug 
                        dispensing fees to support the services 
                        associated with dispensing such specialty 
                        drugs; and
                            ``(vii) recommendations as to whether 
                        specialty pharmacies should be included in the 
                        survey of retail prices to ensure national 
                        average drug acquisition costs capture drugs 
                        sold at specialty pharmacies, and how such 
                        specialty pharmacies should be defined.
                    ``(I) Enforcement.--At the discretion of the 
                Secretary, the Secretary (acting through the Inspector 
                General and in collaboration with the Administrator of 
                the Centers for Medicare & Medicaid Services) may 
                enforce non-compliance with this paragraph by a 
                pharmacy through the establishment of penalties until 
                compliance with this paragraph has been completed.''; 
                and
                    (C) in paragraph (2)--
                            (i) in subparagraph (A), by inserting 
                        ``(including payment rates under managed care 
                        organization as defined in section 
                        1932(a)(1)(B)(i) and PIHPs and PAHPs as defined 
                        in section 1903(m)(9)(D)(iii)(I) and (II), 
                        respectively)'' after ``under this title''; and
                            (ii) in subparagraph (B), by inserting ``, 
                        and the basis for such dispensing fees'' before 
                        the semicolon at the end.
            (2) Effective date.--The amendments made by this subsection 
        shall take effect on the first day of the first quarter that 
        begins on or after the date that is 18 months after the date of 
        enactment of this Act.

SEC. 203. PARITY IN MEDICARE PAYMENTS FOR HOSPITAL OUTPATIENT 
              DEPARTMENT SERVICES FURNISHED OFF-CAMPUS.

    (a) In General.--Section 1833(t)(16) of the Social Security Act (42 
U.S.C. 1395l(t)(16)) is amended by adding at the end the following new 
subparagraph:
                    ``(H) Parity in fee schedule amount for certain 
                services furnished by an off-campus outpatient 
                department of a provider.--
                            ``(i) In general.--Subject to clause (iii), 
                        in the case of specified OPD services (as 
                        defined in clause (v)) that are furnished 
                        during 2025 or a subsequent year by an off-
                        campus outpatient department of a provider (as 
                        defined in clause (iv)) (or, in the case of an 
                        off-campus outpatient department of a provider 
                        that is a hospital described in section 
                        1886(d)(1)(B)(v), or is located in a rural area 
                        or a health professional shortage area, such 
                        services that are furnished during 2026 or a 
                        subsequent year), there shall be substituted 
                        for the amount otherwise determined under this 
                        subsection for such service and year an amount 
                        equal to the payment amount that would have 
                        been payable under the applicable payment 
                        system under this part (other than under this 
                        subsection) had such services been furnished by 
                        such a department subject to such payment 
                        system pursuant to paragraph (21)(C).
                            ``(ii) Not budget neutral implementation.--
                        In making any budget neutrality adjustments 
                        under this subsection for 2025 or a subsequent 
                        year, the Secretary shall not take into account 
                        the reduced expenditures that result from the 
                        application of this subparagraph.
                            ``(iii) Transition.--The Secretary shall 
                        provide for a 4-year phase-in of the 
                        application of clause (i), with clause (i) 
                        being fully applicable for specified OPD 
                        services beginning with 2028 (or in the case of 
                        an off-campus outpatient department of a 
                        provider that is a hospital described in 
                        section 1886(d)(1)(B)(v), or is located in a 
                        rural area or a health professional shortage 
                        area, beginning with 2029).
                            ``(iv) Off-campus department of a 
                        provider.--For purposes of this subparagraph, 
                        the term `off-campus outpatient department of a 
                        provider' means a department of a provider (as 
                        defined in section 413.65(a)(2) of title 42, 
                        Code of Federal Regulations) that is not 
                        located--
                                    ``(I) on the campus (as such term 
                                is defined in such section) of such 
                                provider; or
                                    ``(II) within the distance 
                                (described in such definition of 
                                campus) from a remote location of a 
                                hospital facility (as defined in such 
                                section).
                            ``(v) Other definitions.--For purposes of 
                        this subparagraph:
                                    ``(I) Designated ambulatory payment 
                                classification group.--The term 
                                `designated ambulatory payment 
                                classification group' means an 
                                ambulatory payment classification group 
                                for drug administration services.
                                    ``(II) Health professional shortage 
                                area.--The term `health professional 
                                shortage area' has the meaning given 
                                such term in section 332(a)(1)(A) of 
                                the Public Health Service Act.
                                    ``(III) Rural area.--The term 
                                `rural area' has the meaning given such 
                                term in section 1886(d)(2)(D).
                                    ``(IV) Specified opd services.--The 
                                term `specified OPD services' means 
                                covered OPD services assigned to a 
                                designated ambulatory payment 
                                classification group.''.
    (b) Implementation.--Section 1833(t)(12) of the Social Security Act 
(42 U.S.C. 1395l(t)(12)) is amended--
            (1) in subparagraph (D), by striking ``and'' at the end;
            (2) in subparagraph (E), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(F) the determination of any payment amount under 
                paragraph (16)(H), including the transition under 
                clause (iii) of such paragraph.''.

SEC. 204. REQUIRING A SEPARATE IDENTIFICATION NUMBER AND AN ATTESTATION 
              FOR EACH OFF-CAMPUS OUTPATIENT DEPARTMENT OF A PROVIDER.

