(2) PENALTY.—Section 2723(b) of the Public 
Health Service Act (42 U.S.C. 300gg–22(b)) is 
amended by adding at the end the following: 
‘‘(4) ENFORCEMENT AUTHORITY RELATING TO 
HEALTH
PLAN
SERVICE
PROVIDERS.—Notwith-
standing any provisions to the contrary, the Sec-
retary may assess a penalty against a health plan 
service provider, as defined in section 2799A–11(a) 
(42 U.S.C. 300gg–121(a)), of $100,000 per day for 
each violation of such section, pursuant to substan-
tially similar processes and procedures as those set 
forth in section 2723(b)(2)(D) through (G) (42 
U.S.C. 300gg–121(b)(2)(D) through (G)).’’. 
SEC. 9. STATE PREEMPTION ONLY IN EVENT OF CONFLICT. 
The provisions of sections 2 through 5 (including the 
amendments made by such sections) shall not supersede 
any provision of State law which establishes, implements, 
or continues in effect any requirement or prohibition re-
lated to health care price transparency, including hospital, 
clinical diagnostic laboratory tests, imaging services, and 
ambulatory surgical center, except to the extent that such 
requirement or prohibition prevents the application of a 
requirement or prohibition of such sections (or amend-
ment). Nothing in this section shall be construed to affect 
group health plans established under the Employee Retire-
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ment Income Security Act of 1974, or alter the application 
of section 514 of such Act (29 U.S.C. 1144). 
SEC. 10. REQUIREMENT FOR EXPLANATION OF BENEFITS. 
(a) PHSA AMENDMENTS.— 
(1) EMERGENCY
SERVICES.—Section 2799A– 
1(f)(1)(C) of the Public Health Service Act (42 
U.S.C. 300gg–111(f)(1)(C)) is amended to read as 
follows: 
‘‘(C) A good faith estimate of the amount 
the plan or coverage is responsible for paying 
for items and services included in the estimate 
described in subparagraph (B), including a 
plain language description of each item or serv-
ice and all applicable billing codes for each item 
or service, including modifiers, using standard 
and commonly recognized billing code sets that 
are clearly identified.’’. 
(2) 
EXPLANATION
OF
BENEFITS.—Section 
2799A–1 of the Public Health Service Act (42 
U.S.C. 300gg–111) is amended by adding at the end 
the following: 
‘‘(g) EXPLANATION OF BENEFITS.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after January 1, 2026, each group health 
plan, or a health insurance issuer offering group or 
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individual health insurance coverage shall, within 45 
days of receiving any request for payment for an 
item or service under the plan, provide to the partic-
ipant, beneficiary, or enrollee (through mail or elec-
tronic means, as requested by the participant, bene-
ficiary, or enrollee) a notification (in clear and un-
derstandable language and utilizing substantially the 
same format as the advanced explanation of benefits 
required by subsection (f) to enable comparison) in-
cluding the following: 
‘‘(A) Whether or not the provider or facil-
ity is a participating provider or a participating 
facility with respect to the plan or coverage 
with respect to the furnishing of such item or 
service. 
‘‘(B) An itemized explanation of benefits 
that includes the following: 
‘‘(i) A plain language description of 
each item or service. 
‘‘(ii) All applicable billing codes for 
each item or service, including modifiers, 
using standard and commonly recognized 
billing code sets that are clearly identified. 
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‘‘(iii) The amount the plan or cov-
erage is responsible for paying for each 
item or service. 
‘‘(iv) The amount of any cost-sharing 
for which the participant, beneficiary, or 
enrollee is responsible for each item or 
service (as of the date of such notification). 
‘‘(v) The amount that the participant, 
beneficiary, or enrollee has incurred toward 
meeting the limit of the financial responsi-
bility (including with respect to deductibles 
and out-of-pocket maximums) under the 
plan or coverage (as of the date of such 
notification). 
‘‘(vi) The site of each item or service. 
‘‘(2) FORMAT.—If applicable, the notification 
described in paragraph (1) may be provided in con-
junction with, or as part of, a notice of a claim de-
termination or other communication required by sec-
tion 2719(a) (42 U.S.C. 300gg–19(a)), or regula-
tions thereunder. 
