I 
118TH CONGRESS 
1ST SESSION H. R. 3281 
To promote hospital and insurer price transparency. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2023 
Mrs. RODGERS of Washington (for herself and Mr. PALLONE) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To promote hospital and insurer price transparency. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Transparent Prices 
Required to Inform Consumer and Employers Act’’ or the 
‘‘Transparent PRICE Act’’. 
SEC. 2. PRICE TRANSPARENCY REQUIREMENTS. 
(a) IN GENERAL.—Section 2718(e) of the Public 
Health Service Act (42 U.S.C. 300gg–18(e)) is amend-
ed— 
(1) by striking ‘‘Each hospital’’ and inserting 
the following: 
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‘‘(1) IN GENERAL.—Each hospital’’; 
(2) by inserting ‘‘, without subscription and 
free of charge, in a single machine-readable file,’’ 
after ‘‘a list’’; 
(3) by inserting ‘‘and a list, in plain language 
and without subscription and free of charge, in a 
consumer-friendly format, of the hospital’s standard 
charges for as many of the 70 Centers for Medicare 
& Medicaid Services-specified shoppable services that 
are provided by the hospital, and as many additional 
hospital-selected shoppable services (or all such addi-
tional services, if such hospital provides fewer than 
300 shoppable services) as may be necessary for a 
combined total of at least 300 shoppable services’’ 
after ‘‘Social Security Act’’; and 
(4) by adding at the end the following: ‘‘Such 
lists shall be updated not less frequently than annu-
ally. Beginning January 1, 2024, each hospital shall 
include in its lists of standard charges, along with 
such additional information as the Secretary may re-
quire with respect to such charges for purposes of 
promoting public awareness of hospital pricing in 
advance of receiving a hospital item or service, the 
following: 
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‘‘(A) A plain language description of each 
item or service included on such list, including, 
as applicable, the Healthcare Common Proce-
dure Coding System (HCPCS) code, the Diag-
nosis Related Group (DRG), the National Drug 
Code (NDC), or other payer identifier used or 
approved by the Centers for Medicare & Med-
icaid Services for such item or service. 
‘‘(B) The gross charge, expressed as a dol-
lar amount, for each such item or service, when 
provided in, as applicable, the hospital inpatient 
setting and outpatient department setting. 
‘‘(C) Any 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 when provided in, as applicable, the hos-
pital inpatient setting and outpatient depart-
ment setting. 
‘‘(D) The de-identified maximum and min-
imum negotiated charges for each such item or 
service. 
‘‘(E) The discounted cash price, expressed 
as a dollar amount, for each such item or serv-
ice when provided in, as applicable, the hospital 
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inpatient setting and outpatient department 
setting. If the discounted cash price is a per-
centage of another value provided, the cal-
culated value must be entered as a dollar 
amount. If the discounted cash price equates to 
the gross charge, the gross charge shall be re- 
entered to indicate that no cash discount is 
available. 
‘‘(2) DEEMED COMPLIANCE WITH SHOPPABLE 
SERVICES
REQUIREMENT
FOR
CERTAIN
YEARS.— 
With respect to a year before 2025, a hospital shall 
be deemed to meet the requirement of paragraph (1) 
that such hospital make available a list of standard 
charges for shoppable services if the hospital main-
tains an internet-based price estimator tool that 
meets the following requirements: 
‘‘(A) The tool provides estimates for as 
many of the 70 Centers for Medicare & Med-
icaid Services specified shoppable services that 
are provided by the hospital, and as many addi-
tional hospital-selected shoppable services (or 
all such additional services, if such hospital pro-
vides fewer than 300 shoppable services) as 
may be necessary for a combined total of at 
least 300 shoppable services. 
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‘‘(B) The tool allows health care con-
sumers to, at the time they use the tool, obtain 
an estimate of the amount they will be obligated 
to pay the hospital for the shoppable service. 
‘‘(C) The tool is prominently displayed on 
the hospital’s website and easily accessible to 
the public, without subscription, fee, or having 
to submit personal identifying information, and 
searchable by service description, billing code, 
and payer. 
The Secretary may not deem the establishment of an 
internet-based price estimator tool that meets the re-
quirements of this paragraph to constitute compli-
ance with the requirement of paragraph (1) that 
such hospital make available a list of standard 
charges for shoppable services for 2025 or a subse-
quent year. 
‘‘(3) UNIFORM
METHOD
AND
FORMAT.—Not 
later than January 1, 2025, the Secretary shall im-
plement a standard, uniform method and format for 
hospitals to use in order to satisfy the requirements 
of this subsection for disclosing directly to the public 
charge and price information. Such method and for-
mat may be similar to any template established by 
the Centers for Medicare & Medicaid Services as of 
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the date of the enactment of this paragraph for re-
porting such information under this subsection and 
shall meet such standards as determined appropriate 
by the Secretary. 