    (a) In General.--Section 1833(t) of the Social Security Act (42 
U.S.C. 1395l(t)) is amended by adding at the end the following new 
paragraph:
            ``(23) Use of unique health identifiers; attestation.--
                    ``(A) In general.--No payment may be made under 
                this subsection (or under an applicable payment system 
                pursuant to paragraph (21)) for items and services 
                furnished on or after January 1, 2026, by an off-campus 
                outpatient department of a provider (as defined in 
                subparagraph (C)) unless--
                            ``(i) such department has obtained, and 
                        such items and services are billed under, a 
                        standard unique health identifier for health 
                        care providers (as described in section 
                        1173(b)) that is separate from such identifier 
                        for such provider; and
                            ``(ii) such provider has submitted to the 
                        Secretary, during the 2-year period ending on 
                        the date such items and services are so 
                        furnished, an attestation that such department 
                        is compliant with the requirements described in 
                        section 413.65 of title 42, Code of Federal 
                        Regulations (or a successor regulation).
                    ``(B) Process for submission and review.--Not later 
                than 1 year after the date of enactment of this 
                paragraph, the Secretary shall, through notice and 
                comment rulemaking, establish a process for each 
                provider with an off-campus outpatient department of a 
                provider to submit an attestation pursuant to 
                subparagraph (A)(ii), and for the Secretary to review 
                each such attestation and determine, through site 
                visits, remote audits, or other means (as determined 
                appropriate by the Secretary), whether such department 
                is compliant with the requirements described in such 
                subparagraph.
                    ``(C) Off-campus outpatient department of a 
                provider defined.--For purposes of this paragraph, the 
                term `off-campus outpatient department of a provider' 
                means a department of a provider (as defined in section 
                413.65 of title 42, Code of Federal Regulations, or any 
                successor regulation) that is not located--
                            ``(i) on the campus (as defined in such 
                        section) of such provider; or
                            ``(ii) within the distance (described in 
                        such definition of campus) from a remote 
                        location of a hospital facility (as defined in 
                        such section).''.
    (b) HHS OIG Analysis.--Not later than January 1, 2030, the 
Inspector General of the Department of Health and Human Services shall 
submit to Congress--
            (1) an analysis of the process established by the Secretary 
        of Health and Human Services to conduct the reviews and 
        determinations described in section 1833(t)(23)(B) of the 
        Social Security Act, as added by subsection (a) of this 
        section; and
            (2) recommendations based on such analysis, as the 
        Inspector General determines appropriate.

 TITLE III--SUPPORTING PATIENTS, HEALTH CARE WORKERS, COMMUNITY HEALTH 
                         CENTERS, AND HOSPITALS

SEC. 301. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH 
              SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE 
              GME PROGRAMS.

    (a) Teaching Health Centers That Operate Graduate Medical Education 
Programs.--
            (1) Addition to capped amounts for fiscal years 2024 and 
        2025.--Paragraph (2) of section 340H(b) of the Public Health 
        Service Act (42 U.S.C. 256h(b)) is amended by adding at the end 
        the following:
                    ``(C) Addition.--Notwithstanding any provision of 
                this section, for each of fiscal years 2024 and 2025, 
                the Secretary may use any amounts made available in any 
                fiscal year to carry out this section (including 
                amounts recouped under subsection (f)) to make payments 
                described in paragraphs (1)(A) and (1)(B), in addition 
                to the total amount of funds appropriated under 
                subsection (g).''.
            (2) Reconciliation.--Section 340H(f) of the Public Health 
        Service Act (42 U.S.C. 256h(f)) is amended--
                    (A) by striking ``The Secretary shall determine'' 
                and inserting the following:
            ``(1) Determination.--The Secretary shall determine''; and
                    (B) by adding at the end the following:
            ``(2) Annual report to congress.--For each fiscal year, the 
        Secretary shall submit to the Committee on Energy and Commerce 
        of the House of Representatives and the Committee on Health, 
        Education, Labor, and Pensions of the Senate a report 
        specifying--
                    ``(A) the total amount of funds recouped under 
                paragraph (1);
                    ``(B) the rationale for the funds being recouped; 
                and
                    ``(C) in the case of the reports for each of fiscal 