‘‘(h) REGULATIONS.—The Secretary shall implement 
this section through notice and comment rulemaking in 
accordance with section 553 of title 5, United States 
Code.’’. 
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(b) IRC AMENDMENTS.— 
(1) 
EMERGENCY
SERVICES.—Section 
9816(f)(1)(C) of the Internal Revenue Code of 1986 
is amended to read as follows: 
‘‘(C) A good faith estimate of the amount 
the plan is responsible for paying for items and 
services included in the estimate described in 
subparagraph (B), including a plain language 
description of each item or service and all appli-
cable billing codes for each item or service, in-
cluding modifiers, using standard and com-
monly recognized billing code sets that are 
clearly identified.’’. 
(2) 
EXPLANATION
OF
BENEFITS.—Section 
9816 of the Internal Revenue Code of 1986 is 
amended by adding at the end the following: 
‘‘(g) EXPLANATION OF BENEFITS.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after January 1, 2026, each group health plan 
shall, within 45 days of receiving any request for 
payment for an item or service under the plan, pro-
vide to the participant or beneficiary (through mail 
or electronic means, as requested by the participant 
or beneficiary) a notification (in clear and under-
standable language and utilizing substantially the 
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out-of-pocket maximums) under the plan 
(as of the date of such notification). 
‘‘(vi) The site of each item or service. 
‘‘(2) FORMAT.—If applicable, the notification 
described in paragraph (1) may be provided in con-
junction with, or as part of, a notice of a claim de-
termination or other communication required by sec-
tion 503 of the Employee Retirement Income Secu-
rity Act of 1974 or regulations thereunder. 
‘‘(h) REGULATIONS.—The Secretary shall implement 
this section through notice and comment rulemaking in 
accordance with section 553 of title 5, United States 
Code.’’. 
(c) ERISA AMENDMENTS.— 
(1) 
EMERGENCY
SERVICES.—Section 
716(f)(1)(C) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1185e(f)(1)(C)) is 
amended to read as follows: 
‘‘(C) A good faith estimate of the amount 
the health plan is responsible for paying for 
items and services included in the estimate de-
scribed in subparagraph (B), including a plain 
language description of each item or service and 
all applicable billing codes for each item or serv-
ice, including modifiers, using standard and 
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commonly recognized billing code sets that are 
clearly identified.’’. 
(2) EXPLANATION OF BENEFITS.—Section 716 
of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1185e) is amended by adding at 
the end the following: 
‘‘(g) EXPLANATION OF BENEFITS.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after January 1, 2026, each group health plan 
or health insurance issuer offering group health in-
surance coverage shall, within 45 days of receiving 
any request for payment for an item or service 
under the plan, provide to the participant or bene-
ficiary (through mail or electronic means, as re-
quested by the participant or beneficiary) a notifica-
tion (in clear and understandable language and uti-
lizing substantially the same format as the advanced 
explanation of benefits required by subsection (f) to 
enable comparison) including the following: 
‘‘(A) Whether or not the provider or facil-
ity is a participating provider or a participating 
facility with respect to the plan or coverage 
with respect to the furnishing of such item or 
service. 
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‘‘(B) An itemized explanation of benefits 
that includes the following: 
‘‘(i) A plain language description of 
each item or service. 
‘‘(ii) All applicable billing codes for 
each item or service, including modifiers, 
using standard and commonly recognized 
billing code sets that are clearly identified. 
‘‘(iii) The amount the plan or cov-
erage is responsible for paying for each 
item or service. 
‘‘(iv) The amount of any cost-sharing 
for which the participant or beneficiary is 
responsible for each item or service (as of 
the date of such notification). 
‘‘(v) The amount that the participant 
or beneficiary has incurred toward meeting 
the limit of the financial responsibility (in-
cluding with respect to deductibles and 
out-of-pocket maximums) under the plan 
or coverage (as of the date of such notifi-
cation). 
‘‘(vi) The site of each item or service. 
‘‘(2) FORMAT.—If applicable, the notification 
described in paragraph (1) may be provided in con-
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junction with, or as part of, a notice of a claim de-
termination or other communication required by sec-
tion 503 or regulations thereunder. 
‘‘(h) REGULATIONS.—The Secretary shall implement 
this section through notice and comment rulemaking in 
accordance with section 553 of title 5, United States 
Code.’’. 
SEC. 11. PROVISION OF ITEMIZED BILLS. 