‘‘(4) MONITORING OF PRICING INFORMATION.— 
The Secretary, in consultation with the Inspector 
General of the Department of Health and Human 
Services, shall, through notice and comment rule-
making, establish a process to regularly monitor the 
accuracy and validity of pricing information dis-
played by each hospital pursuant to paragraph (1). 
‘‘(5) DEFINITIONS.—Notwithstanding any other 
provision of law, for the purpose of paragraphs (1) 
and (2): 
‘‘(A) DE-IDENTIFIED
MAXIMUM
NEGO-
TIATED CHARGE.—The term ‘de-identified max-
imum negotiated charge’ means the highest 
charge that a hospital has negotiated with all 
third party payers for an item or service. 
‘‘(B) DE-IDENTIFIED
MINIMUM
NEGO-
TIATED CHARGE.—The term ‘de-identified min-
imum negotiated charge’ means the lowest 
charge that a hospital has negotiated with all 
third party payers for an item or service. 
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‘‘(C) 
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 item or service. 
Hospitals that do not offer self-pay discounts 
may display the hospital’s undiscounted gross 
charges as found in the hospital chargemaster. 
‘‘(D) 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. 
‘‘(E) 
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. 
‘‘(F) SHOPPABLE
SERVICE.—The term 
‘shoppable service’ means a service that can be 
scheduled by a health care consumer in ad-
vance. 
‘‘(G) THIRD
PARTY
PAYER.—The term 
‘third party payer’ means an entity that is, by 
statute, contract, or agreement, legally respon-
sible for payment of a claim for a health care 
item or service. 
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‘‘(6) ENFORCEMENT.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (C), in the case of a hospital that fails 
to comply with this subsection— 
‘‘(i) the Secretary shall notify such 
hospital of such failure not later than 30 
days after the date on which the Secretary 
determines such failure exists; and 
‘‘(ii) not later than 45 days after the 
date of such notification, the hospital shall 
complete 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 subsection (b)(3) or an-
other provision of law, a hospital that has 
received a notification under subparagraph 
(A)(i) and fails to satisfy the requirement 
under subparagraph (A)(ii) or otherwise 
comply with the requirements of this sub-
section by the date that is 90 days after 
such notification shall be subject to a civil 
monetary penalty of an amount— 
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‘‘(I) in the case the hospital pro-
vides not more than 30 beds (as de-
termined 
under 
section 
180.90(c)(2)(ii)(D) of title 45, Code 
of Federal Regulations, as in effect on 
the date of the enactment of this 
paragraph), not to exceed $300 per 
day that the violation is ongoing as 
determined by the Secretary; and 
‘‘(II) in the case the hospital pro-
vides more than 30 beds (as so deter-
mined), equal to— 
‘‘(aa) subject to item (bb), 
$10 per bed per day that the vio-
lation is ongoing as determined 
by the Secretary, but for viola-
tions occurring before January 1, 
2024, not to exceed $5,500 per 
each such day; or 
‘‘(bb) in the case such hos-
pital has failed to satisfy the re-
quirement under subparagraph 
(A)(ii) or otherwise comply with 
the requirements of this sub-
section for any continuous 1-year 
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period beginning on or after Jan-
uary 1, 2024, and the amount 
otherwise imposed under item 
(aa) for such failure for such pe-
riod 
would 
be 
less 
than 
$5,000,000, an amount not less 
than $5,000,000. 
‘‘(ii) INCREASE
AUTHORITY.—In ap-
plying this subparagraph with respect to 
violations occurring in 2025 or a subse-
quent year, the Secretary may through no-
tice and comment rulemaking increase any 
dollar amount applied under this subpara-
graph by an amount specified by the Sec-
retary. 
‘‘(iii) APPLICATION OF CERTAIN PRO-
VISIONS.—The provisions of section 1128A 
of the Social Security Act (other than sub-
sections (a) and (b) of such section) shall 
apply to a civil monetary penalty imposed 
under clause (i) in the same manner as 
such provisions apply to a civil monetary 
penalty imposed under subsection (a) of 
such section. 
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‘‘(C) OPTION TO FORGO NOTICE OF NON-
COMPLIANCE.—In the case that the Secretary 
determines that a hospital has failed to comply 
with this subsection and further determines 
that such hospital has made no effort to comply 
with such subsection, the Secretary may elect to 
request a corrective action plan from such hos-
pital’’. 