                years 2024 and 2025, the total amount of funds recouped 
                under paragraph (1) that were used pursuant to 
                subsection (b)(2)(C) to adjust total payment amounts 
                above the total amounts appropriated under subsection 
                (g).''.
            (3) Funding.--Section 340H(g) of the Public Health Service 
        Act (42 U.S.C. 256h(g)) is amended--
                    (A) by amending paragraph (1) to read as follows:
            ``(1) In general.--To carry out this section, there are 
        appropriated such sums as may be necessary, not to exceed--
                    ``(A) $230,000,000, for the period of fiscal years 
                2011 through 2015;
                    ``(B) $60,000,000 for each of fiscal years 2016 and 
                2017;
                    ``(C) $126,500,000 for each of fiscal years 2018 
                through 2023;
                    ``(D) $175,000,000 for each of fiscal years 2024 
                and 2025;
                    ``(E) $225,000,000 for each of fiscal years 2026 
                and 2027; and
                    ``(F) $300,000,000 for each of fiscal years 2028, 
                2029, and 2030.''; and
                    (B) by adding at the end the following:
            ``(3) Availability.--The amounts made available under 
        paragraph (1) shall remain available until expended.''.
    (b) Extension for Community Health Centers.--Section 10503(b)(1)(F) 
of the Patient Protection and Affordable Care Act (42 U.S.C. 254b-
2(b)(1)(F)) is amended--
            (1) by striking ``and'' before ``$4,000,000,000'' and 
        inserting a comma; and
            (2) by inserting ``, $4,400,000,000 for each of fiscal 
        years 2024 and 2025, and $1,109,000,000 for the period 
        beginning October 1, 2025, and ending December 31, 2025'' 
        before the semicolon.
    (c) Extension for the National Health Service Corps.--Section 
10503(b)(2) of the Patient Protection and Affordable Care Act (42 
U.S.C. 254b-2(b)(2)) is amended--
            (1) in subparagraph (G), by striking ``and'' at the end;
            (2) in subparagraph (H), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
                    ``(I) $350,000,000 for each of fiscal years 2024 
                and 2025, and $88,219,178 for the period beginning 
                October 1, 2025, and ending December 31, 2025.''.
    (d) Government Accountability Office Report.--
            (1) In general.--Not later than one year after the date of 
        enactment of this Act, the Comptroller General of the United 
        States shall submit to the Committee on Energy and Commerce of 
        the House of Representatives and the Committee on Health, 
        Education, Labor, and Pensions of the Senate a report assessing 
        the effectiveness of the National Health Service Corps at 
        attracting health care professionals to HPSAs, including by--
                    (A) assessing the metrics used by the Health 
                Resources and Services Administration in evaluating the 
                program;
                    (B) comparing the retention rates of NHSC 
                participants in the HPSAs where they completed their 
                period of obligated service to the retention rate of 
                non-NHSC participants in the corresponding HPSAs;
                    (C) comparing the retention rates of NHSC 
                participants in the HPSAs where they completed their 
                period of obligated service to the retention rates of 
                NHSC participants in HPSAs other than those where they 
                completed their period of obligated service;
                    (D) identifying factors that influence a NHSC 
                participant's decision to practice in a HPSA other than 
                the HPSA where they completed their period of obligated 
                service;
                    (E) identifying factors other than participation in 
                the National Health Service Corps Scholarship and Loan 
                Repayment Programs that attract health care 
                professionals to a HPSA;
                    (F) assessing the impact the National Health 
                Service Corps has on wages for health care 
                professionals in a HPSA; and
                    (G) comparing the distribution of NHSC participants 
                across HPSAs, including a comparison of rural versus 
                non-rural HPSAs.
            (2) Definition.--In this section:
                    (A) The term ``HPSA'' means a health professional 
                shortage area designated under section 332 of the 
                Public Health Service Act (42 U.S.C. 254e).
                    (B) The term ``NHSC participant'' means a National 
                Health Service Corps member participating in the 
                National Health Service Corps Scholarship or Loan 
                Repayment Program.
    (e) Application of Provisions.--Amounts appropriated pursuant to 
the amendments made by this section shall be subject to the 
requirements contained in Public Law 117-328 for funds for programs 
authorized under sections 330 through 340 of the Public Health Service 
Act.
    (f) Conforming Amendment.--Paragraph (4) of section 3014(h) of 
title 18, United States Code, is amended by striking ``and section 
301(d) of division BB of the Consolidated Appropriations Act, 2021.'' 
and inserting ``section 301(d) of division BB of the Consolidated 
Appropriations Act, 2021, and section 301(e) of the Lower Costs, More 
Transparency Act.''.