Part E of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg–131 et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 2799B–10. PROVIDER REQUIREMENTS FOR ITEMIZED 
BILLS. 
‘‘(a) REQUIREMENTS.— 
‘‘(1) ITEMIZED BILL AND OTHER INFORMATION 
REQUIRED.— 
‘‘(A) IN GENERAL.—A health care provider 
or health care facility that requests payment 
from an individual after providing a health care 
item or service to the patient shall include with 
such request a written, itemized bill of the cost 
of each reasonably expected item or service the 
health care provider or health care facility pro-
vided to the individual, including telehealth vis-
its or visits by other electronic means. The 
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health care provider or health care facility shall 
provide the itemized bill not later than 30 days 
after the health care provider or health care fa-
cility received a final payment on the provided 
service or supply from a third party. 
‘‘(B) REQUIRED INFORMATION.—For each 
item or service provided by the health care pro-
vider or facility or for which the health care 
provider or facility is billing the individual, the 
itemized bill must include— 
‘‘(i) a plain language description of 
each distinct health care item or service; 
‘‘(ii) all applicable billing codes for 
each distinct health care item or service, 
including modifiers, using standard and 
commonly recognized billing code sets that 
are clearly identified; 
‘‘(iii) the price and billed amount, if 
different, of each distinct health care item 
or service or if the provider or facility is 
offering binding, all-in prices for bundled 
items and services, the total binding price 
for bundled items and services and billed 
amount; 
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‘‘(iv) any payments made to the 
health care provider or health care facility 
by or on behalf of the individual (including 
payments by any health plan or insurance) 
for any health care item or service covered 
in the itemized bill; 
‘‘(v) information about the availability 
of language-assistance services for individ-
uals with limited English proficiency 
(LEP); 
‘‘(vi) the identification of an office or 
individual at the health care provider or 
health care facility, including phone num-
ber and email address, that shall be able to 
discuss the specific details of the itemized 
statement and be authorized to make ap-
propriate changes thereto; and 
‘‘(vii) information about the health 
care provider’s or health care facility’s 
charity care policies and instructions on 
how to apply for charity care. 
‘‘(2) COLLECTIONS ACTIONS.— 
‘‘(A) IN GENERAL.—A health care provider 
or health care facility shall not take any collec-
tions actions against an individual— 
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‘‘(i) for any provided health care item 
or service unless the health care provider 
or health care facility has complied with 
paragraph (1); or 
‘‘(ii) with respect to any items or serv-
ices for which the amount appearing on an 
itemized bill described above in paragraph 
(1) exceeds the amount disclosed pursuant 
to Federal health care price transparency 
regulations, including part 180 of title 45, 
Code of Federal Regulations, or provided 
in a good faith estimate that complies with 
section 2799B–6 of this Act and section 
149.610 of title 45, Code of Federal Regu-
lations, or another good faith estimate pro-
vided by a health care entity covered under 
this section but not otherwise covered 
under such section 2799B–6 unless the 
provider or facility documents that the ad-
ditional items or services were medically 
necessary due to unforeseen complications 
or a patient-initiated change, and could not 
reasonably have been anticipated. 
‘‘(B) BURDEN OF PROOF.—The burden of 
proof under subparagraph (A)(ii) shall rest with 
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100 
the provider, and absent the documentation de-
scribed in such subparagraph, the good faith es-
timate shall be binding. 
‘‘(b) FAILURE TO COMPLY.— 
‘‘(1) PENALTIES.—The Secretary shall impose 
penalties on any health care provider or health care 
facility that fails to comply with the requirements of 
this section in an amount not to exceed $10,000 for 
each instance of failure to comply. 
‘‘(2) 
PRESUMPTION
IN
FAVOR
OF
INDI-
VIDUAL.—If a health care provider or health care fa-
cility fails to comply with the requirements of this 
section, the presumption shall be that charges were 
substantially in excess of the good faith estimate (as 
set forth in section 2799B–6) for the purpose of any 
patient-provider dispute, including in accordance 
with section 2799B–7 and regulations promulgated 
thereunder. 
‘‘(c) REGULATIONS.—The Secretary shall implement 
this section through notice and comment rulemaking in 
accordance with section 553 of title 5, United States 
Code.’’. 
Æ 
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