(b) PUBLICATION OF LIST OF HOSPITALS.— 
(1) LIST OF HOSPITALS.—Beginning not later 
than 90 days after the date of enactment of this 
Act, the Secretary of Health and Human Services 
(referred to in this section as the ‘‘Secretary’’) shall 
establish and maintain a publicly available list on 
the website of the Centers for Medicare & Medicaid 
Services of each hospital with respect to which the 
Secretary has conducted a review of such hospital’s 
compliance with the provisions of section 2718(e) of 
the Public Health Service Act (42 U.S.C. 300gg– 
18(e)). Such list shall include, with respect to each 
such hospital that was noncompliant with such pro-
visions, a specification as to whether such hospital— 
(A) has been issued a civil monetary pen-
alty; 
(B) has received a warning notice; or 
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(C) has submitted a corrective action plan. 
(2) ADDITIONS AND UPDATES.—In the case of 
a hospital not included on the list described in para-
graph (1) as of the date of the establishment of such 
list and that is subject to a review of such hospital’s 
compliance with the provisions described in such 
paragraph after such date, the Secretary shall add 
such hospital to such list, along with the specifica-
tions described in such paragraph, not later than 1 
business day after such review occurs. The Secretary 
shall update such specifications with respect to any 
hospital included on such list— 
(A) not later than 1 business day after any 
subsequent review of such hospital’s compliance 
with such provisions; and 
(B) not later than 1 business day after any 
penalty, notice, or request described in para-
graph (1) is made with respect to such hospital. 
(3) FOIA REQUESTS.—Any penalty, notice, or 
request described in paragraph (1) shall be subject 
to public disclosure, in full and without redaction, 
under section 552 of title 21, United States Code, 
notwithstanding any exemptions or exclusions other-
wise available under such section 552. 
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(4) REPORTS TO CONGRESS.—Not later than 1 
year after the date of enactment of this Act and 
each year thereafter, the Secretary of Health and 
Human Services shall submit to Congress, and make 
publicly available, a report that contains information 
regarding complaints of alleged violations of law and 
enforcement activities by the Secretary under the 
hospital price transparency rule implementing sec-
tion 2718(e) of the Public Health Service Act (42 
U.S.C. 300gg–18(e)). Such report shall be made 
available to the public on the website of the Centers 
for Medicare & Medicaid Services. Each such report 
shall include, with respect to the year involved— 
(A) the number of compliance and enforce-
ment inquiries opened by the Secretary pursu-
ant to such section; 
(B) the number of notices of noncompli-
ance issued by the Secretary based on such in-
quiries; 
(C) the identity of each hospital entity that 
received a notice of noncompliance and the na-
ture of the failure giving rise to the Secretary’s 
determination of noncompliance; 
(D) the amount of civil monetary penalty 
assessed against the hospital entity; 
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(E) whether the hospital entity subse-
quently corrected the noncompliance; and 
(F) an analysis of factors contributing to 
increasing health care costs. 
(5) GAO REPORT.—Not later than 1 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 re-
port on the compliance and enforcement with the 
hospital price transparency rule implementing sec-
tion 2718(e) of the Public Health Service Act (42 
U.S.C. 300gg–18(e)). The report shall include rec-
ommendations related to— 
(A) improving price transparency to pa-
tients, employers, and the public; and 
(B) 
increased 
civil 
monetary 
penalty 
amounts to ensure compliance. 
(6) REQUEST
FOR
INFORMATION.—Not later 
than January 1, 2025, the Secretary of Health and 
Human Services shall issue a public request for in-
formation as to the best method through which hos-
pitals may be required to publish quality data (such 
as data required to be reported under the Medicare 
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Hospital Compare program) alongside data required 
to be reported under section 2718(e) of the Public 
Health Service Act (42 U.S.C. 300gg–18(e)). 
SEC. 3. STRENGTHENING HEALTH INSURANCE TRANS-
PARENCY REQUIREMENTS. 
(a) 
TRANSPARENCY
IN
COVERAGE.—Section 
1311(e)(3)(C) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18031(e)(3)(C)) is amended— 
(1) by striking ‘‘The Exchange’’ and inserting 
the following: 
‘‘(i) IN GENERAL.—The Exchange’’; 
(2) in clause (i), as inserted by paragraph (1)— 
(A) by striking ‘‘participating provider’’ 
and inserting ‘‘provider’’; 
(B) by inserting ‘‘shall include the infor-
mation specified in clause (ii) and’’ after ‘‘such 
information’’; 
(C) by striking ‘‘an Internet website’’ and 
inserting ‘‘a self-service tool that meets the re-
quirements of clause (iii)’’; and 
(D) by striking ‘‘and such other’’ and all 
that follows through the period and inserting 
‘‘or, at the option such individual, through a 
paper or phone disclosure (as selected by such 
individual and provided at no cost to such indi-
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