SEC. 302. EXTENSION OF SPECIAL DIABETES PROGRAMS.

    (a) Extension of Special Diabetes Programs for Type I Diabetes.--
Section 330B(b)(2) of the Public Health Service Act (42 U.S.C. 254c-
2(b)(2)) is amended--
            (1) in subparagraph (C), by striking ``and'' at the end;
            (2) in subparagraph (D), by striking the period at the end 
        and inserting a semicolon; and
            (3) by adding at the end the following:
                    ``(E) $170,000,000 for each of fiscal years 2024 
                and 2025, to remain available until expended; and
                    ``(F) $42,849,315 for the period beginning October 
                1, 2025, and ending December 31, 2025, to remain 
                available until expended.''.
    (b) Extending Funding for Special Diabetes Programs for Indians.--
Section 330C(c)(2) of the Public Health Service Act (42 U.S.C. 254c-
3(c)(2)) is amended--
            (1) in subparagraph (C), by striking ``and'' at the end;
            (2) in subparagraph (D), by striking the period at the end 
        and inserting a semicolon; and
            (3) by adding at the end the following:
                    ``(E) $170,000,000 for each of fiscal years 2024 
                and 2025, to remain available until expended; and
                    ``(F) $42,849,315 for the period beginning October 
                1, 2025, and ending December 31, 2025, to remain 
                available until expended.''.

SEC. 303. DELAYING CERTAIN DISPROPORTIONATE SHARE HOSPITAL PAYMENT 
              REDUCTIONS UNDER THE MEDICAID PROGRAM.

    Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C.1396r-
4(f)(7)(A)) is amended--
            (1) in clause (i), in the matter preceding subclause (I), 
        by striking ``2024'' and inserting ``2026''; and
            (2) in clause (ii), by striking ``2024'' and inserting 
        ``2026''.

SEC. 304. MEDICAID IMPROVEMENT FUND.

    Section 1941(b)(3)(A) of the Social Security Act (42 U.S.C. 1396w-
1(b)(3)(A)) is amended by striking ``$7,000,000,000'' and inserting 
``$0''.

TITLE IV--INCREASING ACCESS TO QUALITY HEALTH DATA AND LOWERING HIDDEN 
                                  FEES

SEC. 401. INCREASING PLAN FIDUCIARIES' ACCESS TO HEALTH DATA.

    (a) Plan Fiduciary Access to Information.--
            (1) In general.--Paragraph (2) of section 408(b) of the 
        Employee Retirement Income Security Act of 1974 (29 U.S.C. 
        1108(b)) is amended by adding at the end the following new 
        subparagraph:
            ``(C) No contract or arrangement for services between a 
        group health plan and any other entity, including a health care 
        provider (including a health care facility), network or 
        association of providers, service provider offering access to a 
        network of providers, third-party administrator, or pharmacy 
        benefit manager, is reasonable within the meaning of this 
        paragraph unless such contract or arrangement--
                    ``(i) allows the responsible plan fiduciary to 
                audit or review all de-identified claims and encounter 
                information or data described in section 724(a)(1)(B) 
                to--
                            ``(I) ensure that such entity complies with 
                        the terms of the plan and any applicable law; 
                        and
                            ``(II) determine the reasonableness of 
                        compensation received by such entity; and
                    ``(ii) does not--
                            ``(I) unreasonably limit the number of 
                        audits permitted during a given period of time;
                            ``(II) limit the number of de-identified 
                        claims and encounter information or data that 
                        the responsible plan fiduciary may access 
                        during an audit;
                            ``(III) limit the disclosure of pricing 
                        terms for value-based payment arrangements or 
                        capitated payment arrangements, including--
                                    ``(aa) payment calculations and 
                                formulas;
                                    ``(bb) quality measures;
                                    ``(cc) contract terms;
                                    ``(dd) payment amounts;
                                    ``(ee) measurement periods for all 
                                incentives; and
                                    ``(ff) other payment methodologies 
                                used by an entity, including a health 
                                care provider (including a health care 
                                facility), network or association of 
                                providers, service provider offering 
                                access to a network of providers, 
                                third-party administrator, or pharmacy 
                                benefit manager;
                            ``(IV) limit the disclosure of overpayments 
                        and overpayment recovery terms;
                            ``(V) limit the right of the responsible 
                        plan fiduciary to select an auditor;
                            ``(VI) otherwise limit or unduly delay by 
                        greater than 60 calendar days after the date of 
                        request the responsible plan fiduciary from 
                        auditing all de-identified claims and encounter 
                        information or data; or
                            ``(VII) permit the entity to charge a fee 
                        beyond the reasonable direct costs to provide 
                        the required information and otherwise comply 
                        and assist with an audit request.
                    ``(D) Privacy requirements.--Covered service 
                providers shall provide information under this 
                subparagraph in a manner consistent with the privacy, 
                security, and breach notification regulations 
                promulgated under section 13402(a) of the Health 
                Information Technology for Clinical Health Act, and 
                shall restrict the use and disclosure of such 
                information according to such privacy regulations.
                    ``(E) Disclosure and redisclosure.--
                            ``(i) Limitation to business associates.--A 
                        responsible plan fiduciary receiving a report 
                        under this subparagraph may disclose such 
                        information only to the entity from which the 
                        report was received, the group health plan for 
                        which the report pertains, or to that entity's 
                        business associates as defined in section 
                        160.103 of title 45, Code of Federal 
                        Regulations (or successor regulations) or as 
                        permitted by the HIPAA Privacy Rule (45 C.F.R. 
                        parts 160 and 164, subparts A and E).
                            ``(ii) Clarification regarding public 
                        disclosure of information.--Nothing in this 
                        section shall prevent a group health plan or 
                        health insurance issuer offering group health 
                        insurance coverage, or a covered service 
                        provider, from placing reasonable restrictions 
                        on the public disclosure of the information 
                        contained in a report described in this 
                        subparagraph, except that such plan, issuer, or 
                        entity may not restrict disclosure of such 
                        report to the Department of Labor.''.
            (2) Civil enforcement.--
                    (A) In general.--Subsection (c) of section 502 of 
                such Act (29 U.S.C. 1132) is amended by adding at the 
                end the following new paragraph:
    ``(13) In the case of an agreement between a group health plan and 
a health care provider (including a health care facility), network or 
association of providers, service provider offering access to a network 
of providers, third-party administrator, or pharmacy benefit manager, 
that violates the provisions of section 724, the Secretary may assess a 
civil penalty against such provider, network or association, service 
provider offering access to a network of providers, third-party 
administrator, pharmacy benefit manager, or other service provider in 
the amount of $10,000 for each day during which such violation 
continues. Such penalty shall be in addition to other penalties as may 
be prescribed by law.''.
                    (B) Conforming amendment.--Paragraph (6) of section 
                502(a) of such Act is amended by striking ``or (9)'' 
                and inserting ``(9), or (13)''.
            (3) Existing provisions void.--Section 410 of such Act is 
        amended by adding at the end the following new subsection:
    ``(c) Any provision in an agreement or instrument shall be void as 
against public policy if such provision--
            ``(1) unduly delays or limits a plan fiduciary from 
        accessing the de-identified claims and encounter information or 
        data described in section 724(a)(1)(B); or
            ``(2) violates the requirements of section 408(b)(2)(C).''.
            (4) Technical amendment.--Clause (i) of section 
        408(b)(2)(B) of such Act is amended by striking ``this clause'' 
        and inserting ``this paragraph''.
    (b) Updated Attestation for Price and Quality Information.--Section 
724(a)(3) of the Employee Retirement Income Security Act (29 U.S.C. 
1185m(a)(3)) is amended to read as follows:
            ``(3) Attestation.--
                    ``(A) In general.--Subject to subparagraph (C), the 
                plan fiduciary of a group health plan or health 
                insurance issuer offering group health insurance 
                coverage shall annually submit to the Secretary an 
                attestation that such plan or issuer of such coverage 
                is in compliance with the requirements of this 
                subsection. Such attestation shall also include a 
                statement verifying that--
                            ``(i) the information or data described 
                        under subparagraphs (A) and (B) of paragraph 
                        (1) is available upon request and provided to 
                        the plan fiduciary, the plan administrator, or 
                        the issuer in a timely manner; and
                            ``(ii) there are no terms in the agreement 
                        under such paragraph (1) that directly or 
                        indirectly restrict or unduly delay a plan 
                        fiduciary, the plan administrator, or the 
                        issuer from auditing, reviewing, or otherwise 
                        accessing such information, except as permitted 
                        under section 408(b)(2)(C).
                    ``(B) Limitation on submission.--Subject to clause 
                (ii), a group health plan or issuer offering group 
                health insurance coverage may not enter into an 
                agreement with a third-party administrator or other 
                service provider to submit the attestation required 
                under subparagraph (A).
                    ``(C) Exception.--In the case of a group health 
                plan or issuer offering group health insurance coverage 
                that is unable to obtain the information or data needed 
                to submit the attestation required under subparagraph 
                (A), such plan or issuer may submit a written statement 
                in lieu of such attestation that includes--
                            ``(i) an explanation of why such plan or 
                        issuer was unsuccessful in obtaining such 
                        information or data, including whether such 
                        plan or issuer was limited or prevented from 
                        auditing, reviewing, or otherwise accessing 
                        such information or data;
                            ``(ii) a description of the efforts made by 
                        the plan fiduciary to remove any gag clause 
                        provisions from the agreement under paragraph 
                        (1); and
                            ``(iii) a description of any response by 
                        the third-party administrator or other service 
                        provider with respect to efforts to comply with 
                        the attestation requirement under subparagraph 
                        (A).''.
    (c) Report on Plan Assets.--Not later than 1 year after the date of 
enactment of this Act, the Secretary of Labor shall submit to the 
Committee on Education and the Workforce of the House of 
Representatives a report on the status of de-identified claims and 
encounter information or data described in section 724(a)(1)(B) of the 
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185m), 
including information on the following:
            (1) Whether changes to regulations or guidance would permit 
        such information or data to be deemed a group health plan asset 
        (as defined under section 3(42) of such Act).
            (2) Whether restrictions on the ability of a plan fiduciary 
        to access such information or data violates a requirement of 
        current law.
            (3) The existing regulatory authority of the Secretary to 
        clarify whether such information or data is the property of a 
        group health plan, rather than a service provider.
            (4) Legislative actions that may be taken to establish that 
        such information or data related to a plan belongs to a group 
        health plan and is handled in the best interests of plan 
        participants and beneficiaries.
    (d) Effective Date.--The amendments made by subsections (a) and (b) 
shall apply with respect to a plan beginning with the first plan year 
that begins on or after the date that is 1 year after the date of 
enactment of this Act.

SEC. 402. HIDDEN FEES DISCLOSURE REQUIREMENTS .

    (a) Clarification of the Application of Fee Disclosure Requirements 
to Covered Service Providers.--
            (1) Services.--Clause (ii)(I)(bb) of section 408(b)(2)(B) 
        of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1108(b)(2)(B)) is amended--
                    (A) in subitem (AA) by striking ``Brokerage 
                services,'' and inserting ``Services (including 
                brokerage services),''; and
                    (B) in subitem (BB)--
                            (i) by striking ``Consulting,'' and 
                        inserting ``Other services,''; and
                            (ii) by inserting ``any of the following:'' 
                        before ``plan design''.
            (2) Disclosures.--Clause (iii)(III) of section 408(b)(2)(B) 
        of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1108(b)(2)(B)) is amended by striking ``, either in the 
        aggregate or by service,'' and inserting ``by service''.
    (b) Strengthening Disclosure Requirements With Respect to Pharmacy 
Benefit Managers and Third Party Administrators for Group Health 
Plans.--
            (1) Certain arrangements for pbm services considered as 
        indirect.--
                    (A) In general.--Clause (i) of section 408(b)(2)(B) 
                of the Employee Retirement Income Security Act of 1974 
                (29 U.S.C. 1108(b)(2)(B)) is amended--
                            (i) by striking ``requirements of this 
                        clause'' and inserting ``requirements of this 
                        subparagraph''; and
                            (ii) by adding at the end the following: 
                        ``For purposes of applying section 406(a)(1)(C) 
                        with respect to a transaction described under 
                        this subparagraph, a contract or arrangement 
                        for services between a covered plan and a 
                        health insurance issuer providing health 
                        insurance coverage in connection with the 
                        covered plan in which the health insurance 
                        issuer contracts, in connection with such plan, 
                        with a service provider for pharmacy benefit 
                        management services shall be considered to 
                        constitute an indirect furnishing of goods, 
                        services, or facilities between the plan and 
                        the service provider acting as the party in 
                        interest.''.
                    (B) Health insurance issuer and health insurance 
                coverage defined.--Clause (ii)(I)(aa) of section 
                408(b)(2)(B) of such Act (29 U.S.C. 1108(b)(2)(B)) is 
                amended by inserting before the period at the end ``and 
                the terms `health insurance coverage' and `health 
                insurance issuer' have the meanings given such terms in 
                section 733(b)''.
                    (C) Technical amendment.--Clause (ii)(I)(aa) of 
                section 408(b)(2)(B) of the Employee Retirement Income 
                Security Act of 1974 (29 U.S.C. 1108(b)(2)(B)) is 
                further amended by inserting ``in'' after ``defined''.
            (2) Specific disclosure requirements with respect to 
        pharmacy benefit management services.--
                    (A) In general.--Clause (iii) of section 
                408(b)(2)(B) of such Act (29 U.S.C. 1108(b)(2)(B)) is 
                amended by adding at the end the following:
                    ``(VII) With respect to a contract or arrangement 
                with the covered plan in connection with the provision 
                of pharmacy benefit management services, as part of the 
                description required under subclauses (III) and (IV)--
                            ``(aa) all compensation described in clause 
                        (ii)(I)(dd)(AA), including fees, rebates, 
                        alternative discounts, co-payment offsets, and 
                        other remuneration expected to be received by 
                        the covered service provider, an affiliate, or 
                        a subcontractor from a pharmaceutical 
                        manufacturer, distributor, rebate aggregator, 
                        accumulator, and maximizer, group purchasing 
                        organization, or any other third party;
                            ``(bb) the amount and form of any rebates, 
                        discounts, or price concessions, including the 
                        amount expected to be passed through to the 
                        plan sponsor or the participants and 
                        beneficiaries under the covered plan;
                            ``(cc) all compensation expected to be 
                        received by the covered service provider, an 
                        affiliate, or a subcontractor as a result of 
                        paying a lower amount for the drug than the 
                        amount charged as a copayment, coinsurance 
                        amount, or deductible;
                            ``(dd) all compensation expected to be 
                        received by the covered service provider, an 
                        affiliate, or a subcontractor as a result of 
                        paying pharmacies less than what is charged the 
                        health plan, plan sponsor, or participants and 
                        beneficiaries under the covered plan; and
                            ``(ee) all compensation expected to be 
                        received by the covered service provider, an 
                        affiliate, or a subcontractor from drug 
                        manufacturers and any other third party in 
                        exchange for--
                                    ``(AA) administering, invoicing, 
                                allocating, or collecting rebates 
                                related to the covered plan;
                                    ``(BB) providing business services 
                                and activities, including providing 
                                access to drug utilization data;
                                    ``(CC) keeping a percentage of the 
                                list price of a drug; or
                                    ``(DD) any other reason related to 
                                the role of a covered service provider 
                                as a conduit between the drug 
                                manufacturers or any other third party 
                                and the covered plan.''.
                    (B) Annual disclosure.--Clause (v) of section 
                408(b)(2)(B) of such Act (29 U.S.C. 1108(b)(2)(B)) is 
                amended by adding at the end the following:
                    ``(III) A covered service provider, with respect to 
                a contract or arrangement with the covered plan in 
                connection with providing pharmacy benefit management 
                services, shall disclose, on an annual basis not later 
                than 60 days after the beginning of the current plan 
                year, to a responsible plan fiduciary, in writing, the 
                following with respect to the twelve months preceding 
                the current plan year:
                            ``(aa) All direct compensation described in 
                        subclause (III) of clause (iii) and indirect 
                        compensation described in subclause (IV) of 
                        clause (iii) received by the covered service 
                        provider (including such compensation described 
                        in subclause (VII) of clause (iii)).
                            ``(bb) For each drug covered under the 
                        covered plan, the amount by which the price for 
                        the drug paid by the plan exceeds the amount 
                        paid to pharmacies by the covered service 
                        provider.
                            ``(cc) The total gross spending by the 
                        covered plan on drugs (excluding rebates, 
                        discounts, or other price concessions).
                            ``(dd) The total net spending by the 
                        covered plan on drugs.
                            ``(ee) The total gross spending at all 
                        pharmacies wholly or partially owned by the 
                        covered service provider or any entity 
                        affiliated with the covered service provider, 
                        including mail-order, specialty and retail 
                        pharmacies, with a breakdown by individual 
                        pharmacy location.
                            ``(ff) The aggregate amount of clawback 
                        from such pharmacies, including mail-order, 
                        specialty, and retail pharmacies.
                                    ``(AA) categorical explanations 
                                (grouped by the reason for clawback, 
                                such as contractual true-up provisions, 
                                overpayments, or non-covered medication 
                                dispensed, and including information on 
                                the amount in each category that was 
                                passed through to the covered plan and 
                                to participants and beneficiaries of 
                                the covered plan); or
                                    ``(BB) individual explanations for 
                                such clawbacks.
                            ``(gg) Total aggregate amounts of fees 
                        collected by the covered service provider, an 
                        affiliate, or a subcontractor in connection 
                        with the provision of pharmacy benefit 
                        management services to the covered plan.
                            ``(hh) Any other information specified by 
                        the Secretary through regulations or guidance 
                        that may be necessary for a responsible plan 
                        fiduciary to consider the merits of the 
                        contract or arrangement with the covered 
                        service provider and any conflicts of interest 
                        that may exist.''.
                    (C) Pharmacy benefit management services defined.--
                Clause (ii)(I) of section 408(b)(2)(B) of such Act (29 
                U.S.C. 1108(b)(2)(B)) is amended by adding at the end 
                the following:
                            ``(gg) The term `pharmacy benefit 
                        management services' includes any services 
                        provided by a covered service provider to a 
                        covered plan with respect to the administration 
                        of prescription drug benefits under the covered 
                        plan, including--
                                    ``(AA) the processing and payment 
                                of claims;
                                    ``(BB) design of pharmacy networks;
                                    ``(CC) negotiation, aggregation, 
                                and distribution of rebates, discounts, 
                                and other price concessions;
                                    ``(DD) formulary design and 
                                maintenance;
                                    ``(EE) operation of pharmacies 
                                (whether retail, mail order, specialty 
                                drug, or otherwise);
                                    ``(FF) recordkeeping;
                                    ``(GG) utilization review;
                                    ``(HH) adjudication of claims; and
                                    ``(II) any other services specified 
                                by the Secretary through guidance or 
                                rulemaking.''.
                    (D) Clawback defined.--Clause (ii)(I) of section 
                408(b)(2)(B) of such Act (29 U.S.C. 1108(b)(2)(B)), as 
                amended by subparagraph (C), is amended by adding at 
                the end the following:
                            ``(hh) The term `clawback' means amounts 
                        collected by a provider of pharmacy benefit 
                        management services from a pharmacy for 
                        copayments collected from a participant or 
                        beneficiary in excess of the contracted 
                        rate.''.
            (3) Specific disclosure requirements with respect to third 
        party administration services for group health plans.--
                    (A) In general.--Clause (iii) of section 
                408(b)(2)(B) of such Act (29 U.S.C. 1108(b)(2)(B)), as 
                amended by paragraph (2)(A), is amended by adding at 
                the end the following:
                    ``(VIII) With respect to a contract or arrangement 
                with the covered plan in connection with the provision 
                of third party administration services for group health 
                plans, as part of the description required under 
                subclauses (III) and (IV)--
                            ``(aa) the amount and form of any rebates, 
                        discounts, savings fees, refunds, or amounts 
                        received from providers and facilities, 
                        including the amounts that will be retained by 
                        the covered service provider as a fee;
                            ``(bb) the amount and form of fees expected 
                        to be received from other service providers in 
                        relation to the covered plan, including the 
                        amounts that will be retained by the covered 
                        service provider as a fee; and
                            ``(cc) the amount and form of expected 
                        recoveries by the covered service provider, 
                        including the amounts that will be retained by 
                        the covered service provider as a fee 
                        (disaggregated by category), as a result of--
                                    ``(AA) overpayments;
                                    ``(BB) erroneous payments;
                                    ``(CC) uncashed checks or 
                                incomplete payments;
                                    ``(DD) billing errors;
                                    ``(EE) subrogation;
                                    ``(FF) fraud; or
                                    ``(GG) any other reason on behalf 
                                of the covered plan.''.
                    (B) Annual disclosure.--Clause (v) of section 
                408(b)(2)(B) of such Act (29 U.S.C. 1108(b)(2)(B)), as 
                amended by paragraph (2)(B), is amended by adding at 
                the end the following:
                    ``(IV) A covered service provider, with respect to 
                a contract or arrangement with the covered plan in 
                connection with providing third party administration 
                services for group health plans, shall disclose, on an 
                annual basis not later than 60 days after the beginning 
                of the current plan year, to a responsible plan 
                fiduciary, in writing, the following with respect to 
                the twelve months preceding the current plan year:
                            ``(aa) All direct compensation described in 
                        subclause (III) of clause (iii).
                            ``(bb) All indirect compensation described 
                        in subclause (IV) of clause (iii) received by 
                        the covered service provider, an affiliate, or 
                        a subcontractor (including such compensation 
                        described in subclause (VIII) of clause (iii)).
                            ``(cc) The aggregate amount for which the 
                        covered service provider, an affiliate, or a 
                        subcontractor received indirect compensation 
                        and the estimated amount of cost-sharing 
                        incurred by plan participants and beneficiaries 
                        as a result.
                            ``(dd) The total gross spending by the 
                        covered plan on all costs and fees arising 
                        under or paid under the administrative services 
                        agreement with the covered service provider 
                        (not including any amounts described in items 
                        (aa) through (cc) of clause (iii)(VIII)).
                            ``(ee) The total net spending by the 
                        covered plan on all costs and fees arising 
                        under or paid under the administrative services 
                        agreement with the covered service provider.
                            ``(ff) The aggregate fees collected by the 
                        covered service provider, an affiliate, or a 
                        subcontractor.
                            ``(gg) Any other information specified by 
                        the Secretary through regulations or guidance 
                        that may be necessary for a responsible plan 
                        fiduciary to consider the merits of the 
                        contract or arrangement with the covered 
                        service provider and any conflicts of interest 
                        that may exist.''.
                    (C) Third party administration services for group 
                health plans defined.--Clause (ii)(I) of section 
                408(b)(2)(B) of such Act (29 U.S.C. 1108(b)(2)(B)), as 
                amended by paragraph (2)(C), is amended by adding at 
                the end the following:
                            ``(ii) The term `third party administration 
                        services for group health plans' includes any 
                        services provided by a covered service 
                        provider, an affiliate, or a subcontractor to a 
                        covered plan with respect to the administration 
                        of health benefits under the covered plan, 
                        including--
                                    ``(AA) the processing, repricing, 
                                and payment of claims;
                                    ``(BB) design, creation, and 
                                maintenance of provider networks;
                                    ``(CC) negotiation of discounts off 
                                gross rates;
                                    ``(DD) benefit and plan design;
                                    ``(EE) negotiation of payment 
                                rates;
                                    ``(FF) recordkeeping;
                                    ``(GG) utilization review;
                                    ``(HH) adjudication of claims;
                                    ``(II) regulatory compliance; and
                                    ``(JJ) any other services set forth 
                                in an administrative services agreement 
                                or similar agreement or specified by 
                                the Secretary through rulemaking.''.
            (4) Rule of construction.--Nothing in the amendments made 
        by this section shall be construed to imply that a practice in 
        relation to which a covered service provider is required to 
        provide information as a result of such amendments is 
        permissible under Federal law.
            (5) Effective date.--No contract or arrangement entered 
        into prior to January 1, 2025, shall be subject to the 
        requirements of subsection (b).
    (c) Implementation.--Not later than 1 year after the date of 
enactment of this Act, the Secretary of Labor shall issue notice and 
comment rulemaking as necessary to implement the provisions of this 
section. The Secretary shall ensure that such rulemaking--
            (1) accounts for the varied compensation practices of 
        covered service providers (as defined under section 
        408(b)(2)(B); and
            (2) establishes standards for the disclosure of expected 
        compensation by such covered service providers.

SEC. 403. PRESCRIPTION DRUG PRICE INFORMATION REQUIREMENT.

    (a) PHSA.--
            (1) In general.--Part D of title XXVII of the Public Health 
        Service Act, as amended by section 106, is further amended by 
        adding at the end the following new section:

``SEC. 2799A-12. INFORMATION ON PRESCRIPTION DRUGS.

    ``(a) In General.--A group health plan or a health insurance issuer 
offering group or individual health insurance coverage shall--
            ``(1) not restrict, directly or indirectly, any pharmacy 
        that dispenses a prescription drug to an enrollee in the plan 
        or coverage from informing (or penalize such pharmacy for 
        informing) an enrollee of any differential between the 
        enrollee's out-of-pocket cost under the plan or coverage with 
        respect to acquisition of the drug and the amount an individual 
        would pay for acquisition of the drug without using any group 
        health plan or health insurance coverage; and
            ``(2) ensure that any entity that provides pharmacy 
        benefits management services under a contract with any such 
        health plan or health insurance coverage does not, with respect 
        to such plan or coverage, restrict, directly or indirectly, a 
        pharmacy that dispenses a prescription drug from informing (or 
        penalize such pharmacy for informing) an enrollee of any 
        differential between the enrollee's out-of-pocket cost under 
        such plan or coverage with respect to acquisition of the drug 
        and the amount an individual would pay for acquisition of the 
        drug without using any group health plan or health insurance 
        coverage.
    ``(b) Definition.--For purposes of this section, the term `out-of-
pocket cost', with respect to acquisition of a drug, means the amount 
to be paid by the enrollee under the plan or coverage, including any 
cost-sharing (including any deductible, copayment, or coinsurance) and, 
as determined by the Secretary, any other expenditure.''.
            (2) Conforming amendment.--Section 2729 of the Public 
        Health Service Act (42 U.S.C. 300gg-29) is amended by adding at 
        the end the following new subsection:
    ``(c) Sunset.--The preceding provisions of this section shall not 
apply beginning on the date of the enactment of this subsection.''.
    (b) ERISA.--
            (1) In general.--Subpart B of part 7 of Subtitle B of title 
        I of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1185 et seq.), as amended by section 106, is further 
        amended by adding at the end the following new section:

``SEC. 727. INFORMATION ON PRESCRIPTION DRUGS.

    ``(a) In General.--A group health plan or a health insurance issuer 
offering group health insurance coverage shall--
            ``(1) not restrict, directly or indirectly, any pharmacy 
        that dispenses a prescription drug to a participant or 
        beneficiary in the plan or coverage from informing (or penalize 
        such pharmacy for informing) a participant or beneficiary of 
        any differential between the participant's or beneficiary's 
        out-of-pocket cost under the plan or coverage with respect to 
        acquisition of the drug and the amount an individual would pay 
        for acquisition of the drug without using any group health plan 
        or health insurance coverage; and
            ``(2) ensure that any entity that provides pharmacy 
        benefits management services under a contract with any such 
        health plan or health insurance coverage does not, with respect 
        to such plan or coverage, restrict, directly or indirectly, a 
        pharmacy that dispenses a prescription drug from informing (or 
        penalize such pharmacy for informing) a participant or 
        beneficiary of any differential between the participant's or 
        beneficiary's out-of-pocket cost under such plan or coverage 
        with respect to acquisition of the drug and the amount an 
        individual would pay for acquisition of the drug without using 
        any group health plan or health insurance coverage.
    ``(b) Definition.--For purposes of this section, the term `out-of-
pocket cost', with respect to acquisition of a drug, means the amount 
to be paid by the participant or beneficiary under the plan or 
coverage, including any cost-sharing (including any deductible, 
copayment, or coinsurance) and, as determined by the Secretary, any 
other expenditure.''.
            (2) Clerical amendment.--The table of contents in section 1 
        of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1001 et seq.), as amended by section 106, is further 
        amended by inserting after the item relating to section 726 the 
        following new item:

``Sec. 727. Information on prescription drugs.''.
    (c) IRC.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986, as amended by section 106, is 
        further amended by adding at the end the following:

``SEC. 9827. INFORMATION ON PRESCRIPTION DRUGS.

    ``(a) In General.--A group health plan shall--
            ``(1) not restrict, directly or indirectly, any pharmacy 
        that dispenses a prescription drug to a participant or 
        beneficiary in the plan from informing (or penalize such 
        pharmacy for informing) a participant or beneficiary of any 
        differential between the participant's or beneficiary's out-of-
        pocket cost under the plan with respect to acquisition of the 
        drug and the amount an individual would pay for acquisition of 
        the drug without using any group health plan or health 
        insurance coverage; and
            ``(2) ensure that any entity that provides pharmacy 
        benefits management services under a contract with any such 
        plan does not, with respect to such plan or coverage, restrict, 
        directly or indirectly, a pharmacy that dispenses a 
        prescription drug from informing (or penalize such pharmacy for 
        informing) a participant or beneficiary of any differential 
        between the participant's or beneficiary's out-of-pocket cost 
        under the plan with respect to acquisition of the drug and the 
        amount an individual would pay for acquisition of the drug 
        without using any group health plan or health insurance 
        coverage.
    ``(b) Definition.--For purposes of this section, the term `out-of-
pocket cost', with respect to acquisition of a drug, means the amount 
to be paid by the participant or beneficiary under the plan, including 
any cost-sharing (including any deductible, copayment, or coinsurance) 
and, as determined by the Secretary, any other expenditure.''.
            (2) Clerical amendment.--The table of sections for 
        subchapter B of chapter 100 of the Internal Revenue Code of 
        1986, as amended by section 106, is further amended by adding 
        at the end the following new item:

``Sec. 9827. Information on prescription drugs.''.

SEC. 404. IMPLEMENTATION FUNDING.

    (a) In General.--For the purposes described in subsection (b), and 
in addition to amounts otherwise available for such purposes there are 
appropriated, out of amounts in the Treasury not otherwise 
appropriated, to the Secretary of Labor $12,000,000, for fiscal year 
2024, to remain available through fiscal year 2029.
    (b) Permitted Purposes.--The purposes described in this subsection 
are limited to the following purposes, insofar as such purposes are to 
carry out the provisions of, including the amendments made by, title I 
and IV:
            (1) Preparing, drafting, and issuing proposed and final 
        regulations or interim regulations.
            (2) Preparing, drafting, and issuing guidance and public 
        information.
            (3) Preparing, drafting, and publishing reports.
            (4) Enforcement of such provisions.
            (5) Reporting, collection, and analysis of data.
            (6) Other administrative duties necessary for 
        implementation of such provisions.
    (c) Transparency of Implementation Funds.--The Secretary described 
in subsection (a) shall annually submit, no later than September 1st of 
each year, to the Committees on Education and Workforce and on 
Appropriations of the House of Representatives and the Committees on 
Health, Education, Labor, and Pensions and on Appropriations of the 
Senate a report on funds expended pursuant to funds appropriated under 
this section.
                                 <all>
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